Reproducibility of abdominal aortic aneurysm diameter measurement and growth evaluation on axial and multiplanar computed tomography reformations

Purpose: Compare different methods measuring abdominal aortic aneurysm (AAA) maximal diameter (Dmax) and its progression on multi-detector computed tomography scan (MDCT). Materials and Methods: Forty AAA patients with 2 MDCT acquired at different time (baseline and follow-up) were included. Three observers measured AAA diameters by 7 different methods: on axial images (antero-posterior, transverse, maximal and short axis) and on multi-planar reformation (MPR) images (coronal, sagittal and orthogonal). Diameter measurement and progression were compared over time for the 7 methods. Reproducibility of measurement methods was assessed by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Results: Dmax measured on axial slices at baseline and follow-up (FU) MDCTs was larger than that measured with use of orthogonal method (p=0.00001), whereas Dmax with the orthogonal method was larger than for all other measurement methods (p≤0.0001). The highest inter-observer ICCs were obtained for the orthogonal and transverse method (0.972) at baseline and for orthogonal and sagittal MPR at FU (0.973 and 0.977). Interobserver ICC of the orthogonal method to document AAA progression was higher (ICC=0.833) than measurements taken on axial images (ICC=0.662-0.780) and single plane MPRs (0.772-0.817). Conclusion: AAA Dmax measured on MDCT axial slices overestimates aneurysm size. Diameter measured by the orthogonal method is more reproducible, especially to document AAA progression

Impact of contrast injection and stent-graft implantation on reproducibility of volume measurements in semiautomated segmentation of abdominal aortic aneurysm on computed tomography

Purpose To assessthe impact of contrast injection and stent-graft implantation on feasibility, accuracy, and reproducibilityof abdominal aortic aneurysm (AAA) volume and maximaldiameter (D-max) measurements using segmentation software. Materials and methods CT images of 80 subjects presentingAAA were divided into four equal groups: with or without contrast enhancement, and with or without stent-graft implantation. Semiautomated software was used to segment the aortic wall, once by an expert and twice by three readers. Volume and D-max reproducibility was estimated by intraclass correlation coefficients (ICC), and accuracy was estimated between the expert and the readers by mean relative errors. Results All segmentations were technically successful. Themean AAA volume was 167.0±82.8 mL and the mean D-max 55.0±10.6 mm. Inter- and intraobserver ICCs for volume andD-max measurements were greater than 0.99. Mean relative errors between readers varied between −1.8±4.6 and 0.0± 3.6 mL. Mean relative errors in volume and D-max measurements between readers showed no significant difference between the four groups (P≥0.2). Conclusion The feasibility, accuracy, and reproducibility of AAA volume and D-max measurements using segmentation software were not affected by the absence of contrast injection or the presence of stent-graft

Arterial trauma during central venous catheter insertion: Case series, review and proposed algorithm

BackgroundPercutaneous catheterization is a frequently-used technique to gain access to the central venous circulation. Inadvertent arterial puncture is often without consequence, but can lead to devastating complications if it goes unrecognized and a large-bore dilator or catheter is inserted. The present study reviews our experience with these complications and the literature to determine the safest way to manage catheter-related cervicothoracic arterial injury (CRCAI).MethodsWe retrospectively identified all cases of iatrogenic carotid or subclavian injury following central venous catheterization at three large institutions in Montreal. We reviewed the French and English literature published from 1980 to 2006, in PubMed, and selected studies with the following criteria: arterial misplacement of a large-caliber cannula (≥7F), adult patients (>18 years old), description of the method for managing arterial trauma, reference population (denominator) to estimate the success rate of the therapeutic option chosen. A consensus panel of vascular surgeons, anesthetists and intensivists reviewed this information and proposed a treatment algorithm.ResultsThirteen patients were treated for CRCAI in participating institutions. Five of them underwent immediate catheter removal and compression, and all had severe complications resulting in major stroke and death in one patient, with the other four undergoing further intervention for a false aneurysm or massive bleeding. The remaining eight patients were treated by immediate open repair (six) or through an endovascular approach (two) for subclavian artery trauma without complications. Five articles met all our inclusion criteria, for a total of 30 patients with iatrogenic arterial cannulation: 17 were treated by immediate catheter removal and direct external pressure; eight (47%) had major complications requiring further interventions; and two died. The remaining 13 patients submitted to immediate surgical exploration, catheter removal and artery repair under direct vision, without any complications (47% vs 0%, P = .004).ConclusionDuring central venous placement, prevention of arterial puncture and cannulation is essential to minimize serious sequelae. If arterial trauma with a large-caliber catheter occurs, prompt surgical or endovascular treatment seems to be the safest approach. The pull/pressure technique is associated with a significant risk of hematoma, airway obstruction, stroke, and false aneurysm. Endovascular treatment appears to be safe for the management of arterial injuries that are difficult to expose surgically, such as those below or behind the clavicle. After arterial repair, prompt neurological evaluation should be performed, even if it requires postponing elective intervention. Imaging is suggested to exclude arterial complications, especially if arterial trauma site was not examined and repaired

Vascular e-Learning in the MENA Region during the COVID-19 Pandemic

Introduction: With the steady rise in interest in e-learning and the sudden boost provoked by the COVID-19 pandemic, it becomes necessary to explore the e-learning experience within the medical community in the MENA region. Methods: An online survey was conducted during the early phase of the COVID-19 pandemic (June 15 – October 15, 2020). Results: Seventy-eight vascular surgeons and trainees from 16 countries participated. 88% of the participants were male. 55% attended more than 4 activities. More than half of the activities did not lead to any official certification. Topic was the primary determinant for attending an activity. National societies and social media played a major role in disseminating activity-related information. Lack of time, increased workload, differences in time zone, and technical issues were the main obstacles cited. 84.7% of the participants had a positive impression. Conclusion: As the COVID-19 pandemic boosted e-learning activities in vascular surgery, a shift was observed in the learning mode and new leadership skills were called upon. Novel ways of quality control are required

Dataset of the vascular e-Learning during the COVID-19 pandemic (EL-COVID) survey

This dataset supports the findings of the vascular e-Learning during the COVID-19 pandemic survey (the EL-COVID survey). The General Data Protection Regulation (GDPR) of the European Union was taken into consideration in all steps of data handling. The survey was approved by the institutional ethics committee of the Primary Investigator and an online English survey consisting of 18 questions was developed ad-hoc. A bilingual English-Mandarin version of the questionnaire was developed according to the instructions of the Chinese Medical Association in order to be used in mainland People's Republic of China. Differences between the two questionnaires were minor and did affect the process of data collection. Both questionnaires were hosted online. The EL-COVID survey was advertised through major social media. All national and regional contributors contacted their respective colleagues through direct messaging on social media or by email. Eight national societies or groups supported the dissemination of the EL-COVID survey. The data provided demographics information of the EL-COVID participants and an insight on the level of difficulty in accessing or citing previously attended online activities and whether participants were keen on citing these activities in their Curricula Vitae. A categorization of additional comments made by the participants are also based on the data. The survey responses were filtered, anonymized and submitted to descriptive analysis of percentage