Suitable Anatomy Research Articles

Long term outcomes of fenestrated aortic endovascular repair in patients bearing juxta-renal aneurysms.

IntroductionFenestrated endografts (FEVAR) have been a safe and effective solution in our institution for patients with juxta-renal abdominal aortic aneurysms that were not candidates for conventional repair and had suitable anatomy. The objective of our study was to evaluate the long-term outcomes of these interventions. MethodsBetween September 2005 and December 2021, this study included all the patients bearing juxta-renal aneurysm electively treated with a fenestrated endograft. We conducted a retrospective analysis of prospectively collected monocentric data. Preoperative, perioperative, and postoperative data were processed. Postoperative follow-up included at least a systematic computed tomography scan at 6, 12, 18 and 24 months then every year. Secondary procedure was defined as any additional procedure performed to treat aneurysm or endograft-related complications after index procedure. Demographic and perioperative data were analyzed descriptively. Overall survival and freedom from secondary procedures were determined using the Kaplan-Meier estimate. ResultsA total of 169 patients (92% male) were treated by fenestrated endograft with a mean 55 ± 37 months follow-up. The median aneurysm diameter was 59 mm. In 39 patients (23.1%), we performed a secondary procedure, by endovascular means in 57% of cases, mostly after the first year of follow-up (53.8%). The most frequent cause for secondary procedure was type 1b endoleak due to the evolution of aneurysmal disease of the iliac arteries (25.6%), followed by endograft limb thrombosis (20.5%), local complications related to index procedure (17.9%) and procedures performed to insure target vessel patency over time (18%). On the last CT scan of the follow-up, patients without secondary procedure were significantly more likely to present a shrinkage of the aneurysmal sac (p= 0.001), defined as a modification of the maximum diameter > 5mm. Overall survival was not significantly different between patients that had secondary procedures compared to those that had not (80 months vs 62 months, p=0.3). Freedom from secondary procedures was 87% at 24 months and 63% at 60 months. Excluding secondary procedures within 30 days, freedom from secondary procedures was 76% at 50 months. ConclusionFenestrated endografts constitute a sustainable therapeutic solution in the treatment of juxtarenal abdominal aortic aneurysms. The occurrence of late complications justifies a rigorous follow-up of treated patients.

Chyme reinfusion practices in the neonatal population.

Chyme reinfusion therapy (CRT) is a safe and effective method to improve nutritional outcomes and promote intestinal adaptation in patients with stomas. This practice involves refeeding the proximal stoma output, down the distal limb, and mimics a state of intestinal continuity; thereby promoting growth and adaption of the distal bowel. Despite its promise, CRT in neonates is a relatively underutilised practice and can be of significant value in neonates with congenital bowel anomalies or necrotising enterocolitis. We aimed to identify the frequency, methodology and adverse effects associated with CRT in our neonatal population. We aimed to identify the frequency, methodology and adverse events associated with CRT in our neonatal population. A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded. Of the 49 eligible neonates, 23 (47%) underwent CRT. Indications for CRT included high stoma output, malnutrition with poor weight gain, and routine refeeding prior to stoma reversal. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50-22.89) to 24.37 (19.68-29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). Amongst our cohort, there was a high rate of non-infectious events, including peri-stomal skin irritation (60%), stoma prolapse (43%) and stomal bleeding (26%). CRT is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.

Computed tomography-based anatomic suitability of an Endo-Bentall prosthesis for ascending aortic aneurysms

IntroductionThis study aimed to evaluate the suitability of a coronary-branched ascending aortic endograft, paired with aortic valve (AV) prosthesis (Endo-Bentall), for the endovascular repair of ascending aortic aneurysms. MethodsPre-operative ≤1mm computed tomography angiographies of consecutive patients managed with Bentall procedure or ascending aortic replacement and AV reconstruction/replacement, in a single institution (01.01.2008-31.12.2023), were retrospectively analyzed. Dedicate software was used to assess: (1) vascular access, (2) proximal landing zone, (3) coronary artery anatomy and (4) distal landing. Eligibility criteria for Endo-Bentall were: ≥8mm iliac arteries, without severe calcification/tortuosity, proximal landing with 18-29mm aortic annulus diameter, ≥10mm annulus-coronary ostium distance, no mechanical AV, absence of coronary grafts in the ascending aorta, no left ventricle thrombus, coronary arteries ≥3mm wide and ≥10mm long, with no anatomic abnormalities, ostial stent or stenosis and ≥20mm long and ≤38mm wide distal landing zone within the ascending aorta or applicability of branched endovascular arch repair. ResultsTwenty-nine patients (55.2% females) were included. All patients had adequate proximal landing zone in terms of annulus diameter (median: 25mm, IQR: 5mm). Two (6.8%) had inadequate iliac access (external iliac artery <8mm). Two patients (6.8%) had a mechanical AV. Twenty-six patients (89.6%) had adequate landing zone for stenting of the left main coronary artery (LMCA; median diameter: 5.2mm, IQR: 1.8mm) and 28 (96.6%) had adequate right coronary artery (RCA) landing (median diameter: 4.1, IQR: 1mm). The LMCA and RCA were located at 5:00' and 10:50’ clock positions, respectively. Three patients (20.7%) had an adequate distal landing zone within the ascending aorta. The remaining were suitable for extension with a branched arch device. According to the predefined criteria, 75.9% of patients were anatomically suitable for Endo-Bentall. ConclusionThree out of four patients with ascending aortic aneurysms may be considered as anatomically eligible for endovascular treatment with an Endo-Bentall prosthesis.

Tabular review of contemporary fenestrated-branched endovascular aortic repair experiences for treatment of thoracoabdominal aortic aneurysms.

Repair of thoracoabdominal aortic aneurysms (TAAAs) represents a technical challenge regardless of which technique is used. Open surgical repair (OSR) is the time-tested option against which novel techniques must be compared and it is still considered the gold standard option for younger, fit patients with heritable aortic diseases. Endovascular repair offers a less-invasive alternative in patients with suitable anatomy. This article aims to present a tabular review of the contemporary published data on endovascular repair of TAAAs using fenestrated-branched techniques. The published literature for single-center and multicenter studies evaluating the outcomes of FB-EVAR for TAAAs was searched using MEDLINE and Embase databases. Studies published between January 1st 2010 and July 11th 2024, in the English language which provided data on FB-EVAR of TAAAs with more than fifty reported cases were included. The average patient age at time of repair was 71 years old with majority of males (65.5%). Most patients presented with a Crawford Extent II TAAAs (21.6%), followed by Extent III (21.2%). Early mortality was 4.9% for the entire cohort. The most prevalent adverse event was acute kidney injury (9.4%), followed by spinal cord injury (8.0%). FB-EVAR of TAAAs continues to evolve. Pooled analysis of early mortality and morbidity is lower in this tabular review than historical outcomes of open TAAA repair.

Tabular review of contemporary open surgical repair experiences for treatment of thoracoabdominal aortic aneurysms.

Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) is one of the most challenging operations due to extensive surgical dissection and exposure, risk of complications and need for reconstruction of the aorta and its branches. In the last two decades, endovascular techniques have evolved and now are considered a viable alternative to open surgical repair in patients with suitable anatomy. Regardless of which technique is selected, open or endovascular, reduction of postoperative morbidity and mortality requires large clinical volume, optimal patient selection and a multidisciplinary team that can take care of the surgical, anesthetic, critical care and postoperative issues that occur after these operations. The aim of this article is to summarize the clinical data on open surgical repair of thoracoabdominal aortic aneurysms in a schematic tabular format.

Accuracy of Lone Three-dimensional Transthoracic Echocardiography in Tricuspid Valve Function and Geometry Assessment: Implication for Preoperative Evaluation of Transcatheter Tricuspid Valve Therapies

Introduction: Tricuspid regurgitation (TR) is associated with high rate and poor prognosis in patient undertreated. In recent years, transcatheter tricuspid valve interventions (TTVI) appears like a valuable option in high risk surgical candidates in presence of suitable anatomy. Screening phase with transthoracic, thansoesophageal echocardiography, and cardiac computed tomography (CT) are necessary select patients. Purpose: The aim of the study is to compare different imaging modalities as three-dimensional (3D) transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and ECG-gated cardiac CT for the definition of tricuspid valve (TV) function and geometry assessment. Materials and Methods: Twenty-one (age 79 ± 7 years, female 72%) patients under screening for transcatheter treatment of TR were prospectively enrolled in the study and underwent TTE, TOE, and cardiac CT. All measurements were performed in double blind by three different operators and compared. Results: In the comparison between 2D/3D TTE and 2D/3D TOE, no statistically significant differences were found regarding the evaluation of the valve anatomy, the site of regurgitation, and the underlying mechanism (TTE vs. TOE: 3D septo-lateral diam 45.8 ± 4,92 vs. 45.87 ± 4,98 mm, P = 0.87; 3D antero-posterior diam 43.5 ± 4,58 vs. 43.5 ± 4,53 mm, P = 0.59; Circularity index 0,75 ± 0,08 vs. 0,76 ± 0,08, P = 0.98). When comparing 3D TTE and cardiac CT, no differences were recorded in terms of TV area 17.58 ± 3 versus 17.71 ± 4,3 cm2, P = 0.1; perimeter 14.89 ± 1,6 versus 14.29 ± 1 cm, P = 0.5 and diameters. Similarly, in the study of right ventricular dimensions, obtained through 3D volumetric reconstruction, TTE was not statistically different to Cardiac CT. Conclusions: The present series shows how a lone 3D TTE has a good reliability in the definition of TV function, leaflet characteristics, and geometry when compared with second level imaging modalities and may be safely used to select optimal candidates for complex TTVI.

Stent-graft implantation for late postpancreatectomy hemorrhage after pancreatoduodenectomy

PurposePostpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation. MethodsThis was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± SD when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p value < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients’ survival. ResultsPancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively. ConclusionsWith suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.

Anatomical Suitability of Iliac Branch Devices for East Asian Patients with Abdominal Aortic Aneurysm

This study aimed to identify the iliac artery characteristics of East Asian patients with abdominal aortic aneurysms (AAAs) and to evaluate anatomical suitability rates with current iliac branch devices (IBDs). This was a single centre, retrospective, cross sectional study. Patients diagnosed with AAA between 2008 and 2023 were enrolled. The morphological parameters of the iliac arteries were measured, and their eligibility for four IBDs (Cook ZBIS, Gore IBE, E-Liac IBD, and G-Iliac IBD) was evaluated according to the manufacturer's latest instructions for use (IFU). Among 1 144 AAAs observed in the study, 45.5% (n= 521) presented with concurrent common iliac artery aneurysm (CIAA). In total, 304 patients (26.6%) and 371 iliac arteries necessitated internal iliac artery (IIA) reconstruction. The anatomical suitability rates for the Cook ZBIS, Gore IBE, E-Liac IBD, and G-Iliac IBD were 18.9%, 21.8%, 11.9%, and 22.6%, respectively. The E-Liac IBD exhibited a significantly lower anatomical suitability rate compared with the other three devices (p < .001). The primary IBD exclusion criteria were: a common iliac artery (CIA) length of < 50 mm for Cook ZBIS (n= 211, 56.9%); an IIA diameter of < 6.5 mm or > 13.5 mm for Gore IBE (n= 177, 47.7%); and a CIA bifurcation diameter of < 18 mm both for E-Liac IBD and G-Iliac IBD (n= 244, 65.8%). A total of 198 patients (53.4%) failed to meet the anatomical criteria for any device, while 112 (30.2%) qualified for just one device, 26 (7.0%) for two devices, 25 (6.7%) for three devices, and 10 (2.7%) for all four devices. A significant proportion of East Asian patients with AAA present with concurrent CIAA, necessitating substantial IIA reconstruction. IBD techniques show low anatomical suitability rates among the East Asian population, with 53.4% of patients failing to meet anatomical criteria for any IBD based on the manufacturer's IFU.

Safety and efficacy of Kaffes intraductal self-expanding metal stents in the management of post-liver transplant anastomotic strictures.

Endoscopic management is the first-line therapy for post-liver-transplant anastomotic strictures. Although the optimal duration of treatment with plastic stents has been reported to be 8-12 months, data on safety and duration for metal stents in this setting is scarce. Due to limited access to endoscopic retrograde cholangiopancreatography (ERCP) during the coronavirus disease 2019 pandemic in our centre, there was a change in practice towards increased usage and length-of-stay of the Kaffes biliary intraductal self-expanding stent in patients with suitable anatomy. This was mainly due to the theoretical benefit of Kaffes stents allowing for longer indwelling periods compared to the traditional plastic stents. To compare the safety and efficacy profile of different stenting durations using Kaffes stents. Adult liver transplant recipients aged 18 years and above who underwent ERCP were retrospectively identified during a 10-year period through a database query. Unplanned admissions post-Kaffes stent insertion were identified manually through electronic and scanned medical records. The main outcome was the incidence of complications when stents were left indwelling for 3 months vs 6 months. Stent efficacy was calculated via rates of stricture recurrence between patients that had stenting courses for ≤ 120 d or > 120 d. During the study period, a total of 66 ERCPs with Kaffes insertion were performed in 54 patients throughout their stenting course. In 33 ERCPs, the stent was removed or exchanged on a 3-month interval. No pancreatitis, perforations or deaths occurred. Minor post-ERCP complications were similar between the 3-month (abdominal pain and intraductal migration) and 6-month (abdominal pain, septic shower and embedded stent) groups - 6.1% vs 9.1% respectively, P = 0.40. All strictures resolved at the end of the stenting course, but the stenting course was variable from 3 to 22 months. The recurrence rate for stenting courses lasting for up to 120 d was 71.4% and 21.4% for stenting courses of 121 d or over (P = 0.03). There were 28 patients that were treated with a single ERCP with Kaffes, 21 with removal after 120 d and 7 within 120 d. There was a significant improvement in stricture recurrence when the Kaffes was removed after 120 d when a single ERCP was used for the entire stenting course (71.0% vs 10.0%, P = 0.01). Utilising a single Kaffes intraductal fully-covered metal stent for at least 4 months is safe and efficacious for the management of post-transplant anastomotic strictures.

Endovascular management options and techniques for ruptured thoracoabdominal aortic aneurysm

ObjectiveOpen surgical repair of ruptured thoracoabdominal aortic aneurysms (rTAAAs) carries significant risk of mortality and morbidity; in recent years, endovascular repair has emerged as a suitable alternative. This article aims to review currently available technologies, techniques, and outcomes for endovascular repair of rTAAA. MethodsA narrative review of current literature was performed. ResultsOff-the-shelf branched endografts are available and are often the first-line endovascular therapy for types I, II, and III rTAAA or type IV rTAAA with a lumen diameter ≥24 mm at the level of the renovisceral vessels. In patients with anatomy unsuitable for off-the-shelf branch devices, particularly those with ruptured type IV or pararenal TAAA with a narrow aortic lumen, endovascular repair with in situ laser fenestration is a reasonable alternative. Physician-modified devices as well as endovascular repair with parallel stent grafts (chimney, periscope, sandwich, or Octopus) have been described by select centers with satisfactory outcomes. ConclusionsPatients with rTAAA and suitable anatomy who are at high or prohibitive surgical risk can be managed endovascularly with comparable outcomes. Various techniques are described in the literature, and the choice of technique used should depend on patient anatomy and surgeon expertise.

The evaluation of patients apply for septorhinoplasty in terms of body perception, disability, depression and social phobia

Objective: Psychiatric suitability is an important parameter that is evaluated together with anatomical suitability when deciding on rhinoplasty surgery. There is no matter how successful the treatment or surgery is, the results are not satisfactory in individuals with psychiatric symptoms. In order to make a broader assessment to determine psychiatric suitability, we aimed to evaluate the body perception, disability, depression and social phobia in individuals who applied for rhinoplasty surgery. Method: In this study, patients were planned to be included who applied to …………………… University Hospital Otorhinolaryngology outpatient clinic between 1/1/2019 - 1/1/2020. Among the patients, 50 volunteers who applied with the complaints of dissatisfaction with the aesthetic appearance of the nose and underwent septorhinoplasty were included in the case group. In the control group, 50 patients who applied to the Otorhinolaryngology outpatient clinic and had any complaints other than nasal deformity and were not planned for aesthetic any other operation were included. Results: There was no statistically significant difference found in terms of body image, disability, depression and social phobia. Conclusion: It has been confirmed that depression and body image do not show significant changes in patients who will undergo septorhinoplasty, and the information that disability and social phobia are not effective has been brought to the literature. Further studies with larger samples are needed on preoperative psychiatric evaluation.

Mid-term results of "off-label" use of the Endurant stentgraft in patients with infrarenal abdominal aortic aneurysms.

EVAR is the preferred treatment modality for patients with an infrarenal abdominal aortic aneurysm with suitable anatomy. Each manufacturer of aortic stentgrafts has specific anatomic requirements. In some patients, it is not possible to adhere to the instructions for use, but alternative treatment is also not possible. In these patients, EVAR can be performed outside instructions for use. In this study, all consecutive patients in whom an Endurant II or IIS stentgraft was used between 1 January and 31 December were reviewed. We compared the two patient groups in whom this stentgrafts was used outside and inside instructions for use. Patients with planned adjuvant therapy, for example, chimney procedure or iliac side branches, were excluded. In 74 of 178 (41.6%) patients, the instructions for use were not adhered. The main reason was pathology of the aortic neck. There were more patients with type IA endoleak, this difference was borderline significant (p = .06). There were more patients with limb occlusion in the early postoperative period, but at the end of the follow-up period, the incidence was comparable. Aneurysm-related mortality and all-cause mortality were comparable in both groups. In this study, real-life experience with the Endurant II and IIS stentgraft is described. Non-adherence with instructions for use was associated with a higher risk of endoleak type IA (p = .06). In the early postoperative period, there were more patients with limb occlusion; this finding was not observed anymore at the end of the follow-up period.

Percutaneous Secundum Atrial Septal Defect Closure: Failure Rate and Procedural Predictors

Background: Percutaneous atrial septal defect (ASD) closure is one of therapeutic options for patients with a suitable ASD anatomy, however in developing countries, the exact figure and procedural characteristics remain unknown. Therefore, this study was conducted to identify the failure rate and procedural predictors of the percutaneous ASD closure.Materials and methods: A retrospective study using a database of all patients undergoing percutaneous ASD closure was conducted between March 2010 to November 2023. Patients who developed a pulmonary hypertensive crisis during the procedure were excluded. Procedural and echocardiographic parameter were measured and analyzed.Results: A total of 112 samples were included in this study, 74.1% were female and 55.36% were pediatric patients. The failure rate was 12.5% (n=14) with diameter index was higher in the failed group. Unpaired T-test revealed that ASD size was one of the predictor failure in pediatric patients (mean diameter: 24.7±6.46 mm vs. 16.36±5.94 mm, p=0.001). There were no statistically significant variations in rim diameters, while compared with all patients with appropriate rims (rim ≥7mm), the failure rate was higher in patients with two rims measuring between 5.9 and 6.9 mm and rims less than 5 mm. Two patients presented with device embolization and required surgical device removal.Conclusion: The failure rate of percutaneous ASD closure was 12.5%. A larger ASD increases the risk of failure of percutaneous closure in pediatric patients. Furthermore, patient with 5-6.9 mm on two or more rims as well as those with rim less than 5 mm, have a higher failure rate.Keywords: secundum atrial septal defect, percutaneous closure, failure rate

Development and validation of 3-dimensional simulators for penile prosthesis surgery.

The acquisition of skills in penile prosthesis surgery has many limitations mainly due to the absence of simulators and models for training. Three-dimensional (3D) printed models can be utilized for surgical simulations, as they provide an opportunity to practice before entering the operating room and provide better understanding of the surgical approach. This study aimed to evaluate and validate a 3D model of human male genitalia for penile prosthesis surgery. This study included 3 evaluation and validation stages. The first stage involved verification of the 3D prototype model for anatomic landmarks compared with a cadaveric pelvis. The second stage involved validation of the improved model for anatomic accuracy and teaching purposes with the Rochester evaluation score. The third stage comprised validation of the suitability of the 3D prototype model as a surgical simulator and for skill acquisition. The third stage was performed at 3 centers using a modified version of a pre-existing, validated questionnaire and correlated with the Rochester evaluation score. We sought to determine the suitability of 3D model for training in penile prosthesis surgery in comparison with the available cadaveric model. The evaluation revealed a high Pearson correlation coefficient (0.86) between questions of the Rochester evaluation score and modified validated questionnaire. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding replication of the relevant human anatomy for the penile prosthesis surgery procedure. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding its ability to improve technical skills, teach and practice the procedure, and assess a surgeon's ability. Furthermore, the experts stated that compared with the cadaver, the 3D model presented greater ethical suitability, reduced costs, and easier accessibility. A validated 3D model is a suitable alternative for penile prosthesis surgery training. This is the first validated 3D hydrogel model for penile prosthesis surgery teaching and training that experts consider suitable for skill acquisition. Because specific validated guidelines and questionnaires for the validation and verifications of 3D simulators for penile surgery are not available, a modified questionnaire was used. The current 3D model for penile prosthesis surgery shows promising results regarding anatomic properties and suitability to train surgeons to perform penile implant surgery. The possibility of having an ethical, easy-to-use model with lower costs and limited consequences for the environment is encouraging for further development of the models.

The role of transoral incisionless fundoplication (TIF) in the management of gastroesophageal reflux disease (GERD) following peroral endoscopic myotomy (POEM): A pilot, prospective, patient-driven study.

Gastroesophageal reflux (GERD) is a concern after peroral endoscopic myotomy (POEM). Transoral incisionless fundoplication (TIF) has been recently described as a possible therapy for post-POEM GERD in case series. We prospectively enrolled patients undergoing POEM who agreed to participate in objective post-procedure GERD evaluation. Patients with objective evidence of GERD and suitable anatomy were offered TIF vs. proton pump inhibitor (PPI) only. Patients who underwent TIF were compared to those on PPI-only therapy after follow-up. Of 21 enrolled POEM patients with objective testing, GERD was found in 11 (52%). Of those eligible for TIF, 4 (40%) opted to pursue TIF and were compared to those on PPI-only therapy ( n = 6). Three months post-TIF, 75% of patients had discontinued or significantly decreased PPI. There were no adverse events. GERD health-related quality of life scores were low and comparable between TIF (3.75 ± 6.2) and those who remained on PPI-only therapy (4.1 ± 5). In this pilot, patient-driven prospective study, 75% of patients with post-POEM GERD undergoing TIF had stopped or significantly reduced PPI use. Post-POEM TIF is safe and effective and may be a viable alternative to PPI for POEM-related GERD; however, future studies should include a control arm and post-intervention pH monitoring.

Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models.

The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.

Effects of percutaneous closure of atrial septal defects via the right internal jugular vein.

Percutaneous atrial septal defect (ASD) closure is the preferred treatment for patients with suitable ASD anatomy. The safety and effectiveness of transcatheter closure have been established. However, reports on transesophageal echocardiography (TEE)-guided percutaneous closure of ASD via the right internal jugular vein (RIJV) are limited. The study aims to discuss the safety and effectiveness of percutaneous trans-jugular vein closure of ASD. We conducted a retrospective analysis of patients (n=103) with secondary ASD who underwent surgical treatment in the Department of Cardiovascular Surgery, the Second Hospital of Jilin University between July 2015 to July 2022. The article is a cross-sectional study. Clinical data, including age, gender, weight, defect diameter, tricuspid regurgitation, left atrial (LA) size, and the operation results, were collected and evaluated. Nonparametric rank sum tests were used to assess tricuspid regurgitation before and after surgery, while paired sample t-tests were used to compare LA size before and after surgery. TEE-guided percutaneous closure of ASD via the RIJV was successfully performed in 97 out of 103 (94.2%) cases. The average procedure time was 34.48±13.06 min, and the mean age at the time of the procedure and ASD size were 36±18 years and 15.45±5.82 mm, respectively. On analyzing medical records and echocardiographic images, postoperative complications were found to occur in four (3.9%) patients. Among these, three patients had residual shunt as indicated by echocardiography during the operation, which subsequently disappeared at the three-month follow-up. One patient developed atrial fibrillation after surgery but returned to normal sinus rhythm with medication. Percutaneous closure of ASD via the RIJV was unsuccessful in 6 patients (5.8%), with 5 of them undergoing transthoracic ASD closure and achieving satisfactory results. One patient refused further surgical treatment. No pericardial effusion, thrombosis, atrioventricular block, or other complications were observed during the 3-month to 1-year follow-up period. ASD closure via the RIJV is a safe and effective therapeutic approach. The initial results are satisfactory, but further studies with large sample sizes and long-term follow-up are warranted to assess the long-term outcomes.

Current state of endovascular repair of thoracoabdominal aortic aneurysms

Thoracoabdominal aortic aneurysm (TAAA) is a severe and complex condition with multifactorial etiology that can lead to life-threatening complications. Its treatment is genuinely complex irrespective of the chosen technique, open or endovascular repair. Fenestrated-branched endovascular aneurysm repair (F/B-EVAR) has been increasingly accepted in patients with suitable anatomy, resulting in outcomes compared to or superior to open repair. The selection of patients, judicious surgical planning, and device selection are paramount to achieving successful treatment. The field of TAAA repair is continuously evolving with ongoing research and the development of new techniques and devices to further improve patient outcomes. This paper aims to present a review of endovascular TAAA treatment, summarizing anatomical and clinical features relevant to technical performance and treatment indications.

Tricuspid Valve Transcatheter Edge-to-Edge Repair (TriClip): Initial Outcomes and Experience in Türkiye.

This study aims to assess the efficacy and safety of tricuspid valve (TV) transcatheter edge-to-edge repair (TEER) procedures using the MitraClip or TriClip device in high-risk patients with severe secondary tricuspid regurgitation (TR) and provide Turkish-specific data on procedural outcomes and clinical follow-up. This study enrolled 42 high-risk patients with severe secondary TR who underwent transcatheter edge-to-edge repair using either the MitraClip or TriClip device. Patient selection criteria included severe TR, high surgical risk (EuroScore ≥ 8 and Tricuspid Regurgitation Impact Severity Score (TRI-SCORE) ≥ 6), symptomatic despite medical therapy, and anatomical suitability for TriClip. Patients underwent rigorous evaluation by a specialized cardiac team before the procedure, including 2D/3D transesophageal echocardiography to assess eligibility. The study achieved a 100% procedural success rate, defined as successful implantation and at least one-degree reduction in TR severity. Post-procedure assessments revealed that 88.1% of patients had mild to moderate TR, indicating significant improvement, while only 11.9% retained severe TR. During the median follow-up of 11.5 months, rehospitalization occurred in 23.8% of patients, and mortality was observed in 7.1% of patients, demonstrating a favorable safety profile. Comparative analysis between TriClip and MitraClip devices showed similar efficacy and safety outcomes, with no significant differences in procedural durations or complication rates. The study demonstrates the effectiveness and safety of TV TEER using TriClip or MitraClip devices in managing severe secondary TR in high-risk patients. Procedure success, improved TR severity, and favorable clinical outcomes were observed, supporting the role of transcatheter techniques in TR management.

Hemodialysis Access: US for Preprocedural Mapping and Evaluation of Maturity and Access Dysfunction.

Patients with kidney failure require kidney replacement therapy. While renal transplantation remains the treatment of choice for kidney failure, renal replacement therapy with hemodialysis may be required owing to the limited availability and length of time patients may wait for allografts or for patients ineligible for transplant owing to advanced age or comorbidities. The ideal hemodialysis access should provide complication-free dialysis by creating a direct connection between an artery and vein with adequate blood flow that can be reliably and easily accessed percutaneously several times a week. Surgical arteriovenous fistulas and grafts are commonly created for hemodialysis access, with newer techniques that involve the use of minimally invasive endovascular approaches. The emphasis on proactive planning for the placement, protection, and preservation of the next vascular access before the current one fails has increased the use of US for preoperative mapping and monitoring of complications for potential interventions. Preoperative US of the extremity vasculature helps assess anatomic suitability before vascular access creation, increasing the rates of successful maturation. A US mapping protocol ensures reliable measurements and clear communication of anatomic variants that may alter surgical planning. Postoperative imaging helps assess fistula maturation before cannulation for dialysis and evaluates for early and late complications associated with arteriovenous access. Clinical and US findings can suggest developing stenosis that may progress to thrombosis and loss of access function, which can be treated with percutaneous vascular interventions to preserve access patency. Vascular access steal, aneurysms and pseudoaneurysms, and fluid collections are other complications amenable to US evaluation. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.