Rerouting in vascular access infections using a biosynthetic vascular graft (Omniflow® II)

Background Surgical treatment of infected arteriovenous grafts (AVG) while preserving the hemodialysis access remains a challenge. Partial graft excision (PGE) directly followed by interposition grafting (IG) is an established method but is associated with a high rate of local reinfection. This retrospective study investigated the technique of rerouting using a biosynthetic vascular graft (Omniflow® II). Methods This was a retrospective analysis of all patients at a tertiary referral center undergoing surgical treatment for AVG infections using PGE and IG with the rerouting technique using Omniflow® II between January 2009 and December 2018. Follow-up data were collected until May 2021. Results Fifteen patients (53% male, median age 62 years [range 49-81]) were identified for further analysis, thereof twelve received an Omniflow® II vascular graft. Eleven patients had positive local microbial cultures, with Staphylococcus aureus being the most frequently identified pathogen (9 cases). Mortality and reoperation rates within 30 days were both 0%. Median follow-up was 32 months (range 2–101 months) with a median follow-up index of 0.92 (range 0.18–1). During follow-up a surgical intervention for reinfection was necessary in 3 patients with Omniflow® II at a median of 304 days (range 298–485 days). Conclusion Partial graft excision and direct interposition grafting using a biosynthetic Omniflow® II vascular graft is a valid treatment option in selected patients with AVG infections when total graft excision can be avoided. Using a careful rerouting technique, while preserving clinically noninfected graft sections the risk of early reinfection can be minimized and the dialysis access maintained

Retrograde Retrieval of a Novel Large Mitral Clip After Embolization Into the Left Ventricle.

We describe the successful retrieval of a novel large mitral clip, which embolized in a patient with severe secondary mitral regurgitation and left ventricular dysfunction, dilated left ventricle, and severely tethered mitral valve leaflets in the setting of a challenging anatomy for transcatheter edge-to-edge repair. The description highlights planning, technical issues, and possible adverse events of this bailout procedure. (Level of Difficulty: Intermediate.)

Fenestrated Physician-Modified Endografts for Preservation of Main and Accessory Renal Arteries in Juxtarenal Aortic Aneurysms.

BACKGROUND There is a paucity of reporting outcomes of complex aortic aneurysm treatment such as juxtarenal abdominal aortic aneurysms, where additional techniques to preserve renal artery perfusion are required. METHODS Retrospective analysis of consecutive patients who underwent emergent and elective aortic repair with fenestrated PMEGs between March 2019 and January 2023. Endpoints were technical success, reinterventions, secondary reinterventions and target vessel patency. RESULTS Forty-seven target vessels in 37 patients (23 male, median age 75 years) were targeted, of which 44 were renal arteries (RAs) with a mean diameter of 5.4 ± 1.0 mm. Thirteen were accessory RAs and six had a diameter ≤ 4 mm. Technical success rate was 87% overall; 97% for main and 62% for accessory RAs respectively. Target vessel patency and freedom from secondary reintervention was 100% and 97% at 30 days and 96% and 91% at one year, respectively. There was no 30-day mortality. CONCLUSION Fenestrated physician-modified endografts are safe and effective for the treatment of patients with juxtarenal abdominal aortic aneurysms when incorporating main renal arteries. Limited technical success may be expected when targeting accessory renal arteries, especially when small in diameter. Long-term follow-up is needed to confirm durability of PMEGs for renal artery preservation

Akuttherapie der aortoösophagealen und aortoenteralen Fistel

Die aortoösophageale und aortoenterale Fistel sind seltene Ursachen der gastrointestinalen Blutung. Die niedrige Inzidenz kann Ursache für verzögerte Diagnosestellung und erhöhte Mortalität sein

Infective Native Aortic Aneurysms : A Delphi Consensus Document on Terminology, Definition, Classification, Diagnosis, and Reporting Standards

Publisher Copyright: © 2022 The Author(s)Objective: There is no consensus regarding the terminology, definition, classification, diagnostic criteria, and algorithm, or reporting standards for the disease of infective native aortic aneurysm (INAA), previously known as mycotic aneurysm. The aim of this study was to establish this by performing a consensus study. Methods: The Delphi methodology was used. Thirty-seven international experts were invited via mail to participate. Four two week Delphi rounds were performed, using an online questionnaire, initially with 22 statements and nine reporting items. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements revised, and results presented in iterative rounds. Consensus was defined as ≥ 75% of the panel selecting “strongly agree” or “agree” on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha coefficient > .80. Results: All 38 panellists completed all four rounds, resulting in 100% participation and agreement that this study was necessary, and the term INAA was agreed to be optimal. Three more statements were added based on the results and comments of the panel, resulting in a final 25 statements and nine reporting items. All 25 statements reached an agreement of ≥ 87%, and all nine reporting items reached an agreement of 100%. The Cronbach's alpha increased for each consecutive round (round 1 = .84, round 2 = .87, round 3 = .90, and round 4 = .92). Thus, consensus was reached for all statements and reporting items. Conclusion: This Delphi study established the first consensus document on INAA regarding terminology, definition, classification, diagnostic criteria, and algorithm, as well as reporting standards. The results of this study create essential conditions for scientific research on this disease. The presented consensus will need future amendments in accordance with newly acquired knowledge.Peer reviewe

Management of floating thrombus in the aortic arch

OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients

Completeness of Follow-Up Determines Validity of Study Findings: Results of a Prospective Repeated Measures Cohort Study.

BACKGROUND Current reporting guidelines do not call for standardised declaration of follow-up completeness, although study validity depends on the representativeness of measured outcomes. The Follow-Up Index (FUI) describes follow-up completeness at a given study end date as ratio between the investigated and the potential follow-up period. The association between FUI and the accuracy of survival-estimates was investigated. METHODS FUI and Kaplan-Meier estimates were calculated twice for 1207 consecutive patients undergoing aortic repair during an 11-year period: in a scenario A the population's clinical routine follow-up data (available from a prospective registry) was analysed conventionally. For the control scenario B, an independent survey was completed at the predefined study end. To determine the relation between FUI and the accuracy of study findings, discrepancies between scenarios regarding FUI, follow-up duration and cumulative survival-estimates were evaluated using multivariate analyses. RESULTS Scenario A noted 89 deaths (7.4%) during a mean considered follow-up of 30±28months. Scenario B, although analysing the same study period, detected 304 deaths (25.2%, P<0.001) as it scrutinized the complete follow-up period (49±32months). FUI (0.57±0.35 versus 1.00±0, P<0.001) and cumulative survival estimates (78.7% versus 50.7%, P<0.001) differed significantly between scenarios, suggesting that incomplete follow-up information led to underestimation of mortality. Degree of follow-up completeness (i.e. FUI-quartiles and FUI-intervals) correlated directly with accuracy of study findings: underestimation of long-term mortality increased almost linearly by 30% with every 0.1 drop in FUI (adjusted HR 1.30; 95%-CI 1.24;1.36, P<0.001). CONCLUSION Follow-up completeness is a pre-requisite for reliable outcome assessment and should be declared systematically. FUI represents a simple measure suited as reporting standard. Evidence lacking such information must be challenged as potentially flawed by selection bias

Combined CO & Dust Scaling Relations of Depletion Time and Molecular Gas Fractions with Cosmic Time, Specific Star Formation Rate and Stellar Mass

We combine molecular gas masses inferred from CO emission in 500 star forming galaxies (SFGs) between z=0 and 3, from the IRAM-COLDGASS, PHIBSS1/2 and other surveys, with gas masses derived from Herschel far-IR dust measurements in 512 galaxy stacks over the same stellar mass/redshift range. We constrain the scaling relations of molecular gas depletion time scale (tdepl) and gas to stellar mass ratio (Mmolgas/M*) of SFGs near the star formation main-sequence with redshift, specific star formation rate (sSFR) and stellar mass (M*). The CO- and dust-based scaling relations agree remarkably well. This suggests that the CO-H2 mass conversion factor varies little within 0.6dex of the main sequence (sSFR(ms,z,M*)), and less than 0.3dex throughout this redshift range. This study builds on and strengthens the results of earlier work. We find that tdepl scales as (1+z)^-0.3 *(sSFR/sSFR(ms,z,M*))^-0.5, with little dependence on M*. The resulting steep redshift dependence of Mmolgas/M* ~(1+z)^3 mirrors that of the sSFR and probably reflects the gas supply rate. The decreasing gas fractions at high M* are driven by the flattening of the SFR-M* relation. Throughout the redshift range probed a larger sSFR at constant M* is due to a combination of an increasing gas fraction and a decreasing depletion time scale. As a result galaxy integrated samples of the Mmolgas-SFR rate relation exhibit a super-linear slope, which increases with the range of sSFR. With these new relations it is now possible to determine Mmolgas with an accuracy of 0.1dex in relative terms, and 0.2dex including systematic uncertainties.Comment: ApJ accepte