Aortic Intervention Research Articles

The Impact of Heli-FX EndoAnchor Application on Endograft Material: An Experimental Study

The Impact of Heli-FX EndoAnchor Application on Endograft Material: An Experimental Study

Systematic review and meta-analysis of early aortic valve replacement versus conservative therapy in patients with asymptomatic aortic valve stenosis with preserved left ventricle systolic function

BackgroundA quarter of patients with severe aortic stenosis (AS) were asymptomatic, and only a third of them survived at the end of 4 years. Only a select subset of these...

Exploring Thoracic Aortic Graft Infection: A Comprehensive Review of Diagnosis and Treatment Options with a Management Strategy Algorithm

As surveillance and the diagnosis of pathology grow, increasing numbers of patients are undergoing major aortic interventions globally. As a result, surgeons and physicians will encounter thoracic aortic graft infections with increasing frequency. These infections are extremely challenging, high‐risk problems to deal with. This article provides a comprehensive overview of the pathogenesis, diagnosis, and management both medical and surgical of this high‐risk complication. We provide proposed diagnostic criteria and suggested algorithm for the management of this important group of patients.

Transesophageal echocardiography during surgery of the thoracic aorta in adults

Thoracic aortic surgery poses significant challenges due to the complex anatomy and potential for life-threatening complications. Transesophageal echocardiography (TEE) has emerged as a crucial imaging tool in the management of patients undergoing these operations. TEE offers real-time, high-resolution imaging of the heart and aorta, enabling accurate assessment of aortic pathology, evaluation of cardiac function, and monitoring of intraoperative hemodynamics. Its semi-invasive nature, immediate availability, and ability to provide dynamic information make TEE an indispensable adjunct during these intricate procedures. One of the primary indications for TEE during thoracic aortic surgery is the assessment of aortic pathology, including aneurysms, dissections, and aortic valve diseases. TEE allows precise visualization of the extent, location, and severity of aortic lesions, facilitating decision-making regarding repair strategies, graft sizing, and intraoperative guidance. Furthermore, TEE aids in identifying associated cardiac abnormalities such as valvular or ventricular dysfunction, which may impact surgical planning and outcomes. This review aims to summarize the current evidence supporting the use of TEE during thoracic aortic surgical interventions and highlight its invaluable contributions to perioperative patient care.

National UK Survey of Radiation Doses During Endovascular Aortic Interventions

PurposeEndovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK.Materials and MethodsRadiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR—standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR—between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK.ResultsData from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively.ConclusionThe development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.

Progression of different echocardiographic parameters of aortic stenosis have different clinical associations

Abstract Background Previous reports have described the risk factors for progression of aortic stenosis (AS). However, AS is recognized as a condition of the aortic valve and ventricle, and the AS marker chosen for the assessment of progression may influence the determinants of progression. Purpose To assess whether different clinical and demographic characteristics have a different impact on the progression of echocardiographic parameters on which stroke volume has a lesser (aortic valvular area [AVA], dimensionless severity index [DSI]) or greater influence (mean pressure gradient [MPG], or peak velocity [Vmax]). Methods Patients diagnosed with at least mild AS without an aortic valvular intervention identified from an echocardiographic database from January 1, 2009, to July 26, 2022, from a tertiary level hospital were included. AS progression models were evaluated using univariable and multivariable linear regression or mixed effects. AS severity was defined based on international guidelines. Results A total of 8,720 patients with at least mild AS were included and followed for up to 13.7 years. Multivariable mixed effects models identified important clinical predictors in understanding AS progression. After adjustment for relevant covariates, AVA decreased by 0.02 cm per year (95% CI: -0.025, -0.016, p<0.001), DSI decreased by 0.006 per year (95% CI: -0.008, -0.005), MPG increased by 0.962 mmHg per year (95% CI: 0.818, 1.107, p<0.001), Vmax increased by 6.742 cm/s per year (95% CI: 5.934, 7.549, p<0.001). Age, calcification, revascularisation, ejection fraction below 50%, and rheumatic heart disease, were the most consistent associations of progression of all echocardiographic parameters (Figure 1). Sex was associated with progression of AVA and DSI but not gradients. Changes in gradients (but not AVA and DSI) were associated with ischemic heart disease, chronic kidney disease, and atrial fibrillation or atrial flutter. Conclusion This longitudinal data analysis demonstrates differences in impact of baseline risk factors on AS progression on different echocardiographic parameters.Figure 1.Colour map of clinical predictors

Comorbidity is the driver of adverse outcomes in patients with moderate aortic stenosis

Abstract Background Recent studies showed moderate aortic stenosis (AS) was associated with adverse cardiovascular outcomes. Ongoing studies are addressing whether moderate AS may benefit from early transcatheter aortic valvular replacement (TAVR). However, a high comorbidity burden is common, and may be the main driver of poor outcomes. Purpose We aimed to identify clusters of patients with moderate AS based on comorbidity and echocardiographic profiles. Methods Unsupervised clustering algorithms (including K means, partition around medoids (PAM), hierarchical clustering, Density-Based Spatial Clustering of Applications with Noise (DBSCAN), and Hierarchical Density-Based SCAN (HDBSCAN)) of comorbidities, demographics and echocardiographic parameters were conducted in patients diagnosed with moderate AS [aortic valvular area (AVA) 1-1.5 cm2 or peak velocity (Vmax) 3-4 m/s or dimensionless severity index (DSI) 0.25-0.5]. Cumulative hazard plots and Cox proportional hazards regression models were used to assess the difference in time to cardiac death, heart failure hospitalization or aortic valvular intervention between the clusters. Results Four distinct clusters were identified AS patients (n=2,409) using PAM algorithm. The highest risk of cardiovascular outcomes was found among patients in Cluster 4 (Comorbid cluster), followed by Cluster 3 (Risk factors cluster), and Cluster 2 (Valve morphology cluster) (Table 1, Figure 1). Comparing cardiac death outcomes between patients treated with TAVR vs. no TAVR in each cluster revealed that TAVR was of most benefit in Cluster 2 (HR = 0.05, 95% CI: 0.01-0.34, p=0.002). Conclusions Multiple comorbidities are the key driver of worse outcomes in patients with moderate AS, which can affect treatment outcomes from TAVR. Thus, careful attention to the comorbidities is imperative in the management of patients with moderate AS.Table 1.Characteristics of 4 clustersFig 1.Cumulative Hazard Plot

Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study.

In many studies on aortic disease, women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the ascending aorta (AA) and arch. Electrocardiogram-gated cardiac computed tomography scans of 116 consecutive patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology. In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7.4% wider than female aortas, both in systole and diastole. The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated with decreased AA and arch diameters. In men, increased BSA and age are associated with increased AA and arch diameters, while smoking and diabetes are associated with decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women. Men had 7.4% greater ascending aorta and arch diameters than women in a retrospective cohort, gated computed tomography-based study of 116 patients. Sex-specific differences in ascending aortic and arch size should be considered by aortic endovascular device manufacturers and physicians when developing ascending and arch endografts and planning aortic interventions.

Abstract 14832: Comparative Effectiveness of Intravascular Ultrasound versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis

Introduction: The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in the treatment of aortic conditions remains unclear. Objective: This systematic review and meta-analysis evaluates the evidence for IVUS use during thoracic (TEVAR) and abdominal (EVAR) endovascular aortic repair. Methods: A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted to identify studies comparing outcomes of patients undergoing TEVAR/EVAR with and without IVUS. The primary outcome was all-cause mortality during follow-up. Secondary outcomes included contrast volume, fluoroscopy time, perioperative mortality, and reinterventions during follow-up. Continuous variables, risk ratios (RRs), and hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted from each study. Pooled analysis was performed using a random-effects model. Results: A total of 6,888 patients (n=4,226 IVUS and n=2,662 non-IVUS) from nine observational studies were included in the meta-analysis. The follow-up period ranged from 9 months to 25 months. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference (WMD) [95% CI] = -34.65 mL [-54.73, -14.57]) and fluoroscopy time (WMD [95% CI] = -6.13 min [-11.10, -1.15]) ( Figure 1A&B ). Perioperative mortality was comparable between both groups (RR [95% CI] = 0.67 [0.40-1.12], respectively). Reintervention rates and all-cause mortality during the follow-up period were similar between the two groups (HR [95% CI] = 0.80 [0.33-1.97], HR [95% CI] = 0.75 [0.47-1.18], respectively) ( Figure 1C ). Conclusions: This systematic review and meta-analysis provides evidence that the use of IVUS enables safe and effective deployment of TEVAR and EVAR with reduced contrast agent usage and shorter fluoroscopy duration. These findings support the potential of IVUS as a valuable tool in endovascular aortic interventions.

Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial.

To compare the long term efficacy and safety of rosuvastatin with atorvastatin treatment in adults with coronary artery disease. Randomised, open label, multicentre trial. 12 hospitals in South Korea, September 2016 to November 2019. 4400 adults (age ≥19 years) with coronary artery disease. Participants were assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196) using 2×2 factorial randomisation. The primary outcome was a three year composite of all cause death, myocardial infarction, stroke, or any coronary revascularisation. Secondary outcomes were safety endpoints: new onset diabetes mellitus; hospital admissions due to heart failure; deep vein thrombosis or pulmonary thromboembolism; endovascular revascularisation for peripheral artery disease; aortic intervention or surgery; end stage kidney disease; discontinuation of study drugs owing to intolerance; cataract surgery; and a composite of laboratory detected abnormalities. 4341 of the 4400 participants (98.7%) completed the trial. Mean daily dose of study drugs was 17.1 mg (standard deviation (SD) 5.2 mg) in the rosuvastatin group and 36.0 (12.8) mg in the atorvastatin group at three years (P<0.001). The primary outcome occurred in 189 participants (8.7%) in the rosuvastatin group and 178 (8.2%) in the atorvastatin group (hazard ratio 1.06, 95% confidence interval 0.86 to 1.30; P=0.58). The mean low density lipoprotein (LDL) cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group (P<0.001). The rosuvastatin group had a higher incidence of new onset diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%; hazard ratio 1.39, 95% confidence interval 1.03 to 1.87; P=0.03) and cataract surgery (2.5% v 1.5%; 1.66, 1.07 to 2.58; P=0.02). Other safety endpoints did not differ between the two groups. In adults with coronary artery disease, rosuvastatin and atorvastatin showed comparable efficacy for the composite outcome of all cause death, myocardial infarction, stroke, or any coronary revascularisation at three years. Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new onset diabetes mellitus requiring antidiabetics and cataract surgery compared with atorvastatin. ClinicalTrials.gov NCT02579499.

Systematic Review and Meta-Analysis of Nonoperative Management for SVS Grade II Blunt Traumatic Aortic Injury

SVS Grade II blunt traumatic aortic injury is defined as intramural hematoma with or without external contour abnormality. It is uncertain whether this aortic injury pattern should be treated with endovascular stent-grafting or nonoperative measures. Since the adoption of the SVS Guidelines on endovascular repair of blunt traumatic aortic injury, the practice pattern for management of grade II injuries has been heterogenous. The objective of the study was to report natural history outcomes of grade II blunt traumatic aortic injury. A systematic review of published traumatic aortic injury studies was performed. Online database searches were current to November 2022. Eligible studies included data on aortic injuries that were both managed nonoperatively and classified according to the SVS 2011 Guidelines. Data points on all-cause mortality, aorta-related mortality and early aortic intervention were extracted and underwent meta-analysis. The methodology was conducted in accordance with PRISMA guidance. Thirteen studies were included in the final analysis with a total of 204 cases of SVS grade II blunt traumatic aortic injury treated nonoperatively. The outcomes rates were estimated at 10.4% (95% CI 6.7% - 14.9%) for all-cause mortality, 2.9% (95% CI 1.1% - 5.7%) for aorta-related mortality and 3.3% (95% CI 1.4% - 6.2%) for early aortic intervention. The studies included in the analysis were of fair quality with a mean Downs and Black score 15 (±1.8). Grade II blunt traumatic aortic injury follows a relatively benign course with few instances of aortic-related mortality. Death in the setting of this injury pattern is more often attributable to sequelae of multisystem trauma and not directly related to aortic injury. The current data supports nonoperative management and imaging surveillance for grade II blunt traumatic aortic injury instead of endovascular repair. Longer-term effects on the aorta at the site of injury are unknown.

An aortic arch stentgraft implantation due to endovascular leak as the fourth aortic intervention in a challenging patient.

An aortic arch stentgraft implantation due to endovascular leak as the fourth aortic intervention in a challenging patient.

Insulin Dependence is Associated with Poor Long-Term Outcomes Following AAA Repair

While prior studies have confirmed the protective effect of diabetes on abdominal aortic aneurysm (AAA) development, much less is known about the effect of diabetes, and in particular insulin dependence, on outcomes following AAA repair. In this study, we aim to evaluate the role of insulin dependent diabetes on short- and long-term outcomes following open and endovascular AAA repair. The Vascular Implant Surveillance and Interventional Outcomes Network (VISION), a registry linking the Vascular Quality Initiative (VQI) data with Medicare claims, was queried for patients who underwent open or endovascular AAA repair from 2011 to the present. Exclusion criteria were unknown diabetes status, prior aortic intervention, maximum aneurysm diameter < 45mm at presentation and Medicare Advantage coverage due to inconsistent follow-up. Patients were stratified based on diabetes status (no diabetes vs diabetes) and insulin-dependence (no diabetes or non-insulin dependent diabetes vs insulin dependent diabetes). Of the 38,437 cases in the VISION endovascular aortic aneurysm (EVAR) and open aortic aneurysm repair (OAR) databases, 21,943 met inclusion criteria. Perioperative outcomes after OAR were comparable between diabetic and non-diabetic patients. However, diabetic patients undergoing EVAR were significantly more likely to have a post-operative myocardial infarction (1.0% vs 0.6%, p = .04) and have a 30-day readmission (10.9% vs 8.8%, p<.001). Insulin-dependent diabetic patients were more likely to require a 30-day readmission after OAR (24.5% vs 13.5%, p = .02) and EVAR (15.1% vs 9.0%, p <.001), however, only IDDM patients undergoing EVAR experienced higher rates of postoperative MI (1.9% vs 0.7%, p <.01). After propensity score matching, patients with insulin dependent diabetes undergoing EVAR were additionally at increased risk of mortality at one-, three- and five-year follow-up with the highest risk occurring at the one-year mark (HR 1.79, p <.0001), while IDDM patients undergoing OAR were only at a significantly increased risk of mortality at five-year follow-up (HR 1.90, p = .01). Patients with insulin-dependent diabetes have greater than 14% one-year mortality following open or endovascular aneurysm repair, compared to 8% for all others. Our findings raise questions about whether insulin-dependent diabetics should have a higher size threshold for prophylactic repair, although further studies are needed to address this question and consider the influence of glycemic control on these outcomes.

Outcomes of Thoracic Aortic Interventions in Marfan Syndrome in the State of Texas Over Eleven Years.

Marfan Syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions in the Marfan Syndrome population in the state of Texas from 2009-2019. A retrospective review of the Texas Inpatient Discharge Dataset from 1/1/2009-31/12/2019. Discharges from acute care hospitals with a Marfan Syndrome diagnosis by International Classification of Diseases 9/10 codes and a procedure code for thoracic aortic intervention were analyzed utilizing descriptive, univariate, and multivariable regression statistics. There were 4,641 Marfan Syndrome discharges identified, of whom 644(13.9%) underwent thoracic aortic intervention. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223(34.6%). Thirty-three(5.1%) had a concomitant coronary artery intervention. There were 30(4.7%) in-hospital mortalities, 126(19.6%) diagnoses of acute renal failure, 52(8.1%) had mechanical ventilation >96 hours, and the median length of stay was 10[IQR : 7-16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality (OR : 3.69[IQR : 1.15-11.90], p = 0.029) and acute renal failure (OR : 2.66[IQR : 1.19-5.94], p = 0.017). Aortic dissections/ruptures were associated with acute renal failure (OR : 1.73[IQR : 1.14-2.63], p = 0.010), ventilation >96 hours (OR : 2.19[IQR : 1.21-3.97], p = 0.010), and 15% longer length of stay (95% CI : 2.4-29.1%, p = 0.038). Thoracic aortic interventions are frequent amongst the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines, and preventative management of Marfan Syndrome aortopathy.

Branched endovascular iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation graft: outcomes and reinterventions in our retrospective cohort.

The aim of this retrospective cohort study was to analyze the outcomes and the need for reinterventions following branched iliac artery repair using the Zenith® Branch Endovascular Iliac Bifurcation (ZBIS; Cook Medical Europe LTD, Limerick, Ireland) graft. Patient characteristics and follow-up data on 63 patients following branched iliac artery repair using the ZBIS device were evaluated and compared between patients with and without iliac reinterventions. A competing risk regression model was analyzed to identify independent predictors of reinterventions, and to predict the reintervention risk. ZBIS implantation's technical success rate was 100%, and we observed no in-hospital mortality. Internal iliac artery patency was 93% during a median [first quartile, third quartile] follow-up of 19 [5, 39] months. Thirty-two iliac reinterventions were performed in 23 patients (37%) after a mean time of 3.0 months (IQR: 0.4-6.8) (time to first reintervention). Endoleaks type I and II were the most common indication for reinterventions (n=14, 61%). The internal iliac artery's diameter [subdistribution hazard ratio (sHR): 1.046; P=0.0015] and a prior abdominal aortic intervention (sHR: 0.3331; P=0.0370) were identified as significant variables in the competing risk regression model for a reintervention. The risk for reintervention was 33% (95% CI: 20-46%), and 46% (95% CI: 28-63%) after 12 and 36 months, respectively. Endovascular repair of degenerative iliac artery aneurysms with Zenith Branch Iliac Bifurcation device is a feasible and safe option. Perioperative morbidity and mortality are low with good graft patency rates. The risk for secondary iliac artery interventions is considerable and highlights the need for patients with iliac disease to undergo continuous follow-up in a dedicated vascular center.

Esophageal reconstruction as the first step for treating secondary aortoesophageal fistula due to thoracic endovascular aortic stent infection

BackgroundThe surgical strategy for aortoesophageal fistula (AEF) depends on the experience of each surgeon, and there is no consensus on the strategy to be adopted. We propose our two-stage operation compromising esophagectomy and reconstruction as the first step and in situ aortic graft replacement as the second step after 7 days for treating AEF secondary to thoracic aortic stent graft infection.Case presentationA diagnosis of AEF was made in a 70-year-old man with a history of multiple aortic interventions. The patient underwent esophageal resection and reconstruction with a pedicled stomach roll endoscopically in the right thoracic cavity. Postoperatively, enteral feeding was resumed via a feeding tube placed in the jejunum to maintain adequate nutritional status. There was no evidence of either anastomotic leakage or necrosis. Seven days later, the patient underwent removal of the infected stent graft and in situ graft replacement via a redo left thoracotomy. After the surgery, the patient was able to start oral intake relatively early. Although more than 6 months has passed since the patient was discharged, no recurrence of infection has been observed.ConclusionsThe benefit of our strategy is the radical treatment for secondary AEF and the early resumption of oral intake.

Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease

Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. To assess the midterm outcomes of endovascular aortic repair in patients with CTD. For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.

Breaking the Rules About Endovascular Aortic Intervention and Connective Tissue Disease

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Remote training and evaluation of asimulator-based training course for complex endovascular procedures.

Intimate knowledge of the materials used in endovascular aortic interventions is essential for trainees and supporting staff taking part in an endovascular intervention. Training courses can help to familiarize trainees with the equipment. However, the pandemic has changed the landscape of hands-on training courses significantly. Therefore, we developed atraining course including an educational recording of the procedure to transfer knowledge about the materials used during endovascular interventions and radiation exposure reduction. We produced avideo depicting cannulation of the left renal artery in asilicon cast of an aorta and its major side branches under C‑arm fluoroscopy. Apresentation using the video was given to the trainees. The trainees were randomized into acontrol and an intervention group. Their performance was filmed and rated on astandardized five-point scale in the style of the OSATS global rating scale. The intervention group was remeasured after additional training time. In total, 23trainees participated in the training and agreed to have their performance recorded. The control and intervention groups showed no difference in the assessed performance metrics during their initial attempt. However, after receiving additional training, the intervention group significantly improved in all evaluated metrics. Our data add to the growing evidence that simulator-based training can help to increase trainees' understanding and performance of relevant skills. Astandardized and evidence-based validation process for simulators could improve their acceptance in the medical field.

The Past, Present, and Future of Complex Aortic Intervention.

The Past, Present, and Future of Complex Aortic Intervention.