Low-fidelity simulators for the training of medical students in basic endovascular skills

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Hunting the Carotid Culprit An Intriguing Game:An Intriguing Game

Editoria

Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review

Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery

Laparoscopic treatment of splenic artery aneurysms

OBJECTIVES: The purpose of this study was to report a series of 16 consecutive patients who underwent laparoscopic treatment of splenic artery aneurysms. METHODS: Over a period of 8 years, patients were selected for the laparoscopic option by a team of specialists that included the vascular surgeon, the interventional radiologist, and the laparoscopic surgeon. The mean size of the aneurysm was 32 mm and most was located at the splenic hilum. They were twice as common in females as in males. Ultrasonography with color Doppler function was used to define intraoperative strategy. RESULTS: The laparoscopic treatment entailed excision of the aneurysm or its exclusion, usually reserved for distally located lesions. In one patient, laparoscopic resection and robotic anastomosis of the splenic artery was performed to re-establish flow to the spleen. In two patients, the intraoperative decision was added to combine a laparoscopic splenectomy due to insufficient residual arterial flow to the spleen. There was no conversion, or need for re-operation or related mortality. Analysis of intraoperative arterial flow data avoided unnecessary splenectomy following noncritical reduction of flow to the spleen. CONCLUSIONS: The use of intraoperative color Doppler ultrasonography is essential in deciding the appropriate procedure and whether the spleen should be removed or saved. Early control of the splenic artery proximal to the aneurysm can limit the risk of conversion due to intraoperative bleeding. Distally located aneurysms are more difficult to manage and entail a higher risk of associated splenectomy. The laparoscopic option offers some advantages over the endovascular treatment in selected patients. A multidisciplinary approach is the key to a successful treatment of this uncommon disease

Alternative Nuclear Imaging Tools for Infection Imaging

Purpose of Review Cardiovascular infections are serious disease associated with high morbidity and mortality. Their diagnosis is challenging, requiring a proper management for a prompt recognition of the clinical manifestations, and a multidisciplinary approach involving cardiologists, cardiothoracic surgeons, infectious diseases specialist, imagers, and microbiologists. Imaging plays a central role in the diagnostic workout, including molecular imaging techniques. In this setting, two different strategies might be used to image infections: the first is based on the use of agents targeting the microorganism responsible for the infection. Alternatively, we can target the components of the pathophysiological changes of the inflammatory process and/or the host response to the infectious pathogen can be considered. Understanding the strength and limitations of each strategy is crucial to select the most appropriate imaging tool. Recent Findings Currently, multislice computed tomography (MSCT) and nuclear imaging (F-18-fluorodeoxyglucose positron emission tomography/computed tomography, and leucocyte scintigraphy) are part of the diagnostic strategies. The main role of nuclear medicine imaging (PET/CT and SPECT/CT) is the confirmation of valve/CIED involvement and/or associated perivalvular infection and the detection of distant septic embolism. Proper patients' preparation, imaging acquisition, and reconstruction as well as imaging reading are crucial to maximize the diagnostic information. In this manuscript, we described the use of molecular imaging techniques, in particular WBC imaging, in patients with infective endocarditis, cardiovascular implantable electronic device infections, and infections of composite aortic graft, underlying the strength and limitations of such approached as compared to the other imaging modalities

Rupture Of Abdominal Aortic Aneurysm Due To Endograft Infection After Endovascular Aneurysm Repair (EVAR): A Case Report

Endograft infection is a rare event, with few reports in the literature. This report describes delayed infection of an aortic endoprosthesis that eventually resulted in abdominal aortic aneurysm (AAA) rupture. The procedure was performed in an angiographic suite. In the postoperative period the patient developed a central venous line infection. This appears to be the first recognized and reported case in which the infected aortic neck completely dilated due to the radial force of the stent graft

Ensemble deep learning for the prediction of proficiency at a virtual simulator for robot-assisted surgery

Background Artificial intelligence (AI) has the potential to enhance patient safety in surgery, and all its aspects, including education and training, will derive considerable benefit from AI. In the present study, deep-learning models were used to predict the rates of proficiency acquisition in robot-assisted surgery (RAS), thereby providing surgical programs directors information on the levels of the innate ability of trainees to facilitate the implementation of flexible personalized training. Methods 176 medical students, without prior experience with surgical simulators, were trained to reach proficiency in five tasks on a virtual simulator for RAS. Ensemble deep neural networks (DNN) models were developed and compared with other ensemble AI algorithms, i.e., random forests and gradient boosted regression trees (GBRT). Results DNN models achieved a higher accuracy than random forests and GBRT in predicting time to proficiency, 0.84 vs. 0.70 and 0.77, respectively (Peg board 2), 0.83 vs. 0.79 and 0.78 (Ring walk 2), 0.81 vs 0.81 and 0.80 (Match board 1), 0.79 vs. 0.75 and 0.71 (Ring and rail 2), and 0.87 vs. 0.86 and 0.84 (Thread the rings 2). Ensemble DNN models outperformed random forests and GBRT in predicting number of attempts to proficiency, with an accuracy of 0.87 vs. 0.86 and 0.83, respectively (Peg board 2), 0.89 vs. 0.88 and 0.89 (Ring walk 2), 0.91 vs. 0.89 and 0.89 (Match board 1), 0.89 vs. 0.87 and 0.83 (Ring and rail 2), and 0.96 vs. 0.94 and 0.94 (Thread the rings 2). Conclusions Ensemble DNN models can identify at an early stage the acquisition rates of surgical technical proficiency of trainees and identify those struggling to reach the required expected proficiency level

Intimal Sarcoma of the Descending Aorta Mimicking Aortitis

We describe a 74-year-old male patient with an intimal sarcoma of the descending aorta mimicking aortitis. The patient presented with lower back pain, fever, and increased C-reactive protein, erythrocyte sedimentation rate, and immunoglobulin G4 (IgG4) serum levels, together with Staphylococcus epidermidis-positive blood cultures. These findings, together with evidence of a 49-mm pseudoaneurysm of the descending thoracic aorta, caused us to suspect aortitis. However, postoperative histology and immunohistochemistry demonstrated the presence of an intimal aortic sarcoma. At the 8-month follow-up, local recurrence of the neoplasm and lung metastases were noted

Long-term clinical outcomes in critical limb ischemia--A retrospective study of 181 patients

Critical limb ischemia (CLI) is the most severe manifestation of the peripheral arterial disease. To date, several prognostic factors have been identified but the data of long-term follow-up in real life setting are scarce. The aim of our study is to describe a large group of CLI patients and identify possible prognostic factors, in a long-term follow-up

Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions

To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 +/- 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 +/- 0.4 in those treated with PTA, 1.6 +/- 0.5 in those treated with OSR, and 0.3 +/- 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy