To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions.
We retrospectively evaluated the clinical and procedural outcome data of patients undergoing ...endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention.
Ninety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention.
The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.
To report methodology and first-year results of a new educational project called Televascular Games,” which took place during coronavirus disease 2019 pandemic.
Complex aneurysmal aortic disease was ...discussed during a 2-hour competition webinar, according to three modalities. (1) Planning case competition (PCC): Two to four preoperative computed tomography angiography (CTA) scans of an already performed selected case were submitted for the competition. CTA scans were uploaded anonymously, without any reference to the center or the surgeon who performed the case. The competitor had to prepare a presentation of how he or she would have diagnosed, sized, planned, treated, and followed up the case, of the medical therapy and of the bail-out maneuvers. (2) Challenging case competition (CCC): The competitor elaborates a presentation of an already treated case concerning an aortic topic and discusses sizing, planning, treatment, possible bail-out maneuvers and obtained results. For the CCC and PCC, the competitors with the best score were preselected to present and discuss their plan during the webinars. (3) Quiz competition: Two to six CTA scans of already performed selected aortic cases were submitted for the competition. A quiz with multiple choice questions was answered by the competitors. The top four competitors were selected for the webinars and then they discussed the cases during the webinar. Finally, at the end of the case discussion, the effective case resolution and follow-up were shown. A final winner was voted via televoting, based on six preestablished criteria. The project was endorsed by different national and international societies.
Between October 2020 and December 2021, there were 12 Italian and 1 international webinars with 1695 participants overall (mean, 130; range, 86-177). Competitors were 54 years of age (mean, 27 years; range, 22-38 years). Two editions were CCCs, two quiz competitions, and nine PCCs. The reliability of the interobserver sizing of competitors was κ = 0.43 and κ = 0.62 for the proximal and distal sealing measurements respectively and very good (κ = 0.88-0.95) in the evaluation of orientation of the vessels, presence of angulations, calcifications, and thrombus. The sizing discrepancy resulted in a significant variability of the planning (κ = 0.45). The project ranked 9.6 on a 10-point rating scale by all the participants and competitors.
The formula of gaming and collegial discussion of aortic cases herein reported has proved valid and attractive during coronavirus disease 2019 pandemic period. The variability of the results on sizing and planning suggested to confer with a second opinion, especially for less experienced surgeons.
Objective The goal of this study was to present open surgical conversion with graft salvage or “semiconversion” as a definitive and safe treatment for untreatable and persistent type II endoleaks ...causing sac enlargement after endovascular aneurysm repair. Methods Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal access, whenever possible), the technique consisted of performing a banding of the neck with Teflon (DuPont, Wilmington, Del), a sacotomy to remove the thrombus or the hygroma, or both, and then suturing all of the feeding vessels that were found. Proximal and distal fenestrations were performed to avoid sac repressurization. Results The semiconversion was performed after a mean of 74 months after the initial EVAR. The mean aneurysm size at the time of the EVAR was 6.0 cm (range, 5.0-9.5 cm), and the mean aneurysm size at the time of the semiconversion was 7.7 cm (range, 5.5-11.5 cm). The overall aneurysm size increase was 38%, and the average growth rate was 8.2% per year. One patient had a stable aneurysm size but was treated because of an emergency condition. Technical success was 100%, with resolution of the endoleak and no perioperative deaths. Four cardiac deaths were registered at 12, 26, 30, and 60 months (mean follow-up, 42 months; range, 1-80 months). Conclusions Graft salvage appears to be a valid option compared with open repair when considering treatment of persistent type II endoleak. This case series shows that semiconversion is a safe and effective treatment for otherwise untreatable type II endoleak.
To report short-term and midterm outcomes of endovascular aneurysm repair (EVAR) of complex aneurysms requiring revascularization of visceral arteries.
Prospective data were collected from patients ...deemed unsuitable for conventional EVAR and conventional surgery who were treated with different endovascular approaches according to the clinical presentation of the aneurysm. Custom-made fenestrated endovascular aneurysm repair (CM f-EVAR) was used in the elective setting, homemade fenestrated endovascular aneurysm repair (HM f-EVAR) or HM f-EVAR combined with chimney endovascular aneurysm repair (ch-EVAR) was used in the emergent setting in patients with hemodynamic stability, and ch-EVAR was used in unstable cases. The study included 34 consecutive patients. Primary outcomes measured were perioperative mortality and morbidity, renal function impairment (RFI), target vessel patency, and survival at mean follow-up.
In the CM f-EVAR group (7 of 34 patients; 20.6%), an intraoperative type III endoleak (1 of 7 patients; 14%) sealed spontaneously. At 8.9 months of follow-up, 1 (1 of 7 patients; 14%) death and 1 (1 of 7 patients; 14%) episode of transient RFI were documented. Visceral vessel patency rate was 95.2%. In the HM f-EVAR group (4 of 34 patients; 11.7%) and the combination of HM f-EVAR and ch-EVAR group (3 of 34 patients; 8.8%), no complications were observed at 17.3 months of follow-up. In the ch-EVAR group (20 of 34 patients; 58.8%), visceral patency was 95% at 30.9 months of follow-up. Two cases of transient RFI and 2 cases of permanent RFI were registered (2 of 20 patients; 10%). One asymptomatic renal artery branch occlusion was observed at 11 months of follow-up. No endoleaks were documented.
Endovascular aneurysm repair techniques including CM f-EVAR, HM f-EVAR or HM f-EVAR in combination with ch-EVAR, and ch-EVAR are valid tools to maintain blood flow in visceral arteries during treatment of complex aortic aneurysms. The proposed interventional protocol based on clinical presentation was feasible in all cases.
A commonly used expression for modeling the XAFS of highly disordered systems is shown to generate substantial systematic errors in the coordination number in many cases of practical interest. This ...expression is corrected and generalized. Further, a simpler and more flexible model distribution is proposed, and the corresponding XAFS expression is derived. Comparison with experimental and simulated data show that the new expressions are useful in cases of high disorder for which the cumulant expansion loses its utility, and they explicitly account for the
k-dependence of the mean free path.
How Charisma Cloaks Incompetence Hogan, Robert; Raskin, Robert; Fazzini, Dan
Personnel journal,
05/1990, Letnik:
69, Številka:
5
Journal Article
Corporate leaders tend to share some common characteristics that predict upward mobility. Within that population, however, is a subset of managers who have used the charm and talent that got them to ...the top to hide some detrimental personality quirks. These people are aggressive, paranoid, insecure and narcissistic. Eventually they'll destroy their own careers, but if they aren't detected first they can wreak havoc in organizations
In two experiments, the free-operant shock-avoidance behavior of rats was punished by electric shock. Two aspects of the schedule of response-produced shock were varied: the frequency of punishment ...over time (punishment density) and the temporal interval between the punished response and the punishment (punishment delay). The general finding was that response-produced shock suppressed avoidance responding under most of the density-delay combinations studied, and suppression increased as a function of increases in density and decreases in delay. Rate increases of small magnitude also were observed, usually as an initial reaction to the lesser densities and longer delays. Response suppression, while decreasing the number of punishment shocks received, also increased the number of avoidance shocks, so that the total number of shocks received usually was greater than the minimal number possible. The results were discussed from the standpoint of similarities between the effects of punishing positively and negatively reinforced behavior. The finding that subjects did not minimize the total number of shocks suggested that when avoidance behavior is punished, responding is controlled more by the local consequences of responding than by overall shock frequencies during the course of the session.
The boron precipitation phenomenon in highly supersaturated boron-implanted silicon (10keV B+, 5×1015 ions/cm2) has been investigated by means of atom probe tomography, transmission electron ...microscopy and secondary ion mass spectrometry. We demonstrate that (001) dislocation loops observed by transmission electron microscopy in the region close to the boron projected range and boron precipitates ((001)-platelets) observed by atom probe are the same objects. For sufficiently high thermal budgets (900°C for 5h), boron precipitates close to the stoichiometric SiB3 composition have been observed, indicating that the precipitation induced by high-dose boron implantation can lead to the formation of a stable phase.
► Boron precipitation in Si has been analyzed using correlative techniques. ► Extended defects are observed along (100) Si planes after annealing at 900°C. ► The (100) dislocation loops and the boron precipitates may be the same objects. ► Boron concentration within the precipitates increases with the thermal budgets. ► For high thermal budgets, the boron precipitates composition is close to the SiB3.
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