Abdominal packing for surgically uncontrollable hemorrhage in ruptured abdominal aortic aneurysm repair

AbstractEmergency surgery for ruptured abdominal aortic aneurysms is accompanied with massive blood loss and is correlated with high incidences of coagulopathy. Following established results with abdominal packing to control hepatic hemorrhage, we present this technique for uncontrollable hemorrhage in patients with ruptured abdominal aortic aneurysm. The experience with this technique in 46 patients is described. (J Vasc Surg 2001;33:195-6.

Tips and techniques for optimal stent graft placement in angulated aneurysm necks

An increasing number of patients with severely angulated abdominal aortic aneurysm (AAA) necks are being treated by endovascular aneurysm repair (EVAR). Optimal preprocedural planning and investigation of the AAA morphology is essential to achieve a successful EVAR in these patients. In this article, we discuss specific problems that can be encountered during preoperative planning in relation to periprocedural stent graft deployment in patients with angulated AAA necks and offer potential solutions for these problems

The Incidence of Arterial Stent Fractures with Exclusion of Coronary, Aortic, and Non-arterial Settings

Background: This study aimed to review the literature regarding fracture of arterial stents, especially its relation to location of placement, clinical relevance, and type of stents. Material and methods: We searched published articles in PubMed up to February 2008 by using the terms: stent fracture or stent breakage. Results: Thirty-one articles met our inclusion and exclusion criteria. Most of the studies reported fractures in stents placed in the superficial femoral artery or popliteal arteries. The cumulative incidence of stent fractures ranged from 2% to 65%, i.e. 0.6 to 60 per 1000 person-months. Stent fractures occur more frequently in the superficial femoral artery and are common when multiple stents are deployed and overlap. Stent fractures are associated with a higher risk of in-stent restenosis and re-occlusion. Conclusion: The incidence of stent fracture, its location of placement, and type of stent used were diverse across studies. Stent fracture may cause clinical deterioration especially in the femoropopliteal segment, and it should be detected before clinical manifestation appears. Further studies with larger study population involving new type of stents for a longer follow up period are warranted.Peer reviewe

The 2009 framework for undergraduate medical education in the Netherlands

The 2009 Framework defines the joint Dutch national learning outcomes to be attained by medical students after completing their three-year master programme in medicine. The Framework thus helps to guarantee to society at large and to patients in particular that medical graduates who are starting out as practitioners have attained a certain professional level. This level is the aggregate of the physicians’ target profile, physicians’ (sub-) competencies to be achieved and the list of issues relating to illness and health. In addition, the Framework also defines the profile of the bachelor and the learning outcomes of the bachelor programme in medicine

The 2009 framework for undergraduate medical education in the Netherlands

The 2009 Framework defines the joint Dutch national learning outcomes to be attained by medical students after completing their three-year master programme in medicine. The Framework thus helps to guarantee to society at large and to patients in particular that medical graduates who are starting out as practitioners have attained a certain professional level. This level is the aggregate of the physicians’ target profile, physicians’ (sub-) competencies to be achieved and the list of issues relating to illness and health. In addition, the Framework also defines the profile of the bachelor and the learning outcomes of the bachelor programme in medicine

Total Endovascular Repair of the Aortic Arch:Initial Experience in the Netherlands

Background. We report procedural and early results in the Netherlands of the Relay Branch device (Terumo Aortic, Sunrise, FL) for total endovascular repair of the aortic arch. Methods. Between 2014 and 2018, all consecutive patients who received the Aortic Relay double-branched stent graft in the Netherlands were included in a multicenter, retrospective registry. Results. The Relay Branch device was used in 11 patients to treat saccular (n = 4), fusiform (n = 5), or false aneurysms (n = 2) in the aortic arch. Patients were deemed unfit or extreme high-risk for open (redo) surgery. The brachiocephalic trunk and left common carotid artery were branched using a retrograde approach in all cases. Additional surgical left subclavian artery revascularization was performed in 8 patients. The main device and the branches were successfully introduced, positioned, and deployed with complete exclusion of the aortic pathology in all patients (100% technical success). There was no retrograde type A dissection or conversion to open surgery. Two procedure-related deaths occurred, both caused by perioperative or postoperative strokes. There were 2 minor strokes with full recovery. One patient recovered from transient paraplegia after spinal fluid drainage. No permanent paraplegia was observed. Follow-up imaging showed persistent adequate exclusion of aortic arch pathology. Mean follow-up was 17 months (range, 3-42 months). Conclusions. Total endovascular aortic arch repair using the Relay Branch device is technically feasible and effective in excluding aortic arch pathology. The observed stroke rate in the initial experience, however, was considerable. Although appealing, this new less-invasive technique should be carefully introduced and its progress thoroughly evaluated. (C) 2020 by The Society of Thoracic Surgeon

A ruptured aneurysm after stent graft puncture during computed tomography-guided thrombin injection

Type II endoleaks occur in 5% to 10% of patients who are treated by endovascular aneurysm repair. A persistent type II endoleak combined with documented aneurysm expansion is generally considered an indication for intervention. Thrombin injection directly into the aneurysm sac is described as a safe and efficient treatment option. We present a patient with a ruptured aneurysm caused by a puncture of the stent graft during computed tomography-guided thrombin injection. This case highlights a possible harmful complication of thrombin injection and emphasizes the need for caution while performing such a procedure

Analytical and experimental characterization of a miniature calorimetric sensor in pulsatile flow

The behaviour of a miniature calorimetric sensor, which is under consideration for catheter-based coronary artery flow assessment, is investigated in both steady and pulsatile tube flow. The sensor is composed of a heating element operated at constant power, and two thermopiles that measure flow-induced temperature differences over the sensor surface. An analytical sensor model is developed, which includes axial heat conduction in the fluid and a simple representation of the solid wall, assuming a quasi-steady sensor response to the pulsatile flow. To reduce the mathematical problem, described by a two-dimensional advection-diffusion equation, a spectral method is applied. A Fourier transform is then used to solve the resulting set of ordinary differential equations and an analytical expression for the fluid temperature is found. To validate the analytical model, experiments with the sensor mounted in a tube have been performed in steady and pulsatile water flow with various amplitudes and Strouhal numbers. Experimental results are generally in good agreement with theory and show a quasi-steady sensor response in the coronary flow regime. The model can therefore be used to optimize the sensor design for coronary flow assessment