A pilot study of aortic hemodynamics before and after thoracic endovascular repair with a double-branched endograft

This work was partially supported by Bolton Medical, Sunrise, Florida, US. The authors declare that although Bolton Medical supported this study, the funding company had no control, input or influence on the study design, data analysis or publications.Peer reviewedPublisher PD

Effects of stent design on LDL accumulation at the carotid artery bifurcation

Restenosis typically occurs in regions of low and oscillating wall shear stress which also favours the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to determine how stent strut design may affect in-stent restenosis at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. LDL concentrations were compared for post-stent carotid and the contralateral models reconstructed from patient-specific images. Our results show that closed-cell stent designs are more likely to create atheroprone and procoagulant flow conditions than open-cell designs due to larger area exposed to high LDL concentration

Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis

PURPOSE: Endovascular stenting has been used to manage superior vena cava syndrome for several decades and has become standard firstline practice. This study aims to investigate the outcomes of endovascular stenting in the management of superior vena cava syndrome (SVCS). METHODS: MEDLINE, EMBASE and PUBMED online databases were searched, with studies involving more than ten adult patients included. Studies identified spanned 27 years, from 1993 to 2020. Meta-analyses were performed based on Clopper-Pearson estimation. RESULTS: Fifty-four studies were identified, for a total of 2249 patients, of which 2015 had malignant SVCS and 222 benign SVCS. Pooled technical success and clinical success rates were 96.8% (95% CI 96.0-97.5%) and 92.8% (95% CI 91.7-93.8%). Technical success and clinical success rates for studies investigating benign SVCS alone were identical at 88.8% (95% CI 83.0-93.1%). Pooled patency remained above 90% for the first year. Average complication and re-intervention rates were 5.78% (SD = 9.3182) and 9.11% (SD = 11.190). CONCLUSIONS: This review confirms the effectiveness of endovascular stenting in managing SVCS. Further directions of research may include specific outcomes of endovascular stenting in benign SVCS, and the impact of procedural characteristics, such as the use of anticoagulation and type of stent used, on outcomes. LEVEL OF EVIDENCE: Level III, systematic review of retrospective cohort studies

Acute Complex Type A Dissection associated with peripheral malperfusion syndrome treated with a staged approach guided by lactate levels

Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass grafting followed by aortic arch repair. To accomplish this, we applied a staged therapeutic approach using serial lactate measurements to assess the adequacy of peripheral perfusion and metabolic status prior to surgical repair of the proximal dissection

EMBIO trial study protocol: left gastric artery embolisation for weight loss in patients living with obesity with a BMI 35–50 kg/m²

Introduction: Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 services for obesity. EMBIO is a National Institute for Health Research funded trial, a multicentre double-blinded randomised controlled trial between Imperial College National Health Service Trust and University College London Hospital, comparing LGAE versus Placebo procedure. The key aims of the trial is to evaluate LGAE efficacy on weight loss, its mechanism of action, safety profile and obesity-related comorbidities. / Methods and analysis: 76 participants will be recruited from the existing tier-3 database after providing informed consent. Key inclusion criteria include adults aged 18–70 with a body mass index 35–50 kg/m2 and appropriate anatomy of the left gastric artery and coeliac plexus on CT Angiogram. Key exclusion criteria included previous major abdominal and bariatric surgery, weight >150 kg, type 2 diabetes on any medications other than metformin and the use of weight modifying medications. Participants will undergo mechanistic visits 1 week prior to the intervention and 3, 6 and 12 months postintervention. Informed consent will be received from each participant and they will be randomised in a 1:1 ratio to left gastric artery embolisation and placebo treatment. Blinding strategies include the use of moderate doses of sedation, visual and auditory isolation. All participants will enter a tier-3 weight management programme postintervention. The primary analysis will estimate the difference between the groups in the mean per cent weight loss at 12 months. / Ethics and dissemination: This trial shall be conducted in full conformity with the 1964 Declaration of Helsinki and all subsequent revisions. Local research ethics approval was granted by London-Central Research Ethics Committee, (Reference 19/LO/0509) on 11 October 2019. The Medicines and Healthcare products Regulatory Agency (MHRA) issued the Letter of No Objection on 8 April 2022 (Reference CI/2022/0008/GB). The trial’s development and progress are monitored by an independent trial steering committee and data monitoring and ethics committee. The researchers plan to disseminate results at conferences, in peer- reviewed journals as well as lay media and to patient organisations. / Trial registration number: ISRCTN16158402

Editor's choice : European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia

A

Influence of atomic radiations in HID discharge Lamps

International audienceRadiations of plasma discharge lamps come from different mechanisms that take place inside the lamp. The knowledge of atomic data responsible for these radiations is essential to describe the radiations that take place inside them. A ray tracing method based on the resolution of radiative transfer equation is adopted. The discharge is divided into small cells responsible for launching rays in all directions. The calculations consider that the discharge has a cylindrical symmetry and assume the plasma is at local thermodynamic equilibrium (LTE). Hence, the only knowledge of temperature profile and pressure is sufficient to calculate the plasma composition and to account the mechanisms of broadening of spectral lines in the treatment of radiative transfer. In this work, the atomic data is the only resource to calculate both coefficients. We will show the results for a pure mercury HID lamp. For each spectral line, the local absorption and emission coefficients are strongly dependant on the broadening constants. Calculations reported in the literature use different values for these constants, leading to marked differences in output of the models

A Validated Model for Radiation Transport in an HID Lamp Using the Ray Tracing Method

International audienc