The exposure of patients and operators to radiation is significantly reduced by routine use of image fusion during standard and complex EVAR.

Although we have treated a cohort at high operative risk, our midterm results compare favorably with the published series of conventional surgery. Accurate hemodynamic control represented by high-normal perioperative blood pressure seems to protect against severe postoperative complications.

Objective/background: Spinal cord ischemia (SCI) is a devastating complication following endovascular thoracoabdominal aortic aneurysm (TAAA) repair. In an attempt to reduce its incidence two peri-procedural changes were implemented by the authors in January 2010: (i) all large sheaths are withdrawn from the iliac arteries immediately after deploying the central device and before cannulation and branch extension to the visceral vessels; (ii) the peri-operative protocol has been modified in an attempt to optimize oxygen delivery to the sensitive cells of the cord (aggressive blood and platelet transfusion, median arterial pressure monitoring >85 mmHg, and systematic cerebrospinal fluid drainage).Methods: Between October 2004 and December 2013, 204 endovascular TAAA repairs were performed using custom made devices manufactured with branches and fenestrations to maintain visceral vessel perfusion. Data from all of these procedures were prospectively collected in an electronic database. Early post-operative results in patients treated before (group 1, n ¼ 43) and after (group 2, n ¼ 161 patients) implementation of the modified implantation and peri-operative protocols were compared.Results: Patients in groups 1 and 2 had similar comorbidities (median age at repair 70.9 years [range 65.2e77.0 years]), aneurysm characteristics (median diameter 58.5 mm [range 53e65 mm]), and length of procedure (median 190 minutes [range 150e240 minutes]). The 30 day mortality rate was 11.6% in group 1 versus 5.6% in group 2 (p ¼ .09). The SCI rate was 14.0% versus 1.2% (p < .01). If type IV TAAAs were excluded from this analysis, the SCI rate was 25.0% (6/24 patients) in group 1 versus 2.1% (2/95 patients) in group 2 (p < .01). Conclusion:The early restoration of arterial flow to the pelvis and lower limbs, and aggressive peri-operative management significantly reduces SCI following type IeIII TAAA endovascular repair. With the use of these modified protocols, extensive TAAA endovascular repairs are associated with low rates of SCI.

Well-defined dopamine end-functionalized polymers were synthesized by employing the reversible addition–fragmentation chain transfer (RAFT) polymerization technique. tert-Butyl acrylate, N-isopropylacrylamide, and styrene monomers were polymerized in the presence of azobis (isobutyronitrile) and a new catechol-based biomimetic RAFT agent incorporating a trithiocarbonate unit. All RAFT polymerizations exhibited pseudofirst-order kinetics, a linear increase of the number-average molar mass (M n SEC) with conversion and narrow molar mass distributions (polydispersity <1.2). The resulting homopolymers exhibited the electroactive catechol and the ω-trithiocarbonyl end groups. Subsequent immobilization of dopamine end-functionalized polymers on titanium surfaces was monitored by using a surface plasmon resonance (SPR) sensor, and the resulting films were characterized by contact angle, infrared ATR spectroscopy, atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS).

In this study, EVAR was found to be equal to OSR in terms of 30 day and 1 year mortality. However, EVAR was associated with less severe complications and less consumption of hospital resources than OSR.

Purpose: To determine any difference between bare metal stents (BMS) and balloon-expandable covered stents in the treatment of innominate artery atheromatous lesions. Materials and Methods: A multicenter retrospective study involving 13 university hospitals in France collected 93 patients (mean age 63.2±11.1 years; 57 men) treated over a 10-year period. All patients had systolic blood pressure asymmetry >15 mm Hg and were either asymptomatic (39, 42%) or had carotid (20, 22%), vertebrobasilar (24, 26%), and/or brachial (20, 22%) symptoms. Innominate artery stenosis ranged from 50% to 70% in 4 (4%) symptomatic cases and between 70% and 90% in 52 (56%) cases; 28 (30%) lesions were preocclusive and 8 (9%) were occluded. One (1%) severely symptomatic patient had a <50% stenosis. Demographic characteristics, operative indications, and procedure details were compared between the covered (36, 39%) and BMS (57, 61%) groups. Multivariate analysis was performed to determine relative risks of restenosis and reinterventions [reported with 95% confidence intervals (CI)]. Results: The endovascular procedures were performed mainly via retrograde carotid access (75, 81%). Perioperative strokes occurred in 4 (4.3%) patients. During the mean 34.5±31.2–month follow-up, 30 (32%) restenoses were detected and 13 (20%) reinterventions were performed. Relative risks were 6.9 (95% CI 2.2 to 22.2, p=0.001) for restenosis and 14.6 (95% CI 1.8 to 120.8, p=0.004) for reinterventions between BMS and covered stents. The severity of the treated lesions had no influence on the results. Conclusion: Patients treated with BMS for innominate artery stenosis have more frequent restenoses and reinterventions than patients treated with covered stents.

Complex endovascular repair of postdissection aneurysms is a safe procedure in patients deemed unfit for open surgery. Our experience suggests that close follow-up is mandatory as secondary procedures are frequently required to completely exclude the false lumen.

Today's trainees will be highly exposed to radiation throughout their practice. It is thus compulsory that they undergo dedicated radiation education during their initial training, and regular refresher sessions later. In daily practice, focus on dose reduction and monitoring of patient and staff exposure are mandatory.