ABSTRACT
Fatigue is a material-based phenomenon playing a significant role in the mechanical behavior of components and structures. Although fatigue has been well studied for traditional materials, such as metals, its underlying mechanisms are not thoroughly understood in novel applications such as the case of textiles used as patches to close the arteriotomy in carotid endarterectomy. The latter is a type of vascular surgery for the treatment of carotid artery disease in which after an arteriotomy and removal of atherosclerotic plaque closure is made with a patch sutured on the artery. Completion of the operation signals the initiation of complex mechanical and hemodynamic phenomena. Fatigue performance of the patch eventually determines the successful outcome of carotid endarterectomy. In this study, we evaluate with a two-fold approach the mechanics of patch angioplasty in carotid endarterectomy. First, an analytical model for the fatigue behavior of textiles is developed, considering the microstructure and geometry of the fabric. Then, the surgical procedure is simulated and a finite element analysis of the endarterectomized and patched carotid artery is employed. Stress fields are calculated, while deformation at the site of patch angioplasty indicates a potential cause for the formation of aneurismal degeneration after the surgery. Such analysis can provide a better understanding in the establishment of follow-up protocols.
Subject(s)
Carotid Artery Diseases , Endarterectomy, Carotid , Angioplasty , Carotid Arteries/surgery , Humans , TextilesSubject(s)
Brain Ischemia/drug therapy , Drug Resistance , Platelet Aggregation Inhibitors/therapeutic use , Stroke/drug therapy , Brain Ischemia/blood , Brain Ischemia/diagnosis , Humans , Platelet Aggregation Inhibitors/adverse effects , Platelet Function Tests , Risk Factors , Stroke/blood , Stroke/diagnosis , Time Factors , Treatment OutcomeSubject(s)
Carotid Artery Diseases/surgery , Endarterectomy, Carotid/adverse effects , Hematoma/surgery , Hemostatic Techniques/instrumentation , Staphylococcal Skin Infections/etiology , Surgical Mesh , Surgical Wound Infection/etiology , Aged , Hematoma/diagnostic imaging , Hematoma/etiology , Humans , Male , Staphylococcal Skin Infections/diagnosis , Staphylococcal Skin Infections/microbiology , Staphylococcal Skin Infections/surgery , Surgical Wound Infection/diagnosis , Surgical Wound Infection/microbiology , Surgical Wound Infection/surgery , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Rupture/therapy , Aged, 80 and over , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Rupture/diagnostic imaging , Blood Vessel Prosthesis Implantation , Humans , Male , Tomography, X-Ray ComputedSubject(s)
Aneurysm/surgery , Saphenous Vein/surgery , Thrombectomy , Venous Thrombosis/surgery , Adult , Aneurysm/diagnosis , Female , Humans , Ligation , Treatment Outcome , Venous Thrombosis/diagnosisSubject(s)
Aneurysm/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Hepatic Artery/surgery , Aneurysm/diagnostic imaging , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/instrumentation , Hepatic Artery/diagnostic imaging , Humans , Male , Middle Aged , Prosthesis Design , Stents , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Accidents, Traffic , Aneurysm, False/surgery , Carotid Artery Injuries/surgery , Carotid Artery, Internal/surgery , Endovascular Procedures , Adult , Aneurysm, False/diagnosis , Aneurysm, False/etiology , Carotid Artery Injuries/diagnosis , Carotid Artery Injuries/etiology , Carotid Artery, Internal/diagnostic imaging , Endovascular Procedures/instrumentation , Humans , Male , Platelet Aggregation Inhibitors/therapeutic use , Prosthesis Design , Stents , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Anticoagulants/therapeutic use , Benzimidazoles/therapeutic use , Morpholines/therapeutic use , Pyrazoles/therapeutic use , Pyridines/therapeutic use , Pyridones/therapeutic use , Secondary Prevention , Thiazoles/therapeutic use , Thiophenes/therapeutic use , Venous Thromboembolism/drug therapy , beta-Alanine/analogs & derivatives , HumansABSTRACT
AIM: Venous training in Europe is lacking a formal curriculum among various specialties related to management of venous diseases. We conducted a survey in order to have a snapshot on the actual education and training level among physicians practicing currently venous surgery and phlebology in Europe. METHODS: From April 7, 2014 to June 11, 2014 a survey was carried out using the Survey Monkey system, including 11 main questions covering all the domains of training and education in venous surgery and phlebology. The questionnaire was sent to all physicians included in the current mailing list of the European Venous Forum (EVF) and the Mediterranean League of Angiology and Vascular Surgery. Two questions were particularly addressed to those physicians who had attended the EVF hands-on workshop (HOW) at least once. RESULTS: The response rate was 24% (97/400) and 51.5% of them were practicing in a hospital service. Most responders were vascular surgeons (67.7%), followed by angiologists (19.4%). Only half of the responders felt as being competent to manage the whole spectrum of venous diseases successfully after completion of their training, while a few were able to perform endovenous ablations and even less more advanced venous interventions. Formal training in Duplex ultrasound was undertaken only in 55.2%. The majority suggested that a venous training program should be a separate part of their specialty rotation and should be organized at a national or European level, or even by a specific scientific society. Over 95% of those physicians who already participated in the EVF HOW considered the knowledge they acquired there as useful for their practice. CONCLUSION: There is currently an important need for more specialized venous training for all physicians involved in the diagnosis and management of venous diseases. Therefore all local, national and international initiatives should be encouraged to improve education in this field.