Single Graft Research Articles

Single or multiple arterial grafting to design a coronary bypass: a retrospective study

Aim. To compare the efficiency of single arterial grafting (SAG) and multiple arterial grafting (MAG) at coronary artery bypass graft (CABG) surgery in the long term.Material and Methods. To assess the angiographic outcomes, we evaluated the patency of 323 bypasses at 102 angiograms obtained during coronary angiography performed > 10 years post-CABG surgery.Results. Out of 323 analyzed bypasses, 230 (71.2%) showed physiological functioning, whereas stenosis, occlusions, and other coronary artery alterations were found in 93 (28.8%) bypasses. The most common cause for the failure of anastomoses was competitive flow (most frequently registered in the anastomoses between left internal thoracic artery and left anterior descending artery, left internal thoracic artery and diagonal branches of left anterior descending artery, right internal thoracic artery and left anterior descending artery, and between right internal thoracic artery and right coronary artery), poor distal bed (most frequently revealed in the anastomosis between left internal thoracic artery and obtuse marginal artery, saphenous vein and diagonal branches of left anterior descending artery, saphenous vein and obtuse marginal artery, and between saphenous vein and right coronary artery), progression of atherosclerosis in combination with poor distal bed (most frequently detected in the anastomosis between right internal thoracic artery and obtuse marginal artery), and combination of poor distal bed, competitive flow, and graft degeneration (most frequently found in the anastomoses between radial artery and obtuse marginal artery and between radial artery and right coronary artery). In 5 (5.4%) cases, the cause of coronary bypass dysfunction was unclear.Conclusion. The main causes for the coronary bypass failure included competitive flow (in case with multiple arterial grafting) and poor distal bed (in case with single arterial grafting).

Can the Acetabular Labrum Be Reconstructed With a Meniscal Allograft? An In Vivo Pig Model.

No single graft type has been shown to have a benefit in acetabular labral reconstruction. The native labrum and lateral meniscus share many similarities, suggesting that the meniscus may be a promising source of graft material in labral reconstruction. Using a pig model, we sought to evaluate the healing process of fresh-frozen meniscus allograft for acetabular reconstruction by assessing (1) MRI and macroscopic observations of the meniscus allograft; (2) histologic appearance and immunohistologic evaluation of the meniscus allograft, native meniscus, and labrum; (3) microscopic assessment of the native labrum and meniscus via scanning electron microscopy; and (4) biomechanical assessment of tensile properties. Twelve skeletally mature male miniature Bama pigs (24 hips) were randomly divided into two groups: labral defect group (control) and lateral meniscus allograft group. The selection of Bama pig specimens was based on the similarity of their acetabular labrum to that of the human acetabular labrum, characterized by the presence of fibrocartilage-like tissue lacking blood vessels. The pigs underwent bilateral hip surgery. Briefly, a 1.5-cm-long section was resected in the anterior dorsal labrum, which was left untreated or reconstructed using an allogeneic lateral meniscus. The pigs were euthanized at 12 and 24 weeks postoperatively, and then evaluated by macroscopic observations and MRI measurement to assess the extent of coverage of the labral defect. We also performed a histologic analysis and immunohistologic evaluation to assess the composition and structure of meniscus allograft, native labrum, and meniscus, as well as scanning electron microscopy assessment of the microstructure of the native labrum and meniscus and biomechanical assessment of tensile properties. Imaging measurement and macroscopic observations revealed that the resected area of the labrum was fully filled in the lateral meniscus allograft group, whereas in the control group, the labral defect remained at 24 weeks. The macroscopic scores of the meniscus allograft group (8.2 ± 0.8) were higher than those of the control groups (4.8 ± 1.0) (mean difference 3.3 [95% CI 1.6 to 5.0]; p < 0.001). Moreover, in the meniscus allograft group, histologic assessment identified fibrocartilage-like cell cluster formation at the interface between the graft and acetabulum; cells and fibers arranged perpendicularly to the acetabulum and tideline structure that were similar to those of native labrum could be observed at 24 weeks. Immunohistochemical results showed that the average optical density value of Type II collagen at the graft-acetabulum interface was increased in the meniscus allograft group at 24 weeks compared with at 12 weeks (0.259 ± 0.031 versus 0.228 ± 0.023, mean difference 0.032 [95% CI 0.003 to 0.061]; p = 0.013). Furthermore, the tensile modulus of the lateral meniscus allograft was near that of the native labrum at 24 weeks (54.7 ± 9.9 MPa versus 63.2 ± 11.3 MPa, mean difference -8.4 MPa [95% CI -38.3 to 21.4]; p = 0.212). In a pig model, lateral meniscus allografts fully filled labral defects in labral reconstruction. Regeneration of a fibrocartilage transition zone at the graft-acetabulum interface was observed at 24 weeks. The use of an autograft meniscus for labral reconstruction may be a viable option when labral tears are deemed irreparable. Before its clinical implementation, it is imperative to conduct a comparative study involving tendon grafts, which are extensively used in current clinical practice.

Decannulation in Revision Pediatric Laryngotracheal Reconstruction.

To evaluate how patient characteristics and surgical techniques influence the rate of and time to decannulation after pediatric revision laryngotracheal reconstruction. The study was a retrospective cohort investigation of children with a history of laryngotracheal stenosis treated between 2008 and 2021 with revision open airway surgery. The primary outcome evaluated was decannulation. The secondary outcome analyzed was time to decannulation. Thirty-nine children were included in the study with median age 49 months; 61.5% were male. Children undergoing single stage revision surgery were far more likely to be decannulated (OR 6.25, 95% CI 1.33-45.97, p = 0.0343). Rolling logistic regression of the probability of decannulation stratified by time between open surgeries demonstrated significantly decreased chance of decannulation with reoperation within 6 months. Children managed with anterior/posterior grafting compared with a single graft were observed to have an increased time to decannulation, (HR 0.365, 95% CI 0.148-0.899, p = 0.005, Log-Rank). We observe that in the case of revision pediatric open airway surgery, chance of decannulation is improved when surgery is performed in a single stage as well as 6 months after the most recent procedure. Patients and families should be counseled that complex stenosis requiring double stage procedures or anterior/posterior grafting is associated with a decreased probability of decannulation and increased postoperative time with a tracheostomy, respectively. 4 Laryngoscope, 134:1926-1932, 2024.

Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up

To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P= .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P= .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P= .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P= .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P= .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. Level III, retrospective cohort study.

HURI: Hybrid user risk identification in social networks

The massive adoption of social networks increased the need to analyze users’ data and interactions to detect and block the spread of propaganda and harassment behaviors, as well as to prevent actions influencing people towards illegal or immoral activities. In this paper, we propose HURI, a method for social network analysis that accurately classifies users as safe or risky, according to their behavior in the social network. Specifically, the proposed hybrid approach leverages both the topology of the network of interactions and the semantics of the content shared by users, leading to an accurate classification also in the presence of noisy data, such as users who may appear to be risky due to the topic of their posts, but are actually safe according to their relationships. The strength of the proposed approach relies on the full and simultaneous exploitation of both aspects, giving each of them equal consideration during the combination phase. This characteristic makes HURI different from other approaches that fully consider only a single aspect and graft partial or superficial elements of the other into the first. The achieved performance in the analysis of a real-world Twitter dataset shows that the proposed method offers competitive performance with respect to eight state-of-the-art approaches.

Single Stage Excision and Thick Split Thickness Skin Graft Technique for Facial Giant Congenital Melanocytic Nevi with Consideration of Facial Aesthetic Subunits: A Case Report and Literature Review

Due to their three-dimensional anatomy, functional importance, and esthetic appeal, giant congenital melanocytic nevus (GCMN) of the face pose the greatest challenge to reconstructive surgeons, especially when there are few donors and a significant deformity. A 25-year-old male patient presented with a facial GCMN. GCMN management involves complete nevus removal and reconstruction using tissues of the same color, thickness, and as the surrounding skin. Some defect closure options were inapplicable due to the almost complete forehead defect. This study aims to report the author's successful experience treating an adult case of GCMN with single-stage excision and subunit facial restoration using thick split-thickness skin graft (STSG). In this case, thick STSG is considered to prevent the risk of secondary contracture and conspicuous discoloration. In addition to esthetic and functional outcomes, the patient's social status and self-esteem also improved. This technique promises esthetic results, such as reduced downtime, and improved psychological function.

Robotic-assisted double lingual mucosal graft ureteroplasty for multifocal ureteral strictures: Case report and technical description.

Ureteroplasty with a single onlay graft for proximal ureter stricture has been widely used in the clinic. However, robotic ureteroplasty with a double lingual mucosal graft (RU-DLMG) has not been reported. The intraoperative measured ureteral stricture lengths of patient 1 were 1.8, 2.5, and 4.6cm, and those of patient 2 were 2.5 and 3.5cm. We performed a RU-DLMG in which the diseased ureter was incised longitudinally from the ventral side and repaired with a double lingual mucosal graft to widen the ureteral lumen. Because of the presence of a distal ureter stricture, RU-DLMG combined with ureteral reimplantation was performed in patient 1. Antegrade urography showed no obstruction of the reconstructed ureteral segment after removing the ureteral stent. The patients had no complaints about the donor site and flank pain during the 12-month follow-up. RU-DLMG appears to be a suitable option for multifocal ureteral strictures.

Autologous Fat Grafting: an Emerging Treatment Option for Complex Anal Fistulas

BackgroundAutologous fat grafting (AFG) has shown promise in the treatment of complex wounds, with trials reporting good healing rates and safety profile. We aim to investigate the role of AFG in managing complex anorectal fistulas. MethodsThis was a retrospective review of a prospectively maintained IRB-approved database. We examined the rates of symptom improvement, clinical closure of fistula tracts, recurrence, complications, and worsening fecal incontinence. Perianal disease activity index (PDAI) was obtained for patients undergoing combination of AFG and fistula plug treatment. ResultsIn total, 52 unique patients underwent 81 procedures, of which Crohn’s was present in 34 (65.4%) patients. The majority of patients previously underwent more common treatments such as endorectal advancement flap or ligation of intersphincteric fistula tract. Fat-harvesting sites and processing technique were selected by the plastic surgeons based on availability of trunk fat deposits. When analyzing patients by their last procedure, 41 (80.4%) experienced symptom improvement, and 29 (64.4%) experienced clinical closure of all fistula tracts. Recurrence rate was 40.4%, and complication rate was 15.4% (7 postoperative abscesses requiring I&D and 1 bleeding episode ligated at bedside). The abdomen was the most common site of lipoaspirate harvest at 63%, but extremities were occasionally used. There were no statistically significant differences in outcomes when comparing single graft treatment to multiple treatments, Crohn’s and non-Crohn’s, different methods of fat preparation, and diversion. ConclusionAFG is a versatile procedure that can be done in conjunction with other therapies and does not interfere with future treatments if recurrence occurs. It is a promising and affordable method to safely address complex fistulas.

Bilateral Versus Single Internal Thoracic Artery Grafting for Elderly Patients Undergoing Coronary Revascularisation for Multivessel Disease: A Systematic Review and Meta-Analysis

International guidelines suggest that multiple arterial grafting is preferred for young patients undergoing coronary artery bypass graft (CABG) surgery for multivessel disease. Limited data exist comparing outcomes of single internal thoracic artery (SITA) with bilateral internal thoracic artery (BITA) grafting in elderly patients.

Anatomic Posterolateral Corner Reconstruction With Single Graft Tibial Socket Fixation

Introduction: The posterolateral corner (PLC) is comprised of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Injuries to the PLC are associated with significant morbidity and functional limitation, most frequently manifested through a varus thrust gait. In the previous 2 decades, advances have been made in understanding the importance of the PLC and as a result, many techniques have been developed to address its reconstruction. Material and Methods: The Laprade technique is a previously described anatomic reconstruction of the PLC. We propose some modifications to this technique, which involve dissection of the posterolateral tibia to allow direct protection of the popliteal neurovascular bundle while establishing tibial fixation. A single hamstring graft is utilized for the reconstruction, is routed through the fibular tunnel and subsequently secured with the use of a dual-expanding tenodesis anchor, placed in a tibial socket removing the need for a tibial tunnel. Conclusion: The present study describes a novel anatomic technique that allows for improved protection of neurovascular structures, better control of graft tensioning and tunnel management, and the judicious use of a single tendon autograft while maintaining the described benefits of the anatomic Laprade technique.

Long-Term Survival Associated With Multiple Arterial Grafting in Off-Pump and On-Pump Coronary Bypass Surgery

There is a paucity of evidence on whether the survival advantage of multiple arterial revascularisation (MAG) would have an association with off-pump (OPCAB) or on-pump coronary artery bypass grafting (ONCAB). Therefore, this study sought to evaluate the long-term survival of using multi aterial grafting (MAG) vs single arterial grafting (SAG) in OPCAB and ONCAB cohorts.

Application of a Single T-Shaped Porous High-Density Polyethylene in Oriental Nasal Tip-Plasty.

Porous high-density polyethylene (pHDPE) is an alternative material for septal extension grafts. This study investigated the clinical application of a single T-shaped pHDPE graft combined with auricular cartilage in oriental nasal tip-plasty. A retrospective analysis was conducted of 66 patients who underwent septal extension graft with a T-shaped pHDPE and auricular cartilage graft from December 2018 to November 2021. All patients were female from 19 to 51 years old (average: 28.9 years). Patients were followed up for 5 to 40 months with an average of 23.8 months. The postoperative nasal length (39.8±3.7mm) was significantly improved (35.6±5.7mm preoperatively, P <0.0001) with the tip projection increasing from 23.9±2.3mm preoperatively to 25.3±2.4mm postoperatively ( P =0.0005). There was a significant difference in the nasolabial angle (96.8±14.1 degrees preoperatively versus 101.8±7.2 degrees postoperatively, P =0.0105) but no significant change in the nasofrontal angle (143.3±9.5 degrees preoperatively versus 143.7±5.5 degrees postoperatively, P =0.7546), with an improved tip projection achieved in 93.9% of patients. One patient had an abscess in the nasal septum and a tip graft was performed using auricular cartilage in another patient because of an insufficient postoperative tip projection. There was a slight tip deviation in 2 patients, 1 case of a deviated nasal tip was corrected with a pHDPE sheet graft, while the other was left intact. Two patients had excess cartilaginous graft protruding to the nasal cavity that did not affect nasal ventilation and the shape of the nasal tip was relatively good, so the prominent cartilaginous graft was not addressed. In conclusion, this technique not only improved the bulbous nasal tip, lengthened the short nose, and increase the tip projection, but also prevented absorption of the existing septal cartilage and reduced infection or extrusion of the pHDPE.

Importance of Limb Severity on Primary Graft Patency of Ipsilateral Single Saphenous Vein Grafts for Lower Extremity Artery Bypass in Chromic Limb-threatening Ischemia

Approximately 30% of infrainguinal vein bypasses fail within 2 years after placement. A previous study demonstrated limb severity influenced cellular responses of saphenous veins used for lower extremity arterial bypass. The aim of this study was to assess the impact of wound, ischemia, and foot infection (WIfI) on primary graft patency of ipsilateral saphenous vein grafts. This is a retrospective, observational cohort study of autogenous vein bypass for chromic limb-threatening ischemia. Between 2014 and 2019, 201 (of 253) limbs receiving ipsilateral single great saphenous vein grafts were enrolled as research subjects. The outcome of interest was loss of primary graft patency >1 month after surgery because of occlusion or intervention for graft stenosis. Perioperative graft failure due to technical error successfully repaired by revision surgery were included; however, perioperative unrepaired failed graft and patients dying within 30 days after surgery were excluded, leaving 191 vein grafts for analysis of 2-year primary graft patency. Factors associated with loss of graft patency were predicted by Cox regression modeling based on patients’ background and limb severity. Seventy-six grafts (40%) lost primary patency at 2 years after surgery. The highest stage of WIfI classification had significantly lower primary graft patency than a bundle of other lower stages (49% vs 66%; P = .04). When focusing on the three factors of WIfI, higher wound grade (2 and 3) significantly impaired graft patency compared with lower grade (49% vs 68%; P = .016) and existence of foot infection (grade 1-3) also impaired primary graft patency rate (49% vs 63%; P < .05). There was a trend to lower patency for ischemia grade 3 than grade 2 (54% vs 65%; P = .06). Female sex (hazard ratio [HR], 1.6; 95% confidence interval [CI], 1.0-2.6; P = .04), chronic heart failure (HR, 2.0; 95% CI, 1.2-3.2; P < .01), higher wound grade (HR, 1.9; 95% CI, 1.1-3.1; P = .01) were significant by multivariate analysis. Intriguingly, the impact of wound and foot infection grade on loss of primary patency was not significant for men (n = 129 limbs) (P = .35 for wound and P = .30 for foot infection); however, it was for women (n = 62 limbs) (P = .018 for wound and P = .059 for foot infection). Limb severity as classified by WIfI, especially wound grade, was associated with loss of primary graft patency. This impact was weighted in women, not men; hence, further basic investigation will be needed with focus on differing cellular responses of saphenous vein stratified by sex.

Suture and glue-free autologous graft for pterygium surgery

Of various techniques of pteryium surgeries to prevent recurrence, conjunctival limbal auto graft has been the most successful adjuvant since the studies have shown the role of limbal stem cell deficiency (LSCD) as pathology of pterygium. The most common method of auto-graft fixation post pterygium excision is suturing; with drawbacks of prolonged operating time and postoperative discomfort. Replacing sutures with tissue adhesives may shorten the operating time, improve postoperative comfort; however, the major concern of the commercial fibrin glue is the cost and the potential risk of transmission of infection.To study, 1. The efficacy and complications of suture free and glue free conjunctival-limbal auto-graft for the management of pterygia, 2. The outcome of surgeries by two different qualified surgeons Prospective, interventional case study of 108 consecutive cases of pterygia that had excision with conjunctival-limbal auto-grafting without using glue or sutures. The operated eye patched for a day and followed up on day 1, 3 and 7, 6 weeks and 6 months; watched for hemorrhage beneath the graft, graft retraction, chemosis, recurrence or any other complication. The mean age of the patients was 40.7 years (range, 25 – 68 years) with female preponderance (60.2%) and nasal pterygia in 65.7 %. Not a single graft was dislodged and none had recurrence in the follow up period of 9-20 months. Graft retraction occurred in 7 cases (6.5%) and one patient had sub-graft hemorrhage which lasted for nine days. 76.9% had no discomfort even in immediate post-operative period. The results were comparable among patients of both the surgeons.Suture- and glue-freelimbal conjunctival auto-grafting following pterygium excision is a safe, effective and economical option for the management of both primary and recurrent pterygium. Learning curve is short and consistently similar results possible in different hands.

Influence of the Combination of Single Fascicle Grafting and Vascular Epithelial Growth Factor on the Nerve Reconstruction in the Rat Sciatic Nerve Injury Model: Experimental Study

Background and Aim: The purpose of this study was to evaluate the regeneration effects after sciatic nerve reconstruction with single fascicle grafting + vascular endothelial growth factor (VEGF) compared with traditional epineural suture. Methods: Sixty-four Wistar rats were divided into 2 groups randomly and created 10-25 mm sciatic nerve defects. In control group, nerve was reconstructed using traditional epineural suture and the rats of the study group were treated with single fascicle grafting + VEGF. At the point of 6 and 12 weeks, testing consisted of sciatic nerve function index (SFI), gastrocnemius muscle weight, toe spread test, pin-prick test was undergone. Results: The rats of 25mm defect subgroup repaired with single fascicle grafting + VEGF demonstrated significantly higher SFI score, toe spread test score, re- innervated muscle weight at the points of 6, 12 weeks. And in the 20, 25 mm defect rats of study group, pin-prick test score were significantly higher than the control group. Conclusion: Single fascicle grafting + VEGF was better to reconstruct long nerve defect compared to epineural suture.

The effect of the multiple arterial grafts compared with single arterial graft for coronary artery bypass grafting on sternal wound complications: A meta-analysis.

A meta-analysis investigation was executed to measure the influence of multiple arterial grafts (MAGs) compared with single arterial graft (SAG) for coronary artery bypass grafting (CABG) on sternal wound complications (SWCs). A comprehensive literature inspection till February 2023 was applied and 1048 interrelated investigations were reviewed. The seven chosen investigations enclosed 11 201 individuals with CABG in the chosen investigations' starting point, 4870 of them were using MAGs, and 6331 were using SAG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the MAGs compared with SAG for CABG on SWCs by the dichotomous approaches and a fixed or random model. MAGs had significantly higher SWC (OR, 1.38; 95% CI, 1.10-1.73, P = .005) compared with those with SAG in CABG. MAGs had significantly higher SWC compared with those with SAG in CABG. However, care must be exercised when dealing with its values because of the low number of selected investigations for the meta-analysis.

Single Layered Free ILM Graft Technique in Large Macular Holes with Associated ERM

ABSTRACT Purpose We aimed to describe single layered free ILM graft technique (FIGT) and present results of this technique in the primary surgery of large macular holes (MHs). Methods In this retrospective study, we identified MHs with a minimum hole diameter >400 μm that underwent FIGT by a single surgeon. Nineteen eyes were found to have an associated epiretinal membrane (ERM) and four eyes demonstrated a patchy ILM staining intraoperatively. A single layered FIGT was performed first by peeling the ILM around the hole and then creating a free ILM flap and transplanting it to cover the hole. All cases were evaluated for anatomical closure and visual improvement. Results Twenty-three eyes of 22 patients (mean age 68.7 ± 7.4 years) were included in the study. The mean follow-up was 9.6 ± 4.9 months. Flap closure was observed in two eyes (8.6%) at week 1, while all eyes (100%) showed a complete closure at month 1. Mean preoperative visual acuity of 1.42 ± 0.66 LogMAR increased to 1.11 ± 0.51, 0.99 ± 0.34, 0.92 ± 0.38, 0.74 ± 0.37, 0.52 ± 0.28, 0.64 ± 0.39 respectively at week 1, month 1, month 3, month 6, year 1 and final follow-up postoperatively (p < .05 for all). In none of the eyes ERM recurred, nor flap contraction developed. Conclusion The study showed encouraging results using free ILM graft in the primary surgery of large MHs. This technique might be considered in large MHs that are associated with ERM or demonstrate patchy ILM staining. Further studies are needed to prove the effectiveness also in the long-term.

Anatomical Feasibility of an Off-the-shelf Single-Renal Scalloped Stent-Graft for Hostile Neck Abdominal Aortic Aneurysm: A Preclinical Study

To evaluate the feasibility of a standardized single-renal scallop stent-graft. Preclinical, single-center, real-world, all-comers, retrospective cohort study. A total of 1347 abdominal aortic aneurysm (AAA) repairs (endovascular and open) performed between 2010 and 2020 were screened for elective treatment and retrievable preoperative high-quality computed tomography angiography (CTA) performed <6 months of the surgical procedure. Six hundred of the included CTAs involved prespecified measurements and a morphological assessment protocol (NCT05150873). The proximal sealing zones suitable for standard stent-graft implantations were further analyzed (N=547). The primary outcome assessed the feasibility of 2 single-renal scallop designs (10×10 mm and 15×10 mm, height × width). The feasibility was the inter-renal length ≥10 mm and ≥15 mm for prototypes #10 and #15, respectively. The secondary outcome quantified hypothetical length and surface improvements comparing those suitable for investigational devices implantation (study group) versus those not (control group). Of the total, 24.7% (n=135) was feasible with prototype #10. The study versus control group sealing zones were shorter (p=0.008), with a smaller surface (p=0.009) and a higher alpha angle (p=0.039). The length and surface area increased by about 25% and 23%, respectively, (both p<0.001) within the study group and became significantly better versus the control group (standard stent-graft; both p<0.001). Of the total, 7.1% (n=39) was suitable for prototype #15. The study versus control group sealing zones were shorter (p=0.148), with a smaller surface (p=0.077) and a higher alpha angle (p=0.027). The length and surface area increased by about 34% and 31%, respectively, (both p<0.001) within the study group and became significantly higher versus the control group (standard stent-graft; both p<0.001). The use of single-renal scalloped stent-graft might be feasible in a considerable number of AAA patients. The breakthrough stands in treating hostile AAAs presenting in mismatched renal arteries, keeping the complexity of the repair as similar as possible to standard endovascular repair with a remarkable improvement in sealing. The anatomic feasibility of a single renal stent graft for the treatment of "hostile" abdominal aortic aneurysm (AAA) with mismatched renal arteries was evaluated. The experimental device could be feasible in a considerable number of patients with AAA, approaching 25%, and demonstrate significant improvements in sealing. As far as we know, this is the first paper to report the prevalence of mismatched renal arteries in a large cohort of AAA patients in the real world, while proposing a dedicated device. The breakthrough is to keep the complexity of the repair as close as possible to standard endovascular repair.

The hammer graft: A novel technique to provide dorsal support, tip projection, and rotation in rhinoplasty

BackgroundThere are numerous cartilaginous grafts that can be used in rhinoplasty, depending on the specific needs of the patient. These include spreader grafts, dorsal onlay, tip grafts, septal extension, and columellar struts grafts, among others. ObjectiveThe aim of this study is to demonstrate use of the hammer graft in rhinoplasty; this technique can be used to improve dorsal support, tip projection, and tip rotation using a single cartilage graft. Materials and methodsThis novel graft was applied in 18 patients who underwent rhinoplasty. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septum cartilage. They were followed in average 12 months (between 6 and 18 months). ResultThree of these patients were revision cases and 15 were primary cases. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septal cartilage. The targeted results were achieved to a large extent in all patients. All patients had satisfactory esthetic results. ConclusionThe hammer graft as a single and stable graft useful support for the dorsal part, caudal part and extension part of the septum to be used in primary and revision rhinoplasty.

Single stem visceral debranching for complex aortic disease

What this paper adds Treatment of complex aortic diseases including thoracoabdominal aortic aneurysms and aortic dissection is highly challenging. Hybrid repair may be useful in some situations wherein anatomy, the need of emergent repair or patient comorbidities preclude the use of total endovascular or direct open reconstruction. This paper details an original hybrid repair in which a single branch is used to reroute all visceral vessels. Abstract: Objective: Hybrid treatment of complex aortic disease has been described with various techniques of retrograde visceral bypass. The use of a single branch to revascularize all renal and visceral vessels may be less cumbersome than multiple synthetic branches and may seems to be efficient in terms of patency. Methods: We retrospectively included 15 patients between 2013 and 2021. Indication was aortic dissection (AD) (type A, acute or chronic type B), thoracoabdominal aortic aneurysms (TAA), visceral occlusive disease. Surgery consisted in median laparotomy, visceral vessel debranching from native aorta or from an aortic graft. In case of AD, surgical fenestration was performed. Additional TEVAR completed the treatment when indicated, during the same procedure or later on Results: Mean age was 60 years. 9 (60%) patients were treated for AD, 3 (20%) for TAA, 3 (20%) for occlusive disease. A total of 65 target vessels were debranched through the single stem retrograde vascular graft (SSRVG) technique. Aortic surgical fenestrations were performed in 8 cases and TEVAR in 4 cases. In the postoperative course, 3 TAA patients died,7 patients developed renal insufficiency (47%), 4 patients presented pneumonia (27%) and 3 colonic ischemia (20%). After a mean follow up of 21 months, all vessels (but 2 IMAs) were patent and no endoleak was noted. Conclusion: SSRVG technique offers a feasible and safe solution in various complex aortic diseases. The use of a single graft makes the technique straightforward by reducing the volume of multiple branch assembly in the retroperitoneal space with satisfying patency rates. Further studies with larger patient sample size and longer follow up are needed to elucidated the efficacy and durability of the technique.