hospital factory for manufacturing customised patient specific 3d anatomo functional models and prostheses

The fabrication of personalised prostheses tailored on each patient is one of the major needs and key issues for the future of several surgical specialties. Moreover, the production of patient-specific anatomo-functional models for preoperative planning is an important requirement in the presence of tailored prostheses, as also the surgical treatment must be optimised for each patient. The presence of a prototyping service inside the hospital would be a benefit for the clinical activity, as its location would allow a closer interaction with clinicians, leading to significant time and cost reductions. However, at present, these services are extremely rare worldwide. Based on these considerations, we investigate enhanced methods and technologies for implementing such a service. Moreover, we analyse the sustainability of the service and, thanks to the development of two prototypes, we show the feasibility of the production inside the hospital

Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection

OBJECTIVE: Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. METHODS: Retrospective case-control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low (<30\ub0), moderate (30\ub0-60\ub0) and high tortuosity (>60\ub0). RESULTS: Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p\u2009<\u20090.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p\u2009<\u20090.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p\u2009<\u20090.001) and group of tortuosity (p\u2009<\u20090.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p\u2009<\u20090.001). CONCLUSION: This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome

Gender Related Access Complications After TEVAR: Analysis from the Retrospective Multicentre Cohort GORE\uae GREAT Registry Study

Objective: The Global Registry for Endovascular Aortic Treatment (GREAT), a retrospective sponsored registry, was queried to determine the incidence and identify potential predictors of access related complications after TEVAR. Methods: This is a multicentre, observational cohort study. For the current study, all patients were treated only with the Conformable GORE\uae TAG\uae Thoracic Endoprosthesis and GORE\uae TAG\uae Thoracic Endoprosthesis devices for any kind of thoracic aortic disease. All serious adverse events within 30 days of the procedure were documented by sites. The following were considered access related complications: surgical site infection, pseudoaneurysm, avulsion, dissection, arterial bleeding, access vessel thrombosis/occlusion, seroma, and lymphocoele. Results: A total of 887 patients was analysed: most of the cases had an operative indication for TEVAR of degenerative atherosclerotic aneurysm (n = 414, 46.7%) and type B dissection (n = 270, 30.4% either complicated or uncomplicated). Two hundred and ninety-five patients (33.3%) were female. The overall access related complication rate was 2.8% (n = 25): 4.7% (n = 14) in women and 1.8% (n = 11) in men (p = .013). After adjustment for age, urgency, device diameter, introducer sheath ( 6524Fr vs. 64 24Fr), access vessel diameters, and access method, female gender was significantly associated with the risk of access complications (OR 2.85; p = .038). Brachial artery for access was also found to be an independent predictor of access related complications (OR 8.32; p < .001). Conclusion: This analysis suggests that women may have a higher access related complication rate after TEVAR, irrespective of the clinical setting, type of aortic disease, and device sizing