44 results on '"Andrew Winterbottom"'
Search Results
2. Life and bladder cancer: protocol for a longitudinal and cross-sectional patient-reported outcomes study of Yorkshire (UK) patients
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Amy Downing, Adam W Glaser, Samantha J Mason, Penny Wright, Sarah E Bottomley, Andrew Winterbottom, and James W F Catto
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Medicine - Abstract
IntroductionLittle is known about the impact of bladder cancer (BC) and its treatments on health-related quality of life (HRQL). To date, most work has been small in scale or restricted to subsets of patients. Life and bladder cancer is a cross-sectional and longitudinal study collecting patient-reported outcomes within two distinct cohorts.Methods and analysisA longitudinal study will collect patient-reported outcomes at 3-monthly intervals from newly diagnosed patients. Eligible cases will be identified by recruiting hospitals and surveyed at baseline, 6, 9 and 12 months postdiagnosis to explore changes in outcomes over time. A separate cross-sectional cohort of patients diagnosed within the last 10 years across Yorkshire will be identified through cancer registration systems and surveyed once to explore longer-term HRQL in BC survivors. A comprehensive patient-reported outcome measure (PROM) has been developed using generic, cancer-specific and BC-specific instruments. The study will provide evidence about how useful these PROMs are in measuring BC patient HRQL. The outcome data will be linked with administrative health data (eg, treatment information from hospital data).Ethics and disseminationThe study has received the following approvals: Yorkshire and the Humber—South Yorkshire Research Ethics Committee (17/YH/0095), Health Research Authority Confidentiality Advisory Group (17/CAG/0054). Results will be made available to patients, funders, NHS Trusts, Clinical Commissioning Groups, Strategic Clinical Networks and other researchers.
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- 2019
- Full Text
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3. Ureteric stones
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Lisa Bibby, Mostafa Sheba, Andrea Lavinio, Andrew Winterbottom, and Oliver Wiseman
- Abstract
This case looks at one of the commonest emergency surgical presentations, ureteric colic. It covers the initial management of such patients in the emergency room, including the evidence behind which analgesia to use and which imaging to undertake. The patient discussed then re-presents with urosepsis, and the discussion centres around management of this, including the options for emergency drainage, with expert comment from an interventional radiology point of view regarding the nephrostomy, and an intensive therapy unit point of view for the identification and management of sepsis. Further management of this patient is with a ureteroscopy, and some of the tips and tricks of ureteroscopy are covered, including the evidence of whether to insert a JJ stent. The case finishes with discussion about metabolic work up and medical management of these patients, who often have a high stone recurrence rate.
- Published
- 2023
4. Percutaneous Cystolitholapaxy Using the LithoClast Trilogy for Multiple Bladder Stones
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Kasra Saeb-Parsy, Oliver Wiseman, Matthew H V Byrne, Andrew Winterbottom, and Laurian Dragos
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medicine.medical_specialty ,Percutaneous ,business.industry ,Urology ,030232 urology & nephrology ,Large bladder ,Case Reports ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,03 medical and health sciences ,Neck of urinary bladder ,Cystolitholapaxy ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,In patient ,Bladder stones ,business - Abstract
Background: Multiple large bladder calculi are traditionally managed through open cystolithotomy or transurethrally in patients who have an open bladder neck. Open procedures are technically challenging in patients who may have had multiple previous open surgeries, and may be associated with significant morbidity in patients with a high comorbid burden. Therefore, a percutaneous approach to such stones has been used especially when there is a closed bladder neck, and has been shown to be effective. There are a number of available devices for breaking stones in these approaches, the newest of which is the LithoClast Trilogy™ (EMS, Nyon, Switzerland) device, a probe that provides ultrasonic and mechanical calculi fragmentation and suction in a single instrument. Case Presentation: We describe the first reported case of percutaneous cystolitholapaxy using the LithoClast Trilogy device in a 41-year-old woman with spina bifida, and multiple large bladder calculi with a history of ileocystoplasty and Mitrofanoff formation, and a bladder neck closure for neuropathic bladder. The calculi measured 31 and 25 mm, and had a volume of 19.6 and 7.9 cm(3) and average HU of 408 and 462, respectively. The calculi were composed of 37% calcium phosphate and 63% magnesium ammonium phosphate. Conclusion: We demonstrate that this approach can be used as a viable alternative to open surgery, which is of particular importance for complex patients who have undergone multiple previous open operations, and who may have a high comorbid burden.
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- 2020
5. 'Case of the Month' from Cambridge University, UK: managing intractable bleeding from a 375 cc prostate in an anti-coagulated patient
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Brendan Koo, Anne Y. Warren, Samih Al-Hayek, Tevita Aho, and Andrew Winterbottom
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Dalteparin ,Leiomyosarcoma ,Male ,medicine.medical_specialty ,business.industry ,Urology ,General surgery ,MEDLINE ,Prostate ,Anticoagulants ,Prostatic Neoplasms ,Organ Size ,Shock, Hemorrhagic ,Embolization, Therapeutic ,medicine.anatomical_structure ,medicine ,Humans ,Diagnostic Errors ,business ,Erythrocyte Transfusion ,Pulmonary Embolism ,Therapeutic Irrigation ,Aged ,Hematuria - Published
- 2020
6. Progressive Device Failure at Long Term Follow Up of the Nellix EndoVascular Aneurysm Sealing (EVAS) System
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Patrick A. Coughlin, Tasneem Pope, Kapila S. Benaragama, Jonathan R. Boyle, Andrew Winterbottom, Seamus C. Harrison, and Aminder A. Singh
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Adult ,Male ,medicine.medical_specialty ,Long term follow up ,medicine.medical_treatment ,Bowel ischaemia ,030204 cardiovascular system & hematology ,030230 surgery ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,Foreign-Body Migration ,Median follow-up ,medicine ,Humans ,Device failure ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Stent ,Middle Aged ,medicine.disease ,Thrombosis ,Abdominal aortic aneurysm ,Surgery ,Blood Vessel Prosthesis ,Prosthesis Failure ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objective High rates of midterm failure of the Nellix EndoVascular Aneurysm Sealing (EVAS) System resulted in device withdrawal from the UK market. The study aim was to report long term Nellix EVAS outcomes and management of a failing device. Methods A retrospective review of EVAS procedures at a tertiary unit was performed. Device failure was defined as a triad of stent migration, stent separation, and secondary sac expansion, or any intervention for type 1 endoleak, device rupture, or explant. Results 161 (male n = 140, female n = 21) patients with a median follow up of 6.0 (IQR 5.0–6.6) years were included. Freedom from all cause mortality estimate at six years was 41.5%. There were 70 (43.5%) device failures with a freedom from device failure estimate at six years of 32.3%. Failure was the result of sac expansion (n = 41), caudal stent migration (n = 36), stent separation (n = 26), and secondary AAA rupture (n = 15). A substantial number of type 1 endoleaks was present (1a n = 33, 1b n = 11), but the type 2 endoleak rate was low at 3.7%. Some 36 (22.4%) patients required re-intervention. Twenty-one patients underwent explant with no 30 day deaths. Six patients underwent Nellix-in-Nellix application (NINA) with one early death from bowel ischaemia and one patient who died later from non-aneurysm related cause. Two NINA patients have ongoing sac expansion and two have had thrombosis of a Nellix limb or visceral stent. Proximal embolisation was only successful in one of six cases. Conclusion The long term failure rate of Nellix EVAS is high. All patients with a device must be informed and be enrolled in enhanced surveillance. EVAS explant is an acceptable technique with favourable outcomes. Management by open explant, if the patient is fit, should be considered early and offered to those with device failure.
- Published
- 2020
7. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial
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John D. Chester, Anthony Blacker, Mark Johnson, Thomas Powles, David Dolling, Satinder Jagdev, Andrew Winterbottom, Alison Birtle, Chris Harris, Paul Anthony Elliott, John Wagstaff, Richard T. Bryan, Robert Jones, Rebecca Lewis, Emma Hall, Francis X. Keeley, Caroline Wilson, Rachel Todd, Benjamin Jenkins, Ann French, James W.F. Catto, Jenny L Donovan, Prabir Chakraborti, and Roger Kockelbergh
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Adult ,Male ,medicine.medical_specialty ,Urologic Neoplasms ,medicine.medical_treatment ,Antineoplastic Agents ,030204 cardiovascular system & hematology ,Deoxycytidine ,Article ,Disease-Free Survival ,law.invention ,Carboplatin ,03 medical and health sciences ,chemistry.chemical_compound ,Rare Diseases ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Humans ,030212 general & internal medicine ,Adverse effect ,Aged ,Aged, 80 and over ,Chemotherapy ,Carcinoma, Transitional Cell ,business.industry ,Hazard ratio ,Combination chemotherapy ,General Medicine ,Reference Standards ,Middle Aged ,Chemotherapy regimen ,Gemcitabine ,Clinical trial ,chemistry ,Chemotherapy, Adjuvant ,Administration, Intravenous ,Female ,Cisplatin ,business - Abstract
Background:\ud Urothelial carcinomas of the upper urinary tract (UTUCs) are rare, with poorer stage-for-stage prognosis than urothelial carcinomas of the urinary bladder. No international consensus exists on the benefit of adjuvant chemotherapy for patients with UTUCs after nephroureterectomy with curative intent. The POUT (Peri-Operative chemotherapy versus sUrveillance in upper Tract urothelial cancer) trial aimed to assess the efficacy of systemic platinum-based chemotherapy in patients with UTUCs.\ud \ud Methods:\ud We did a phase 3, open-label, randomised controlled trial at 71 hospitals in the UK. We recruited patients with UTUC after nephroureterectomy staged as either pT2–T4 pN0–N3 M0 or pTany N1–3 M0. We randomly allocated participants centrally (1:1) to either surveillance or four 21-day cycles of chemotherapy, using a minimisation algorithm with a random element. Chemotherapy was either cisplatin (70 mg/m2) or carboplatin (area under the curve [AUC]4·5/AUC5, for glomerular filtration rate
- Published
- 2020
8. Branched Thoraco-Abdominal Aortic Aneurysm Repair with Branch Access Through a Transapical Left Ventricular Approach
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Serena Goon, Amir Helmy, Pedro Catarino, John Dunning, Paul D. Hayes, and Andrew Winterbottom
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medicine.medical_specialty ,Heart Ventricles ,Carotid arteries ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,Left ventricular apex ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Thoracic aorta ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Access route ,Percutaneous aortic valve replacement ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Diaphragm (structural system) ,Treatment Outcome ,030228 respiratory system ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Branched thoracic aortic aneurysm repair requires arterial access from above the diaphragm in order to insert the visceral branches. This is routinely performed from the subclavian, axillary or carotid arteries and less commonly direct thoracic aorta puncture. The left ventricular apex is an alternative access route which is commonly used for percutaneous aortic valve replacement and rarely used for EVAR, FEVAR and TEVAR access. Here we describe two patients for which the left ventricular apex was the most suitable available access to the visceral branches during a branched thoracic aortic aneurysm repair. This access should be considered as an alternative approach if conventional arterial access is not available.
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- 2018
9. Editor's Choice – Occurrence and Classification of Proximal Type I Endoleaks After EndoVascular Aneurysm Sealing Using the Nellix™ Device
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Leo H. van den Ham, Andrew Holden, Janis Savlovskis, Andrew Witterbottom, Kenneth Ouriel, Michel M.P.J. Reijnen, Leo van den Ham, Michel Reijnen, Dainis Krievins, Andrew Winterbottom, Paul Hayes, Jan Heyligers, Dittmar Böckler, Jean-Paul de Vries, Sebastian Zerwes, Rudi Jakob, Marwan Youssef, Patrick Berg, Roland Stroetges, Alexander Oberhuber, Eric Zimmermann, Michelangelo Ferri, and Jorg de Bruin
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Male ,medicine.medical_specialty ,Endoleak ,medicine.medical_treatment ,Technical success ,Early detection ,Computed tomography ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,Risk Factors ,Humans ,Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Endovascular Procedures ,Stent ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,Female ,Core laboratory ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Objective/Background Proximal type I endoleaks are associated with abdominal aortic aneurysm (AAA) growth and rupture and necessitate repair. The Nellix™ EndoVascular Aneurysm Sealing (EVAS) system is a unique approach to AAA repair, where the appearance and treatment of endoleaks is also different. This study aimed to analyse and categorise proximal endoleaks in an EVAS treated cohort. Methods All patients, treated from February 2013 to December 2015, in 15 experienced EVAS centres, presenting with proximal endoleak were included. Computed tomography scans were analysed by a core laboratory. A consensus meeting was organised to discuss and qualify each case for selection, technical aspects, and possible causes of the endoleak. Endoleaks were classified using a novel classification system for EVAS. Results During the study period 1851 patients were treated using EVAS at 15 centres and followed for a median of 494 ± 283 days. Among these, 58 cases (3.1%) developed a proximal endoleak (1.5% early and 1.7% late); of these, 84% of 58 patients were treated outside the original and 96% outside the current, refined, instructions for use. Low stent positioning was the most likely cause in 44.6%, a hostile anatomy in 16.1%, and a combination of both in 33.9%. Treatment, by embolisation or proximal extension, was performed in 47% of cases, with a technical success of 97%. Conclusion The overall incidence of proximal endoleak after EVAS is 3.1% after a mean follow-up period of 16 months, with 1.5% occurring within 30 days. Their occurrence is related to patient selection and stent positioning. Early detection and classification is crucial to avoid the potential of sac rupture.
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- 2017
10. Peripheral Non-atherosclerotic Arterial Disorders
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Tariq Ali, Andrew Winterbottom, and Miltiadis Krokidis
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medicine.medical_specialty ,Heterogeneous group ,Adverse outcomes ,business.industry ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Peripheral ,03 medical and health sciences ,Cystic adventitial disease ,0302 clinical medicine ,Need to know ,Radiological weapon ,Arterial Disorder ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Intensive care medicine ,business - Abstract
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.
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- 2017
11. Evaluation of velocity-sensitized and acceleration-sensitized NCE-MRA for below-knee peripheral arterial disease
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Andrew Winterbottom, Teik Choon See, Martin J. Graves, David J. Lomas, Nadeem Shaida, and Andrew N. Priest
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medicine.medical_specialty ,medicine.diagnostic_test ,Arterial disease ,Vascular disease ,business.industry ,Image enhancement ,medicine.disease ,Arterial tree ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,Peripheral ,03 medical and health sciences ,0302 clinical medicine ,McNemar's test ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Reference standards ,030217 neurology & neurosurgery - Abstract
Purpose To evaluate the diagnostic performance of velocity- and acceleration-sensitized noncontrast-enhanced magnetic resonance angiography (NCE-MRA) of the infrageniculate arteries using contrast-enhanced MRA (CE-MRA) as a reference standard. Materials and Methods Twenty-four patients with symptoms of peripheral arterial disease were recruited. Each patient's infrageniculate arterial tree was examined using a velocity-dependent flow-sensitized dephasing (VEL-FSD) technique, an acceleration-dependent (ACC-FSD) technique, and our conventional CE-MRA technique performed at 1.5T. The images were independently reviewed by two experienced vascular radiologists, who evaluated each vessel segment to assess visibility, diagnostic confidence, venous contamination, and detection of pathology. Results In all, 432 segments were evaluated by each of the three techniques by each reader in total. Overall diagnostic confidence was rated as moderate or high in 98.5% of segments with CE-MRA, 92.1% with VEL-FSD, and 79.9% with ACC-FSD. No venous contamination was seen in 96% of segments with CE-MRA, 72.2% with VEL-FSD, and 85.8% with ACC-FSD. Per-segment, per-limb, and per-patient sensitivities for detecting significant stenotic disease were 63.4%, 73%, and 92%, respectively, for ACC-FSD, and 65.3%, 87.2%, and 96% for VEL-FSD, and as such no significant statistical change was detected using McNemar's chi-squared test with P-values of 1.00, 0.13, and 0.77 obtained, respectively. Conclusion Flow-dependent NCE-MRA techniques may have a role to play in evaluation of patients with peripheral vascular disease. Increased sensitivity of a velocity-based technique compared to an acceleration-based technique comes at the expense of greater venous contamination. Level of Evidence: 2J. Magn. Reson. Imaging 2016.
- Published
- 2016
12. Use of heparin coated vascular stents in femoropopliteal chronic total occlusions: Long term outcomes
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Brendan Koo, Andrew Winterbottom, Nicholas J Hilliard, Nadeem Shaida, Ahmet Peker, Miltiadis Krokidis, and Baven Balendran
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Diabetes mellitus ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Popliteal Artery ,Prospective Studies ,Adverse effect ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Heparin ,Stent ,Anticoagulants ,Retrospective cohort study ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Vascular stent ,Femoral Artery ,Treatment Outcome ,Amputation ,030220 oncology & carcinogenesis ,Chronic Disease ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Purpose To evaluate the long-term clinical efficacy of the Tigris © stent (Gore ©) in femoropopliteal chronic total occlusions (CTOs). Material and methods This single centre retrospective study included 29 patients treated with 47 Tigris© stents for CTOs. Lesion location, type, length, revascularisation method, smoking status and diabetes were reviewed. Clinical follow-up was performed. Primary safety points were complications and adverse events. Secondary efficacy points were symptom deterioration, freedom from target lesion revascularization (TLR) and amputation rate. Freedom from TLR was evaluated with Kaplan-Meier analysis; Cox multivariable logistic regression analysis of the factors associated with stent re-occlusion was also performed. Results All procedures were technically successful without any peri- or post-procedural complications and adverse events. Median follow-up was 48 months (range: 7–70). Lesions were located in the superficial femoral (19), popliteal (3) and femoropopliteal (7) arteries with mean lesion length 13.9 ± 7.6 cm. In 12 patients subintimal recanalization was performed. Freedom from TLR rates at 6, 12, 18, 24 and 36 months were 96.6 %, 85.7 %, 81.9 %, 78.2 % and 74.3 % respectively. No stent fracture was observed and no amputation was performed in any of the patients. Smoking status, the presence of diabetes, lesion localization and recanalization type were not associated with stent re-occlusion. Conclusion This study demonstrated that use of a heparin coated vascular stent for femoropopliteal CTOs appears to offer satisfactory long-term results.
- Published
- 2019
13. Appearance of the Nellix endoprosthesis on postoperative imaging: implications for patient and device surveillance
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N.J. Hilliard, Andrew Winterbottom, and P. Hayes
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Diagnostic Imaging ,medicine.medical_specialty ,Endoleak ,Computed Tomography Angiography ,medicine.medical_treatment ,Computed tomography ,030204 cardiovascular system & hematology ,Prosthesis Design ,Aortography ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Temporal change ,Ultrasonography, Doppler, Color ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Ultrasound ,Stent ,Magnetic resonance imaging ,Blood Vessel Prosthesis ,Image evaluation ,Contrast medium ,Treatment Outcome ,Plain radiography ,Stents ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Aortic Aneurysm, Abdominal - Abstract
The Nellix stent graft has novel features that influence interpretation of imaging follow-up, in particular, the use of endobags that seal the aneurysm sac. The polymer within the endobags contains a small amount of contrast medium, which causes a predictable temporal change in appearances. Understanding of these features allows correct image evaluation. In this article, we review the appearance of Nellix on computed tomography, ultrasound, magnetic resonance imaging, and plain radiography. We describe the special considerations that are important to consider when reviewing imaging, including endobag position and seal, endobag configuration, endobag and polymer maturation, and endobag gas. Detection of complications is discussed, with suggestion of a follow-up protocol based on the authors' experience.
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- 2016
14. Imaging After Nellix Endovascular Aneurysm Sealing
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Janis Savlovskis, Paul D. Hayes, Michel M.P.J. Reijnen, Matt M. Thompson, Jean-Paul P.M. de Vries, Andrew Holden, Jeffrey P. Carpenter, Dainis Krievins, Andrew Winterbottom, Leo H. van den Ham, Dittmar Böckler, and Andrew Hill
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Diagnostic Imaging ,medicine.medical_specialty ,Consensus ,Time Factors ,Aortography ,Endoleak ,Investigational device exemption ,030204 cardiovascular system & hematology ,Prosthesis Design ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Predictive Value of Tests ,Blood vessel prosthesis ,otorhinolaryngologic diseases ,medicine ,Medical imaging ,Humans ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Doppler, Duplex ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Reproducibility of Results ,Vascular System Injuries ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Treatment Outcome ,Stents ,Surgery ,sense organs ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Aortic Aneurysm, Abdominal - Abstract
Endovascular aneurysm sealing (EVAS) using the Nellix system is a new and different method of abdominal aortic aneurysm repair. Normal postoperative imaging has unique appearances that change with time; complications also have different and specific appearances. This consensus document on the imaging findings after Nellix EVAS is based on the collective experience of the sites involved in the Nellix EVAS Global Forward Registry and the US Investigational Device Exemption Trial. The normal findings on computed tomography (CT), duplex ultrasound, magnetic resonance imaging, and plain radiography are described. With time, endobag appearances change on CT due to contrast migration to the margins of the hydrogel polymer within the endobag. Air within the endobag also has unique appearances that change over time. Among the complications after Nellix EVAS, type I endoleak usually presents as a curvilinear area of flow between the endobag and aortic wall, while type II endoleak is typically small and usually occurs where an aortic branch artery lies adjacent to an irregular aortic blood lumen that is not completely filled by the endobag. Procedural aortic injury is an uncommon but important complication that occurs as a result of overfilling of the endobags during Nellix EVAS. The optimum imaging surveillance algorithm after Nellix EVAS has yet to be defined but is largely CT-based, especially in the first year postprocedure. However, duplex ultrasound also appears to be a sensitive modality in identifying normal appearances and complications.
- Published
- 2015
15. Gadofosveset-enhanced thoracic MR venography: a comparative study evaluating steady state imaging versus conventional first-pass time-resolved dynamic imaging
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Nicholas J Hilliard, Teik Choon See, Ilse Patterson, Martin J. Graves, Ed Soh, Richard A Parker, Andrew J. Patterson, David J. Lomas, Andrew Winterbottom, Graves, Martin [0000-0003-4327-3052], Lomas, David [0000-0003-2904-8617], and Apollo - University of Cambridge Repository
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Thorax ,Adult ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Image quality ,Dynamic imaging ,Thoracic ,Venography ,Contrast Media ,Gadolinium ,Sensitivity and Specificity ,Magnetic resonance angiography ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Image Interpretation, Computer-Assisted ,medicine ,Organometallic Compounds ,Humans ,Radiology, Nuclear Medicine and imaging ,angiography ,steady state ,Aged ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Gadofosveset ,Reproducibility of Results ,General Medicine ,contrast agent ,Middle Aged ,medicine.disease ,Image Enhancement ,Stenosis ,030220 oncology & carcinogenesis ,Angiography ,Female ,business ,Nuclear medicine ,Artifacts ,Magnetic Resonance Angiography ,medicine.drug - Abstract
Background Dedicated blood-pool contrast agents combined with optimal angiographic protocols could improve the diagnostic accuracy of thoracic magnetic resonance angiography (MRA). $\textbf{Purpose}$ To assess the clinical utility of Gadofesveset-enhanced imaging and compare an optimized steady-state (SS) sequence against conventional first-pass dynamic multi-phase (DMP) imaging. $\textbf{Material and Methods}$ Twenty-nine patients (17 men, 12 women; mean age = 42.7, age range = 18–72 years) referred for MR thoracic venography were recruited. Imaging was performed on a 1.5T MRI system. A blood-pool contrast agent (Gadofesveset) was administered intravenously. Thirty temporal phases were acquired using DMP. This was immediately followed by a high-resolution SS sequence. Three radiologists in consensus reviewed seven thoracic vascular segments after randomizing the acquisition order. Image quality, stenoses, thromboses, and artifacts were graded using a categorical scoring system. The image quality for both approaches was compared using Wilcoxon’s signed-rank test. McNemar’s test was used to compare the proportions of stenosis grades, thrombus and artifacts. $\textbf{Results}$ SS had significantly better image quality than DMP (3.14 ± 0.73 and 2.92 ± 0.60, respectively; P < 0.001). SS identified fewer stenoses (>50%) than DMP; the differences in stenosis categorizations was statistically significant (P = 0.013). There was no significant difference in the proportions of vessels with thromboses (P = 0.617). DMP produced more artifacts than SS (101 versus 85); however, the difference was not statistically significant (P = 0.073). $\textbf{Conclusion}$ Gadofesveset-enhanced thoracic angiography is clinically feasible. SS imaging produces better image quality and fewer artifacts than conventional DMP imaging., The study was supported by the imaging theme of the NIHR Cambridge Biomedical Research Centre in partnership with the University of Cambridge.
- Published
- 2018
16. MP18-03 RESULTS OF POUT - A PHASE III RANDOMISED TRIAL OF PERI-OPERATIVE CHEMOTHERAPY VERSUS SURVEILLANCE IN UPPER TRACT UROTHELIAL CANCER (UTUC)
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Alison Birtle, James Catto, Mark Johnson, Roger Kockelbergh, Francis Keeley, Richard Bryan, John Chester, Robert Jones, Michaela Hill, Jenny Donovan, Ann French, Chris Harris, Thomas Powles, Rachel Todd, Lucy Tregellas, Caroline Wilson, Andrew Winterbottom, Rebecca Lewis, and Emma Hall
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Urology - Published
- 2018
17. An observational study showed that explaining randomization using gambling-related metaphors and computer-agency descriptions impeded randomized clinical trial recruitment
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Marcus Jepson, Daisy Elliott, Carmel Conefrey, Julia Wade, Leila Rooshenas, Caroline Wilson, David Beard, Jane M. Blazeby, Alison Birtle, Alison Halliday, Rob Stein, Jenny L. Donovan, Andrew Carr, Jonathan Cook, Cushla Cooper, Benjamin Dean, Alastair Gray, Stephen Gwilym, Andrew Judge, Naomi Merritt, Jane Moser, Jonathan Rees, Ines Rombach, Julian Savulescu, Irene Tracey, Karolina Wartolowska, Paul Barham, Sara T. Brookes, Tom Crosby, Stephen J. Falk, S. Michael Griffin, William Hollingworth, Andrew D. Hollowood, Richard Krysztopik, Wyn Lewis, Jo Nicklin, Christopher Streets, Sean Strong, Dan Titcomb, Geraint Williams, Rik Bryan, James Catto, John Chester, Ann French, Emma Hall, Chris Harris, Mark Johnson, Rob Jones, Francis Keeley, Tony Kirkbank, Roger Kockelbergh, Rebecca Lewis, Michelle Newton, Thomas Powles, Rachel Waters, Andrew Winterbottom, Jean-Pierre Becquemin, Anna Belli, Marc Bosiers, Piergiorgio Cao, Christina Davies, Michael Gough, Elizabeth Hayter, Peter Leopold, Sumaira McDonald, Jonathan Michaels, Borislava Mihaylova, Richard Peto, Steven Robertson, Peter Rothwell, Rachael Scott, Dafydd Thomas, Frank Vermassen, John Bartlett, David Cameron, Amy Campbell, Peter Canney, Janet Dunn, Helena Earl, Mary Falzon, Adele Francis, Peter Hall, Victoria Harmer, Helen Higgins, Louise Hiller, Luke Hughes-Davies, Claire Hulme, Iain Macpherson, Andreas Makris, Andrea Marshall, Christopher McCabe, Adrienne Morgan, Sarah Pinder, Christopher Poole, Daniel Rea, and Nigel Stallard
- Subjects
Randomization ,Psychotherapist ,Epidemiology ,Article ,law.invention ,03 medical and health sciences ,Random Allocation ,0302 clinical medicine ,Randomized controlled trial ,Patient Education as Topic ,law ,Qualitative research ,Agency (sociology) ,Journal Article ,Humans ,030212 general & internal medicine ,Decision Making, Computer-Assisted ,Randomized Controlled Trials as Topic ,Random allocation ,Patient Selection ,United Kingdom ,3. Good health ,Comprehension ,Patient information ,Centre for Surgical Research ,030220 oncology & carcinogenesis ,Gambling ,CLARITY ,Randomized controlled trials ,Recruitment to RCTs ,Metaphor ,Observational study ,Recruitment ,Psychology - Abstract
Objectives To explore how the concept of randomization is described by clinicians and understood by patients in randomized controlled trials (RCTs) and how it contributes to patient understanding and recruitment. Study Design and Setting Qualitative analysis of 73 audio recordings of recruitment consultations from five, multicenter, UK-based RCTs with identified or anticipated recruitment difficulties. Results One in 10 appointments did not include any mention of randomization. Most included a description of the method or process of allocation. Descriptions often made reference to gambling-related metaphors or similes, or referred to allocation by a computer. Where reference was made to a computer, some patients assumed that they would receive the treatment that was “best for them”. Descriptions of the rationale for randomization were rarely present and often only came about as a consequence of patients questioning the reason for a random allocation. Conclusions The methods and processes of randomization were usually described by recruiters, but often without clarity, which could lead to patient misunderstanding. The rationale for randomization was rarely mentioned. Recruiters should avoid problematic gambling metaphors and illusions of agency in their explanations and instead focus on clearer descriptions of the rationale and method of randomization to ensure patients are better informed about randomization and RCT participation., Highlights • Practices commonly used to describe randomisation in RCT recruitment could confuse patients. • Patients found it difficult to comprehend gambling-related metaphors of randomisation. • Computer-agency descriptions led to patients believing they would receive the best treatment.
- Published
- 2018
18. Morphometric Assessment as a Predictor of Outcome in Older Vascular Surgery Patients
- Author
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Graeme K. Ambler, Alex Walker, Andrew Winterbottom, Mohammed M. Chowdhury, Ellie R. Atkins, Naail Al Zuhir, and Patrick A. Coughlin
- Subjects
Male ,Sarcopenia ,medicine.medical_specialty ,Sarcopenia/diagnosis ,Frail Elderly ,Subcutaneous Fat ,Kaplan-Meier Estimate ,Psoas Muscles/anatomy & histology ,Intra-Abdominal Fat ,030230 surgery ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Health care ,Intra-Abdominal Fat/anatomy & histology ,medicine ,Humans ,Survival rate ,Psoas Muscles ,Aged ,Aged, 80 and over ,Subcutaneous Fat/anatomy & histology ,business.industry ,Fourth lumbar vertebra ,General Medicine ,Vascular surgery ,Surgery ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cohort ,Vascular Surgical Procedures/adverse effects ,Abdomen ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Tomography, X-Ray Computed ,Vascular Surgical Procedures ,Cohort study - Abstract
BACKGROUND: Frailty is a recognized predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerized tomographic (CT) imaging. We aimed to assess the predictive power of such objective assessments in a broad cohort of vascular surgical patients.METHODS: A consecutive series of patients aged over 65 years admitted to a vascular unit, who had undergone CT imaging of the abdomen, were analyzed. Demographic and patient-specific data were collated alongside admission relevant information. Outcomes included mortality, length of stay, health care-related costs, and discharge destination. Images were analyzed for 4 morphometric measurements: (1) psoas muscle area, (2) mean psoas density, (3) subcutaneous fat depth, and (4) intra-abdominal fat depth, all taken at the level of the fourth lumbar vertebra.RESULTS: Two hundred and ten patients were initially analyzed. Forty-four patients had significant retroperitoneal and abdominal abnormalities that limited appropriate CT analysis. Decreased subcutaneous fat depth was significantly associated with mortality, readmission within 12 months, and increased cost of health care (P < 0.01, adjusted for confounders). Psoas muscle area was significantly associated with readmission-free survival.CONCLUSIONS: Morphometric analysis predicts poorer outcome in a broad cohort of vascular surgery patients. Such assessment is likely to enhance patient counseling regarding individual risk as well as enhancing the ability to undertake risk-modified surgical audit.
- Published
- 2018
19. Bladder Cancer Patient Advocacy: A Global Perspective
- Author
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Edoardo Fiorini, Andrea Necchi, Rick Bangs, Monica Smith, David Guttman, Tammy Northam, Stephanie Demkiw, Diane Zipursky Quale, Andrew Winterbottom, Quale, Dz, Bangs, R, Smith, M, Guttman, D, Northam, T, Winterbottom, A, Necchi, A, Fiorini, E, and Demkiw, S
- Subjects
Pazienti Liberi dale Neoplasie Uroteliali (PaLiNUro) ,Urology ,partnership ,Review ,Bladder Cancer Canada (BCC) ,Patient advocacy ,patient education ,Quality of life (healthcare) ,Bladder Cancer Advocacy Network (BCAN) ,Nursing ,Bladder Cancer Australia (BCA) ,medicine ,Bladder cancer ,business.industry ,Perspective (graphical) ,Cancer ,patient advocacy ,Public relations ,medicine.disease ,Maturity (finance) ,patient advocate ,quality of life ,Oncology ,improved outcomes ,General partnership ,Fight Bladder Cancer ,business ,public awareness ,Patient education - Abstract
Over the past 20 years, cancer patient advocacy groups have demonstrated that patient engagement in cancer care is essential to improving patient quality of life and outcomes. Bladder cancer patient advocacy only began 10 years ago in the United States, but is now expanding around the globe with non-profit organizations established in Canada, the United Kingdom and Italy, and efforts underway in Australia. These organizations, at different levels of maturity, are raising awareness of bladder cancer and providing essential information and resources to bladder cancer patients and their families. The patient advocacy organizations are also helping to advance research efforts by funding research proposals and facilitating research collaborations. Strong partnerships between these patient advocates and the bladder cancer medical community are essential to ensuringsustainability for these advocacy organizations, increasing funding to support advances in bladder cancer treatment, and improving patient outcomes.
- Published
- 2015
20. Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair
- Author
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Shahzad Ilyas, Teik Choon See, Shao J. Ong, James Tanner, Claire Cousins, Andrew Winterbottom, Darren Klass, Ynyr Hughes-Roberts, and Avnesh S. Thakor
- Subjects
Diagnostic Imaging ,medicine.medical_specialty ,medicine.medical_treatment ,Prosthesis Design ,Aortic aneurysm ,Aneurysm ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Computed tomography angiography ,Surgical repair ,Aorta ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,Stent ,Magnetic resonance imaging ,General Medicine ,Perioperative ,medicine.disease ,Aortic Aneurysm ,Blood Vessel Prosthesis ,Surgery ,cardiovascular system ,Stents ,Radiology ,business - Abstract
Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.
- Published
- 2015
21. Radiation dosage in the urolithiasis population: Do we over-radiate our patients?
- Author
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Ismail Omar, William Finch, Oliver Wiseman, Andrew Winterbottom, and Mark Wynn
- Subjects
education.field_of_study ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,Population ,Radiation dose ,Computed tomography ,Radiation ,Radiation exposure ,Medicine ,Surgery ,Radiology ,business ,education - Abstract
Introduction: There is increasing concern about the amount of radiation that patients with urolithiasis receive. Ensuring patients are exposed to the minimum necessary radiation is imperative. Here we review the radiation dosages that newly diagnosed urolithiasis patients received in the year following their presentation, both those presenting acutely and those referred electively. Patients and methods: A retrospective study of 95 treatment-naïve patients (47 acute, 48 elective) referred for management of urolithiasis was undertaken. The analysis included all imaging modalities related to stone disease for both patient groups within one year following presentation. The total effective dose (mSV) in one year was calculated by summing the dose for each individual radiation exposure. Results: An average of 5.6 radiological investigations (range 1–14) was carried out for acute patients and 4.57 for elective patients (range 1–11). The mean total effective dose was 14.45 mSV for the acute cases and 12.87 mSV for the elective cases. The maximum radiation dose reached 30.1 mSV in acute patients and 36.51 mSV in elective ones. None of the patients exceeded the maximal annual dose recommended by the International Commission on Radiological Protection (ICRP) of 50 mSV. Conclusion: Management of acute and elective urolithiasis patients can be achieved with acceptable radiation dose exposure. It is extremely important to keep the hazards of radiation in mind whilst managing patients with urolithiasis and clinicians need to remember adherence to the ALARA principle.
- Published
- 2015
22. Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula?
- Author
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Nadeem Shaida, Oliver Wiseman, Andrew Winterbottom, Richard Johnston, and William Finch
- Subjects
Stone clearance ,business.industry ,Urology ,Prolate spheroid ,medicine.disease ,Ellipsoid ,Region of interest ,Medicine ,Kidney stones ,Tomography ,Algebra over a field ,Nuclear medicine ,business ,Volume (compression) - Abstract
Objectives To determine the optimal method for assessing stone volume, and thus stone burden, by comparing the accuracy of scalene, oblate, and prolate ellipsoid volume equations with three-dimensional (3D)-reconstructed stone volume. Kidney stone volume may be helpful in predicting treatment outcome for renal stones. While the precise measurement of stone volume by 3D reconstruction can be accomplished using modern computer tomography (CT) scanning software, this technique is not available in all hospitals or with routine acute colic scanning protocols. Therefore, maximum diameters as measured by either X-ray or CT are used in the calculation of stone volume based on a scalene ellipsoid formula, as recommended by the European Association of Urology. Methods In all, 100 stones with both X-ray and CT (1–2-mm slices) were reviewed. Complete and partial staghorn stones were excluded. Stone volume was calculated using software designed to measure tissue density of a certain range within a specified region of interest. Correlation coefficients among all measured outcomes were compared. Stone volumes were analysed to determine the average ‘shape’ of the stones. Results The maximum stone diameter on X-ray was 3–25 mm and on CT was 3–36 mm, with a reasonable correlation (r = 0.77). Smaller stones ( 15 mm towards scalene ellipsoids. There was no difference in stone shape by location within the kidney. Conclusions As the average shape of renal stones changes with diameter, no single equation for estimating stone volume can be recommended. As the maximum diameter increases, calculated stone volume becomes less accurate, suggesting that larger stones have more asymmetric shapes. We recommend that research looking at stone clearance rates should use 3D-reconstructed stone volumes when available, followed by prolate, oblate, or scalene ellipsoid formulas depending on the maximum stone diameter.
- Published
- 2014
23. Results of POUT - a phase III randomised trial of peri-operative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC)
- Author
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Emma Hall, Alison Birtle, M. Hill, Andrew Winterbottom, Robert Jones, John D. Chester, Thomas Powles, Rebecca Lewis, Jenny L Donovan, Francis X. Keeley, A. French, James W.F. Catto, Caroline Wilson, Richard T. Bryan, Chris Harris, Mark A. Johnson, Roger Kockelbergh, L. Tregellas, and Rachel Todd
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Chemotherapy ,business.industry ,Urology ,medicine.medical_treatment ,Perioperative ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Upper tract ,030220 oncology & carcinogenesis ,medicine ,Urothelial cancer ,business - Published
- 2018
24. Management and clinical outcome of concomitant pulmonary embolism and paradoxical saddle aortic arch embolism
- Author
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Diane R Hildebrand, Jonathan R. Boyle, Andrew Winterbottom, and Enrico Mancuso
- Subjects
Male ,Aortic arch ,medicine.medical_specialty ,Computed Tomography Angiography ,medicine.medical_treatment ,Shock, Cardiogenic ,Foramen Ovale, Patent ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Fasciotomy ,03 medical and health sciences ,0302 clinical medicine ,Embolus ,Forearm ,medicine.artery ,medicine ,Humans ,Thrombolytic Therapy ,cardiovascular diseases ,Stroke ,Aged ,Patient Care Team ,Unusual Presentation of More Common Disease/Injury ,business.industry ,Infarction, Middle Cerebral Artery ,General Medicine ,medicine.disease ,Pulmonary embolism ,Surgery ,body regions ,Treatment Outcome ,medicine.anatomical_structure ,Embolism ,cardiovascular system ,Patent foramen ovale ,Pulmonary Embolism ,business ,Echocardiography, Transesophageal ,030217 neurology & neurosurgery ,Embolism, Paradoxical - Abstract
A 65-year-old man presented in a peri-arrest situation after collapse, he was found hypoxic with ischaemic arms. CT imaging showed massive bilateral pulmonary embolisms (PEs) and an aortic arch embolus extending from brachiocephalic trunk to left subclavian artery. Following intravenous thrombolysis, repeat imaging revealed that the aortic embolus had migrated distally into both axillary arteries and had occluded the right carotid from origin to skull base. Bilateral upper limb embolectomies were carried out from the brachial arteries together with forearm fasciotomies. Left hemianopia related to a right middle cerebral artery territory infarct was managed conservatively; forearm fasciotomy wounds were primarily closed and the patient was discharged on lifelong anticoagulation. A transoesophageal echocardiogram revealed a patent foramen ovale. This case demonstrates a very unusual presentation of concomitant PE and paradoxical saddle aortic arch embolism. A multidisciplinary approach has resulted in an excellent clinical outcome for this complex patient.
- Published
- 2019
25. P1.45: Mycotic aneurysm after Liver and Small Bowel Transplantation
- Author
-
Andrew J. Butler, Irum Amin, Sara Upponi, Chris J Watson, Andrew Winterbottom, Neil Russell, and Lisa Sharkey
- Subjects
Transplantation ,medicine.medical_specialty ,business.industry ,medicine ,Mycotic aneurysm ,business ,Surgery - Published
- 2019
26. Initial clinical evaluation of a non-contrast-enhanced MR angiography method in the distal lower extremities
- Author
-
Andrew Winterbottom, David J. Lomas, Teik Choon See, Andrew N. Priest, Martin J. Graves, and Ilse Joubert
- Subjects
medicine.medical_specialty ,business.industry ,Vascular disease ,Mr angiography ,Gold standard (test) ,medicine.disease ,eye diseases ,nervous system diseases ,Peripheral ,Background suppression ,cardiovascular system ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Non contrast enhanced ,cardiovascular diseases ,Radiology ,business ,Clinical evaluation ,circulatory and respiratory physiology - Abstract
Purpose To report the initial experience and diagnostic performance applying a novel flow-dependent non-contrast-enhanced MR angiography (NCE-MRA) method, in patients with suspected peripheral vascular disease, in comparison with established contrast-enhanced MRA (CE-MRA). Methods The lower legs of 34 patients were imaged at 1.5 T with both NCE-MRA and CE-MRA. The NCE-MRA method consisted of a cardiac-gated balanced-SSFP sequence with controllable flow-suppression preparation. Flow-suppressed and unsuppressed datasets were subtracted to obtain angiograms. Two experienced radiologists assessed both NCE-MRA and CE-MRA images, first independently and then in consensus to resolve significant disagreements. Signal loss, vessel conspicuity, vascular disease, venous contamination, artifacts, and diagnostic confidence were assessed. Results Using the CE-MRA as the “gold standard,” the per-segment sensitivity and specificity for detection of significant disease were 81.7% and 90.9%, respectively. Mean diagnostic confidence (scale 0–4) was 3.4 for NCE-MRA and 3.9 for CE-MRA. Most vessel segments were well visualized but the popliteal arteries often suffered some technique-related signal loss. Conclusions The NCE-MRA method was able to visualize most vessel segments with good or excellent confidence, few artifacts, and excellent background suppression, giving moderate agreement with CE-MRA. However, some segments were poorly visualized, probably due to flow profile distortion in these patients. Magn Reson Med 70:1644–1652, 2013. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
27. Peripheral Non-atherosclerotic Arterial Disorders: What Radiologists Need to Know
- Author
-
Tariq, Ali, Miltiadis E, Krokidis, and Andrew, Winterbottom
- Subjects
Peripheral Arterial Disease ,Angiography ,Disease Management ,Humans ,Arteries ,Technology, Radiologic - Abstract
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.
- Published
- 2016
28. Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents?
- Author
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Brendan Koo, Miltiadis Krokidis, Tariq Ali, Teik Choon See, Nadeem Shaida, Andrew Winterbottom, and Nicholas J Hilliard
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Embolism ,Embolectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,medicine.artery ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Popliteal Artery ,cardiovascular diseases ,Aged ,Retrospective Studies ,Aged, 80 and over ,Leg ,business.industry ,Stent ,Thrombolysis ,Middle Aged ,equipment and supplies ,medicine.disease ,Limb Salvage ,Popliteal artery ,Surgery ,Femoral Artery ,Treatment Outcome ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Intraprocedural distal embolization is an accepted complication of femoropopliteal angioplasty. The purpose of this study is to assess the use of below-the-knee stents in the "bail-out" of conventional methods.We retrospectively reviewed 1485 of femoropopliteal angioplasties that were performed in our centre in a 4-year period and analysed 12 cases (1%) where distal embolization that required further intervention occurred. In all cases lesions were chronic and 75% suffered from critical limb ischaemia. The target vessel was the SFA in all of the cases with a long (10 cm) occlusion in 50%. A three-vessel run-off was present in only 25%. Patients that received a stent as a limb salvage attempt were analysed. Outcome measures were technical success, clinical success and procedure-related complications. Multivariate regression analysis of the factors related to stenting was also performed.In 41% of the cases with distal embolization, recanalization with aspiration, thrombolysis or angioplasty offered a satisfactory result. In 59%, conventional methods were ineffective; a stent was deployed in 85%, whereas in 15% surgical embolectomy was required. Technical and clinical success of the stent cases was 100% without any procedure-related complications. There was significance (p 0.05) between critical limb ischaemia and stenting; single-vessel run-off has also shown a positive trend (p = 0.88).Stents appear as a valid salvage option for infragenicular distal embolization when conventional methods fail; the likelihood of having to use a stent is higher for patients with critical limb ischaemia and a single-vessel run-off.
- Published
- 2016
29. Endovascular Occlusion of a Ruptured Popliteal Artery Aneurysm
- Author
-
Jonathan R. Boyle, Andrew Winterbottom, Paul D. Hayes, David G. Cooper, Parag R Gajendragadkar, and R. J. Paul Smith
- Subjects
Male ,medicine.medical_specialty ,Septal Occluder Device ,Arterial Occlusive Diseases ,Aneurysm, Ruptured ,Popliteal aneurysm ,Aneurysm ,medicine.artery ,Occlusion ,Humans ,Medicine ,Popliteal Artery ,cardiovascular diseases ,Aged ,business.industry ,Angiography, Digital Subtraction ,General Medicine ,Critical limb ischemia ,medicine.disease ,Embolization, Therapeutic ,Arterial occlusion ,Popliteal artery ,Surgery ,Treatment Outcome ,cardiovascular system ,Radiology ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,Complication ,business ,Ligation - Abstract
Popliteal artery aneurysms are the most common of the peripheral aneurysms. Rupture is a rare complication of these aneurysms. Here we present a case of a ruptured popliteal aneurysm in a patient with severe joint disease and immobility due to rheumatoid arthritis. The condition was treated endovascularly with an Amplatzer arterial occlusion device. The aneurysm was successfully thrombosed without inducing critical limb ischemia, as the distal popliteal was chronically occluded. Ligation of peripheral aneurysms is an infrequent treatment without simultaneous bypass graft placement. Endovascular occlusion of ruptured popliteal aneurysms should be considered a valid therapeutic strategy where exclusion bypass is not required due to distal arterial occlusion.
- Published
- 2010
30. Occurrence and Classification of Proximal Type I Endoleaks After EndoVascular Aneurysm Sealing Using the Nellix™ Device
- Author
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Janis Savlovskis, L.H. van den Ham, Rudi Jakob, Alexander Oberhuber, Andrew Holden, J. Savlovskis, Marwan Youssef, M.M.P.J. Reijnen, Kenneth Ouriel, Michel M.P.J. Reijnen, Patrick Berg, Jorg L. de Bruin, Eric Zimmermann, Andrew Winterbottom, Leo H. van den Ham, Michelangelo Ferri, Sebastian Zerwes, Dittmar Böckler, Dainis Krievins, A. Witterbottom, Jan M.M. Heyligers, Jean-Paul P.M. de Vries, Paul D. Hayes, and Roland Stroetges
- Subjects
medicine.medical_specialty ,business.industry ,030204 cardiovascular system & hematology ,medicine.disease ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
31. Juxtarenal abdominal aortic aneurysms: fenestrations versus chimneys
- Author
-
Nadeem Shaida and Andrew Winterbottom
- Abstract
Limitations of conventional infrarenal endovascular abdominal aortic aneurysm repair (EVAR) include a short infrarenal neck or aneurysmal disease involving the abdominal aortic visceral segment. A number of newer endovascular treatments, including fenestrated EVAR, branched endovascular stent grafts, and chimney stents, have been proposed. We describe one such case treated with a four-vessel fenestrated EVAR and also review the current options available for the treatment of juxtarenal and suprarenal abdominal aortic aneurysm disease.
- Published
- 2015
32. Retroperitoneal Aortic Hemorrhage Caused by Penetration of an Endovascular Stent-Graft Anchoring Barb
- Author
-
Andrew Winterbottom, Christopher P. Twine, Jonathan R. Boyle, and Nadeem Shaida
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,Endovascular aneurysm repair ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aorta, Abdominal ,Retroperitoneal Space ,Retroperitoneal hemorrhage ,Intraoperative Complications ,Aged ,Aorta ,biology ,business.industry ,Stent ,Penetration (firestop) ,medicine.disease ,biology.organism_classification ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Barb ,surgical procedures, operative ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Aortic Aneurysm, Abdominal - Abstract
To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft.A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously.Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.
- Published
- 2013
33. The European Cancer Patient Coalition’s white policy paper on the value of innovation in oncology
- Author
-
Lydia Makaroff, L. Baker, F. De Lorenzo, Andrew Winterbottom, Anna Rek, D. Cimpoeru, J. Pelouchova, Szymon Chrostowski, N. Bolanos Fernandez, Francesco Florindi, Isabelle Manneh-Vangramberen, and Kathi Apostolidis
- Subjects
medicine.medical_specialty ,White (horse) ,Oncology ,business.industry ,Family medicine ,Medicine ,Cancer ,Hematology ,business ,medicine.disease ,Value (mathematics) - Published
- 2017
34. Reply to: Intraprocedural Distal Embolization After Femoropopliteal Angioplasty: Is There a Role for Below-the-Knee Stents? A Statistical Analysis Point of View
- Author
-
Tariq Ali, Nadeem Shaida, Andrew Winterbottom, Miltiadis Krokidis, Nicholas J Hilliard, Brendan Koo, and Teik Choon See
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Ultrasound ,Distal embolization ,030218 nuclear medicine & medical imaging ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Angioplasty ,medicine ,Radiology, Nuclear Medicine and imaging ,Statistical analysis ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
35. Value of innovation in oncology: The position of European cancer patients on access to innovative treatments
- Author
-
Jana Pelouchova, Kathi Apostolidis, Francesco Florindi, Jiska Bolhuis, Lydia Makaroff, Natacha Bolanos, Isabelle Manneh-Vangramberen, Dan Cimpoeru, Andrew Winterbottom, Anna Rek, Szymon Chrostowski, and Francesco De Lorenzo
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Internal medicine ,General partnership ,medicine ,Position (finance) ,Cancer ,medicine.disease ,business ,Value (mathematics) - Abstract
e18021 Background: The paper presents the position of the European Cancer Patient Coalition (ECPC), in partnership with Interel, on the value of innovation in oncology today, focusing on issues that would benefit most from the direct involvement of patients.The objective of the paper is to present key factors affecting access to innovation in oncology in Europe and to propose key recommendations on how to improve equity in access and to actively involve patients in decision-making. Methods: The document was produced under the supervision of the ECPC Board of Directors, and the contribution of the ECPC General Assembly, which was consulted in June 2016 during the Annual General Meeting.The paper is based also on a systemic literature review. Results: The paper analyses the main systems barriers to access to innovation, which affect all European cancer patients: low level fo health expenditure on cancer; high cost of innovative treatments; complex regulatory and reimbursement pathways; lack of enabling environments; limited patient involvement in decision making. The paper goes on identifying 40 key policy recommendations in 10 pivotal areas (see Table). Conclusions: Innovative healthcare technologies, strategies, and services offer the potential to improve the lives of many people living with cancer. Ensuring that effective innovations are accessible and affordable to all patients is a challenge facing all cancer stakeholders. The successful development and implementation of new cancer care modalities stems from putting the needs of patients at the centre of the innovation process. Patients are the ultimate beneficiaries and users of cancer diagnosis, treatment, and care. They have unique knowledge, perspectives, and experiences that improves and encourages innovation in oncology. Optimal innovation can only be obtained by understand the diverse needs and preferences of cancer patients, and integrating patient-centred approaches into the regulatory and healthcare system. [Table: see text]
- Published
- 2017
36. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications
- Author
-
Andrew Winterbottom, Shahzad Ilyas, Avnesh S. Thakor, Claire Cousins, and Nadeem Shaida
- Subjects
medicine.medical_specialty ,Endoleak ,medicine.medical_treatment ,Endovascular aneurysm repair ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,medicine.artery ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aorta, Abdominal ,Ultrasonography ,Aorta ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Blood Vessel Prosthesis ,Prosthesis Failure ,surgical procedures, operative ,Treatment Outcome ,Cuff ,cardiovascular system ,Stents ,Radiology ,business ,Tomography, X-Ray Computed ,Abdominal surgery ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) is a well-established procedure, which has long-term mortality rates similar to that of open repair. It has the additional benefit of being less invasive, making it the favoured method of treating abdominal aortic aneurysms in elderly and high-risk patients with multiple co-morbidities. The main disadvantage of EVAR is the higher rate of re-intervention, due to device-related complications, including endoleaks, limb occlusion, stent migration, kinking, and infection. As a result lifelong surveillance is required. In order to avoid missing these complications, intricate knowledge of stent graft design, good-quality diagnostic ultrasound skills, multiplanar reformatting of CT images, and reproducible investigations are important. Most of these complications can be treated via an endovascular approach using cuff extensions, uncovered stents, coils, and liquid embolic agents. Open surgery is reserved for complex complications, where an endovascular approach is not feasible.
- Published
- 2014
37. European Association of Urology (@Uroweb) recommendations on the appropriate use of social media
- Author
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Carl Wijburg, Morgan Rouprêt, Peter J. Boström, Henry H. Woo, James W.F. Catto, Joan Palou, Andrew Winterbottom, Luis Martínez-Piñeiro, Alexander Kutikov, Matthew R. Cooperberg, Manfred P. Wirth, Todd M. Morgan, Henk G. van der Poel, and Kate D. Linton
- Subjects
medicine.medical_specialty ,Association (object-oriented programming) ,Urology ,Control (management) ,Clinical Sciences ,Context (language use) ,Guidelines as Topic ,Guidelines ,Appropriate use ,Risk Assessment ,Social media ,Medical ,medicine ,Humans ,Societies, Medical ,ta3126 ,Ethics ,Internet ,Physician-Patient Relations ,business.industry ,Field (Bourdieu) ,Attendance ,Urology & Nephrology ,Europe ,Form of the Good ,business ,Societies ,Social Media ,Confidentiality - Abstract
Socialmedia use is becoming common inmedical practice. Although primarily used in this context to connect physicians, social media allows users share information, to create an online profile, to learn and keep knowledge up to date, to facilitate virtual attendance at medical conferences, and to measure impact within a field. However, shared content should be considered permanent and beyond the control of its author, and typical boundaries, such as the patient-physician interaction, become blurred, putting both parties at risk. The European Association of Urology brought together a committee of stakeholders to create guidance on the good practice and standards of use of socialmedia. These encompass guidance about defining an online profile; managing accounts; protecting the reputations of yourself and your organization; protecting patient confidentiality; and creating honest, responsible content that reflects your standing as a physician and your membership within this profession. (C) 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
- Published
- 2014
38. Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula?
- Author
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William, Finch, Richard, Johnston, Nadeem, Shaida, Andrew, Winterbottom, and Oliver, Wiseman
- Subjects
Radiography ,Kidney Calculi ,Imaging, Three-Dimensional ,Image Processing, Computer-Assisted ,Humans ,Algorithms ,Mathematics ,Software - Abstract
To determine the optimal method for assessing stone volume, and thus stone burden, by comparing the accuracy of scalene, oblate, and prolate ellipsoid volume equations with three-dimensional (3D)-reconstructed stone volume. Kidney stone volume may be helpful in predicting treatment outcome for renal stones. While the precise measurement of stone volume by 3D reconstruction can be accomplished using modern computer tomography (CT) scanning software, this technique is not available in all hospitals or with routine acute colic scanning protocols. Therefore, maximum diameters as measured by either X-ray or CT are used in the calculation of stone volume based on a scalene ellipsoid formula, as recommended by the European Association of Urology.In all, 100 stones with both X-ray and CT (1-2-mm slices) were reviewed. Complete and partial staghorn stones were excluded. Stone volume was calculated using software designed to measure tissue density of a certain range within a specified region of interest. Correlation coefficients among all measured outcomes were compared. Stone volumes were analysed to determine the average 'shape' of the stones.The maximum stone diameter on X-ray was 3-25 mm and on CT was 3-36 mm, with a reasonable correlation (r = 0.77). Smaller stones (9 mm) trended towards prolate ellipsoids ('rugby-ball' shaped), stones of 9-15 mm towards oblate ellipsoids (disc shaped), and stones15 mm towards scalene ellipsoids. There was no difference in stone shape by location within the kidney.As the average shape of renal stones changes with diameter, no single equation for estimating stone volume can be recommended. As the maximum diameter increases, calculated stone volume becomes less accurate, suggesting that larger stones have more asymmetric shapes. We recommend that research looking at stone clearance rates should use 3D-reconstructed stone volumes when available, followed by prolate, oblate, or scalene ellipsoid formulas depending on the maximum stone diameter.
- Published
- 2013
39. Early results of fenestrated endovascular repair of juxtarenal aortic aneurysms in the United Kingdom
- Author
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M. G. Wyatt, C. Bishop, J.B. Naik, Matthew Waltham, A.C. Fisher, D. Simring, G. Hamilton, R. Canavati, P. Gkoutzios, Robert J. Hinchliffe, Robert Morgan, T. Loosemore, I. Ahmed, P.L. Harris, K. Ivancev, Jonathan R. Boyle, J. Cross, Paul D. Hayes, Tom Carrell, Edward Choke, Stephen Black, T.C. See, Peter J. Holt, Ferdinand Serracino-Inglott, J. Raja, L. Wilson, D. Boardley, T. Metha, Richard G. McWilliams, Kevin Varty, Obi Agu, P. Bourke, F. Farquharson, Colin Bicknell, D. Smith, Ralph Jackson, Matt M. Thompson, Andrew Winterbottom, John A. Brennan, Matthew J. Bown, M.J. McCarthy, C. Cousins, G.P. Copeland, Michael Jenkins, Ian J. Franklin, Mark Tyrrell, S.R. Vallabhaneni, Nicholas J.W. Cheshire, D.J. Adam, R. Salter, Ian M. Loftus, J. Hague, Meryl Davis, Rachel Bell, John Rose, Robert K. Fisher, Randi M. Williams, A. James, Tarun Sabharwal, V. Wealleans, A.W. Bradbury, Toby Richards, A. Sharif, M.J. Clarke, R.D. Sayers, C.J. Wilkins, J. Hardman, A. Tamberaja, and Graeme K. Ambler
- Subjects
Male ,medicine.medical_specialty ,Patient demographics ,medicine.medical_treatment ,Target vessel ,Kaplan-Meier Estimate ,Endovascular aneurysm repair ,Physiology (medical) ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aneurysm morphology ,business.industry ,Open surgery ,Endovascular Procedures ,Stent ,Perioperative ,Middle Aged ,United Kingdom ,Surgery ,Blood Vessel Prosthesis ,Treatment Outcome ,Early results ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies - Abstract
Background— Fenestrated endovascular repair of abdominal aortic aneurysms has been proposed as an alternative to open surgery for juxtarenal and pararenal abdominal aortic aneurysms. At present, the evidence base for this procedure is predominantly limited to single-center or single-operator series. The aim of this study was to present nationwide early results of fenestrated endovascular repair in the United Kingdom. Methods and Results— All patients who underwent fenestrated endovascular repair between January 2007 and December 2010 at experienced institutions in the United Kingdom(>10 procedures) were retrospectively studied by use of the GLOBALSTAR database. Site-reported data relating to patient demographics, aneurysm morphology, procedural details, and outcome were recorded. Data from 318 patients were obtained from 14 centers. Primary procedural success was achieved in 99% (316/318); perioperative mortality was 4.1%, and intraoperative target vessel loss was observed in 5 of 889 target vessels (0.6%). The early reintervention (30 days) was 90% (0.02), 86% (0.03), and 70% (0.08) at 1, 2, and 3 years. Conclusions— In this national sample, fenestrated endovascular repair has been performed with a high degree of technical and clinical success. Late survival and target vessel patency are satisfactory. These results support continued use and evaluation of this technique for juxtarenal aneurysms, but illustrate the need for a more robust evidence base.
- Published
- 2012
40. Acceptability of virtual unenhanced CT of the aorta as a replacement for the conventional unenhanced phase
- Author
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David J. Lomas, Andrew Winterbottom, Nadeem Shaida, Ashley Shaw, David J. Bowden, Teik Choon See, Tristan Barrett, Amy E Taylor, and Edmund M. Godfrey
- Subjects
Male ,medicine.medical_specialty ,Radiodensity ,Contrast Media ,Objective analysis ,Aorta, Thoracic ,medicine.artery ,Hounsfield scale ,medicine ,Thoracic aorta ,Humans ,Radiology, Nuclear Medicine and imaging ,Aorta, Abdominal ,Aorta ,business.industry ,Abdominal aorta ,Reproducibility of Results ,Thrombosis ,General Medicine ,Radiographic Image Enhancement ,Female ,Radiology ,Tomography ,business ,Tomography, X-Ray Computed ,Arterial phase - Abstract
Aim To evaluate whether virtual unenhanced (VU) computed tomography (CT) images generated of the aorta were of sufficient quality to replace the conventional unenhanced (CU) images. Materials and methods Forty-nine patients undergoing examination of the thoracic or abdominal aorta were examined using a dual-energy protocol. VU images were generated from the arterial phase images and compared to the CU images. Objective analysis was performed by drawing paired regions of interest (ROIs) within the thoracic and abdominal aorta and measuring the radiodensity in Hounsfield units attenuation within the ROIs. Subjective analysis was performed by two experienced readers evaluating the VU images in terms of noise, quality, calcium loss, and overall acceptability. Results The attenuation was significantly higher in the VU images compared to the CU images within the thoracic aorta ( p p = 0.15). Overall the VU images of the abdominal aorta were deemed acceptable as replacements for the CU images in 93% of cases. For the thoracic aorta, the VU images were deemed acceptable in only 12% of cases, primarily due to pulsation artefact. Conclusion VU images of the abdominal aorta are acceptable as replacements for the CU images in the vast majority of cases; however, they are not suitable as replacements for the CU images of the thoracic aorta.
- Published
- 2011
41. Endovascular aortic stent graft infection with Streptococcus equi: the first documented case
- Author
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Jitesh Parmar, Fiona J. Cooke, Michael E. Gaunt, Andrew M. L. Lever, and Andrew Winterbottom
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Male ,Reoperation ,medicine.medical_specialty ,Streptococcus equi ,Prosthesis-Related Infections ,medicine.medical_treatment ,Aortic stent ,Aortography ,Multimodal Imaging ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,Streptococcal Infections ,Zoonoses ,Medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Horses ,Device Removal ,Strangles ,Aged ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,medicine.disease ,Surgery ,Anti-Bacterial Agents ,Blood Vessel Prosthesis ,surgical procedures, operative ,Treatment Outcome ,Infectious disease (medical specialty) ,Positron-Emission Tomography ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Tomography, X-Ray Computed ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
Streptococcus equi is a common equine infectious disease, but transmission to man is rare and confined to those who commonly come into close contact with horses. Similarly, prosthetic stent graft infection is a rare complication of endovascular aortic aneurysm repair. We describe the first reported case of aortic stent graft with S. equi occurring in a professional racehorse trainer. Clinical presentation, investigations, imaging and management of this case are described. In conclusion, clinicians should consider infection with rare organisms in patients with prosthetic implants who regularly come into contact with horses and other ruminants.
- Published
- 2011
42. Emerging Trends in Endoscopic Retrograde Cholangiopancreatography and Common Bile Duct Exploration—Reply
- Author
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Andrew Winterbottom, William J.H. Griffiths, Alexander Gimson, Muhammad F. Dawwas, Asif Jah, and Emmanuel Huguet
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medicine.medical_specialty ,Common bile duct exploration ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,General surgery ,medicine ,Surgery ,business - Published
- 2011
43. Image of the Month—Quiz Case
- Author
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William J.H. Griffiths, Andrew Winterbottom, Asif Jah, Emmanuel Huguet, Alexander Gimson, and Muhammad F. Dawwas
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Jejunum ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Biliary tract ,Perforation (oil well) ,Medicine ,Surgery ,business ,Small intestine - Published
- 2011
44. The radiation burden from increasingly complex endovascular aortic aneurysm repair
- Author
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Michael E. Gaunt, Andrew Winterbottom, Mathew Mercuri, Claire Cousins, and Avnesh S. Thakor
- Subjects
medicine.medical_specialty ,Group based ,Iliac artery ,Aortic aneurysm repair ,Aortic aneurysm ,medicine.diagnostic_test ,Endovascular ,business.industry ,Radiation dose ,Interventional radiology ,medicine.disease ,Surgery ,Radiation risk ,Radiological weapon ,medicine ,Radiology, Nuclear Medicine and imaging ,Original Article ,business ,Repair ,Neuroradiology - Abstract
Objectives With increasing experience, endovascular aortic aneurysm repair (EVAR) has been extended to patients with less suitable aorto-iliac anatomy in an attempt to reduce peri-operative mortality. However, more complex EVAR procedures may take longer and can result in higher rates of complications, additional interventional procedures and more frequent radiological imaging, which may offset some of the benefit. This study determined the radiation burden for standard EVAR, as determined by the EVAR-1 trial criteria, and more complex EVAR. Methods A total of 123 elective patients aged >60, with aneurysms >5.5 cm who received a bifurcated stent-graft were allocated into a group based on whether or not they fulfilled strict EVAR-1 trial criteria. The mean radiation dose was calculated for each group, together with the additional radiation burden from routine pre- and post-EVAR CT examinations and pre-EVAR iliac artery embolisation. Results Patients not meeting the EVAR-1 trial criteria had significantly longer fluoroscopic screening times and higher radiation doses. The radiation burden in all patients was higher following exposure from routine CT examinations and following pre-EVAR iliac artery embolisation. Conclusion Whilst the radiation from standard EVAR is acceptable, more complicated and challenging EVARs, accompanied with additional radiological investigations and procedures, can significantly increase the radiation burden.
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