Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta

AbstractObjective: We sought to study changes in morphology and stent-graft configuration of descending thoracic aortic aneurysms after endovascular repair. Methods: Twenty-three patients treated with custom-made stent-grafts were studied. The stent-graft consisted of continuous, stainless-steel Z stents mounted within a polyester graft. In the last 11 cases the stents were interconnected with 3 longitudinal wires. Contrast-enhanced spiral computed tomography was performed preoperatively and at 1, 3, and every 6 months postoperatively. Angiography was used preoperatively and at 1-year follow-up. Proximal and distal necks were assessed for diameter and length. Aneurysm diameter, endoleaks, stent-graft migration, and changes in stent-graft configuration were evaluated. Results: During follow-up (median, 18 months; range, 1-48 months), excluded aneurysms decreased in diameter by 4 mm (0.5-10 mm, P =.0018). Endoleaks prevented size decrease. Five patients displayed neck dilatation, 4 at both the proximal and distal fixation sites and 1 only distally. In 7 (30%) patients there was proximal migration of the distal end of the stent-graft. Three (13%) patients displayed both distal migration of the proximal end of the stent-graft and proximal migration of the distal end of the stent-graft. There was a significant correlation between stent-graft kinking and appearance of proximal or distal stent-graft migration (P =.05 and P =.0007, respectively). In no case did the migration lead to appearance of an endoleak before intervention was performed. Conclusion: Excluded descending thoracic aortic aneurysms decrease in size on midterm follow-up. A subgroup of patients prone to neck dilatation might exist. A combination of neck dilatation and vector forces acting on stent-grafts in the tortuous thoracic aorta might lead to stent-graft migration.J Thorac Cardiovasc Surg 2001;122:47-5

How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart

Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up

AbstractPurpose: The purpose of this study was to report an initial experience with the endovascular repair of descending thoracic aortic aneurysm. Complications and intermediate-term morphologic changes were identified with the intent of altering patient selection and device design. Methods: Endografts were placed into 25 patients at high-risk for conventional surgical repair over a 3 ½–year period. Devices were customized on the basis of preoperative imaging information. Follow-up computed tomography scans were obtained at 1, 3, 6, and 12 months and yearly thereafter. Additional interventions occurred in the setting of endoleaks, migration, and aneurysm growth. Results: The overall 30-day mortality rate was 20% (12.5% for elective cases; 33% for emergent cases). There were 3 conversions to open repair. Neurologic deficits developed in 3 patients; 1 insult resulted in permanent paraplegia. Neurologic deficits were associated with longer endografts (P = .019). Three endoleaks required treatment, and 1 fatal rupture of the thoracic aneurysm treated occurred 6 months after the initial repair. Migrations were detected in 4 patients. The maximal aneurysm size decreased yearly by 9.15% (P = .01) or by 13.5% (P = .0005) if patients with endoleaks (n = 3 patients) were excluded. Both the proximal and distal neck dilated slightly over the course of follow-up (P = .019 and P = .001, respectively). The length of the proximal neck was a significant predictor of the risk for endoleakage (P = .02). Conclusion: The treatment of descending thoracic aortic aneurysms with an endovascular approach is feasible and may, in some patients, offer the best means of therapy. Early complications were primarily related to device design and patient selection. All aneurysms without endoleaks decreased in size after treatment. Late complications were associated with changing aneurysm morphologic features and device migration. The morphologic changes remain somewhat unpredictable; however, alterations in device design may result in improved fixation and more durable aneurysm exclusion. (J Vasc Surg 2000;31:147-56.

How to Recondition Ex Vivo Initially Rejected Donor Lungs for Clinical Transplantation: Clinical Experience from Lund University Hospital

A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. We have recently reported the results of the first six double lung transplantations performed with donor lungs reconditioned ex vivo that had been deemed unsuitable for transplantation by the Scandiatransplant, Eurotransplant, and UK Transplant organizations because the arterial oxygen pressure was less than 40 kPa. The three-month survival of patients undergoing transplant with these lungs was 100%. One patient died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are still alive and well 24 months after transplantation, with no signs of bronchiolitis obliterans syndrome. The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation circuit using STEEN solution mixed with erythrocytes, to dehydrate edematous lung tissue. Functional evaluation was performed with deoxygenated perfusate at different inspired fractions of oxygen. The arterial oxygen pressure was significantly improved in this model. This ex vivo evaluation model is thus a valuable addition to the armamentarium in increasing the number of acceptable lungs in a donor population with inferior arterial oxygen pressure values, thereby, increasing the lung donor pool for transplantation. In the following paper we present our clinical experience from the first six patients in the world. We also present the technique we used in detail with flowchart

Complicated Acute Type B Dissections-An 8-years Experience of Endovascular Stent-graft Repair in a Single Centre.

Objective. To analyze the experience of a single centre using stent-grafts for treatment of complicated acute aortic type B-dissections (EVR-ABD). Design. Retrospective analysis of prospectively collected data from patients undergoing EVR-ABD between January 1997 and December 2004. Methods. EVR-ABD was performed in 31 patients (20 males, median age 74. years (IQR: 64-79)). Indications for treatment were aortic rupture (22 patients), intractable pain and hypertension (six patients), acute bowel ischemia (two patients) and transient paraplegia, lower limb and renal ischemia in one patient. Initially home-made devices (five patients) and subsequently commercially available thoracic stent-grafts were used. Results. Five patients (16%) died within 30 days of EVR-ABD. Postoperative complications occurred in 15 (48%) patients, including one paraplegia converted to paraparesis after cerebrospinal fluid drainage, five strokes, three lower limb ischemia, three myocardial infarction, two pneumonia and one colitis). Re-interventions were required in nine patients (29%). Six more deaths occurred during a median follow-up of 22 (IQR: 16-34) months, two related to the stent-graft and four due to cardiac disease. Conclusions. Stent-graft repair of complicated acute type B dissections seems to provide acceptable results and, therefore, it may be considered a valuable alternative to open surgery

Nygammal metod minskar neurologisk risk vid arcus aortae-kirurgi. Selektiv antegrad hjärnperfusion ger bra skydd, visar retrospektiv studie

nnominate artery and left carotid artery cannulation for antegrade brain perfusion allows accurate bilateral pressure-controlled brain perfusion. The aim of this study was to evaluate the incidence of adverse neurological events and 90-day mortality in 40 consecutive patients undergoing elective aortic arch repair using this technique. Forty consecutive patients underwent elective aortic arch repair using selective antegrade brain perfusion. The perfusion was instituted by cannulation of the innominate artery (using standard cannulae) and by direct cannulation of the left common carotid artery (using cannulae having a built-in-side arm for pressure monitoring). Bilateral radial artery and left common carotid artery pressure monitoring allowed precise, pressure-controlled bilateral brain perfusion. Bilateral selective antegrade brain perfusion was given with a perfusion rate of 4.6 ml to 15.9 ml/kg/min (mean 9.6 ml/kg/min). This was sufficient to obtain dual-controlled mean cerebral perfusion pressures of 50-70 mmHg as monitored simultaneously in the right radial artery and the left carotid artery. The incidence of stroke and transient neurological dysfunction was 2.5 % each. Ninety-day mortality was 2.5 %. Pressure-controlled, bilateral, selective antegrade brain perfusion by innominate artery cannulation seems to be a safe method for cerebral protection during elective aortic arch repair

Studies on the functional anatomy of urino-genital system of some Kashmir fishes.

The study deals with functional anatomy of urino-genital system of fishes of Kashmir viz. Schizothorax esocinus, Oreinus plagiostomus, Cyprinus carpio, Crossochailus Latius and Glyptothorax Kashmir. The study reveals that the occurrence of Haemophietic tissue in the head kidneys and measal kidneys of schizothorax. The kidneys of Kashmir fishes studied are classified into four Categories: 1. Schizothoracine type (found in schizothorax Oreinus) 2. Cyprinine type (found in cyprinus) 3. Botine type (found in Botia) 4. Solurine type (found in Glytothorax) The study reveals that functional kidneys of all the fishes are Glomerular. The seminal vesicles reported by many workers are not found by any of the species. The original studies on the sperm of these fishes and difference in their sizes is reported