Reintervention Rate Research Articles

Impact of class of obesity on clinical outcomes following fenestrated-branched endovascular aneurysm repair

BackgroundObesity represents a prevalent and escalating health concern among vascular surgery patients. Evidence pertaining to the influence of body mass index (BMI) on clinical outcomes after fenestrated-branched endovascular aneurysm repair (B/FEVAR) remains unclear. This study aims to assess the effect of obesity on short- and midterm clinical outcomes among individuals undergoing B/FEVAR. MethodsThis was a single-center retrospective analysis of all patients who underwent B/FEVAR from 2007 to 2020, with a median follow-up of 3.3 years (interquartile range, 1.6-5.3 years). Obesity was defined as a BMI of ≥30 kg/m2. Patients were divided into nonobese (NO) and obese cohorts according to their BMI. Outcomes were compared between the two groups subsequently. ResultsA total of 264 patients, 96 obese and 168 NO, were included. Patients with obesity were younger (72.8 ± 6.9 years vs 76.0 ± 7.3 years; P < .001), but had a higher prevalence of diabetes mellitus (27.1% vs 12.0%; P = .01) and dyslipidemia (80.2% vs 68.5%; P = .03). Both cohorts had similar rates of percutaneous access (37.5% for obese vs 35.1%; P = .7), and no significant differences in the rate of conversion to open access (8.3% for obese vs 4.2% for NO; P = .16). Technical success was similar between the cohorts (89% for obese vs 86%; P = .59). Major adverse events (MAEs) were higher in the NO group (13.1% vs 4.2%; P = .02). Patients in the obese cohort suffered more access site related infections (7.3% vs 1.2%; P = .01). All-cause mortality over 5 years was significantly higher in the NO group (35.1% vs 21.9%; P = .02). No statistical differences were found in spinal cord injury or dialysis requirement rates. Furthermore, on follow-up at 5 years, endoleak, branch instability, and reintervention rates were not statistically different between the two cohorts. ConclusionsPatients with obesity are on average younger; however, they were more likely to suffer access site infections compared with NO patients. They had increased survival rates on follow-up, although rates of reinterventions and endoleaks were similar between the two cohorts. Our study demonstrates that, despite higher comorbidities, patients with obesity had similar intraoperative success with decreased postoperative mortality; however, access site infections remains a significant clinical concern.

STABILISE for acute type B aortic dissection.

Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) is an extended downstream endovascular management technique for acute type B aortic dissection (TBAD), that aimed to achieve complete aortic remodeling. This systematic review aimed to assess the early and mid-term clinical outcomes with STABILISE in the management of TBAD. A literature search was performed on the Medline, Web of Science, Scopus, and SciELO databases, which returned 195 studies. Five studies were included. Data were extracted using predefined forms. In total, one hundred patients with acute or subacute TBAD managed with STABILISE were included. All studies reported a technical success of 100%. Thirty-day mortality was estimated at 4% (4/100) with no further deaths documented during an estimated mean follow-up of 12.7 months (range 12-15 months). Five percent developed spinal cord ischemia and another 5% developed visceral artery occlusions. One case of aortic rupture during time of balloon inflation was reported. Rare complications included delayed retrograde dissection (1%), aortobronchial fistula (1%), and renal failure (1%). One case of disconnection between stent-graft and bare stent was documented. Six percent of patients developed endoleak, predominately type I. Overall re-intervention rate was 21%, as reported in all studies. Complete obliteration of the false lumen in the thoracic aorta was achieved in 99% of patients and in the abdominal aorta in 96% of patients. STABILISE technique carries promising early and mid-term outcomes with high technical success and low mortality and morbidity. Excellent results on complete false lumen obliteration were observed. However, the heterogeneity among available studies' methodology does not permit firm conclusions, and further prospective analyses are needed to study the long-term outcomes of STABILISE.

Comparing thulium fiber versus high power holmium laser in bilateral same sitting retrograde intrarenal surgery for kidney stones: Results from a multicenter study.

Traditionally, bilateral urolithiasis treatment involved staged interventions due to safety concerns. Recent studies have shown that same-sitting bilateral retrograde intrarenal surgery (SSB-RIRS) is effective, with acceptable complication rates. However, there's no clear data on the optimum laser for the procedure. This study aimed to assess outcomes of SSB-RIRS comparing thulium fiber laser (TFL) and high-power holmium:yttrium-aluminum-garnet (Ho:YAG) laser in a multicenter real-world practice. Retrospective analysis was conducted on patients undergoing SSB-RIRS from January 2015 to June 2022 across 21 centers worldwide. Three months perioperative and postoperative outcomes were recorded, focusing on complications and stone-free rates (SFR). A total of 733 patients were included, with 415 in group 1 (Ho:YAG) and 318 in group 2 (TFL). Both groups have similar demographic and stone characteristics. Group 1 had more incidence of symptomatic pain or hematuria (26.5% vs. 10.4%). Operation and lasing times were comparable. The use of baskets was higher in group 1 (47.2% vs. 18.9%, p<0.001). Postoperative complications and length of hospital stay were similar. Group 2 had a higher overall SFR. Multivariate regression analysis indicated that age, presence of stone at the lower pole, and stone diameter were associated with lower odds of being stone-free bilaterally, while TFL was associated with higher odds. Our study shows that urologists use both lasers equally for SSB-RIRS. Reintervention rates are low, safety profiles are comparable, and single-stage bilateral SFR may be better in certain cases. Bilateral lower pole and large-volume stones have higher chances of residual fragments.

233. UTILITY OF SINGLE TRANSHIATAL CHEST DRAINAGE AFTER MINIMALLY INVASIVE OESOPHAGECTOMY: A PROPENSITY-SCORE MATCHED STUDY OF FEASIBILITY

Abstract Background The routine placement of intercostal chest drains remains common practice following minimally invasive oesophagectomy (MIO). Chest drains may contribute to increased post-operative pain and morbidity. The aim of this study was to compare the outcomes of transhiatal chest drain with intercostal chest drain. We analysed use of analgesia, length of hospital stay, and postoperative pulmonary morbidity following MIO. Methods This was a retrospective case-control study of patients undergoing elective MIO at a quaternary centre in Western Australia between September 2016 and September 2023. To reduce confounding, propensity score matching was performed. All patients were identified from a prospectively maintained database. In patients undergoing MIO with exclusive transhiatal drainage, a 19 French Blake’s drain was advanced through the hiatus into the right pleural cavity and positioned adjacent to the anastomosis. Results Thirty patients were included in the study, fifteen of whom had exclusively transhiatal drain placement. Mean total daily oral morphine dose equivalent was significantly lower in the transhiatal drain group (58mg+/-35.8) compared with intercostal drain group (100.8mg+/-64.0) on day 1 (p=0.04). There is no statistically significant difference between the total oral morphine use on days 3 (p=0.44) and 6 (p=0.97). No significant difference was observed in reintervention rate (p=1.00), length of stay (p=0.78) or postoperative pulmonary complications (p=1.00). Conclusion The results of this study suggest that transhiatal drain placement following MIO is associated with a reduction in post-operative pain and no increase in pulmonary complications or length of stay. Larger, prospective studies are needed to further evaluate the safety of single transhiatal chest drain placement following MIO.

Effect of minimally invasive cardiac surgery on hospital length of stay: A systematic review and meta-analysis

Background: Perioperative management using minimally invasive cardiac surgery (MICS), compared to full sternotomy (FS) cardiac surgery, is considered to improve postoperative recovery, and reduce hospital length of stay (LOS). Methods: A comprehensive systematic search was conducted across MEDLINE/PubMed, Embase, and the Cochrane library to identify RCT comparing MICS to FS approach for aortic valve, mitral valve, and coronary artery bypass surgery. Meta-analysis of extracted data was performed using random effects models. Results: A total of 33 RCTs including 2920 patients were identified. Overall MD (95% CI) for hospital and intensive care unit (ICU) LOS after MICS was significantly shorter compared to FS (-0.88 days (-1.55;-0.20), p&lt;0.013; 2606 patients) and (-0.23 days (-0.41;-0.05), p=0.012; 2242 patients), respectively. Additionally, postoperative blood loss was reduced with the use of MICS, (-192.07 ml (-292.32;-91.82), p=0.002; 718 patients). There was no evidence for differences between both groups in terms of postoperative ventilation times, duration of surgery, reintervention rate, incidence of postoperative atrial fibrillation or stroke, hospital mortality, or 1-year mortality. Conclusion: Within the limitations of a meta-analysis, MICS was found to be effective in promoting faster recovery by reducing postoperative blood loss, ICU, and hospital LOS.

The Incidence and Impact of Cardiac Function Decline after Lower Extremity Revascularization

The impact of cardiac function decline on major adverse limb events (MALE) following lower extremity revascularization (LER) in patients with peripheral arterial disease (PAD) has not been described. The electronic records of patients undergoing LER for PAD in a single center were reviewed. Two transthoracic echocardiograms were captured, the first within 6months of LER and the second on later follow-up (most recent to date). Patients were then divided into 2 groups: cardiac function decline (decrease in left ventricular ejection fraction ΔEF ≥10%) or stable cardiac function (reduction in ΔEF <10%, no change or improved EF). Patient characteristics and outcomes, including MALE, were compared. Of the 926 patients who underwent LER, 222 (24.0%) experienced a cardiac function decline, with 704 (76.0%) patients having stable cardiac function. Patients with cardiac function decline were more likely to have diabetes mellitus and heart failure than patients with stable cardiac function. There were no differences in the mode of revascularization (open vs. endovascular) between both groups. Patients with cardiac function decline demonstrated higher rates of periprocedural bleeding after initial LER. After a mean follow-up of 3years, patients with cardiac function decline had higher mortality. However, Kaplan-Meier analysis revealed no difference in freedom from MALE or reintervention rates between the 2 groups. Patients with cardiac function decline after LER for PAD have increased mortality but no significant difference in limb outcomes compared to patients with stable cardiac function.

324. A RETROSPECTIVE SINGLE CENTRE PROPENSITY-MATCHED ANALYSIS OF TRANSTHORACIC VERSUS TRANSABDOMINAL PROCEDURES FOR GIANT HIATAL HERNIAS

Abstract Background Transthoracic open procedure (TTO) was historically the preferred approach for treatment of giant hiatal hernias. However, the last decades transabdominal laparoscopic procedures (TAL) became the standard approach in many centres. The aim of the study was to compare short-term and midterm outcomes, as well as patient-reported outcome measures (PROMs, between TTO and TAL for giant hiatal hernias. Methods A retrospective analysis was conducted on all primary surgeries performed for giant hiatal hernias between 2008 and 2022. Patients who underwent TAL were propensity-matched (n= 36) to those who underwent TTO based on: age, gender, Charlson Comorbidity Score and hernia type. The two groups were compared in terms of surgery duration, length of stay (LOS), Clavien-Dindo score, intrahospital reoperation, hernia recurrence and need for reinterventions. PROMswere compared between total of TTO (n= 187) and TAL (n= 48): for symptom score, QoL-score, overall satisfaction and wound pain. Median clinical follow-up was 365.5 days. Median PROMsfollow-up was 55.3 months. Results Surgery duration (224 vs 177min, P&amp;lt;0.001) and LOS (11 vs 4days, P&amp;lt;0.001) were longer in TTO. Clavien-Dindo scores were alike (P= 0.260). Intrahospital reoperation was not statistically different (8.3% vs 0%, P= 0.239). Midterm recurrence rates suggested a non-significant trend towards lower recurrence in TTO (2.8% vs 16.7%, P= 0.107). Reintervention rates were alike (16.7% vs 11.1%, P= 0.735). QoL-score was inferior for TTO (0.705 vs 0.355, P= 0.036). Wound pain scores were higher in TTO (1 vs 0, P &amp;lt;0.001). Symptom score and satisfaction scores were alike, respectively 0.685 vs 0.760, P= 0.688 and 9 vs 9, P= 0.421. Conclusions TAL for giant hiatal hernias showed superior results compared to TTO for duration of surgery, length of hospital stay, QoL-score and wound pain scores. However, midterm results showed a noticeable trend towards higher recurrence rates for TAL. TAL should be considered when proceeding with surgery for giant hiatal hernias but a possible higher risk of recurrence must be taken into account. Further long-term clinical follow-up and comparison to PROMscould guide future decision-making.

772. EVALUATING OUTCOMES OF LES OBSTRUCTION AND REFLUX IN PATIENTS UNDERGOING PERORAL ENDOSCOPIC MYOTOMY GUIDED BY THE 16CM IMPEDANCE PLANIMETRY CATHETER

Abstract Background Peroral endoscopic myotomy (POEM) is a standard treatment option in achalasia. The endoluminal functional lumen imaging probe (FLIP) system utilizes impedance planimetry to measure diameter and distensibility at the esophagogastric junction (EGJ) in real-time. Most reports of the intraoperative FLIP experience focus on the 8 cm balloon, but the 16 cm balloon catheter also provides topographical assessments in addition to EGJ metrics. The aim of this study is to determine the clinical outcomes after a tailored myotomy using the 16 cm balloon during POEM. Methods We conducted a retrospective review of consecutive patients who underwent POEM with intraoperative FLIP with the 16 cm balloon catheter between January 2020 and September 2023. Operative reports were reviewed, and data including FLIP metrics and topographical assessments and myotomy length, which was guided by FLIP panometry, were recorded. Clinical parameters for lower esophageal sphincter (LES) obstruction (defined by FLIP-EGJ metrics, BEDQ/Eckardt scores and/or need for LES re-intervention) and reflux (defined by GERD-HRQL/RSI scores, +pH testing, LA B/C/D reflux esophagitis, PPI use and/or need for anti-reflux surgery) were collected during the 6-36 month follow up time period. Results Of 100 patients (57 female, mean 56.1y), 82 had Achalasia, 15 EGJOO, and 3 hypercontractile esophagus. Myotomy length was tailored (mean 8.2cm, range 3 – 15) by FLIP, and 10% had a short myotomy (≤4cm). Among 16 patients with previous Heller, the myotomy targeted contractile activity proximal to the previous myotomy in 10 cases. On follow up of 71 patients (median time 14mo), clinical outcomes are noted in Table 1. Obstructive symptoms and FLIP metrics showed significant improvement. Repeat myotomy was required in 5.6%. While reflux symptom scores improved, 37.5% had abnormal %AET, 4.7% had reflux esophagitis, and 7.0% required anti-reflux surgery. Conclusion A tailored myotomy with guidance of a 16 cm FLIP catheter to assess EGJ metrics and topographical assessments during POEM appears to be safe and effective at 6-36 month follow up. A tailored myotomy allows for a shorter myotomy than traditional surgical lengths and can be extended to capture residual disease noted with the 16 cm FLIP catheter in patients with previous surgery. Use of the 16 cm balloon during POEM results in overall low rates of LES re-intervention and post-myotomy reflux.

516. HELLER MYOTOMY FOR SYMPTOMATIC ACHALASIA: TRADITIONAL LAPAROSCOPY OR ROBOTICS? A SYSTEMATIC REVIEW WITH META-ANALYSIS

Abstract Background Laparoscopic Heller myotomy (LH) has been established as the gold standard for symptomatic achalasia; robotic-assisted laparoscopic myotomy (RH) has shown promising outcomes regarding safety and effectiveness. We aim to meta-analyse data comparing LH and RH surgical outcomes and complications. Methods A systematic search was conducted in February 2024 without restrictions according to PRISMA guidelines in PubMed, Web of Science, Scopus, and Cochrane Register. Studies comparing laparoscopic and robotic approach for Heller myotomy in adults with symptomatic achalasia were included for systematic review. Meta-analysis was performed trough generalized linear mixed model in R 4.3.2. Results 16 observational studies, out of 273, were included; reporting on 15076 patients. No statistically differences in preop characteristics were noted. RH had significantly fewer intraoperative esophageal perforations (OR=7.29, p&amp;lt; 0.0001, 95%), fewer subsequent myotomies and endoscopic treatments for recurrence (OR= 3.64, p=0.01 and OR= 3.38, p=0.03) and better symptom score improvement (OR=0.507, p=0.04). Although not clinically significant, RH had shorter hospital stays (MD=0.45 days, p= 0.005,) and reduced intraoperative blood loss (MD=10.46 ml, p=0.0002). Although not statistically significant, RH had fewer bleeding episodes, lower conversion, reintervention and mortality rates, comparable morbidity and postoperative GERD and higher operative time. Conclusion This updated meta-analysis suggests that RH is associated with lower regarding perforations, recurrence rates and symptom improvement compared to LH, with negligible lengthening of operative times. RH for symptomatic achalasia represents a feasible treatment for symptomatic achalasia, with a satisfying safety and effectiveness profile. RCTs on the topic and about cost-effectiveness evaluations are necessary to support the reported data.

Predictors of left ventricular outflow tract obstruction after biventricular repair in interrupted aortic arch or aortic coarctation

BackgroundLeft ventricular outflow tract obstruction (LVOTO) re-intervention is a significant cause of morbidity and mortality in patients with coarctation of the aorta (CoA) or interrupted aortic arch (IAA) after aortoplasty. MethodsThis retrospective study analyzed data from neonates with IAA/CoA who underwent biventricular repair between 2012 and 2022. LVOTO events were defined by the detection of color Doppler flow acceleration ≥3.0 m/s at the valvular, subvalvular, or supravalvular regions via transthoracic echocardiography, and the necessity for surgical or catheter intervention to relieve the obstruction. ResultsAmong 121 neonates with CoA/IAA, 16 (13.7%) primary aortoplasty patients developed LVOTO. Additionally, one patient (25%) who underwent a staged Yasui operation developed LVOTO due to a narrowed ventricular septal defect–pulmonary atresia tunnel. During follow-up, 58% of patients with a bicuspid valve and 25% of patients with a subaortic ridge developed LVOTO. The combination of either a bicuspid valve, subaortic ridge, or an aortic valve annulus Z-score < −3.0 predicted a high re-intervention rate (7/8 [87.5%]). ConclusionsIn patients with IAA/CoA, the presence of multiple risk factors, including a bicuspid valve, subaortic ridge, and an aortic valve annulus Z-score < −3.0, is associated with a significantly increased rate of re-intervention for LVOTO.

The early and medium-term results of the Ross procedure in pediatric patients

Introduction and objectivesThe Ross procedure is the preferred surgical treatment for pediatric aortic valve diseases, and its long-term outcomes have been extensively documented. This article presents the results of the Ross and Ross–Konno procedures performed on pediatric patients in our center. MethodsRoss and Ross–Konno procedures were performed on 20 patients in our center between January 2015 and January 2019. ResultsThe patients’ mean age was 10.6 years (range: 23 days to 18 years) and mean weight was 37.6 kg (range: 3–63 kg). Thirteen had aortic valve stenosis, four had aortic valve insufficiency, and three had a mixed disease. The Ross–Konno procedure was used for four patients. The mean cardiopulmonary bypass time was 184.68±60.1 min and the mean cross time was 149±67.8 min. One neonatal patient died in the early postoperative phase due to low cardiac output. The mean follow-up time was 60.15±24.45 months. One patient later underwent reoperation due to conduit stenosis. One patient is being monitored for moderately serious conduit stenosis. At present, of those who underwent the procedure, one has moderate aortic regurgitation, two have mild or moderate aortic regurgitation, and others have minimal aortic regurgitation. No patients required intervention for left ventricular outflow tract obstruction and mortality was not observed in the long term. Conclusion(s)The reintervention rates for autograft and conduit-related cases were low in early and medium-term follow-up, and no significant autograft insufficiency was observed. Ross or Ross–Konno surgery is preferred for aortic diseases in pediatric patients due to its low mortality and satisfactory long-term results.

Outcomes of revascularization of stenotic inframalleolar lesions in chronic limb-threatening ischemia.

For chronic limb-threatening ischemia, revascularization has been reported for occlusions but not for stenosis in the inframalleolar (IM) lesions. We investigated the clinical outcomes of balloon dilation for stenotic IM lesions distal to the treatment target in the infrapopliteal (IP) legion. We conducted a retrospective analysis of patients who had chronic limb-threatening ischemia and underwent revascularization of stenotic IM lesions distal to the target IP lesions between January 2015 and August 2022. The outcome measures were amputation-free survival, wound healing rate, and freedom from target IM reintervention. The 87 patients had a mean age of 72.7 ± 10.7 years and comprised 67.8% men, 74.7% with diabetes mellitus, 55.2% on dialysis, 33.3% who had Rutherford six classification. The amputation-free survival (AFS), wound healing, and freedom from target IM reintervention rates at 1 year were 82.9%, 53.3%, and 58.4%, respectively. On Cox proportional multivariate analysis, the predictors were Wound, Ischemia, and foot Infection (WIfI) ≥3 and diffuse stenosis in the target IM vessels for delayed wound healing and Global Limb Anatomic Staging System stage Ⅲ and ≥3 diseased IM vessels before endovascular therapy for target IM reintervention. At the time of reintervention, the lesion morphology had progressed from stenosis to occlusion in 50% of cases. In patients with chronic limb-threatening ischemia, revascularization of stenosis in IM lesions showed a high reintervention rate and progression of lesion morphology, although AFS and wound-healing rates were acceptable.

Endovascular Aortic Repair With the E-Tegra Device: Preliminary Outcomes From a Multicenter National Registry.

Endovascular aortic repair (EVAR) is currently expanding its feasibility thanks to design innovations, but hostile proximal necks and narrow iliac arteries are still a constraint, as expressed by the Instructions for Use (IFU) of most devices. Our aim is to report the preliminary results of the E-Tegra endograft in infrarenal abdominal aortic aneurysms (AAAs) performed in 15 high-volume centers. The e-Tegra Italian endoGraft REgistry (TIGRE) is a prospectively maintained database of consecutive EVAR with the E-Tegra stent-graft across 15 participating centers between March 2021 and March 2023. The registry records baseline clinical data, anatomic measurements of the abdominal aorta, perioperative and postoperative outcomes, with a scheduled follow-up period of 3 years for all patients. This is a preliminary analysis of the first results updated to January 2024. The primary endpoints are technical and clinical success, perioperative mortality, freedom from endograft rupture, and aortic-related mortality. The secondary endpoints are freedom from reintervention, and any type of endoleak (EL). The results were analyzed in relation with the anatomic characteristics of the AAAs, namely, iliac axes tortuosity and proximal neck hostility. The registry included 147 consecutive EVAR (138 elective and 9 in emergent setting), 7 of which were associated with an iliac branch implantation. Ninety patients had at least 1 criterion of anatomical hostility, and 25 were treated outside the device IFU. Primary technical success was achieved in 146 cases (99.3%) and assisted success in 147 (100%), with no perioperative mortality. After a median follow-up period of 20 months, no aneurysm-related mortality occurred. Reinterventions were 5: 2 for type IB EL and 3 for type II ELs with aneurysm sac increase. Five more type II ELs with aneurysm sac stability are under observation. No differences in terms of reinterventions were noted between aneurysms with standard and hostile anatomy. The E-Tegra endograft is safe and effective in treating AAAs with standard and hostile anatomy, with a low rate of complications and reinterventions, although longer-term outcomes and larger numbers are needed to compare its performances related to specific anatomic criteria. This multi-center nationwide Registry reports a real-world experience of EVAR performed with the E-Tegra abdominal endograft across 15 high-volume Centers, providing early- and mid-term device-specific results, which will help vascular surgeons in endograft selection. In particular, this study focuses on clinical results obtained in treating aneurysms with hostile anatomy, analyzing the performances of the E-Tegra endograft in cases of hostile proximal necks and narrow or tortuous iliac axes.

The Enzen Trial: Analysis of EVAR Endoprosthesis Zenith and Endurant for Infrarenal Aortoiliac Aneurysms Regarding Outcomes, Endoleaks, and Reinterventions.

The main objective of this paper is to analyze the outcomes regarding endoleaks, reinterventions, and death related to aneurysm complications in patients submitted to endovascular repair (EVAR) for abdominal aortoiliac aneurysm (AAA) using Endurant II (Medtronic) and Zenith Flex (Cook) endografts. This was a prospective, consecutive cohort study of patients with AAA who underwent EVAR between January 2019 and December 2022. Two groups of patients were evaluated: Group Endurant (patients submitted to EVAR with the use of Endurant II) and Group Zenith (patients submitted to EVAR with the use of Zenith Flex). A total of 156 patients were evaluated. Group Zenith (67 patients, 42.9%) and Group Endurant (89 patients, 57.1%). The perioperative mortality was 5.1%, eight patients (six patients Group Zenith, and two patients Group Endurant, p=0.054). There were 28 patients (17.9%) submitted to urgent repair of the aneurysm (expansion or rupture), with no differences among the groups. There were 36 cases (23.1%) of later endoleak, with a higher incidence in Zenith group (23 patients, 34.3%) than Endurant group (13 patients, 14.6%, p=0.002), most of them Type II endoleak (21 patients, 13.4%). There were 12 cases of Type I endoleak, also with a higher prevalence in Zenith group (13.4%) than Endurant group (3.4%, p=0.002). Moreover, regarding limb graft occlusion (LGO), there were nine patients (5.8%), with a higher prevalence in Zenith group (9%) than Endurant group (3.4%, p=0.045). The overall survival in a Kaplan-Meier at 720 days was 82.3% in the Zenith group and 89.1% in the Endurant group, with no statistical significance among the groups (p=0.09). The freedom from reintervention rates in a Kaplan-Meier at 720 days was 82.8% in the Zenith group and 93.2% in the Endurant group (p=0.001). In this present study, Zenith endograft had higher rates of endoleaks, aneurysms related mortality, LGO and reinterventions than patients submitted to Endurant II endografts. The linear regression analysis showed that the presence of endoleaks, type of endograft device (Zenith graft) and limb graft occlusion were related to higher reintervention rates. In this present study, Zenith endograft had higher rates of endoleaks, aneurysms related mortality, limb graft occlusions and reinterventions than patients submitted to Endurant II endografts. The main impact and the innovation that this article provides is an opportunity to evaluate and choose the best endograft suitable for the patient with AAA during EVAR.

TREO Aortic Endograft Demonstrates Superior Aneurysmal Sac Regression Over Mid-Term Follow-Up

IntroductionAneurysmal sac regression is a predictor of long-term outcomes after endovascular aneurysm repair (EVAR). This study aimed to compare a large cohort of TREO and non-TREO endografts over a mid-term follow-up and compare abdominal aortic aneurysm sac regression. The hypothesis was that TREO endografts have an increased sac regression by 24 mo. MethodsThis is a retrospective analysis of all EVARs completed at a single institution between 2015 and 2024. Clinical and imaging data were collected from an institutional database and patients’ records. The analysis included all TREO and age, sex, anticoagulation use and current smoking-matched non-TREO endografts that satisfied anatomic indications for use of the TREO graft. The primary outcomes were sac regression at 12 and 24 mo, and secondary outcomes were rates of mortality, endoleak, and reintervention. ResultsTwenty-one TREO grafts were matched to 68 non-TREO grafts. The groups were similar in demographics, comorbidities, and preoperative anatomy. Preoperative abdominal aortic aneurysm sac size was larger in the TREO cohort. The mean reduction in sac size in mm was greater in the TREO cohort compared to the non-TREO cohort (−12.6 ± 8.95 versus −7.83 ± 7.74 mm, P = 0.039) over the study period. Cox regression analysis identified the TREO stent graft to be associated with 1-y sac regression (hazard ratio = 2.42, P = 0.019). The incidence of all-cause endoleaks, reintervention, and mortality were similar between cohorts. ConclusionsThese findings suggest that the TREO endograft offers better mid-term outcomes with respect to sac regression with no differences in the incidence of endoleak, mortality, or reintervention.

Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids

This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. A meta-analysis was performed on all available studies that evaluated the relative benefits and harms of MYO and UEA for the management of patients suffering from UFs. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and other complications. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR 1.84; 95% CI 1.62–2.10; P < 0.01; I2 = 39%), hysterectomy rate (OR 4.04; 95% CI 3.45–4.72; P < 0.01; I2 = 59%), and symptom-severity score (OR − 4.02; 95% CI 0.82, 7.22; P = 0.01; I2 = 0%) compared to MYO at a four-year follow-up. However, UAE was associated with a lower rate of early complications (OR 0.44; 95% CI 0.20–0.95; P = 0.04; I2 = 25%), and readmission rate (OR 1.16; 95% CI 1.01–1.33; P = 0.04; I2 = 0%) compared to MYO. Furthermore, both procedures had comparable improvement in pregnancy rates and abnormal uterine bleeding. In conclusion, UAE and MYO are effective in treating symptomatic UFs but they have different outcomes. The decision on which procedure to choose should be made based on individual preferences and the physician’s expertise.

Long-term Outcome of Conjunctival Transposition Flaps for Contracted Sockets.

To assess the efficacy, and reintervention rate, of a conjunctival transposition technique in the treatment of contracted fornices in anophthalmic sockets. Retrospective case-note review of patients with contracted anophthalmic sockets who received a novel conjunctival mucosal transposition flap for augmentation of socket lining. Contracted anophthalmic sockets were categorized as grade 1 (minimal contraction), grade 2 (inferior and/or superior fornix), grade 3 (advanced scarring of the entire upper and lower fornices), and grade 4 (severe palpebral phimosis, recurrent cases, and irradiated sockets). Of 32 patients (56% male), 53% had mild-to-moderate contracted anophthalmic sockets (grades 1 or 2). The transposition flap was combined with secondary ball implantation (3 cases), ball exchange (1 case), primary orbital floor (1 case), or revisional floor (3 cases) implantation. By an average follow up of 9.2 years, 16% (5 cases with grade 3 or 4) required additional relining, with another patient declining further surgery; this yielding an overall anatomic success of 81% (100% in grades 1 and 2; 60% in grades 3 and 4). At the last follow up, 91% of patients had adequate socket lining and 94% reported a comfortable socket with stable prostheses. Having results similar to free grafting but without remote donor-site morbidity, this novel transposition flap satisfactorily addresses mild-to-moderate fornix contracture, and most patients achieve stable and comfortable prosthetic wear. Some patients with severe contracted anophthalmic sockets required further autologous grafting: this generally arose because the transposition flap included tissue from above the socket's horizontal raphé (with later contracture of the upper fornix).

Outcomes of balloon-assisted maturation with large-diameter balloons.

Balloon-assisted maturation (BAM) is a well-established technique for maturation of inadequate arteriovenous fistulas (AVF). The objective of this study was to evaluate outcomes of initial BAM using large-diameter angioplasty balloons. Charts of patients who underwent BAM between 2018 and 2021 at a single academic institution were reviewed. AVF maturation rate was the primary outcome. Secondary outcomes included procedural complications, re-intervention rates, post-procedure vein diameter, and time to catheter-free hemodialysis (HD). Outcomes of patients that underwent initial BAM with ⩾7 mm diameter balloons (Group I) were compared to those of patients that had initial BAM with <7 mm balloons (Group II). Group I (n = 149) was a significantly younger cohort and had more men compared to Group II (n = 90). There were no significant differences associated with procedural details and complication rates. Median vein diameter was larger (5.9 mm, IQR: 5-6.4) in Group I compared to Group II (5.1 mm, IQR: 4.2-5.9; p = 0.03) on post-procedure Duplex ultrasound. There was also a higher incidence of vein stenosis in Group II. The overall maturation rate was higher in Group I (97% vs 88%, p = 0.003), and a larger proportion of patients in Group II required more than one BAM to achieve maturation (33% vs 16%, p = 0.002). The median time to catheter-free HD after first BAM was 29 days (IQR: 19-47) in Group I and 42 days (IQR: 24-75) in Group II (p = 0.002). At 60 days after first BAM, the incidence of catheter-free HD was 83% in Group I versus 67% in Group II (p = 0.001). Our study demonstrates that the ability to utilize large angioplasty balloons during initial BAM is associated with higher rates of AVF maturation with fewer re-interventions and shorter time to catheter-free dialysis. AVFs that can tolerate this procedure often have more favorable baseline characteristics.

Postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis.

To report our experience of fetal aortic valvuloplasty (FAV) for critical aortic stenosis (AS), with a focus on the postnatal evolution of the patients. This was a retrospective study including all fetuses with critical AS which underwent FAV in a single center between January 2011 and June 2022. FAV was performed under ultrasound guidance. Technical success was based upon balloon inflation across the aortic valve and improvement of the antegrade aortic flow across the aortic valve. At birth, a biventricular circulation (BVC) strategy was decided assuming the left ventricular (LV) systolic and diastolic function would ensure the systemic circulation. Sixty-three FAV procedures were performed in 58 fetuses, at a median (range) gestational age of 26.2 (20.3-32.2) weeks. The procedure was technically successful in 50/58 (86.2%) fetuses. There were 11/58 (19.0%) cases of in-utero demise and 9/58 (15.5%) terminations of pregnancy. No patient was liveborn after an unsuccessful procedure. Thirty-eight (65.5%) infants were liveborn, at a median (range) gestational age of 38.1 (29.0-40.6) weeks, of whom 21 (55.3%) required prostaglandin treatment. Twenty-eight of the 38 (73.7%) liveborn children (48.3% of the study population) entered the BVC pathway at birth. Among them, 20 (71.4%) required an aortic valvuloplasty procedure at birth (11 (55.0%) percutaneous balloon, nine (45.0%) surgical) and eight (28.6%) did not require any treatment at birth, but, of these, five (62.5%) underwent surgical valvuloplasty between day 26 and day 1200 of age. Eleven (39.3%) of the infants with BVC at birth required a second intervention and four (14.3%) of them required a third intervention. Two (7.1%) infants who entered the BVC pathway at birth underwent conversion to univentricular circulation (UVC). None of the surviving children with BVC developed pulmonary hypertension. The overall survival rate in those with BVC at birth was 22/28 (78.6%) at a median (range) follow-up of 23.3 (2.0-112.6) months. Ten of the 58 (17.2%) patients had UVC at birth. Among these, six (60.0%) received compassionate care from birth and four (40.0%) underwent surgery. Three of the 10 patients who had UVC at birth were still alive at the latest follow-up assessment, at a median (range) gestational age of 24.3 (8.3-48.7) months. FAV for critical AS led to increase of antegrade aortic flow in 86.2% of fetuses, with BVC being achieved in 48.3% (73.7% of the liveborn cases). Among patients with BVC at birth, the rate of reintervention was high, but 78.6% of these children were alive at the latest evaluation. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong.

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms of menstrual pain, and quality of life were examined. Major and minor complications, together with re-intervention rates, were evaluated. Results: Eighty-one HIFU treatments were performed in seventy-nine premenopausal women. The follow-up period was up to 95 months. A total of 65 women underwent treatment for uterine fibroids and 14 were treated for adenomyosis. For patients with uterine fibroids, the baseline fibroid volume median was 190.1 cm3 (18.5-1729.4 cm3). Fibroid volume was reduced by 50.1% (-26.2-97.8, p < 0.0001) at 6 months and 66.9% (-33.7-98.3, p < 0.0001) at 12 months after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores had decreased by 43.5% (0-62.5%, p < 0.0001) at 6 months and 50% (0-73%, p < 0.0001) at 12 months after treatment. In the adenomyosis arm, the median baseline uterine volume was 97.7 cm3 (43.7-367.4 m3). Uterine volume was reduced by 19.6% (range: 1.2-42.0, p = 0.28) at 6 months and 41.9% (18.9-69.2, p = 0.04) at 12 months after treatment. UFS-QOL scores were reduced by 38.1% (6-66.7%, p < 0.0001) at 6 months and 40% (0-70%, p < 0.0001) at 12s month after treatment. Fourteen (21.5%) patients with uterine fibroid and five (35.7%) patients with adenomyosis required subsequent interventions. Conclusions: HIFU provides symptomatic relief to most patients with uterine fibroids and adenomyosis. It is a promising uterus-sparing treatment for patients with these conditions.