Search

Introduction: Fenestrated branched endovascular aortic repair with custom manufactured devices (CMDs) has been applied to treat post-dissection thoraco-abdominal aortic aneurysms (TAAA), but the long waiting period for device manufacture limits its application in symptomatic or contained ruptured aneurysms. Report: A 59 year old female presented with a 7 cm chronic post-dissection extent II TAAA. The patient underwent first stage total arch repair with the elephant trunk technique. At the time of the initial placement of the thoracic stent graft a fenestration was created in the septum to perfuse the right renal artery, which originated from the false lumen. A second stage procedure was planned with a CMD, but the patient presented with severe chest pain and lower extremity weakness, which was attributed to compression of the true lumen below the renal arteries due to increased flow into a pressurised false lumen. The patient underwent successful repair using a physician modified endograft (PMEG) with four fenestrations and preloaded guidewires. Follow up at 21 months showed no complications and a widely patent stent graft. Discussion: The Zenith Alpha has several advantages over the TX2 platform for modification, notably lower profile fabric and wider Z tents, which provide greater flexibility for the creation of fenestrations or branches. In this case, the creation of a larger fenestration during the first stage procedure probably contributed to pressurisation of the false lumen. PMEGs remain a valuable option for TAAA repair, including chronic post-dissection aneurysms. Their application is particularly useful in symptomatic patients who are not candidates for an off the shelf endograft and cannot wait for a device to be manufactured.

Microplastics (MP) are a global concern due to their small size, insolubility in water, and non-degradable nature, and long-term environmental persistence. Weathering processes, such as ultraviolet (UV) radiation, can alter their properties, enhancing their ability to absorb pollutants or release harmful substances, such as pesticides, which is also an environmental concern, thereby complicating their environmental impact and mitigation efforts. This study investigates the impact of UVB-induced photoaging on polyethylene (PE) microplastics and their sorption behavior towards the pesticide chlorpyrifos (CP). PE microplastics were exposed to varying UVB aging durations, leading to significant changes in their physicochemical and morphological properties. The sorption experiments revealed that aged microplastics exhibited increased affinity for CP, with adsorption capacity rising by 17.9% compared to pristine PE. This enhanced adsorption was attributed to the (1) introduction of oxygen-containing functional groups, facilitating the formation of hydrogen bonds between the microplastic surface and surrounding water molecules, thereby contributing to the adsorption of CP; (2) formation of irregular micropores and surface roughness, potentially providing ample sites for pesticide adsorption and (3) reduction in crystallinity from 35% to 30%, which favors the sorption of hydrophobic organic pollutants. Density Functional Theory (DFT) calculations supported these findings by showing changes in the electronic structure of PE that facilitate interactions with CP. These results provide critical insights into the environmental behavior of aged microplastics and their potential to adsorb hazardous chemicals, underscoring the need for further research on the environmental impact of microplastic aging., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carla Bastos Vidal reports financial support was provided by by National Council for Scientific and Technological Development - CNPq. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The aim of the present study was to assess the effect of obesity on procedural metrics, radiation exposure, quality of life (QOL), and clinical outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of pararenal and thoracoabdominal aortic aneurysms., Methods: We reviewed the clinical data from 334 patients (236 men; mean age, 75 ± 8 years) enrolled in a prospective nonrandomized study to evaluate FB-EVAR from 2013 to 2019. The patients were classified using the body mass index (BMI) as obese (BMI ≥30 kg/m 2 ) or nonobese (BMI <30 kg/m 2 ). QOL questionnaires (short-form 36-item questionnaire) and imaging studies were obtained preoperatively and at 2 months and 6 months postoperatively, and annually thereafter. The procedures were performed using two different fixed imaging systems. The end points included procedural metrics (ie, total operative time, fluoroscopic time, contrast volume), radiation exposure, technical success, 30-day mortality, and major adverse events, QOL changes, freedom from target vessel instability, freedom from reintervention, and patient survival., Results: The aneurysm extent was a pararenal aortic aneurysm in 117 patients (35%) and a thoracoabdominal aortic aneurysm in 217 patients (65%). Both groups had similar demographics, cardiovascular risk factors, and aneurysm extent, except for a greater incidence of hyperlipidemia and diabetes among the obese patients (P < .05). No significant differences were found in the procedural metrics or intraprocedural complications between the groups, except that the obese patients had greater radiation exposure than the nonobese patients (mean, 2.5 vs 1.6 Gy; P < .001), with the highest radiation exposure in those obese patients who had undergone the procedure using system 1 (fusion alone) instead of system 2 (fusion and digital zoom; mean, 4.1 vs 1.5 Gy; P < .001). Three patients had died within 30 days (0.8%), with no difference in mortality or major adverse events between the groups. The mental QOL scores had improved in the obese group at 2 and 12 months compared with the nonobese patients, with persistently higher scores up to 3 years. At 3 years, the obese and nonobese patients had a similar incidence of freedom from target vessel instability (74% ± 6% vs 80% ± 3%; P = .99, log-rank test), freedom from reintervention (66% ± 6% vs 73% ± 4%; P = .77, log-rank test), and patient survival (83% ± 5% vs 75% ± 4%; P = .16, log-rank test)., Conclusions: FB-EVAR was performed with high technical success and low mortality and morbidity, with no significant differences between the obese and nonobese patients. The procedural metrics and outcomes were similar, with the exception of greater radiation exposure among obese patients, especially for the procedures performed using system 1 with fusion alone compared with system 2 (fusion and digital zoom). Obese patients had higher QOL mental scores at 2 and 12 months, with a similar reintervention rate, target vessel outcomes, and survival compared with nonobese patients., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)