Acute Appendicitis after Liver Transplantation: A Case Report and Review of the Literature

Acute appendicitis is one of the most common etiologies for acute abdomen. However, fewer than 30 cases of acute appendicitis after liver transplantation have so far been reported in the literature. Previous case studies have concluded that acute appendicitis after liver transplantation may present differently than in non-immunosuppressed patients and thus may lead to more complications. Herein, we describe the fourth case of laparoscopic appendectomy in a 40-year-old female presenting with an acute abdomen, 10 years after orthotopic liver transplantation for autoimmune hepatitis. Additionally, we review the literature, and emphasize the importance for laparoscopic, rather than open appendectomy after liver transplantation. Overall, despite the small number of reported cases of appendicitis after orthotopic liver transplantation, we found the incidence and clinical presentation are similar to patients without liver transplantation. The etiologies for appendicitis in patients after liver transplantation may be different than in those not chronically immunosuppressed, with significantly less lymphoid hyperplasia and increased fecalith and cytomegaloviral infections. Preliminary results showed that laparoscopic appendectomy after liver transplantation results in decreased hospital stays and fewer complications

Characterization and Management of Type II and Complex Endoleaks after Fenestrated/Branched Endovascular Aneurysm Repair

Introduction: Endoleaks are more common after fenestrated/branched endovascular aneurysm repair (F/B-EVAR) than infrarenal EVAR secondary to the length of aortic coverage and number of component junctions. While reports have focused on type I and III endoleaks, less is known regarding type II endoleaks following F/B-EVAR. We hypothesized that type II endoleaks are common, and often complex (associated with additional endoleak types), given the potential for multiple inflow and outflow sources. We sought to describe the incidence and complexity of type II endoleaks after F/B-EVAR. Methods: F/B-EVAR data prospectively collected at a single institution in an investigational device exemption clinical trial (G130210) were retrospectively analyzed (2014-2021). Endoleaks were characterized by type, time to detection, and management. Primary endoleaks were defined as those present on completion imaging or at first postoperative imaging; secondary were those on subsequent imaging. Recurrent endoleaks were those that developed after a successfully resolved endoleak. Reinterventions were considered for type I or III endoleaks, or any endoleak associated with sac growth \u3e5mm. Technical success, defined as absence of flow in the aneurysm sac at procedure conclusion as well as methods of intervention were captured. Results: Among 335 consecutive F/B-EVARs (mean±SD follow-up 2.5±1.5 years), 125 patients (37%) experienced 166 endoleaks (81 primary, 72 secondary, 13 recurrent). Of these 125 patients, 50 (40% of patients) underwent 71 interventions for 60 endoleaks. Type II endoleaks were the most frequent (n=100, 60%), with 20 identified during the index procedure, 12 (60%) of which resolved prior to 30-day follow-up. Of the 100 type II endoleaks, 20 (20%; 12 primary, 5 secondary, 3 recurrent) were associated with sac growth; 15 (75%) of those with associated sac growth underwent intervention. At intervention, 6 (40%) were reclassified as complex, with concomitant type I or type III endoleak. Initial technical success for endoleak treatment was 96% (68 of 71). There were 13 recurrences, all of which were associated with complex endoleaks. Conclusions: Nearly half of the patients who underwent F/B-EVAR experienced an endoleak. The majority were classified as type II, with nearly a fifth associated with sac expansion. Interventions for type II endoleak frequently led to reclassification as complex, with a concomitant type I or III endoleak not appreciated on CTA and/or duplex. Further study is needed to determine if the primary treatment goal for complex aneurysm repair is sac stability or sac regression, as this would inform both the importance of properly classifying endoleaks noninvasively and the intervention threshold for managing type II endoleaks. Keywords: NESVS 2022 Annual Meeting; endoleak; fenestrated branched endovascular aneurysm repair; thoracoabdominal aneurysm; type II endoleak

Fiber Optic RealShape technology in endovascular surgery

Fiber Optic RealShape technology is a new endovascular guidance system that aims to simplify endovascular procedures by improving wire, catheter, and device visualization, while reducing reliance on ionizing radiation. Developed by Philips, the system uses light refracted through optical fibers to generate real-time renderings of wires and catheters in three-dimensional space. Currently, devices with embedded Fiber Optic RealShape technology are being studied in human patients undergoing endovascular procedures. Early findings demonstrate the technology to be safe and effective in offsetting procedural complexity. Research and development to improve rendering accuracy and expand the selection of available Fiber Optic RealShape–enabled endovascular devices continues