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OBJECTIVE: The use of intravascular ultrasound (IVUS) reduces contrast medium use and radiation exposure during conventional endovascular aneurysm repair (EVAR). The aim of this study was to evaluate the safety and efficacy of IVUS in detecting bridging stent graft (bSG) instability during fenestrated and branched EVAR (F/B-EVAR). METHODS: This was a prospective observational multicentre study. The following outcomes were evaluated: (1) technical success of the IVUS in each bSG, (2) IVUS findings compared with intra-operative angiography, (3) incidence of post-operative computed tomography angiography (CTA) findings not detected with IVUS, and (4) absence of IVUS related adverse events. Target visceral vessel (TVV) instability was defined as any branch or fenestration issues requiring an additional manoeuvre or re-intervention. Any IVUS assessment that detected stenosis, kinking, or any geometric TVV issue was considered to be branch instability. All procedures were performed in ad hoc hybrid rooms. RESULTS: Eighty patients (69% males; median age 72 years; interquartile range 59, 77 years) from four aortic centres treated with F/B-EVAR between January 2019 and September 2021 were included: 70 BEVAR (21 off the shelf; 49 custom made), eight FEVAR (custom made), and two F/B-EVAR (custom made), for a total of 300 potential TVVs. Two TVVs (0.7%) were left unstented and excluded from the analysis. The TVVs could not be accessed with the IVUS catheter in seven cases (2.3%). Furthermore, 17 (5.7%) TVVs could not be examined due to a malfunction of the IVUS catheter. The technical success of the IVUS assessment was 91.9% (274/298), with no IVUS related adverse events. Seven TVVs (2.5%) showed signs of bSG instability by means of IVUS, leading to immediate revisions. The first post-operative CTA at least 30 days after the index procedure was available in 268 of the 274 TVVs originally assessed by IVUS. In seven of the 268 TVVs (2.6%) a re-intervention became necessary due to

PURPOSE: In situ laser fenestration (ISLF) is a recently introduced technology that offers the potential to perform total endovascular treatment of aortic arch and thoracoabdominal aortic pathologies in the acute setting. This experiment's aim was to assess ISLF in some currently common aortic endografts and bridging stent-grafts. MATERIALS AND METHODS: Three different aortic endografts were evaluated: (1) Zenith Alpha, (2) Zenith TX2, and (3) Conformable GORE TAG. Each endograft was submerged in 37°C saline to create fenestrations using the 308 nm CVX-300 Excimer Laser System fitted with a 2.3 mm diameter Turbo-Elite laser atherectomy catheter compatible with a 0.018″ guidewire. Three different 8 mm bridging stent-grafts were evaluated: (1) BeGraft peripheral, (2) BeGraft peripheral plus, and (3) GORE VIABAHN VBX Balloon Expandable. All bridging stent-grafts were deployed and exposed to different balloon sizes and pressures. The ISLFs and bridging stent-grafts were then evaluated for any tears, stenoses, and seal. RESULTS: A laser fenestration was consistently rapidly obtained in the Zenith Alpha and the Zenith TX2 endografts while it proved difficult to achieve a timely fenestration in the C-TAG. No fabric tears were noted in the Zenith Alpha and Zenith TX2 when inflating Armada (Abbott) 8 mm balloon in the fenestrations with pressures up to 15 atmospheres (rated burst pressure) nor when flaring bridging stent-grafts with balloons up to 12 mm in diameter at 10 atmospheres, while major tears were frequently noted in the C-TAG when the Armada 8 mm balloons were inflated. BeGraft Peripheral and BeGraft Peripheral Plus were all firmly attached to the fenestrations showing good seal on manual testing, while every sixth VBX bridging stent-graft displayed poorer attachment to the fenestration before dilatation at high pressure. Commonly, significant stenoses remained in the bridging stent-grafts after dilatation at nominal pressure, which could only be eradicated with hi

Objective: Treatment of complex aortic aneurysms with the in situ laser fenestration (ISLF) technique involves implantation of a balloon expandable stent graft (bSG) in the created fenestration. Adequate expansion of this bSG is of importance both to achieve seal and to ensure target vessel stability. This experimental study assessed the expansion rate of different bSGs in the ISLF setting using intravascular ultrasound (IVUS). Methods: A commercially available aortic endograft was used to test the laser fenestration technique (Zenith Alpha, Cook Medical LLC, Bloomington, IN, USA). The ISLF was stented with the following bSGs: two Gore Viabahn VBX balloon expandable endoprostheses (WL Gore & Associates, Bloomington, IL, USA), three BeGraft Peripheral and three BeGraft Plus (Bentley InnoMed GmbH; Hechingen, Germany), and three Advanta V12 (Atrium, Hudson, NH, USA). The bSGs were expanded in three steps: (1) nominal, (2) rated burst pressure, and (3) dilation with a non-compliant balloon at 15 atmospheres. After each step, an IVUS assessment of the bSG minimum diameter and the area at the fenestration (FA) and in a fully expanded segment distal to the fenestration (SA) was performed. A mean of the three IVUS measurements was used as the value for comparison. An insufficient bSG expansion was defined as a mean of FA/SA of <0.8 (i.e., <80% expansion). Results: The VBX was the only bSG that could be expanded to its intended diameter (i.e., at least 80%) at nominal pressure. The BeGraft Peripheral and BeGraft Plus had the lowest degree of expansion after nominal and rated burst pressure. All bSGs that were tested reached a sufficient expansion degree after using a higher pressure balloon. Conclusion: In this ex vivo experiment, dilation up to nominal pressure showed satisfactory expansion only for the VBX. The consistency of the results when applied to the different types of stent grafts that were analysed reflects structural stent graft specific issues to consi

Bakgrund: Ishockey är en av de största idrotterna i Sverige med cirka 80 000 licensieradespelare. Fysiologiska krav i ishockey inkluderar både anaerob och aerob uthållighet. Träningsbelastning, som mäts både internt (hjärtfrekvens, upplevd ansträngning) och externt (hastighet, distans), är avgörande för att undvika överträning och optimera prestation. Syftet är att undersöka träningsbelastning i jämförelse med matchbelastning för ishockeyspelare med hjälp av objektiva och subjektiva mått i form av intern belastning samt undersöka korrelationen mellan hjärtfrekvens och Borg CR10. Metod: Tillfrågade att delta i studien uppgick till 44 elitishockeyspelare fördelat på damer(n=18) och herrjuniorer (n=26). Analys inkluderade data från mätningar av hjärtfrekvens och skattningar av upplevd ansträngning efter träningar och matcher. Exklusionskriterier bestod av sjukdom eller frånvaro från träning/match. Hjärtfrekvens samlades in med hjälp av PolarH10 pulsband och upplevd ansträngning med hjälp av Borg CR10-skalan. Ett etiskt förhållningssätt genom pseudonymiserad data säkerställde deltagarnas säkerhet och analysergenomfördes i separat Excelfil utan namn och ålder på deltagare. Resultat: Av de 44 tillfrågade så resulterade det slutligen i 22 deltagare bestående avherrjuniorer (n=11) samt damer (n=11). Analysen visade på en signifikant högre maximal hjärtfrekvens (HFmax) under matcher jämfört med träningar hos herrjuniorerna (p<0,05). Däremot sågs ingen signifikant skillnad hos damerna (p=0,68). Det visade på en måttlig korrelation mellan medelhjärtfrekvens och upplevd ansträngning genom Borg CR10 (r=0,52;r=0,68). Konklusion: Studien visade att herrjuniorer har signifikant högre fysisk belastning (HFmax) under match jämfört med träning (p <0.05), medan ingen signifikant skillnad sågs i damlaget(p=0.68). Det fanns en måttlig korrelation mellan HFmedel och upplevd ansträngning (BorgCR10) i båda grupperna. Framtida forskning bör inkludera fler deltagare för bättre generalis

The off-the-shelf single fenestrated stent graft is based on the Cook Zenith fenestrated platform (Cook Medical Europe) with a premade 8-mm fenestration for the superior mesenteric artery (SMA). The device is suitable for emergency treatment of paravisceral aneurysms when combined with in situ laser fenestration for the renal arteries (and, if required, the celiac trunk). The presence of a premade SMA fenestration results in minimal visceral ischemia time. We present the case of a 69-year-old woman with a ruptured Crawford type I thoracoabdominal aortic aneurysm and a tandem abdominal aortic aneurysm that was treated successfully using the single fenestrated device with in situ laser fenes-tration for the renal arteries, with no SMA ischemia time. A 6-month computed tomography angiogram showed patent renovisceral stents without an endoleak.

Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort. Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed to identify factors associated with mortality. Results: One hundred and sixty-nine patients with surgically treated abdominal AGI were identified, comprising 43 SC (14 endografts; 53% with a graft enteric fistula [GEF] in total) and 126 RS (26 endografts; 50% with a GEF in total). The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan -Meier estimated five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan -Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 -1.5). Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.

Objective: A commonmeasure to lower the risk for spinal cord ischemia (SCI) during complex endovascular aortic repair (cEVAR) is prophylactic cerebrospinal fluid drainage (CSFD). This method has caused controversy because of drainrelated complications. Spinal drains are usually pressure directed. The objective of this study was to evaluate the risk of CSFD-related complications and SCI within the context of an automated volume-directed drain protocol. Methods: This is a retrospective, single-center study of all cEVARs with CSFD at a tertiary vascular center between January 2014 and December 2020. Demographics, complications, and spinal drain data were recorded. All drainages were volume based using an automatic drainage system (LiquoGuard7; Moller Medical GmbH). Spinal drain complications were categorized as disabling and nondisabling according to the modified Rankin scale. The primary end point was any CSFDrelated complication. Results: A total of 448 cEVAR patients were identified, of whom 147 (32.8%) had prophylactic CSFD. The mean age was 69 years (63% male). The most common pathology (61%) was thoracoabdominal aortic aneurysm, and the most common procedure was branched EVAR (55.1%). Eighteen (12.2%) patients developed a CSFD-related complication, whereof three (2%) were disabling. Nineteen (13%) patients developed SCI: 12 (8.4%) paraparetic, 5 (3.4%) paraplegic, and 2 (1.4%) paresthesias. Of these, 13 (68%) had full reversal of symptoms, whereas 6 patients (4%) had residual symptoms and were deemed disabling. Drain-related complications were more common in patients with SCI (31.6%) compared with those without (9.4%, P 1/4 .014). In the latter group, only two patients (1.6%) developed a disabling drain-related complication. Conclusions: Selective use of prophylactic, automated volume-directed CSFD in patients at high risk for SCI was associated with a high incidence of complications and should be used with caution. Among those developing SCI, reversalwas achieve

Background: In situ laser fenestration (ISLF) is a novel endovascular technique which allows customization of a standard stent graft to a patient's anatomy. While most reported cases involve revascularization of the left subclavian artery (LSA), some centers have now reported their initial experience treating branches of the visceral aorta for aortic aneurysms. The aim of this study is to examine the adoption of ISLF in emergent aortic pathology at a specialized aortic center. Methods: Between December 2020 and February 2022, all patients who underwent ISLF as part of endovascular intervention for complex aortic pathology at a university hospital were identified. Cases were collected from a prospective aortic database with additional information obtained from a retrospective review of electronic hospital records. Results: Fifteen patients (11 men and 4 women) underwent emergency ISLF, with a median age of 76 years. Eleven presented with symptomatic or ruptured aortic aneurysms, three with acute complicated aortic dissections and 1 aortic traumatic transection. Most aortic aneurysms were thoraco-abdominal (n = 7), with 1 arch, 1 thoracic, 1 supra-renal, and one-juxta-renal aortic aneurysm. ISLF was performed to revascularize the LSA in 8 cases, and branches of the reno-visceral aorta in 7 cases. All LSA ISLF cases had left brachial artery exposure. Femoral access was percutaneous in 14 of 15 cases. Technical success was 96.3% (26/27)). Median ischemic times were: superior mesenteric artery 7 min, renal arteries 22 min, and celiac trunk 43.5 min. There were 2 early aortic/fenestration related reinterventions. There was no stroke and 1 death caused by heparin-induced thrombocytopenia within 30 days. The majority of patients did not require intensive care admission (n = 8). The median intensive care unit stay was 0 days and hospital length of stay 18 days. There was no fenestration endoleak or reintervention post discharge with a median follow-up of 168 days. Conclusion

This master's thesis presents the development of a conceptual model, SMARTQUAL LITE, designed to measure and evaluate the quality of services delivered by smart buildings. The purpose of this research is to provide a foundation for a comprehensive service quality model, SMARTQUAL, enabling smart building service providers to enhance their service offerings and effectively meet tenant demands. The study addresses three key research questions: firstly, it explores how smart building services can be leveraged to improve the quality of office spaces. Secondly, it investigates whether property owners adequately meet tenant demands for smart building services. Lastly, it aims to establish a reliable and valid method for measuring the quality of smart building services. The findings highlight the presence of numerous digital tools and solutions offered by established companies specializing in smart infrastructure and smart buildings. These solutions offer substantial advantages, with their limitations gradually diminishing. The PropTech market is poised for the implementation of smart digital solutions to enhance office space quality. However, a significant challenge lies in convincing property owners of the intangible benefits provided by these solutions. While the argument for energy efficiency is relatively straightforward due to its cost-saving potential, the objective value of other smart building services remains unclear. This study aims to bridge this gap by proposing a simplified yet valid and credible measurement of smart buildingservice quality. Additionally, it explores the responsiveness of property owners to tenant demands. By developing SMARTQUAL LITE, this research provides a practical framework for assessing the service quality of smart building offerings. The model contributes to the ongoing advancement of smart building technology and encourages service providers to make informed decisions about service upgrades and offerings. Ultimately, it seeks to crea, Denna masteruppsats presenterar utvecklingen av en konceptuell modell, SMARTQUAL LITE, designad för att mäta och utvärdera kvaliteten på tjänster som levereras av smarta byggnader. Syftet med denna forskning är att ge en grund för en heltäckande tjänstekvalitetsmodell, SMARTQUAL, som gör det möjligt för leverantörer av smarta byggnadstjänster att förbättra sina tjänsteerbjudanden och effektivt möta hyresgästernas krav. Studien tar upp tre viktiga forskningsfrågor: för det första undersöker den hur smarta byggnadstjänster kan utnyttjas för att förbättra kvaliteten på kontorsutrymmen. För det andra undersöks om fastighetsägare uppfyller hyresgästernas krav på smarta tjänster på ett lämpligt sätt. Slutligen syftar det till att etablera en trovärdig och giltig metod för att mäta kvaliteten på smarta byggnadstjänster. Resultaten belyser närvaron av många digitala verktyg och lösningar som erbjuds av etablerade företag som specialiserar sig på smart infrastruktur och smarta byggnader. Dessa lösningar erbjuder betydande fördelar, medan deras begränsningar gradvis minskar. PropTech-marknaden är redo för implementering av smarta digitala lösningar för att förbättra kvaliteten av kontorsutrymmen. En betydande utmaning ligger dock i att övertygafastighetsägare om de immateriella fördelarna med dessa lösningar. Även om argumentet för energieffektivitet är relativt enkelt på grund av dess kostnadsbesparingspotential, är det objektiva värdet av andra smarta byggnadstjänster fortfarande oklart. Denna studie syftar till att överbrygga denna klyfta genom att föreslå en förenklad men giltig och trovärdig mätning av kvaliteten på smarta byggnadstjänster. Dessutom utforskar den fastighetsägares lyhördhet för hyresgästernas krav och efterfrågan. Genom att utveckla SMARTQUAL LITE ger denna forskning ett praktiskt ramverk för att bedöma servicekvaliteten hos smarta byggnader. Modellen bidrar till den pågående utvecklingen av smart byggnadsteknik och uppmuntrar tjänsteleverantörer att fatt

Objective: Pre-emptive embolization of aortic side branches may be effective in preventing type II endoleaks (T2EL) based on a previous systematic review and meta-analysis by our group. Data up to 2019 was, however, only based on retrospective studies. The aim of the current study was to update the meta-analysis and evaluate the current evidence on this treatment strategy. Methods: A systematic literature search was performed with the same keywords and strategies used in the previous study. The complementary search included all articles published from January 1, 2019, through May 29, 2022. The incidence of aneurysm sac growth was the primary outcome of interest. Results: Four new studies were identified, including one randomized controlled study and one nationwide registry-based retrospective study. Overall, the incidence of sac size enlargement was 4.3% in the embolization group compared with 6.8% in the control group (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.26-0.55), the incidence of T2EL was 19.7% vs 37.4% (OR, 0.38; 95% CI, 0.30-0.47), and the incidence of reintervention for T2EL was 1.2% vs 11.2% (OR, 0.12; 95% CI, 0.06-0.23). Conclusions: Current evidence confirms lower incidence of aneurysm sac growth, T2EL, and reinterventions when preemptive embolization of aortic side branches is performed in conjunction with endovascular aneurysm repair, compared with no embolization. However, a higher level of evidence is still required to support a broad change of practice, including data on cost-effectiveness and on the potential effect on rupture.

The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a significant risk of bleeding or ischemia of vital organs, resulting in a fatal outcome. Morbidity and mortality associated with aortic pathologies remain significant, despite improvements in medical therapy and endovascular techniques. In this narrative review, we present an overview of the transitions in the management of these pathologies and discuss current challenges and future perspectives. Diagnostic challenges include differentiating between thoracic aortic pathologies and cardiac diseases. Efforts have been made to identify a blood test that can rapidly differentiate these pathologies. Computed tomography is the cornerstone of diagnosing thoracic aortic emergencies. Our understanding of DTA pathologies has improved substantially due to the significant advancement in imaging modalities in the last 2 decades. On the basis of this understanding, the treatment of these pathologies has been revolutionized. Unfortunately, robust evidence from prospective and randomized studies is still lacking for the management of most DTA diseases. Medical management plays a crucial role in achieving early stability during these life-threatening emergencies. This includes intensive care monitoring, heart rate and blood pressure control, and considering permissive hypotension for patients presenting with ruptured aneurysms. Over the years, surgical management of DTA pathologies changed from open repair to endovascular repair with dedicated stent-grafts. Techniques in both spectrums have improved substantially.