Homocysteine as biomarker for carotid surgery risk stratification

Das Ziel der Carotis-Endarterektomie (CEA) ist die Schlaganfalls-Prävention durch chirurgische Entfernung der Arteria carotis interna-Stenose. Die Effizienz der CEA in symptomatischen Patienten ist weithin bekannt, jedoch ist die Effizienz der CEA in asymptomatischen Patienten Gegenstand heftiger Diskussion, besonders in alten und weiblichen Patienten. Eine Möglichkeit die Effizienz von Carotischirurgie in asymptomatischen Patienten zu steigern ist jene zu identifizieren, die lang genug leben, um trotz des perioperativen Risikos von der Operation zu profitieren. Nachdem der Myokardinfarkt für 50% der perioperativen Todesursachen verantwortlich ist und mehr zur perioperativen Mortalität beiträgt als der Schlaganfall, eignet sich die Prädiktion der kardiovaskulären und damit Gesamtmortalität mittels eines Biomarkers zur Identifizierung dieser Patienten. Ein potentieller Kandidat zur Risikostratifizierung in der Carotischirurgie ist die Aminosäure Homocysteine, welche einen bekannten Risikofaktor für kardiovaskuläre Ereignisse in beiden Geschlechtern darstellt.  The aim of carotid endarterectomy (CEA) is to prevent stroke by removal of the internal carotid artery (ICA) stenosis. The efficacy of carotid endarterectomy in symptomatic patients is well documented. However, the efficacy of CEA in asymptomatic patients, especially in elderly and women, is subject of intense debate. An approach to increase the benefit from carotid surgery in asymptomatic patients is to identify those who live long enough to outweigh the perioperative risks. As myocardial infarction is responsible for up to 50 % of perioperative deaths and thus, causes more postoperative deaths than strokes, a prediction of cardiovascular and thus overall mortality by a biomarker would help to identify these patients. A potential candidate for risk stratification in carotid surgery is the amino acid homocysteine, which is a widely acknowledged risk factor for cardiovascular adverse events in both genders.submitted by Nikolaus DuschekAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersZsfassung in dt. SpracheWien, Med. Univ., Diss., 2015OeBB(VLID)171475

Simulator training on pulsatile vascular models significantly improves surgical skills and the quality of carotid patch plasty

Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills

Rationale, scope, and 20-year experience of vascular surgical training with lifelike pulsatile flow models

Vascular surgical training currently has to cope with various challenges, including restrictions on work hours, significant reduction of open surgical training cases in many countries, an increasing diversity of open and endovascular procedures, and distinct expectations by trainees. Even more important, patients and the public no longer accept a "learning by doing" training philosophy that leaves the learning curve on the patient's side. The Vascular International (VI) Foundation and School aims to overcome these obstacles by training conventional vascular and endovascular techniques before they are applied on patients. To achieve largely realistic training conditions, lifelike pulsatile models with exchangeable synthetic arterial inlays were created to practice carotid endarterectomy and patch plasty, open abdominal aortic aneurysm surgery, and peripheral bypass surgery, as well as for endovascular procedures, including endovascular aneurysm repair, thoracic endovascular aortic repair, peripheral balloon dilatation, and stenting. All models are equipped with a small pressure pump inside to create pulsatile flow conditions with variable peak pressures of ~90 mm Hg. The VI course schedule consists of a series of 2-hour modules teaching different open or endovascular procedures step-by-step in a standardized fashion. Trainees practice in pairs with continuous supervision and intensive advice provided by highly experienced vascular surgical trainers (trainer-to-trainee ratio is 1:4). Several evaluations of these courses show that tutor-assisted training on lifelike models in an educational-centered and motivated environment is associated with a significant increase of general and specific vascular surgical technical competence within a short period of time. Future studies should evaluate whether these benefits positively influence the future learning curve of vascular surgical trainees and clarify to what extent sophisticated models are useful to assess the level of technical skills of vascular surgical residents at national or international board examinations. This article gives an overview of our experiences of >20 years of practical training of beginners and advanced vascular surgeons using lifelike pulsatile vascular surgical training models

Simulator training on pulsatile vascular models significantly improves surgical skills and the quality of carotid patch plasty

Vascular surgeons perform numerous highly sophisticated and delicate procedures. Due to restrictions in training time and the advent of endovascular techniques, new concepts including alternative environments for training and assessment of surgical skills are required. Over the past decade, training on simulators and synthetic models has become more sophisticated and lifelike. This study was designed to evaluate the impact of a 3-day intense training course in open vascular surgery on both specific and global vascular surgical skills