Combined Endovascular/Surgical Management of a Ruptured Para-Anastomotic Aneurysm of the Left Common Iliac Artery#

A 75-year old man presented with signs and symptoms of acute abdomen and a clinical picture of hypovolemic shock. An emergency CT scan revealed a ruptured para-anastomotic left common iliac artery aneurysm. The patient had undergone an elective abdominal aortic aneurysm repair operation and placement of an aortoiliac bifurcated graft 10 years before. Para-anastomotic aneurysms had developed in all 3 (aortic and the 2 iliac) anastomosis. As the patient was highrisk, a combined endovascular/surgical approach was undertaken. The patient was discharged 4 days later

Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

<p>Abstract</p> <p>Background</p> <p>The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1^stJanuary 2009 and 31st December 2010.</p> <p>Results</p> <p>Overall, 2452 (49.4%) out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6%) needed vascular surgical intervention.</p> <p>Conclusions</p> <p>The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.</p

Endovascular repair for ruptured abdominal aortic aneurysm confers an early survival benefit over open repair

Background: Despite the intuitive advantages of endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (AAAs), uncertainty remains about the optimal management in the absence of convincing high-quality evidence. Our objective was to undertake a comprehensive literature review and perform a meta-analysis of outcome data of treatment modalities for ruptured AAAs. Methods: Systematic searches were conducted of electronic information sources to identify studies comparing perioperative outcomes of EVAR and open repair for AAA rupture. Summary estimates of odds ratios (ORs) or standardized mean difference and 95% confidence intervals (CIs) were obtained with a random-effects model. Meta-regression models were formed to explore potential heterogeneity as a result of changes in practice over time. Results: We selected 41 studies for analysis. The entire meta-analysis population comprised 59,941 patients (8201 EVAR patients and 51,740 open repair patients). EVAR was associated with a significantly lower incidence of in-hospital mortality (OR, 0.56; 95% CI, 0.50-0.64; P &lt; .01; meta-analysis of risk-adjusted observational studies and randomized controlled trials: OR, 0.58; 95% CI, 0.46-0.73; P &lt; .01). EVAR patients had a significantly decreased risk of developing respiratory complications (OR, 0.59; 95% CI, 0.49-0.69; P &lt; .01) and acute renal failure (OR, 0.65; 95% CI, 0.55-0.78; P &lt; .01) and a trend toward a reduced incidence of cardiac complications (OR, -0.02; 95% CI, -0.03 to 0.00; P = .05) and mesenteric ischemia (OR, 0.66; 95% CI, 0.44-1.00; P = .05). Patients treated with EVAR had significantly less requirements of intraoperative blood transfusion (standardized mean difference, -0.88; 95% CI, -1.06 to -0.70; P &lt; .01). Random-effects meta-regression revealed no statistical evidence for an association between death and year of publication (P = .19). Conclusions: Our analysis provides evidence to motivate the adoption of an EVAR-first policy in a nonelective setting and the establishment of standardized protocols for the management ruptured AAAs

Co-designed Innovation and System for Resilient Exascale Computing in Europe: From Applications to Silicon (EuroEXA)

EuroEXA targets to provide the template for an upcoming exascale system by co-designing and implementing a petascale-level prototype with ground-breaking characteristics. To accomplish this, the project takes a holistic approach innovating both across the technology and the application/system software pillars. EuroEXA proposes a balanced architecture for compute and data-intensive applications, that builds on top of cost-efficient, modular-integration enabled by novel inter-die links, utilises a novel processing unit and embraces FPGA acceleration for computational, networking and storage operations. EuroEXA hardware designers work together with system software experts optimising the entire stack from language runtimes to low-level kernel drivers, and application developers that bring in a rich mix of key HPC applications from across climate/weather, physical/energy and life-science/bioinformatics domains to enable efficient system co-design and maximise the impact of the project