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Background/Introduction Acute type B aortic dissection (ATBAD) is a cardiovascular emergency with high risk of morbidity and mortality. Elucidating male-female differences in ATBAD might help optimize patient-specific care, while data is scarce on this topic. Purpose The aim of this study was to identify differences between male and female ATBAD patients in presentation, management and outcomes. Methods A retrospective cohort study was conducted including all consecutive patients who presented with ATBAD between 2007–2017 in four tertiary centers. Non-acute, traumatic, and iatrogenic dissections were excluded. We included patients presenting with an intramural hematoma or penetrating aortic ulcer in acute setting. Results The study population consisted of 384 patients, of which 41% (n=156) was female. In comparison to males, females presented at an older age (67 [IQR: 57–73] vs. 62 [IQR: 52–71], p=0.015) and fewer female patients had a history of abdominal aortic aneurysm (6% vs. 15%, p=0.009). Imaging diagnostics revealed a smaller proportion of patients with distally extended dissections in females. DeBakey type IIIb was diagnosed less frequently in females (73% vs. 85%, p=0.008) as was renal artery involvement (48% vs. 66%, p=0.009). Furthermore, classical type B dissection was less often observed in female patients compared to male patients (56% vs. 78%, p Conclusion This study showed that female patients were older at presentation, while male patients more often had distally extended dissections. Although mortality was not significantly different, we encourage male-female specific risk factor studies on late mortality. In this way ATBAD male and female patients at high risk of mortality can be identified and patient-specific care can be implemented. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMw

Purpose: Lifelong follow-up after endovascular abdominal aortic aneurysm repair (EVAR) is recommended due to a continued risk of complications, especially if the first postoperative imaging shows abnormal findings. We studied the long-term outcomes in patients with abnormalities on the first postoperative computed tomography angiography (CTA) following EVAR. Materials and Methods: This is a retrospective study of all consecutive patients who underwent elective EVAR for nonruptured abdominal aortic aneurysm (AAA) between January 2007 and January 2012 in 16 Dutch hospitals with follow-up until December 2018. Patients were included if the first postoperative CTA showed one of the following abnormal findings: endoleak type I–IV, endograft kinking, infection, or limb occlusion. AAA diameter, complications, and secondary interventions during follow-up were registered. Primary endpoint was overall survival, and other endpoints were secondary interventions and intervention-free survival. Kaplan-Meier analyses were used to estimate overall and intervention-free survival. Cox regression analyses were used to identify the association of independent determinants with survival and secondary interventions. Results: A total of 502 patients had abnormal findings on the first postoperative CTA after EVAR and had a median follow-up (interquartile range IQR) of 83.0 months (59.0). The estimated overall survival rate at 1, 5, and 10 years was 84.7%, 51.0%, and 30.8%, respectively. Age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.05 to 1.10] and American Society of Anesthesiologists (ASA) classification (ASA IV HR 3.20, 95% CI 1.99 to 5.15) were significantly associated with all-cause mortality. Overall, 167 of the 502 patients (33.3%) underwent 238 secondary interventions in total. Fifty-eight patients (12%) underwent an intervention based on a finding on the first postoperative CTA. Overall survival was 38.4% for patients with secondary interventions and 44.5% for patients without (log rank; p=0.166). The intervention-free survival rate at 1, 5, and 10 years was 82.9%, 61.3%, and 45.6%, respectively. Conclusions: Patients with abnormalities on the first postoperative CTA after elective EVAR for infrarenal AAA cannot be discharged from regular imaging follow-up due to a high risk of secondary interventions. Patients who had a secondary intervention had similar overall survival as those without secondary interventions.

Background The sharp decrease in open surgical repair (OSR) for abdominal aortic aneurysm (AAA) has raised concerns about contemporary postoperative outcomes. The study was designed to analyse the impact of complications on clinical outcomes within 30 days following OSR. Methods Patients who underwent OSR for intact AAA registered prospectively between 2016 and 2019 in the Dutch Surgical Aneurysm Audit were included. Complications and outcomes (death, secondary interventions, prolonged hospitalization) were evaluated. The adjusted relative risk (aRr) and 95 per cent confidence intervals were computed using Poisson regression. Subsequently, the population-attributable fraction (PAF) was calculated. The PAF reflects the expected percentage reduction of an outcome if a complication were to be completely prevented. Results A total of 1657 patients were analysed. Bowel ischaemia and renal complications had the largest impact on death (aRr 12·44 (95 per cent c.i. 7·95 to 19·84) at PAF 20 (95 per cent c.i. 8·4 to 31·5) per cent and aRr 5·07 (95 per cent c.i. 3·18 to 8.07) at PAF 14 (95 per cent c.i. 0·7 to 27·0) per cent, respectively). Arterial occlusion had the greatest impact on secondary interventions (aRr 11·28 (95 per cent c.i. 8·90 to 14·30) at PAF 21 (95 per cent c.i. 14·7 to 28·1) per cent), and pneumonia (aRr 2·52 (95 per cent c.i. 2·04 to 3·10) at PAF 13 (95 per cent c.i. 8·3 to 17·8) per cent) on prolonged hospitalization. Small effects were observed on outcomes for other complications. Conclusion The greatest clinical impact following OSR can be made by focusing on measures to reduce the occurrence of bowel ischaemia, arterial occlusion and pneumonia.

A 14-year-old girl presented with a progressively cold, pale foot. Pedal pulses were absent and there was sensory and motor loss. CT angiography revealed a thromboembolic occlusion of the crural arteries and a popliteal artery entrapment. Following thromboembolectomy with popliteal artery patch angioplasty and release of the gastrocnemius muscle, the girl fully recovered.

The evolution of stent-grafts and endovascular delivery systems has substantially improved the application rate for and patient outcomes with endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA), but further development is needed in order to reduce the continuing incidence of complications and secondary re-interventions. Severe angulations at the proximal aneurysm neck and tortuous, calcified, and small iliac arteries are still recognized as important risk factors for successful EVAR of AAA and hence as criteria for exclusion of many potential patients. The Endurant stent-graft is part of a next-generation system that was designed with the clear intention of expanding the applicability of EVAR for AAA while also continuing to improve treatment outcomes and reduce complications. Innovative features of the system design include anchoring pins for ensuring proximal fixation, wire-formed M-shape body stents for improved flexibility and conformability, and a low-profile delivery system with hydrophilic coating that improves trackability and pushability to facilitate the vascular access even in small challenging arteries. Initial clinical experience with the Endurant stent-graft system, including preliminary results from the first-in-human European trial of the device, has demonstrated that the device can be delivered and deployed safely, even in highly angulated anatomies. Technical success was achieved in 90.3% of the patients in the trial. No device-related serious adverse events were seen during the first follow-up period, and no device-related deaths were reported. This new stent-graft will potentially enlarge the patient population suitable for EVAR of AAA.

Rupture of the thoracic aorta after a blunt traumatic accident is a life-threatening event. This injury is instantly fatal in about 80% of the victims, and half of those who initially survive the incident will die during the first day, if left untreated. Before 1997, patients were treated with an open repair, but the conventional surgical approach carries a high mortality and morbidity rate. Graft interposition and cross-clamping of the aorta are responsible for a high paraplegia rate. Despite the fact that active distal perfusion of the aorta lowers the incidence of neurological deficit, the timing of these extensive procedures in the severely injured multi-trauma patient is difficult. The endovascular repair of a traumatic thoracic aortic rupture has gained rapid acceptance as a better alternative. This minimally invasive procedure has a median operating time of1 h, and it can be done during the same session in which other life-threatening injuries are repaired. There is no need for a thoracotomy or single lung ventilation, blood loss is minimal and systemic heparinization is not required. So far, no spinal cord ischemia has been described for the endovascular repair. Besides numerous advantages, a few problems can be expected. The narrow aortic diameter of these young trauma-victims, combined with a steep aortic arch, makes the adaptation of the endograft along the inner curvature sometimes difficult. Because the smallest endograft usually exceeds the narrow aortic diameter, only excessively oversized devices can be used, which explains the high type I endoleak encountered in the published series. No randomized studies are yet available comparing the open with the endovascular technique, but the initial results of the endovascular repair seem promising and lower mortality and morbidity rates are documented. Long-term outcome are lacking so far, but are needed to address the durability of the procedure. Further research and development should concentrate on the problems we have seen with steep and narrow aortic arches, and devices with more flexible curves and smaller diameters should become available in the near future.

This paper is concerned with the research activities on man-machine systems at the Department of industrial Engineering at Eindhoven University of Technology. The research is carried out in field situations as well as in the department laboratory by means of a digital simulation of an industrial distillation process. After a brief survey of research topics, a description is given of simulation soft- and hardware. In the second part the results of a pilot-study with the simulated process are presented. The aim of this study was to acquire experience with the simulation itself and to investigate the learning behaviour of experienced and non-experienced subjects At the same time the effects of speeding up the simulation on control performance and control behaviour were investigated.