Nellix endovascular aortic sealing endoprosthesis late explantation for concomitant type I endoleak and stent frames proximal caudal migration

Endovascular aneurysm sealing (EVAS) using the Nellix™ System was introduced in clinical practice with the aim of reducing the incidence of complications such as migration, endoleaks, and reinterventions after conventional endovascular aneurysm repair (EVAR). Although, initial efficacy data on this device have been encouraging, EVAS has also demonstrated to undergo adverse events. Herein, we report a case of Nellix graft explant due to endobags shrinkage after air bubble reabsorption leading to proximal type I A endoleak and stent migration. The focus of this article is on the importance of a more assiduous surveillance of this new device, in particular in those cases with air into the endobags immediately after the procedure; this surveillance should be aimed to timely identify complications which can otherwise lead to consequences that require open conversion

Single-center experience in the treatment of visceral artery aneurysms

Background: Visceral artery aneurysms (VAAs), although rare, represent a life-threatening disease with high mortality rates. With the more frequent use of diagnostic tests, there has been an incidental detection of these lesions which are mostly asymptomatic. It follows that surgeons are increasingly called to decide on the most appropriate management of VAAs between an open surgical or endovascular approach and among the different endovascular options currently available. The aim of this retrospective study was to evaluate the results of open surgery and interventional endovascular strategies of visceral artery aneurysms with respect to technical success, therapy-associated complications, and postinterventional follow-up in the elective and emergency situation. Methods: From January 1992 to January 2017, 125 open surgical or endovascular interventions for VAA were performed at our institution. Once the VAA was diagnosed and the indication for treatment was assessed, the preoperative diagnostic work-up consisted of contrast computed tomography (CT) or magnetic resonance imaging (MRI) and, in some patients, digital subtraction angiography. Follow-up included clinical and duplex ultrasound scan (DUS) and contrast-enhanced ultrasound to assess the treated vessel patency and organ perfusion after 1, 6, and 12 months, and yearly thereafter. CT or MRI controls were also performed at 1 year of follow-up and only when DUS was not diagnostic or showed a complication thereafter. After the first 5 years of follow-up, the status of the patient was obtained by a structured telephone survey. Results: The treatment option was endovascular in 56 of 125 cases (44.8%). Technical success was 98.3%. In one case, the procedure was interrupted for the extensive dissection of the afferent vessel. Twenty-six patients were treated by coil embolization while 29 with covered stenting. The endovascular approach was in emergency in two cases (3.6%). In the endovascular group, mortality was nil. Complications occurred in 5 cases (8.9%): 1 subacute intestinal ischemia caused by superior mesenteric artery dissection, 2 aneurysm reperfusion, 1 stent thrombosis, and 1 massive splenic hematoma. In 69 (55.2%) cases, surgical treatment was preferred, with 24 VAA resections and 45 arterial reconstructions. In 20 cases (29%), open surgery was performed in emergency conditions. In the surgical group, 8 emergency patients (40%) died intraoperatively. The mortality after elective surgical interventions was nil. Complications after surgery were 4 graft late thrombosis (5.8%): asymptomatic in three cases and requiring splenectomy in one. Conclusions: There is no overall consensus regarding the indications for treatment of VAA. Currently in emergent setting, the endovascular approach should be considered as the first choice because of its reduced invasiveness, faster way to access and bleeding control; this accounts for the lower morality of the interventional therapy than open surgery. Endovascular approach is effective for elective repair of VAAs, but procedure-related complications may occur in a not negligible number of patients. Given comparable mortality rates and low procedure-related complication rate, surgical approach still has space in the elective management of VAAs, especially for aneurysms unsuitable or challenging for the endovascular option in patients with low surgical risk. The size, location, and morphology of VAAs, systemic or local comorbidities, and specific anatomical situations such as previous abdominal surgery should dictate treatment choice

Outcomes in the emergency endovascular repair of blunt thoracic aortic injuries

Abstract Thoracic aorta blunt injury (BAI) is a highly lethal lesion. A large number of victims die before obtaining emergency care. Thoracic endovascular aneurysm repair (TEVAR) is a less invasive method compared with open surgery and may change protocols for BAI treatment. This retrospective study was developed to evaluate the potential issues about thoracic endografting in the management of these patients. Twenty-seven patients with a BAI underwent aortic stent grafting. Intervention was preceded by the treatment of more urgent associated lesions in nine cases. In-hospital mortality was 7.4%. No paraplegia or ischemic complications developed because of the coverage of the left subclavian artery. In one case (3.2%), a type I endoleak was detected, proximal endograft infolding in two cases (7.4%) and endograft distal migration in further two cases were detected during follow-up (6-110 months). Thoracic endovascular aneurysm repair of BAI showed encouraging results in terms of perioperative mortality and morbidity. Concerns still remain about the potential mid- and long-term complications in younger patients

Avalanche ruggedness of parallel SiC power MOSFETs

© 2018 Elsevier Ltd The aim of this paper is to investigate the impact of electro-thermal device parameter spread on the avalanche ruggedness of parallel silicon carbide (SiC) power MOSFETs representative of multi-chip layout within an integrated power module. The tests were conducted on second generation 1200 V, 36 A–80 mΩ rated devices. Different temperature-dependent electrical parameters were identified and measured for a number of devices. The influence of spread in measured parameters was investigated experimentally during avalanche breakdown transient switching events and important findings have been highlighted

TherMos3, a tool for 3D electrothermal simulation of Smart Power Mosfets

In this paper we report on a novel simulation tool designed for the 3D coupled electro-thermal simulation of Smart Power Mosfets, that is a tool capable of taking into account not only the electrical (and thermal) behaviour of the power device but also the different driving strategies as they are imposed by a control logic circuit which usually resides on the same chip. The simulator is fully developed under Matlab and solves, self consistently, the 3D heat equation with proper boundary conditions and heat sources. An adaptive meshing algorithm based on temperature gradients and an optimized time stepping strategy have also been developed to reduce computational load and speed up simulation time without loosing accuracy. To validate this approach, simulator results are finally compared to experimental data obtained on a commercial Smart Power device used in automotive applications.Comment: Submitted on behalf of TIMA Editions (http://irevues.inist.fr/tima-editions

Appeal No. 0873: Stonebridge Operating Co., LLC. v. Division of Oil & Gas Resources Management

Chief\u27s Orders 2014-39 (suspension of operations); 2014-236, 2014-238,2014-239, 2014-241 (denials of plug-back permits); 2014-253, 2014-256 thru 2014-262 & 2014-264 thru 2014-266 (plug orders

Blood Viscosity in Subjects With Normoglycemia and Prediabetes

OBJECTIVE Blood viscosity (BV) is higher in diabetic patients and might represent a risk factor for the development of insulin resistance and type 2 diabetes. However, data in subjects with normal glucose or prediabetes are missing. In the current study, we evaluated the relationship between BV and blood glucose in subjects with normal glucose or prediabetes. RESEARCH DESIGN AND METHODS Enrolled subjects were divided into three groups according to blood glucose: group A ( n = 74), blood glucose <90 mg/dL; group B ( n = 96), blood glucose ranging from 90 to 99 mg/dL; and group C ( n = 94), blood glucose ranging from 100 to 125 mg/dL. BV was measured at 37°C with a cone-plate viscometer at shear rates ranging from 225 to 22.5 s−1. RESULTS Blood pressure, blood lipids, fibrinogen, and plasma viscosity were similar in the three groups. BMI and waist circumference were significantly increased in group C. Hematocrit ( P < 0.05) and BV ( P between 0.01 and 0.001) were significantly higher in groups B and C compared with group A. Blood glucose was significantly and inversely correlated with HDL cholesterol and directly with BMI, waist, hematocrit ( r = 0.134), and BV (from 225 s−1 to 22.5 s−1; r ranging from 0.162 to 0.131). BV at shear rate 225 s−1 was independently associated with blood glucose. CONCLUSIONS The current study shows a direct relationship between BV and blood glucose in nondiabetic subjects. It also suggests that, even within glucose values considered completely normal, individuals with higher blood glucose levels have increased BV comparable with that observed in subjects with prediabetes

114th Congress

This report covers policy issues in areas such as: U.S. trade negotiations; U.S. trade and economic relations with regions and countries; international trade institutions; tariff and nontariff barriers; worker dislocation from trade liberalization; trade remedy laws; import and export policies; international investment; economic sanctions; and trade policy functions of the federal government

Single pulse avalanche robustness and repetitive stress ageing of SiC power MOSFETs

This paper presents an extensive electro-thermal characterisation of latest generation silicon carbide (SiC) Power MOSFETs under unclamped inductive switching (UIS) conditions. Tests are carried out to thoroughly understand the single pulse avalanche ruggedness limits of commercial SiC MOSFETs and assess their aging under repetitive stress conditions. Both a functional and a structural characterisation of the transistors is presented, with the aim of informing future device technology development for robust and reliable power system development