Outcomes of Elective and Non-elective Fenestrated-branched Endovascular Aortic Repair for Treatment of Thoracoabdominal Aortic Aneurysms.

OBJECTIVE: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs). BACKGROUND: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described. METHODS: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair. RESULTS: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001). CONCLUSIONS: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment.

Fiber Optic RealShape imaging using upper extremity and transfemoral access for fenestrated-branched endovascular aortic aneurysm repair.

We report our initial experience using Fiber Optic RealShape (FORS), an innovative real-time three-dimensional visualization technology that uses light instead of radiation, to achieve upper extremity (UE) access during fenestrated/branched endovascular aortic aneurysm repair (FBEVAR). An 89-year-old male patient with a type III thoracoabdominal aortic aneurysm, unfit for open aortic repair, underwent FBEVAR. Dual fluoroscopy, intravascular ultrasound, and three-dimensional fusion overlay were used, in addition to FORS. All target artery catheterizations were successfully accomplished using FORS, from UE access, without radiation. Our experience demonstrates that FBEVAR with FORS using UE access can be used for target artery catheterization without radiation.

Comparison of single- and multistage strategies during fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms.

OBJECTIVE: The aim of this study was to compare outcomes of single or multistage approach during fenestrated-branched endovascular aortic repair (FB-EVAR) of extensive thoracoabdominal aortic aneurysms (TAAAs). METHODS: We reviewed the clinical data of consecutive patients treated by FB-EVAR for extent I to III TAAAs in 24 centers (2006-2021). All patients received a single brand manufactured patient-specific or off-the-shelf fenestrated-branched stent grafts. Staging strategies included proximal thoracic aortic repair, minimally invasive segmental artery coil embolization, temporary aneurysm sac perfusion and combinations of these techniques. Endpoints were analyzed for elective repair in patients who had a single- or multistage approach before and after propensity score adjustment for baseline differences, including the composite 30-day/in-hospital mortality and/or permanent paraplegia, major adverse event, patient survival, and freedom from aortic-related mortality. RESULTS: A total of 1947 patients (65% male; mean age, 71 ± 8 years) underwent FB-EVAR of 155 extent I (10%), 729 extent II (46%), and 713 extent III TAAAs (44%). A single-stage approach was used in 939 patients (48%) and a multistage approach in 1008 patients (52%). A multistage approach was more frequently used in patients undergoing elective compared with non-elective repair (55% vs 35%; P < .001). Staging strategies were proximal thoracic aortic repair in 743 patients (74%), temporary aneurysm sac perfusion in 128 (13%), minimally invasive segmental artery coil embolization in 10 (1%), and combinations in 127 (12%). Among patients undergoing elective repair (n = 1597), the composite endpoint of 30-day/in-hospital mortality and/or permanent paraplegia rate occurred in 14% of single-stage and 6% of multistage approach patients (P < .001). After adjustment with a propensity score, multistage approach was associated with lower rates of 30-day/in-hospital mortality and/or permanent paraplegia (odds ratio, 0.466; 95% confidence interval, 0.271-0.801; P = .006) and higher patient survival at 1 year (86.9±1.3% vs 79.6±1.7%) and 3 years (72.7±2.1% vs 64.2±2.3%; adjusted hazard ratio, 0.714; 95% confidence interval, 0.528-0.966; P = .029), compared with a single stage approach. CONCLUSIONS: Staging elective FB-EVAR of extent I to III TAAAs was associated with decreased risk of mortality and/or permanent paraplegia at 30 days or within hospital stay, and with higher patient survival at 1 and 3 years.

Análise do Aprendizado de Suporte Básico de Vida e a Obtenção Prévia da Autorização para Conduzir Veículos / Basic Support of Life Learning Analysis and Previous Obtaining Authorization to Drive

O conhecimento teórico e as habilidades práticas durante o Suporte Básico de Vida (SBV) estão entre os determinantes mais importantes dastaxas de sucesso em situações de emergência, o que ressalta a importância de dedicadas ações educacionais. O objetivo deste estudo foi analisaro aprendizado de acadêmicos do primeiro período de Medicina no treinamento prático do SBV, em imediato e médio prazo e correlacionar coma obtenção prévia da Carteira Nacional de Habilitação (CNH). Método: estudo prospectivo no qual os dados foram obtidos em três momentos,a saber: um questionário (pré-teste) antes do treinamento em SBV, outro, imediatamente após e o último, 21 dias depois. O questionáriocontinha dados demográficos e 15 questões de múltipla escolha sobre o assunto. Foram avaliados 79 alunos, com média de idade de 19,9 (±2,3) anos. Apenas quatro (5,1%) haviam recebido treinamento prévio nos moldes do SBV. A média de acertos no primeiro teste foi de 29,7%.Na avaliação pós-curso, a média de acertos foi 94,1%. Já no terceiro teste, a média de acertos foi de 83,3%. Utilizando o teste t Student paraamostras independentes, não houve diferenças estatísticas entre aqueles que portavam e os que não portavam a CNH (p = 0,3264). Com basena caracterização dos alunos e do desempenho deles nas avaliações, pode-se concluir que o treinamento de SBV demonstrou uma importantequalidade na retenção de aprendizado. Evidenciou-se que portadores da CNH não tiveram resultados estatisticamente superiores aos que não apossuíam quanto aos conhecimentos adquiridos previamente ao treinamento.

The theory and practical skills during Basic Life Support (BLS) are among the most important determinants of success rates during emergencies,which emphasizes the importance of dedicated educational activities. The objective of this study is analyze the learning skills of the first periodmedical academics in practical training of BLS from now and medium term and inquire about the prior achievement of National Driver?sLicense. Method: prospective study in which data were obtained from three moments: a questionnaire (pre-test) done before the course, theother immediately after the course and the final, 21 days later. In the questionnaire there were students? data and 15 multiple choice questionsabout BLS. The total of 79 students were evaluated, with average of 19.88 (± 2.28) years old. Only four (5.06%) had received prior training inSBV models. The average rate in the first test was 29.7%. In the immediate post-test, the average rate was 94.06%. In the second post-test, theaverage rate was 83.33%. Using the t student?s test for independent samples, there were no statistical differences between the group that hadthe National Driver?s License and those who did not (p = 0.3264). Based on the students characters and their performance on the tests, it canbe concluded that the BLS training demonstrated an important quality of learning. It became clear that carriers of National Driver?s Licensehad no statistically better results than those who do not own it concerning the knowledge acquired before training.