Primary Success Rate Research Articles

25-Gauge pars plana vitrectomy combined with air tamponade for primary rhegmatogenous retinal detachment

This study was performed to evaluate the outcomes of 25-gauge (25-G) pars plana vitrectomy (PPV) with air tamponade for primary rhegmatogenous retinal detachment (RRD). This retrospective consecutive case series included 126 eyes of 125 patients with primary RRD who underwent 25-G PPV with air tamponade. The patients were followed up for at least 6 months following surgery. The main outcome measures were the primary and final anatomical success rates and postoperative complications. The mean age of the 125 patients (80 men and 45 women) was 53.7 ± 10.0 years. The mean follow-up period was 8.3 ± 2.2 months (range, 6-18 months). Twenty-four eyes (19.0%) presented with high myopia, and 13 eyes (10.3%) were pseudophakic. Of the 126 eyes, 37 (29.4%) had inferior breaks, 2 (1.6%) had choroidal detachment, and 86 (68.3%) had macular detachment. The single- and final-operation success rates were 96.0% and 100%, respectively. Postoperative complications included macular hole formation in two eyes. During follow-up, secondary cataract surgery was performed in 27 (23.9%) of the 113 phakic eyes. 25-G PPV with air tamponade is effective and safe in treating selected patients with primary RRD with a high anatomical success rate.

DRAINAGE RETINOTOMY IS A RISK FACTOR FOR SURGICAL FAILURE AFTER PARS PLANA VITRECTOMY IN PATIENTS WITH PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT.

To identify risk factors for recurrent retinal detachment after uncomplicated pars plana vitrectomy in patients with primary rhegmatogenous retinal detachment (RRD). This single-center retrospective study included patients with primary RRD who underwent 23-gauge and 25-gauge pars plana vitrectomy at Hiroshima University Hospital between January 2016 and May 2021. All patients had ≥3 months of follow-up. Patients were excluded if they had preoperative proliferative vitreoretinopathy worse than Grade C1; giant retinal tears; tractional, exudative, or traumatic retinal detachment; or the use of perfluorocarbon liquid. Factors that influenced RRD treatment outcome and postoperative complications were evaluated. We analyzed 519 eyes of 509 patients who underwent pars plana vitrectomy for primary RRD. The primary and final success rates were 93.8% and 99.8%, respectively. Drainage retinotomy was a risk factor for surgical failure in both multivariate analysis (odds ratio 2.36, 95% confidence interval 1.08-5.15, P = 0.0314) and a propensity score-matching analysis (odds ratio 3.20, 95% confidence interval 1.14-9.04, P = 0.0277). Postoperative epiretinal membrane was associated with drainage retinotomy in multivariate analysis (odds ratio 1.93, 95% confidence interval 1.04-3.57, P = 0.0358). The avoidance of drainage retinotomy during small-gauge pars plana vitrectomy in patients with RRD may lead to better surgical success and less frequent epiretinal membrane formation.

Efficacy and safety of self-expandable metal stent placement for treatment of primary and metastatic gastric outlet obstruction.

The data of 42 patients with GOO who received SEMS from November 2016 to April 2022 were reviewed retrospectively. Patients were divided into primary group (n = 25) and metastatic group (n = 17) according to the cause of GOO. The rates of technical and clinical success, stent patency, and complications were compared between the two groups. The overall technical and clinical success rates were 97.9% and 93.5%, respectively. The total SEMS implantation time was 48.2 ± 33.5 (10.0-140.0) minutes. The primary technical success rate was 100.0% in both primary and metastatic groups, and the primary clinical success rate was 96.0% (24/25) in the primary group vs 88.2% (15/17) in the metastatic group (P = 0.350). After reintervention, the secondary technical success rate was 100.0% (27/27) in the primary group vs 95.0% (19/20) in the metastatic group (P = 0.330); and the secondary clinical success rate was 96.3% (26/27) in the primary group vs 89.5% (17/19) in the metastatic group (P = 0.367). No serious complications, such as gastrointestinal perforation, stent migration, bleeding, or aspiration pneumonia, were observed in these patients. SEMS under fluoroscopic guidance is an effective and safe treatment for primary and metastatic GOO. The etiology of obstruction did not influence stent patency or complications. Therefore, stent implantation is recommended for patients with metastatic GOO caused by multiple peritoneal metastases to improve their quality of life.

Acute interventions-dialysis shunt recanalization

An arteriovenous fistula is vital for patients who need regular hemodialysis. Continuous patency and sufficient functionality determine quality of life and associated morbidity and mortality of patients. Following successful hemodialysis shunt creation, intimal hyperplasia and consecutive thrombosis or complete occlusion may cause different types of shunt dysfunctionality or even critical failure. Immediate shunt recanalization and revision by using an endovascular-first approach is crucial for long-term survival of hemodialysis fistula. There are several mechanisms available for catheter-based thrombus removal to unmask the typically underlying shunt stenosis. Primary technical recanalization success rates are very similar for clot cleaning. Treatment of intimal hyperplasia is preferably addressed by using drug-coated balloon angioplasty to allow for increased shunt patency compared to plain old balloon angioplasty. Stents and stent grafts are only used for resistant or repeated short-term recurrence of severe stenosis. Finally, surgical revision has a classical role in case of repeated failure of endovascular measures.

Percutaneous Approach in Endovascular Aortic Procedures Using a Suture-Mediated Closure Device.

The purpose of this study is to assess the efficacy of a suture-mediated closure device during percutaneous endovascular aortic repair. A single-center, retrospective analysis of patients undergoing endovascular repair for infrarenal, thoracic and thoracoabdominal aortic aneurysms and aortic dissections via percutaneous femoral access between April 2017 and June 2021 was performed. The primary endpoint of the study was the efficacy and technical success of the Perclose ProGlide closure device during percutaneous endovascular procedures. The secondary endpoints were intraoperative and postoperative inguinal and vascular complications during and after device use. A total of 376 punctures were performed in 263 patients with the deployment of the ProGlide vascular closure system. Twenty-two cases involved percutaneous re-puncture as part of a staged procedure. The primary and secondary technical success rates were 93.1% (350/376) and 94.7% (356/376), respectively. In 20 patients (5.3%), intraoperative femoral exposure due to complications was required. Postoperative complications occurred in 13 cases (3.5%), 2 of which required surgical reintervention. There was no statistical significance between the type of endovascular procedure and primary technical success (p = 0.56). The introduction of larger-diameter sheaths was not associated with increased intraoperative and postoperative complication rates (p = 0.75 and p = 0.78, respectively). Percutaneous re-puncture of the vascular access site did not result in a lower overall technical success rate (20/22, 90.9% primary technical success rate, p = 0.67; 21/22, 95.5% secondary technical success rate, p = 0.86) or an increased number of perioperative complications (1/22, 4.5% intraoperative complications, p = 0.86; 2/22, 9.1% postoperative complications, p = 0.13). The application of the ProGlide closure system is a safe and efficient method to achieve hemostasis during percutaneous endovascular aortic repair. Complex aortic pathologies, which often require a staged approach with re-puncture, can also be successfully treated with this closure system.

Characteristics of Bilateral Retinal Detachment

Introduction: Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD. Methods: The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed. Results: A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break. Conclusion: Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.

Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt-Hogg-Dubé Syndrome.

Simple SummaryPercutaneous thermal ablation (TA) could be a safe and efficient nephron-sparing treatment for treating renal cell carcinoma (RCCs) associated with Birt–Hogg–Dubé (BHD) syndrome, a rare hereditary condition at greater risk of repeated treatments, even in the case of advanced chronic kidney disease, and should be systematically discussed as a treatment option. Indications for nephron-sparing management of these tumors in BHD patients depends on many factors, including size, number, and location of the tumor(s) in each kidney, patient surgical history, and renal function. The role of the tumor board including radiologists, interventional radiologists, urologists, and oncologists is essential.BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease.

Virtual navigation bronchoscopy-guided intraoperative indocyanine green localization in simultaneous surgery for multiple pulmonary nodules.

BackgroundAccurate localization of pulmonary nodules is the main difficulty experienced in wedge resection. Commonly used localization methods have their own advantages and disadvantages. However, clinical work has demonstrated that intraoperative indocyanine green localization under electromagnetic navigation bronchoscopy/virtual navigation bronchoscopy (VNB) is more advantageous than conventional methods for patients with multiple pulmonary nodules undergoing simultaneous surgery, especially for those undergoing bilateral lung surgery.MethodsData of patients undergoing simultaneous surgery for multiple pulmonary nodules with preoperative methylene blue localization by computed tomography (CT)‐guided percutaneous lung puncture (methylene blue group) or intraoperative indocyanine green localization under VNB (virtual navigation group) were retrospectively analyzed. Patient characteristics, pulmonary nodule features, localization time, preoperative location time, location success rate, operation time, complication incidence, visceral pleural staining rate after localization, and pulmonary nodule primary resection success rate were compared between the two groups.ResultsThe methylene blue and virtual navigation groups comprised 39 and 20 patients with 119 and 67 pulmonary nodules resected, respectively. Sex, age, number of pulmonary nodules resected simultaneously, unilateral/bilateral lung surgery, pulmonary nodule size, distance between pulmonary nodules and the visceral pleura, pulmonary nodule consolidation‐to‐tumor ratio, location of pulmonary nodules in the pulmonary lobe, postoperative pathology, visceral pleura staining rate, primary pulmonary nodule resection success rate, and surgical duration did not differ significantly between the groups (p > 0.05). The localization time of the virtual navigation group was significantly shorter than that of the methylene blue group (p < 0.05), regardless of unilateral or bilateral multiple nodules. In the methylene blue group, 25.64% (10/39) of patients presented complications, all of which were pneumothorax, whereas no complications were found in the virtual navigation group.ConclusionsFor patients with multiple pulmonary nodules undergoing simultaneous surgery, indocyanine green injection under VNB can achieve a similar effect on pulmonary nodule localization as classical methylene blue injection under CT‐guided percutaneous lung puncture, with shorter localization time and fewer complications.

27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease: A meta-analysis.

We performed a meta-analysis to evaluate the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease. A systematic literature search up to June 2022 was performed and 1264 subjects with the vitreoretinal disease at the baseline of the studies; 562 of them were using the 27-gauge microincision vitrectomy surgery, and 722 were using 25-gauge microincision vitrectomy surgery. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease using the dichotomous, and contentious methods with a random or fixed-effect model. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication (OR, 6.66; 95% CI, 0.46-0.95, P=.02), and wound suture number (OR, 0.38; 95% CI, 0.20-0.71, P=.002), and best corrected visual acuity (MD, -0.03; 95% CI, -0.05 to -0.001, P=.02) compared with 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. However, 27-gauge microincision vitrectomy surgery subjects had no significant difference in the wound closure time (MD, -8.45; 95% CI, -23.44 to 6.55, P=.27), operation time (MD, 0.85; 95% CI, -1.17 to 2.86, P=.41), intraocular pressure at postoperative day 1 (MD, 0.42; 95% CI, -1.45-2.28, P=.66), primary anatomical success rate (OR, 0.83; 95% CI, 0.42-1.63, P=.58), and central macular thickness (MD, 1.81; 95% CI, -21.76 to 25.37, P=.88) compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication, wound suture number, and best corrected visual acuity, and no significant difference in the wound closure time, operation time, intraocular pressure at postoperative day 1, primary anatomical success rate, and central macular thickness compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The analysis of outcomes should be with caution because of the low sample size of 12 out of 15 studies in the meta-analysis and a low number of studies in certain comparisons.

Outcome in octogenarian patients with lower extremity artery disease after endovascular revascularisation: a retrospective single-centre cohort study using in-patient data

ObjectivesTo investigate the clinical benefit of endovascular revascularisation (EVR) in octogenarian (aged ≥80 years) patients with lower extremity artery disease (LEAD).DesignRetrospective single-centre study.SettingUniversity hospital with a specialised centre for vascular...

Efficacy and safety of selective renal arterial embolization in renal angiomyolipoma: a prospective single-center study

BackgroundPreventing acute complication of renal angiomyolipoma (AML), preserving renal parenchyma, and improving long-term renal function are the treatment targets of renal angiomyolipoma. Treatment should be considered for symptomatic lesions or those who are at risk of complications, especially bleeding symptoms, which are linked to tumor size, angiogenic component grade, and presence of tuberous sclerosis complex (TSC). Selective arterial embolization (SAE) has become the new norm for preventive or emergency treatment of renal AMLs with minimally invasive selective targeting of small arterial feeders, we aimed to assess the efficacy and safety of selective renal arterial embolization (SAE) in the management of complicated renal angiomyolipoma and to detect the predictors of prophylactic SAE in cases of non-complicated AML.ResultsBleeding symptoms were significantly more frequent in patients with TSC-associated renal AMLs (C = 0.333 and p = 0.036) and patients with intra-lesional aneurysm > 3 mm (C = 0.387 and p = 0.013). Overall success rate: thirty-three (91.7%) renal AMLs were successfully embolized with no recurrence. While three (8.3%) renal AMLs were not; one (2.8%) renal AML was not embolized due to technical failure and two (5.5%) renal AMLs showed recurrence. Primary (technical) success rate: thirty-three (86.9%) successful embolization, five (13.1%) arteriographies were done with failed embolization. The maximum diameter and volume of the lesions after SAE showed statistically significant reduction (z = 4.25 and p < 0.001).ConclusionsSAE is an effective and safe technique to manage renal AMLs preoperatively or in an emergency. TSC-associated lesions, and intra-lesional aneurysms (aneurysms > 3 mm in diameter) were significantly more associated with bleeding symptoms, considering them significant predictors for prophylactic SAE in non-complicated AML.

Anatomical description and short-term follow up clinical results for ultrasound-guided injection of medial collateral ligament bursa: New conservative treatment option for symptomatic degenerative medial meniscus tear

BackgroundIn this study, we investigated newly developed ultrasound (US)-guided medial collateral ligament (MCL) bursa injection as a conservative therapy for symptomatic degenerative medial meniscal (MM) tears. We aimed to describe the anatomical target and precise technique of this injection, confirm its accuracy using fresh cadaveric knees, and then evaluate preliminary clinical outcomes. MethodsAnatomical studies were performed on three fresh cadavers. For the clinical study, 50 patients with medial knee joint pain without knee osteoarthritis were treated with US-guided MCL bursa injection. Severity of pain was assessed pre-injection, and 1 week and 4 weeks post-injection using a 0–10 numerical rating scale (NRS). Clinical success was defined as a full return to daily activities. All patients underwent magnetic resonance imaging (MRI) within 1 week of the first injection. Patients who underwent surgery within 12 months of the first injection were investigated as clinically unsuccessful cases, and MRI and arthroscopic findings were examined. ResultsCompared with pre-injection (6.8 ± 1.2), the average NRS score was significantly lower at 1 week (1.8 ± 2.0) and at 4 weeks (1.5 ± 1.7) post-injection (both P < 0.01). The primary clinical success rate was 76.0%, and injection-related adverse events were not observed. Nine patients underwent surgery (arthroscopic surgery for degenerative flap tear (n = 7) and high tibial osteotomy for medial meniscus posterior root tear and proximal tibial malalignment (n = 2)). ConclusionsUS-guided MCL bursa injection is safe, reproducible, and effective for symptomatic MM degenerative tears. However, US-guided injections of the MCL bursa may be ineffective for flap tears and posterior root tears.

Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques.

Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched endovascular aortic repair in a single centre. Demographic, anatomical, procedural, and postoperative variables were collected. Our elective patient cohort consisted of 9 pararenal aneurysms (45%) and 11 thoracoabdominal aortic aneurysms (55%), with the latter including 4 chronic dissection cases (20%). A total of 71 branch vessels were incorporated (3.5 ± 0.9 per patient). The per vessel technical success rate was 100%. In-hospital mortality was 5% (1/20). At an average follow-up of 14 ± 22 months, the primary clinical success rate was 45% (9/20) and the secondary clinical success was achieved in 75% of cases (15/20). All-cause mortality at 14 months was 20% (4/20; aortic related: 1/20, 5%). Four bridging stent occlusions were found (5.6%). Mortality and reintervention rates were comparable to the initial results of high-volume centres, while the complexity of our cases and the per vessel technical success rate was comparable to the values reported as late experience. The morbidity of the learning curve could be decreased if operators are skilled in basic endovascular procedures.

Non-Valvular Atrial Fibrillation Cardioversion: Experience of the Cardiology department of Mohammed V Military Teaching Hospital

anticoagulation therapy would be the removal of this arrhythmia and any future recurrence, a goal often difficult to achieve.The aim of this work is to evaluate the efficacy of atrial fibrillation cardioversion as well as the success predictive factors of sinus rhythm maintenance at one year following a successful cardioversion. Materials and methods: 50 patients with non-valvular atrial fibrillation underwent cardioversion: 70% by electrical shock and 30% by pharmacological means, the clinical characteristics of the patients the results of cardioversion and follow-up were collected and analyzed. Results: The average age of our patients was 53 years with a sex ratio of 2. 30% of patients had hypertensive heart disease, 8% ischemic heart disease, 8% dilated cardiomyopathy and the rest had no underlying heart disease. The average diameter of the left atrium was 41 mm and the average surface area was 20 cm². Primary success rate of cardioversion was 82% with better efficacy of electric shock compared to pharmacological cardioversion. The maintenance rate of sinus rhythm at 1 year was 70%. Predictive factors of failure and / or recurrence at 1 year were old atrial fibrillation and significant dilation of the left atrium. Conclusion: This study confirms the interest of atrial fibrillation cardioversion and underlines the importance of preliminary selection of the patients, such a selection must be made on the basis of the predictive factors of success usually recognized in the literature.

Study on the Relationship between Different Body Mass Indexes and Puncture Pain and Image Quality in Patients Undergoing Coronary Angiography with Intravenous Indwelling Needle.

Objective To investigate the effect of different body mass indexes (BMIs) on patients' puncture pain, puncture success rate, and image quality in coronary angiography (CAG) performed with an intravenous indwelling needle, and to provide a basis for selecting the appropriate intravenous indwelling needle for CAG in patients with different BMIs in an outpatient clinic. Method In this study, 300 patients undergoing CTA at the department of radiology in the First Affiliated Hospital of Wenzhou Medical University from January to May 2021 were divided into group 1 (BMI 1 ≤ 18.5), group 2 (18.5 < BMI ≤ 24), and group 3 (BMI > 24) according to their BMI, with 100 cases in each group, and a 20 G intravenous indwelling needle was used in each group. The age, sex, height, and weight of each patient were recorded, and the primary puncture success rate, contrast leakage rate, injection success rate, pain perception, and subjective ratings of image quality and objective indicators were compared in patients with different BMI values. Results There was no statistically significant difference between the age, gender, and heart rate of the patients in the three groups (P > 0.05). There was no statistically significant difference between the primary puncture success rate, injection success rate, and contrast leakage rate of the three groups of patients (P > 0.05). The pain scores of group 3 during contrast injection were significantly higher than those of the remaining two groups (P < 0.05), while the differences between the pain scores of group 2 and group 1 during contrast injection were not statistically significant (P > 0.05); the comparison of the pain scores of the three groups during puncture and during retention was not statistically significant (P > 0.05). The differences between the subjective ratings of image quality and the objective indicators of the three groups were not statistically significant (P > 0.05). Conclusion The 20 G indwelling needle can basically meet the coronary angiography examination of patients with different body mass indexes, but patients with a BMI greater than 24 are recommended to use a larger diameter indwelling needle to reduce contrast leakage as well as to reduce patient pain and improve patient comfort.

Improving procedural success rate of retrograde ethanol infusion in the vein of Marshall

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Retrograde ethanol infusion in the vein of Marshall (VOM) is a relatively new adjunctive therapy of atrial arrhythmias. The VOM is an epicardial left atrial vein. Its surrounding autonomic ganglia and proarrhythmogenic muscle fibers are accepted extrapulmonary triggers of AF and can be ablated by retrograde ethanol infusion. This facilitates the achievement of bidirectional mitral isthmus block. Moreover, it seems to improve outcomes in terms of rhythm stability if performed in addition to RF ablation in persistent atrial fibrillation. However, retrograde ethanol infusion in the vein of Marshall (VOM) can be technically challenging. Technical improvement of the procedure has the potential of higher primary success rate and therefore may secondary lead to better outcome of interventional therapy of persistent AF. Purpose International experienced centers achieve an acute procedural success rate around 85%. The purpose of our investigation was to study the impact of adding procedural techniques to the standard procedure as described before on the acute procedural success. Methods We analyzed all ethanol infusions in the VOM performed in our department between Nov 2019 and Nov 2021. Our standard approach resembles the technique published before primarily performed via a transfemoral access. If a VOM is angiographically not visible using the standard approach, we perform a rotational angiography. In case of negative angiography of the VOM, we try the atraumatic wiring assuming a typical anatomical location of the vein draining just proximal of the valve of Vieussens into the CS. If very proximal location of the VOM in the CS led to an instable catheter via transfemoral access we used transjugular access and a CRT-sheath. We collected data on additionally used techniques and their value for acute procedural success. All data are given as mean ± SD or number/percentages. Results Ethanol infusions were mostly performed as standalone procedures (136/147, 92,5%) or in a minority of cases as adjunctive therapy during RF-ablation. The ethanol infusion was succesful in 143 of the 147 patients (97%). In 21 patients (14%) extention of the technique exceeding the standard approach led to a succesful procedure. A rotational angiography revealed a previously not visible VOM in 5 patients (3,4%). Atraumatic wiring of the angiographic negative VOM in typical position was successful in 11 patients (7,5%). 5 patients (3,4%) benefitted from a transjugular venous access. Periprocedural complications were rare. We observed no vascular access site complications or pericardial effusion/tamponade. One patient suffered from a transient ischemic attack one week after the procedure. Conclusions Acute procedural success of ethanol infusion in the VOM amounted to 83% using the standard approach. We were able to improve the success rate to 97% by adding further imaging and modifying the technical approach while the positive safety profile remained.

Single-center outcome after ablation of atrial fibrillation using very high-power short duration pulmonary vein isolation

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation of atrial fibrillation is (AF) an established second line therapy for patients with symptomatic paroxysmal (PAF) and persistent AF (persAF). Novel ablation catheters with integrated thermocouples allow fast application of radiofrequency lesions with powers up to 90W. We aimed to describe primary and secondary outcomes after very high-power short duration (vHPSD) ablation. Methods 126 consecutive patients (78 PAF, 43 persAF, 5 longstanding persistent AF) underwent pulmonary vein isolation (PVI) using the QDOT Micro Catheter (Biosense Webster) with the ablation mode QMODE+ (90W, 4s, interlesion distance ≤4mm anterior, ≤6mm posterior). Results Mean age was 62±9 years, 33% were female, median CHA2DS2-VASc Score was 2 (0, 7). Median follow up duration was 204 (14, 461) days. 30% of patients had additional ablation of typical right atrial flutter. Primary success rate to achieve pulmonary vein isolation was achieved in all patients, no catheter-related complications (e.g., charring, steam pop) occurred. First pass isolation of all 4 PVs was achieved in 48% of patients, re-ablations were necessary in the carina regions (right: 37% of cases, left: 29%) and ridge (14%). Median procedure for PVI only were 102 (45-210) minutes. Arrhythmia-free survival was 79,6% (see Figure 1). Eight patients underwent re-do procedures during follow-up showing most commonly showing gaps in the right inferior PV (63%) and ridge (50%). Conclusion Very high-power short duration ablation allows safe and quick pulmonary vein isolation. However, first pass isolation rate is low due to gaps in the carina regions. Arrhythmia-free survival is comparable to other pulmonary vein isolation techniques. Figure 1: Left panel: Sample image of a vHPSD-PVI, posterior view of the left atrium. Right panel: Single procedure arrhythmia-free survival after vHPSD-PVI.

Rhegmatogenous retinal detachment repair—does age, sex, and lens status make a difference?

PurposeTo analyze the correlation between lens status, age, and sex in the epidemiology and success rates of rhegmatogenous retinal detachment (RRD) surgery.MethodsThe files of all consecutive patients undergoing vitreoretinal surgery for uncomplicated RRD between Jan 2005 und Dec 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment occurring within 3 months after surgery.Results5502 eyes with uncomplicated primary RRD were included. Mean age of the patients was 61.1 years (± 13.6 SD). In the age group over 40 years, a male predominance was found. The percentage of pseudophakic RRD increased from 25 to 40% during the 15 years observation period. In the age group 50 to 69 years, patients with pseudophakic detachments were male in 786 out of 1079 cases (72.9%). In the same age group, 1285 of 2110 (60.9%) patients with phakic RRD were male. Overall, primary success rate after one procedure was 91.2% (5018 of 5502). In the phakic eyes, the primary success rate was higher in those eyes that underwent combined phacovitrectomy (93.0%), compared to those without simultaneous cataract surgery (88.7%; p = 0.002).ConclusionThe ratio of male and female patients with RRD varies between age groups. The proportion of pseudophakic RRD has increased within 15 years. The male predominance in RRD is stronger in pseudophakic than in phakic eyes. In phakic eyes with RRD, a combined phacovitrectomy yielded better anatomical results.

O-Arm-Navigated, Robot-Assisted Versus Conventional CT Guided Radiofrequency Ablation in Treatment of Osteoid Osteoma: A Retrospective Cohort Study.

BackgroundOsteoid osteoma is a common benign bone tumor, and clinically there is severe local pain that typically worsens at night. The conventional CT-guided radiofrequency ablation (RFA) was widely used in the treatment of osteoid osteoma (OO), which could result in some radiation-related and imprecise complications due to the overdose of radiation exposure. This study aimed to compare the surgical effect of robot-assisted RFA with O-arm navigation and conventional CT-guided RFA in the treatment of OO.MethodsSixty-two patients who underwent robot-assisted RFA with O-arm navigation (Robot-RFA, n = 24) or CT-guided RFA (CT-RFA, n = 38) were included in this retrospective cohort study. The mean follow-up time was 23.3 months. The intra-operative data, primary technical success rate, visual analog scale (VAS), and post-operative complications were analyzed.ResultsPrimary technical success was obtained in 23 patients who had robot-assisted RFA, and 35 patients who had conventional CT-guided RFA. One patient in Robot-RFA group and three patients in CT-RFA group with pain recurrence received repeat-RFA and had a secondary success. Mean operation time and dose of radiation exposure were lower in Robot-RFA group than that in CT-RFA group. The Robot-RFA group took fewer K-wire adjustment times for each patient than the CT-RFA group. There was a statistically significant difference in the mean operation time, dose of radiation exposure, and K-wire adjustment times between the groups (p < 0.05). No complications associated with the procedure were reported in the two groups during the follow-up period.ConclusionRobot-assisted RFA with O-arm navigation is a safer and more precise strategy in the treatment of osteoid osteoma with less operation time and radiation exposure compared with the conventional CT-guided radiofrequency ablation.

Endoscope-Assisted Vitrectomy Without Scleral Buckling in Retinal Detachment

A multicenter, prospective case series study conducted at four institutes revealed that ophthalmic endoscope-assisted vitrectomy could achieve a good primary success rate (94.5%, 258 out of 273 eyes) without scleral buckling in uncomplicated retinal detachment.