Lymphangiography, thoracic duct embolization and thoracic duct disruption are successful interventional strategies in children with chylothorax and should be considered as viable treatment options at any age.

Elective abdominal aortic aneurysm (AAA) repair is recommended for aneurysms greater than 5.5 cm, symptomatic, or rapidly expanding more than 0.5 cm in 6 months. Seventy-five percent of AAAs today are treated with endovascular aneurysm repair (EVAR) rather than open repair. This is fostered by the lower periprocedural mortality, complications, and length of hospital stay associated with EVAR. However, some studies have demonstrated EVAR to result in higher reintervention rates than with open repair, largely due to endoleaks. Type II is the most common, making up 10-25% of all endoleaks. Type II endoleaks, can potentially enlarge and pressurize the aneurysm sac with a risk of rupture. However, many type II endoleaks spontaneously resolve or never lead to sac enlargement. Imaging surveillance and approaches to management of type II endoleaks are reviewed here.

No abstract

No abstract

Thrombosis of the inferior vena cava and iliac veins, known as iliocaval thrombosis, is a common cause of significant morbidity. Patients with chronic iliocaval obstruction often present with life-limiting occlusive symptoms secondary to recurrent lower extremity deep venous thrombosis, swelling, pain, venous stasis ulcers, or phlegmasia. Endovascular iliocaval reconstruction is a technically successful procedure that results in favorable clinical outcomes and stent patency rates with few complications and is often able to relieve debilitating symptoms in affected patients. This review presents an approach to endovascular iliocaval stent reconstruction in patients suffering from chronic iliocaval thrombosis, including background, patient selection, timing of intervention, procedural steps, technical considerations, patient follow-up, and a brief review of outcomes. Schematic illustrations and clinical cases outlining iliocaval stent reconstruction and crossing chronic venous occlusions have been provided.

No abstract

The multiobjective simulation optimization (MOSO) problem is a nonlinear multiobjective optimization problem in which multiple simultaneous and conflicting objective functions can only be observed with stochastic error. We provide an introduction to MOSO at the advanced tutorial level, aimed at researchers and practitioners who wish to begin working in this emerging area. Our focus is exclusively on MOSO methods that characterize the entire efficient or Pareto-optimal set as the solution to the MOSO problem; later, this set may be used as input to the broader multicriteria decision-making process. Our introduction to MOSO includes an overview of existing theory, methods, and provably convergent algorithms that explicitly control sampling error for (1) MOSO on finite sets, called multiobjective ranking and selection; (2) MOSO with integer-ordered decision variables; and (3) MOSO with continuous decision variables. In the context of integer-ordered and continuous decision variables, we focus on methods that provably converge to a local efficient set under the natural ordering. We also discuss key open questions that remain in this emerging field.

No abstract