3D printing in the endovascular treatment of visceral artery aneurysms.

Visceral artery aneurysms (VAAs) are vascular pathologies that are difficult to treat. The variable geometry of the vessels and the location of aneurysms render difficult their evaluation in radiological imaging studies. Less invasive endovascular procedures are increasingly used in common practice. Our aim was to test the feasibility of using 3D printing technology in the preparation of preoperative spatial models of visceral artery aneurysms and their impact on interventional treatment. In our observational study, we examined a group of patients with true aneurysms of the visceral arteries who were followed and who underwent endovascular procedures with the use of 3D prints for better imaging of vascular lesions. We analyzed the fused filament fabrication method of 3D printing and printable materials in the preparation of spatial vascular models. We confirmed that more accurate visualization and analysis of vascular anatomy could assist operators in attempting minimally invasive treatment with good results. Extending imaging studies using 3D printing models that allow for the assessment of the position, morphology and geometry of the aneurysm sac, particularly of vessel branches, could encourage surgeons to perform endovascular procedures.

3D printing in the preoperative planning and endovascular treatment of splenic artery aneurysm. Own clinical experience and literature review.

Splenic artery aneurysms (SAAs) are the most common visceral aneurysms. Endovascular treatment of SAAs is increasingly used. Appropriate preoperative imaging of aneurysms is crucial to treatment planning. The case of a patient with accidentally detected SAA on angio-CT examination was the basis for implementation of 3D printing to prepare an artery model. The 3D model made it easier to qualify for endovascular treatment of the SAA and helped to visualize its morphology. An excellent treatment effect was achieved. 3D printing provides an opportunity for better visualization of SAA anatomy, which has a direct impact on the choice of minimally invasive treatment method.

Brachiocephalic Vein Stenting and Body-Floss Technique as a Treatment of CVD in Dialysis-Dependent Patient - Case Report and Literature Review.

BACKGROUND: Given the increasing number of elderly hemodialysis-dependent patients with concomitant chronic diseases the successful creation and maintenance of reliable vascular access become a real challenge. In current literature central vein disease (CVD) is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava (SVC), brachiocephalic (BCV), subclavian (SCV) and internal jugular vein (IJV). The incidence of CVD has been reported to be as high as 23% in the total dialysis population and 41% in those with access related complains. CASE REPORT: 61-year-old man has been admitted to the local radiology department with symptoms of the superior vena cava syndrome. The venography revealed occlusion of the right brachiocephalic vein. Due to Tortuosity and lack of stamp of right subclavian vein contributed to the decision to perform recanalization by "body floss" technique. In a further step we have performed PTA of obstructed vein segment using 7×40 mm balloon. Due to the presence of residual stenosis it was decided to implant two self - expanding stents 10×40 mm. After the procedure the patient was discharged in good condition and transferred to dialysis center. CONCLUSIONS: Main objective was the salvage of a functioning arteriovenous fistula. Performed endovascular intervention is a safe and effective approach to correct CVD for a short term. To ensure long lasting effects the patient will require enhanced follow-up and inevitable reinterventions. For that matter, prevention of CVD remains critical.

Mechanical thrombectomy using Rotarex system and stent-in-stent placement for treatment of distal femoral artery occlusion secondary to stent fracture - a case report and literature review.

BACKGROUND: Treatment of peripheral arterial diseases may be distinguished into conservative and interventional management; the latter is divided into surgical and endovascular procedures. Management of peripheral artery stenosis and occlusion with vascular stents is associated with the risk of late complications such as restenosis, stent fracture or dislocation. CASE REPORT: A 62-year-old woman with generalized atherosclerosis, particularly extensive in lower limb arteries, was admitted to the Department of Angiology 11 months after having an endovascular procedure performed due to critical ischemia of left lower limb. Because of stent occlusion, a decision to perform angiographic examination of lower limb arteries was made. Examination revealed occlusion of the superficial femoral artery along its entire length, including previously implanted stents. Distal stent was fractured with slight dislocation of the proximal segment. A decision was made to perform mechanical thrombectomy using a Rotarex system followed by a stent-in-stent placement procedure. Follow-up angiography and ultrasound scan performed 24 hours after the procedure revealed a patent vessel with satisfactory blood flow. DISCUSSION: Nowadays, imaging diagnostics of peripheral artery stenosis involves non-invasive examinations such as ultrasound, minimally invasive examinations such as angio-MRI and MDCT, or invasive examinations such as DSA and IVUS. DSA examinations are used to confirm significant stenosis or occlusion of a vessel, particularly when qualifying a patient for endovascular treatment. Due to their anatomic location, the superficial femoral artery and the popliteal artery are subject to various forces e.g. those exerted by the working muscles. Mechanical thrombectomy and atherectomy are efficient methods of arterial recanalization used in the treatment of acute, subacute or even chronic occlusions or stenosis of peripheral vessels. CONCLUSIONS: Frequency of angioplasty and vascular stent implantation procedures is increased in patients with peripheral arterial disease, thus increasing the incidence of reported early and late complications such as acute stent thrombosis, restenosis and stent fractures. The Rotarex transcutaneous mechanical thrombectomy system is an efficient method of treating occlusions in arterial stents. It is also safe when performed by experienced operators.

[Dual source computed tomography in analysis of significance and morphology carotid plaques]. / Dwuzródlowa wielorzedowa tomografia komputerowa w ocenie morfologii i istotnosci blaszek miazdzycowych tetnic szyjnych.

One of the most common causes of stroke is carotid atherosclerosis, stroke affects about 60 thousand Polish people each year and about 27% of them die within a year. About 72%-86% are ischemic strokes, whereas intracerebral or subarachnoid haemorrhages account for about 9-18% of strokes. Stroke is the third most common cause of death worldwide, after heart disease and cancer, and the most often cause of chronic disability in people over 40. Carotid atherosclerosis is one of the most important stroke risk factors. The degree of stenosis is a standard parameter usually used in risk assessment. It was shown that patients with stenosis greater than 70% undergoing endarterectomy achieve the best results in reducing the risk of stroke compared with pharmacotherapy. However, it was found that in the general population of people over 64 the stenosis greater than 70% occurred in 10% of patients, while changes below 70% were very common and appeared in 70% of men and 60% of women. For this reason, the importance of atherosclerotic plaque morphology in the risk assessment is growing. Histopathological and ultrasound (intravascular ultrasound) morphological changes in the composition of the atherosclerotic plaque lead to the creation of the vulnerable plaque concept. Stroke risk seems to be connected with certain morphological features of the plaque, such as thin fibrous cap, lipid core, or ulceration. Ulceration is especially important, as 30% of those patients develop neurological symptoms within 2 years. On the other hand strong plaque calcification, particularly superficial, appears to pose lower risk. Ultrasound imaging of carotid arteries is currently the most widely used non-invasive diagnostic method for detecting and assessing the extent of carotid atherosclerosis. However, apart from undeniable advantages it also has its limitations such as the scope of the imaging and lower sensitivity and specificity in the evaluation of carotid stenosis in relation to magnetic resonance imaging and computed tomography (CT) as showed in metaanalyses from multicenter research (e.g. Chapel et al. metaanalysis). Previous studies using CT demonstrated the suitability of this method in the evaluation of morphology and significance of carotid arteries stenosis. Recent introduction of dual source multidetector computed tomography (DSCT) is a next technological step increasing the usefulness of CT in the assessment of plaque morphology. Due to simultaneous operation of 2 lamps the DSCT uses two concurrent X-ray sources (80 kv and 80 kV or 120 kV or 140 kV) to obtain different radiation absorption coefficients for a given tissue (in Hounsfield units). This allows for better tissue differentiation and advanced image processing, e.g. easy removal of bone parts for better visualization of vascular areas. This method also facilitates more accurate visualization of the lipid core and ulcerations. However, it should be emphasized that still relatively low spatial resolution of this method (0.6 mm) is a serious limitation to an accurate analysis of small structures, such as the components of the atherosclerotic plaque. Therefore, further comparative studies with other invasive diagnostic methods are necessary to improve the imaging protocols.

Aortoesophageal fistula as a complication of thoracic aorta aneurism stent grafting - a case report and literature review.

BACKGROUND: Endovascular stent grafting is performed in patients with aneurysms of aorta or other major vessels. The procedure is considered to be generally safe, with a low risk of complications, the most common of which include endoleaks, stenosis or thrombosis at the stagraft and itsmigration. Very rare complications include aortoesophageal and aortobronchial fistulas (0.5-1.7% cases). CASE REPORT: A 64-year-old patient was admitted to our hospital with suspected aortoesophageal fistula. Two years prior, the patient had undergone a stent graft repair of the thoracic aorta at the local vascular surgery clinic. Both laboratory results and CT angiography revealed aortoesophageal fistula, which was also detected in endoscopic examination. Despite intensive treatment and preparation for surgery, the patient died 6 days after admission. CONCLUSIONS: Aortoesophageal and aortobronchial fistulas are among the most dangerous and difficult-to-treat complications in the treatment of thoracic aortic aneurysms by endovascular stent-grafting. This clearly indicates that preventive care and regular medical examinations are important to prevent their occurrence.