Vessel Reconstruction Research Articles

The diagnostic performance of AccuFFRangio for evaluating coronary artery stenosis under different computational conditions.

A computational method (AccuFFrangio) based on invasive coronary angiography (ICA) and computational fluid dynamics (CFD) to calculate fractional flow reserve (FFR) without a pressure wire has been devised to clarify the physiological significance of coronary stenosis. This study aimed to evaluate the diagnostic performance of AccuFFRangio computation under different boundary conditions and vessel reconstruction approaches. Consecutive patients with stable angina pectoris who underwent ICA and FFR assessment from 2 centers were analyzed retrospectively. Using wire-based FFR as the reference standard, the diagnostic performances of AccuFFRangio and its variations were evaluated and compared. The calculation of AccuFFRangio involves several key boundary conditions, including patient-specific aortic pressure, contrast flow velocity derived from the thrombolysis in myocardial infarction (TIMI) frame count method, and vessel reconstruction based on 2 angiographic views. We considered the following 3 variations: (I) a fixed aortic pressure [fixed pressure AccuFFRangio (pAccuFFRangio)], (II) an empirical hyperemic velocity [fixed velocity AccuFFRangio (vAccuFFRangio)], and (III) vessel reconstruction using a single angiographic view [single view AccuFFRangio (sAccuFFRangio)]. A total of 230 patients with 230 vessels were included in the final analysis. The accuracy for standard AccuFFRangio, pAccuFFRangio, vAccuFFRangio, and sAccuFFRangio was 93.91%, 86.52%, 81.74%, and 83.48%, respectively; the sensitivity was 90.74%, 51.85%, 83.33%, and 46.30%, respectively; the specificity was 94.89%, 97.16%, 81.25%, and 94.89%, respectively; and the area under the receiver operating characteristic curve was 0.971, 0.928, 0.892, and 0.870, respectively. The comparison suggested that the overall performance of the standard AccuFFRangio was superior to other variations and had the highest accuracy among all the cases.

Rekonstrukcija forme trupa tradicionalnog hrvatskog ribarskog broda i predviđanje efektivne snage

Recently, an increasing attention is given to preservation and popularization of Croatian traditional boat building, which plays an important role in Croatian cultural and national heritage. Reconstruction and revitalization projects of individual historical vessels are key factors within preservation process, where the lack of technical documentation is one of the main issues. In this paper, a simple and efficient procedure for taking offsets of a traditional fishing vessel guc is presented to document and preserve the traditional Croatian vessel form. A 3D model of a guc is generated using the points on the hull surface obtained by the manual measurement and a fairing process. Numerical simulations of the resistance test for a fishing vessel are carried out for a wide range of speeds, and the curve of effective power as a function of vessel speed is provided.

TransFusionNet: Semantic and Spatial Features Fusion Framework for Liver Tumor and Vessel Segmentation Under JetsonTX2.

Liver cancer is one of the most common malignant diseases worldwide. Segmentation and reconstruction of liver tumors and vessels in CT images can provide convenience for physicians in preoperative planning and surgical intervention. In this paper, we introduced a TransFusionNet framework, which consists of a semantic feature extraction module, a local spatial feature extraction module, an edge feature extraction module, and a multi-scale feature fusion module to achieve fine-grained segmentation of liver tumors and vessels. In addition, we applied the transfer learning approach to pre-train using public datasets and then fine-tune the model to further improve the fitting effect. Furthermore, we proposed an intelligent quantization scheme to compress the model weights and achieved high performance inference on JetsonTX2. The TransFusionNet framework achieved mean IoU of 0.854 in vessel segmentation task, and achieved mean IoU of 0.927 in liver tumor segmentation task. When profiling the Computational Performance of the quantized inference, our quantized model achieved 4TFLOPs on Node with NVIDIA RTX3090 and 132GFLOPs on JetsonTX2. This unprecedented segmentation effect solves the accuracy and performance bottleneck of automated segmentation to a certain extent.

Abstract Number ‐ 79: Flow Diversion for Traumatic Vertebral Artery Arteriovenous Fistula: A Case Report

Introduction Arterial pseudoaneurysms and arteriovenous fistulas of intracranial and extracranial vessels are an uncommon occurrence following blunt and penetrating trauma and are commonly treated by vessel sacrifice,dependent on collateral flow1‐3. Others have treated these cases with covered stents4 and flow diversion5. Advances in flow diversion technology have led to their use in other pathologies, including carotid cavernous fistulas6 and vertebral artery pseudoaneurysms7. We present a case of a traumatic arteriovenous fistula of the dominant vertebral artery requiring vessel preservation and reconstruction. Methods A 42‐year‐old male presented with a gunshot wound to the face below the right eye. Trauma imaging identified fractures of the right maxillary sinus and orbital floor. CTA of the head/neck showed a dominant right vertebral artery dissection and pseudoaneurysm with a non‐dominant left vertebral artery (VA), effectively ending in PICA. Results Due to the inefficient supply to the posterior circulation via the left VA, the decision was made to preserve and reconstruct the right VA and the patient was brought to the angiography suite. Angiographically, the patient was noted to have retrograde filling of the posterior circulation, basilar and right VA through the anterior circulation in injection of both ICAs, suggesting decreased antegrade flow from the injured right VA. The right VA was catheterized which showed a high‐flow, high‐grade arteriovenous fistula from the V3 segment with venous drainage into multiple extraspinal cervical and epidural cervical veins. This also identified the fistulous point at the location of the pseudoaneurysm on CTA. The diagnostic catheter was exchanged for a guide catheter, and a Phenom 27 microcatheter (Medtronic; Minneapolis, MN) was navigated into the basilar artery. A Duo microcatheter (Microvention; Aliso Viejo, CA)/Synchro 2 (Stryker; Kalamazoo, MI) standard microwire complex was used to identify the fistulous point and positioned for jailing. A Pipeline Flex 4.75×20mm (Medtronic; Minneapolis, MN) was deployed from the proximal V4 segment across the pseudoaneurysm with persistence of the AVF. A second Pipeline Flex 5×20mm was placed in telescoping fashion with persistence of the AVF. A third Pipeline Flex 5×16mm was placed in telescoping fashion and flow diversion was observed. Using the jailed catheter, the pseudoaneurysm and fistulous point were coil embolized using a combination of helical and 3D HydroSoft coils (Microvention; Aliso Viejo, CA) of varying sizes. Final angiogram demonstrated resolution of the high‐flow AVF, improvement of antegrade flow through the right vertebral artery, and a slow‐flow low‐grade fistulous communication with the posterior extraspinal cervical veins. There were no thromboembolic complications and the patient recovered well from the procedure. Follow‐up angiography at 2 months post‐treatment showed obliteration of the AVF with a small remnant pseudoaneurysm of the right V3 segment. Conclusions Flow diversion is viable in the setting of a traumatic arteriovenous fistula requiring reconstruction of the parent vessel.

Abstract Number ‐ 139: Endovascular Management of Intracranial Pediatric Traumatic Pseudoaneurysms: A Case Series and Systematic Review

Introduction Intracranial pseudoaneurysms (IPA) are rare and potentially life‐altering lesions. Although IPAs represent less than 1% of all intracranial aneurysms, they account for more than 19% of pediatric intracranial aneurysms. The goal of this study was to systematically review the management and outcomes of pediatric patients who developed pseudoaneurysms following head trauma. Methods Following PRISMA guidelines, a systematic literature review was performed using PubMed, EMBASE, OVID Medline and Web of Science databases from date of database inception to May 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective analysis was conducted on pediatric patients who underwent endovascular evaluation and treatment for intracranial pseudoaneurysms originating from head trauma at a single institution. Results A total of 221 articles were identified in our review, 51 studies met inclusion criteria. A total of 80 patients were treated for 81 intracranial traumatic pseudoaneurysms, including 5 cases from our institution, with 46 males, 28 females, and a mean age of 9.90 years (range 0.04 ‐18 years). 71 total pseudoaneurysms were the result of external trauma while 10 resulted from iatrogenic trauma. Vessels of the anterior circulation were injured in 75.3% (61/81) of cases. Posterior circulation was involved in 24.7% (20/81) of cases. The internal carotid artery was the most impacted vessel at 45.7% (37/81). The next most common territory injured was the anterior cerebral artery and its distal branches, including the pericallosal and callosomarginal arteries, at 17.3% (14/81). The basilar artery was the third most affected artery, representing 12.3% (10/81) of cases. Hemorrhage was present in 41 patients (51.3%). Subarachnoid hemorrhage was present in 33.8% (27/80), while intracerebral hemorrhage and interventricular hemorrhage (IVH) were present 22.5% and 18.8% of cases, respectively. A total of 92 procedures were performed, with only 8 patients requiring more than 1 procedure for treatment. Only 1 patient required more than 2 procedures. Aneurysm embolization, parent vessel occlusion, parent vessel reconstruction, and aneurysm trapping were performed in 31.5%, 22.8%, 43.5%, and 2.2% of cases, respectively. The intraoperative complication rate was 3.26%, all were ischemic in nature. Two of these ischemic complications resulted focal neurological deficits from parent vessel occlusion. Aneurysm recurrence was encountered in 7 cases, with 6 of these resulting from coil embolization. In patients treated with parent vessel reconstruction, 1 aneurysm ruptured post‐treatment and 2 patients experienced in‐stent thrombosis. Overall, 83.8% of patients had a good neurological outcome and 77.8% of aneurysms were completed occluded on follow‐up imaging. Conclusions The development of pseudoaneurysms in the pediatric population are an important consideration in cases of traumatic head injuries or iatrogenic vessel trauma. These lesions grow rapidly and can carry a high risk of morbidity and mortality if left untreated. Our findings suggest that endovascular treatment of traumatic pseudoaneurysms in the pediatric populations is safe and effective, with high rates of aneurysm occlusion and good neurological outcome. Overall, complications rates are low. Aneurysm embolization can carry an increased risk of aneurysm recurrence.

Single-cell sequencing reveals that endothelial cells, EndMT cells and mural cells contribute to the pathogenesis of cavernous malformations

Cavernous malformations (CMs) invading the central nervous system occur in ~0.16–0.4% of the general population, often resulting in hemorrhages and focal neurological deficits. Further understanding of disease mechanisms and therapeutic strategies requires a deeper knowledge of CMs in humans. Herein, we performed single-cell RNA sequencing (scRNA-seq) analysis on unselected viable cells from twelve human CM samples and three control samples. A total of 112,670 high-quality cells were clustered into 11 major cell types, which shared a number of common features in CMs harboring different genetic mutations. A new EC subpopulation marked with PLVAP was uniquely identified in lesions. The cellular ligand‒receptor network revealed that the PLVAP-positive EC subcluster was the strongest contributor to the ANGPT and VEGF signaling pathways in all cell types. The PI3K/AKT/mTOR pathway was strongly activated in the PLVAP-positive subcluster even in non-PIK3CA mutation carriers. Moreover, endothelial-to-mesenchymal transition (EndMT) cells were identified for the first time in CMs at the single-cell level, which was accompanied by strong immune activation. The transcription factor SPI1 was predicted to be a novel key driver of EndMT, which was confirmed by in vitro and in vivo studies. A specific fibroblast-like phenotype was more prevalent in lesion smooth muscle cells, hinting at the role of vessel reconstructions and repairs in CMs, and we also confirmed that TWIST1 could induce SMC phenotypic switching in vitro and in vivo. Our results provide novel insights into the pathomechanism decryption and further precise therapy of CMs.

Reconstructive vascular surgery in pediatric oncology: literature review

Background. In some rare cases pediatric solid tumors may infiltrate or incase major vessels, which may require vascular plastics as part of radical tumor resection. As these situations are rare in pediatric surgeon practice, there is no common approach to this problem. In order to analyze the available experience we reviewed published cases concerning vascular plastics in pediatric oncosurgery. Materials and methods. The references from MEDLINE (PubMed), HighWire Press, and eLibrary electronic databases were analyzed for references describing practical vascular surgery experience with vascular implants published in 2002–2022. Results. There is few published data on major vessels reconstruction in patients with pediatric solid tumors. Most publications describe single cases or small case series. The vascular plastics in these children is difficult due to small vessel diameter, difficulties in choosing the right graft, risk of thrombosis, and the need to provide adequate circulation in a rapidly growing child. As there are no major studies of this subject we still have no consensus on optimal vascular reconstruction tactics in children with solid tumors. Therefore, new systematic studies are needed. Conclusion. We provide a brief review on currently used methods of vascular plastics and reconstruction available for use in children with solid tumors.

A technique for a single-stage off-pump repair of Kommerell diverticulum with antegrade branch vessel reconstruction.

Kommerell diverticula (KD) are uncommon. When a KD is identified, repair is indicated if symptomatic or if interval growth is demonstrated. Because of their rarity, no standardized technique has been established. Approaches reported have various limitations that include multiple operative stages, need for cardiopulmonary bypass (CPB) or circulatory arrest, or reconstruction of arch branches with retrograde flow, and at times relying on a single inflow. The technique presented addresses most of these limitations.

Development of an image processing algorithm (IPA‐Delfin) for the digital reconstruction of composite overwrapped pressure vessels

AbstractWet filament winding has been established as the primary manufacturing process for overwrapped pressure vessels. However, the prediction of the mechanical performance of pressure vessels is still not sufficiently accurate, mostly due to process‐induced deviations within the laminate structure. In this work, we present an image processing algorithm (IPA‐Delfin) that enables the real‐time generation of a digital reconstruction based on the actual geometry and position of the placed roving. A Type‐IV pressure vessel is analyzed under real manufacturing conditions. Our approach allows the measurement of the overlapping degree of roving within the laminate and the prediction of gaps. The results show that the fiber‐band width and the overlapping area vary significantly when the roving is placed directly on the vessel's polymer liner. A more constant and uniform fiber‐band width and overlapping area were observed when the filament winding took place on the previously placed roving. Hence, the IPA‐Delfin can be potentially used for the generation of digital twins of composite overwrapped pressure vessels.

A contemporary review of the diagnosis and management of vascular Ehlers–Danlos syndrome

Introduction: Vascular Ehlers–Danlos syndrome (vEDS) is a connective tissue disorder weakening the vasculature. There is a perceived lack of awareness within the medical fraternity on this condition. This paper reviews contemporary evidence to enhance the understanding of this complex condition. Methods: A systematic review was performed. Inclusion criteria were studies in humans with a minimum of five patients. Exclusion criteria were laboratory or animal-based studies, reviews and studies not in English. A total of 115 papers were assessed with articles grouped into four categories: diagnosis, natural history, medical and surgery therapy. Results: The Villefranche criteria have a high sensitivity/negative predictive value for diagnosing EDS. Assessment of skin architecture/radiological investigation of large vessels can facilitate diagnosis. Genetic testing is available for the pathogenic COL3A1 variant. With regard to natural history, an overall review of 1,400 patients showed that age at diagnosis ranged from 4 to 40 years, age of death ranged from 28 to 54 years and vascular complications were frequent. The key medical therapy is celiprolol, which is associated with a reduction in arterial events three times greater with treatment than without. Non-operative therapy/non-invasive imaging techniques are suggested to be used when possible. Vessel reconstruction is possible but fragile tissue makes this challenging and endovascular interventions are ideally suited for the treatment of false aneurysms. There is a high rate of procedure-related complications (early and late). Conclusions: The poor natural history of vEDS means that accurate diagnosis is key to allow extension of complication-free periods. Vascular interventions are associated with high complication rates

3D Visualization of Pulmonary Vessel Based on Low-Cost Segmentation and Fast Reconstruction

Real-time visual-aided navigation and path strategy for pneumonoconiosis and efficient 3D visualization of pulmonary vessels are of great research and clinical significance in the treatment of lung diseases. The complex structure of lung tissue limits the application of deep learning in pulmonary vascular visualization due to the lack of vascular labeling datasets. Also, the existing methods have large computational complexity and are low efficiency. This study proposes a method for high-quality 3D visualization of pulmonary vessels based on low-cost segmentation and fast reconstruction, consisting of three steps: 1) Pulmonary vessel feature extraction from lung CT images using self-supervised learning, 2) Segmentation of pulmonary sparse vessels in lung CT images using self-supervised transfer learning, and 3) 3D reconstruction of pulmonary vessels based on segmentation results of step (2) using interpolation. The accuracy of pulmonary vascular contour segmentation was improved from 91.31% using the sparse coding to 98.65% using our proposed method (27,270 test sample points); the classifier evaluation accuracy was improved from 95.33% to 98.26%, and the average running time of the model with the test set data was 44 ms per slice. the segmentation results can automatically generate a complete vascular tree model with an average time of 10.8s ± 1 1.6s. The results demonstrate that the proposed method provides fast and accurate 3D visualization of pulmonary vessels, and is promising for more precise and reliable information for pneumonoconiosis patients.

Vascular reconstructions and transplant technologies in liver surgery (part I)

To systematize technical aspects of liver resections with reconstruction of afferent and efferent liver blood supply and/or inferior vena cava, as well as to analyze the results of surgical treatment in patients with focal liver lesions. The study included 413 patients with parasitic lesions, primary and secondary liver tumors with great vessel invasion (portal vein, hepatic artery, hepatic veins, inferior vena cava, right atrium). These features excluded radical liver resections without vascular resection and reconstruction, as well as liver autotransplantation in vivo, liver autotransplantation ante situ (ex situ in vivo), extracorporeal liver resections with autotransplantation (ex vivo). Surgical interventions were systematized depending of surgical tactics and techniques, technical complexity, type and number of reconstructed vessels, the use of total vascular isolation and cold preservation techniques, resection and reconstruction of great vessels. Thus, 4 gradations were allocated (Grade I-IV). The definition of transplantation technologies in liver surgery was proposed. Transplantation technologies in liver surgery include liver resections supplemented with vascular reconstruction of afferent and efferent liver blood supply, inferior vena cava including total vascular isolation of liver under normo- or hypothermia. These measures can significantly extend the possibilities of resection.

Development of pre-seeded tissue-engineered vascular grafts in vitro

Current vascular surgery employs reconstruction of occluded blood vessels using autologous grafts. As a considerable proportion of patients lack healthy autologous vessels to be used as the grafts, the development of tissue-engineered, small-diameter vascular grafts has significant clinical relevance. Biodegradable vascular grafts, which have a defined degradation rate upon the implantation, provide an opportunity for the controlled vascular regeneration. Such polymer framework acts as a guiding matrix for organising the patient's newly formed tissues to ensure consistent and complete vessel remodeling. The crucial aspect of tissue-engineered vascular graft regeneration is endothelialisation, as non-endothelialised blood vessels suffer from the thrombosis if having < 5 mm diameter because of low blood flow. This review describes two approaches to stimulate endothelialization. The first is the biofunctionalization of the luminal surface with the bioactive peptides with the following in situ implantation. Using the body as a bioreactor, this approach relies on the selective recruitment of endothelial cells. The second approach includes in vitro pre-seeding of a luminal surface with an endothelial cell monolayer. The development of such pre-seeded vascular grafts requires the choice of an appropriate polymer for the manufacture of a 3D matrix, isolation of endothelial cell culture, and tuning of mechanical stimuli to control the cell specification during the pre-seeding. In addition to the pre-seeding of endothelial cells on the luminal surface, it is necessary to adapt them to the flow to prevent shedding or incorrect orientation. Cell adhesion can be enhanced by the attachment of extracellular matrix proteins to the luminal surface or by mimicking natural blood flow conditions. Sustained mechanical stimuli facilitate the adaptation of endothelial cells to the flow and contribute to the maturation of endothelial progenitor cells.

Magnetic-assisted rapid liver transplantation blood vessel anastomosis from conception to clinical practice

The anastomotic reconstruction of liver accessory vessels is the primary surgical procedure in liver transplantation. The overall surgical outcome and long-term patient survival are related to the anastomosis speed and quality. The application of magnetic anastomosis technology based on the concept of magnetic surgery to achieve rapid reconstruction of liver accessory vessels has the unique advantages of safety and high efficiency, which greatly shorten the time of the anhepatic phase and also provide new possibilities for the development of liver transplantation under minimally invasive conditions.

Free Jejunal Graft Interposition with Vascular Reconstruction in Patients Undergoing Pharyngo Laryngo Esophagectomy

Pharyngo-esophageal reconstruction using free jejunal grafts has been widely used for the treatment of locally advanced carcinomas of the hypopharynx and cervical esophagus. However, the procedure is technically demanding and requires complex recontractions. The aim of this study was to evaluate our institutional outcomes of reconstruction using a free jejunal graft with vascular reconstruction in patients undergoing pharyngo laryngo esophagectomy with a multidisciplinary surgical team. There were 90 consecutive patients between October 2006 and February 2021. The mean age was 64.6±10.3years, and there were 76 male patients. Of 90 patients, 49 underwent preoperative chemotherapy and/or radiotherapy. Jejunal vessels were commonly anastomosed to the common carotid artery and the internal jugular vein (77.8% and 92.2%, respectively). Continuous intravenous infusion of heparin was used postoperatively. Necrosis of the graft was observed in 5 patients. An isolated revision of vein was necessary in 1 patient. In all cases of graft failure, heparin was not used postoperatively. On the other hand, among the patients without graft failure, heparin was used for about two-thirds of the patients and was significantly different (0% vs. 66%, P=0.01). Free jejunal graft with vessel reconstruction is a safe and effective method for patients undergoing pharyngo laryngo esophagectomy. The position for the prevention of kinking as well anastomosis maneuver of vein is especially important. Moreover, early postoperative anticoagulation is essential.

Endothelialization and smooth muscle cell regeneration capabilities of a bi-layered small diameter vascular graft for blood vessel reconstruction

Despite the tremendous advances in the past few decades, the clinical problems associated with low mechanical strength, thrombosis, and inadequate endothelialization still have not been improved in small diameter vascular grafts. The objective of this study is to design and fabricate a dual layered small-diameter vascular graft by electrospinning process which will mechanically and biologically match the gold standard of blood vessel substitution. The presented graft was composed of polycaprolactone/gelatin (inner layer) and polyurethane/polycaprolactone (outer layer) and fabricated by sequential electrospinning process. Physico-mechanical evaluation, in vitro biocompatibility and hemocompatibility assays were performed for both layers to ensure safe in vivo applications Then, the vascular grafts were successfully implanted into a rat abdominal aorta model. Tubular vascular graft had a nanofibrous and porous outer structure, which provided a conducive micro-environment for smooth muscle cell migration as well as proliferation but the lumen wall had a smooth surface to reduce thrombogenicity and improve endothelialization. Both layers showed excellent biocompatibility and hemocompatibility in all in vitro assays. After three months, the harvested grafts exhibited smooth muscle cell regeneration and complete endothelialization on the graft lumen. The dual layered graft could therefore play a pivotal role in the arena of vascular tissue regeneration application.

Extracorporeal Pedicles for Free Flap Reconstruction in Diabetic Lower Extremity Wounds.

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.

Osteogenic Differentiated Human Bone Marrow Stem Cells Contribute to Sprouting Angiogenesis Deceleration via Paracrine Excreted IGFBP7

AbstractDeceleration of sprouting angiogenesis until its final disappearance after blood vessel reconstruction is crucial for controlled tissue repair; however, its underlying mechanism remains unclear. It is reported that osteogenic differentiated bone marrow stem cells (OD‐BMSCs) contribute to sprouting angiogenesis deceleration by releasing intrinsic “OFF” signals. In vitro experiments show that insulin‐like growth factor‐binding protein 7 (IGFBP7) is the main component of OD‐BMSCs paracrine products which could inhibit the tube formation ability of endothelial cells. In addition, cell functional experiments show that IGFBP7 inhibits sprouting angiogenesis by reducing cell migration and tip cell specification. Furthermore, it is found that early IGFBP7 intervention, which accelerates sprouting angiogenesis deceleration during the early stage of healing, impedes bone defect healing. These results demonstrate that OD‐BMSCs could offer intrinsic inhibitory signals on sprouting angiogenesis and the appropriate emergence timing of these signals is crucial to maintain vasculature homeostasis during bone repairing. These results provide insight into the complex interaction between osteogenesis–angiogenesis coupling and suggest the potential therapeutic application of IGFBP7 in regulating vascular homeostasis.

Postoperative results of the in situ fenestrated open stent technique for acute aortic dissection type A

ObjectiveTotal arch replacement is commonly used for acute aortic dissection type A at some facilities, especially since open stent grafting became commercially available in Japan. Left subclavian artery (LSCA) reconstruction involves deep view manipulation, is difficult to expose and anastomose, and involves the risk of complications and surrounding vascular injury.MethodsWe evaluated 137 patients (mean age 73.8 ± 15.6 years) who underwent total arch replacement for acute aortic dissection type A, at our hospital between September 2014 and March 2022, and divided them into two groups: 70 patients for total arch replacement with fenestrated open stent technique (FeneOS), and 67 for conventional total arch replacement with the reconstruction of three-branch cerebral vessels. We performed FeneOS by deploying the graft from the entry of the left subclavian artery into the descending aorta and fenestrating the LSCA side of the stenting portion. The four-branched artificial vessel was then anastomosed between the left common carotid artery and LSCA.ResultsThe surgical results of FeneOS were satisfactory and enabled significant reductions in operative time, selective cerebral perfusion time, cardiopulmonary bypass time, and lower body circulatory arrest time. Long-term observation (mean follow-up = 5.5 years) showed no left recurrent laryngeal nerve palsy or postoperative problems with left subclavian artery blood flow.ConclusionsFeneOS can minimize LSCA exposure because there is no need for LSCA reconstruction, reducing operation time and avoiding the risk of left recurrent laryngeal nerve injury and bleeding problems associated with LSCA exposure and anastomosis during left subclavian artery exposure.

Towards Autonomous Robotic Minimally Invasive Ultrasound Scanning and Vessel Reconstruction on Non-Planar Surfaces.

Autonomous robotic Ultrasound (US) scanning has been the subject of research for more than 2 decades. However, little work has been done to apply this concept into a minimally invasive setting, in which accurate force sensing is generally not available and robot kinematics are unreliable due to the tendon-driven, compliant robot structure. As a result, the adequate orientation of the probe towards the tissue surface remains unknown and the anatomy reconstructed from scan may become highly inaccurate. In this work we present solutions to both of these challenges: an attitude sensor fusion scheme for improved kinematic sensing and a visual, deep learning based algorithm to establish and maintain contact between the organ surface and the US probe. We further introduce a novel scheme to estimate and orient the probe perpendicular to the center line of a vascular structure. Our approach enables, for the first time, to autonomously scan across a non-planar surface and navigate along an anatomical structure with a robotically guided minimally invasive US probe. Our experiments on a vessel phantom with a convex surface confirm a significant improvement of the reconstructed curved vessel geometry, with our approach strongly reducing the mean positional error and variance. In the future, our approach could help identify vascular structures more effectively and help pave the way towards semi-autonomous assistance during partial hepatectomy and the potential to reduce procedure length and complication rates.