20 results on '"Pawel Rynio"'
Search Results
2. An unusual case of aortic rupture after deployment of a bare stent in the treatment of aortic dissection in a patient with giant-cell arteritis
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Pawel Rynio, Arkadiusz Kazimierczak, Piotr Gutowski, and Miloslaw Cnotliwy
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stent graft ,endovascular treatment ,aortic dissection ,giant-cell arteritis ,aortic rupture ,petticoat ,Medicine - Abstract
Giant-cell arteritis is associated with a higher risk of aortic aneurysm and aortic dissection formation. We present a women with aortic dissection type B treated with a stent graft and bare-metal stent implantation. After the stent deployment we noticed aortic rupture, which was successfully treated with implantation of an additional stent graft. This report highlights the difficulty of endovascular therapy in patients with giant-cell arteritis. We have to bear in mind that chronic inflammation of the aorta leads to a more fragile aortic wall than normal. We recommend the use of a stent graft over a bare-metal stent and gentle use of a balloon catheter.
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- 2017
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3. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell’s Diverticulum
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Clare Moffatt, Jonathan Bath, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchell R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley MBBCH, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Mario D'Oria, Sandro Lepidi, Peter Lawrence, and Karen Woo
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
4. Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
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Jonathan Bath, Mario D'Oria, Richard T. Rogers, Jill J. Colglazier, Drew J. Braet, Dawn M. Coleman, Salvatore T. Scali, Martin R. Back, Gregory A. Magee, Anastasia Plotkin, Philip Dueppers, Alexander Zimmermann, Rana O. Afifi, Sophia Khan, Devin Zarkowsky, Gregory Dyba, Michael C. Soult, Kevin Mani, Anders Wanhainen, Carlo Setacci, Massimo Lenti, Loay S. Kabbani, Mitchelle R. Weaver, Daniele Bissacco, Santi Trimarchi, Jordan B. Stoecker, Grace J. Wang, Zoltan Szeberin, Eniko Pomozi, Clare Moffatt, Hugh A. Gelabert, Shahed Tish, Andrew W. Hoel, Nicholas S. Cortolillo, Emily L. Spangler, Marc A. Passman, Giovanni De Caridi, Filippo Benedetto, Wei Zhou, Yousef Abuhakmeh, Daniel H. Newton, Christopher M. Liu, Giovanni Tinelli, Yamume Tshomba, Airi Katoh, Sammy S. Siada, Manar Khashram, Sinead Gormley, John R. Mullins, Zachary C. Schmittling, Thomas S. Maldonado, Amani D. Politano, Pawel Rynio, Arkadiusz Kazimierczak, Alexander Gombert, Houman Jalaie, Paolo Spath, Enrico Gallitto, Martin Czerny, Tim Berger, Mark G. Davies, Francesco Stilo, Nunzio Montelione, Luca Mezzetto, Gian Franco Veraldi, Sandro Lepidi, Peter Lawrence, and Karen Woo
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Aberrant subclavian artery ,Kommerell's diverticulum ,Surgery ,Cardiology and Cardiovascular Medicine ,Settore MED/22 - CHIRURGIA VASCOLARE - Published
- 2023
5. Multidisciplinary aortic arch procedures within the 'Aortic Team'
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Tomasz Jędrzejczak, Pawel Rynio, Maciej Lewandowski, Andrzej Żych, Anita Rybicka, Maciej Żukowski, and Arkadiusz Kazimierczak
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Surgery ,Cardiology and Cardiovascular Medicine - Abstract
The European societies EACTS (European Association for Cardio-Thoracic Surgery) and ESVS (European Society for Vascular Surgery) recommend the establishment of "Aortic Teams" from 2019. In Poland, the first such team was officially established in Specialist University Hospital no. 2 in Szczecin in 2021.Sixty-four patients were treated for aortic arch pathology using frozen elephant trunk (Among thoracic endovascular aortic repair (TEVAR) plus (chimneys/periscopes,Implementation of the recommendation to create aortic teams within cardiac surgery departments is possible and may be cost-effective in Polish conditions.
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- 2021
6. Physician-Modified Stent-Grafts Created in the Three-Dimensionally Aortic Template Have Better Reliability and Greater Alignment With the Target Vessels Than Stent-Grafts Modified Based on Measurements From Computed Tomography
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Pawel Rynio, Piotr Gutowski, and Arkadiusz Kazimierczak
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Radiology, Nuclear Medicine and imaging ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Purpose: Physician-modified stent-grafts (PMSG) are widely used, especially when a patient’s condition precludes waiting for a custom-made device. In recent years, the modification process has been upgraded using 3-dimensional (3D) aortic templates. Nonetheless, the reliability of PMSG and accuracy of fenestration alignment with the target vessel are not known. Thus, the study is aimed to fulfill the gap in current knowledge. Materials and Methods: Ten computed tomographic (CT) scans of aortic aneurysm previously treated with the fenestrated endovascular repair were selected to 3D-print aortic templates and elastic vessel phantoms. Two vascular surgeons performed fenestrations using the 3D template and modification plan based on CT measurements. Two operators each performed 10 fenestrated stent-grafts in the aortic template and 10 using CT measurements, for a total of 40 fenestrated stent-grafts. Then, stent-grafts were implanted in elastic vessel phantoms, which served to evaluate fenestration alignment with the target vessel. The alignment was judged in a 5-point scale: 0%, 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. The distances between fenestrations served to calculate interobserver variability for both methods. The measurements were processed as interclass correlation coefficient (ICC), Pearson and Spearman correlation, and Bland-Altman plots. Results: PMSG created with a 3D template had higher interclass correlation coefficient values and Pearson/Spearman correlation than fenestrations created from CT measurements. The rate of fenestration alignment with the target vessel was higher for PMSG created with a 3D template (p=0.007). Conclusions: PMSGs created with a 3D template are more reliable and have better fenestration alignment with the target vessel than PMSGs created based on CT measurements.
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- 2022
7. The Rate of Postoperative Complications in Complicated Acute, and Subacute Type B Aortic Dissections after TEVAR vs. PETTICOAT Procedures: Systematic Review and Meta-Analysis
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Natalia Niklas, Klaudia Królikowska, Kinga Zdrodowska, Piotr Gutowski, Arkadiusz Kazimierczak, and Paweł Rynio
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PETTICOAT ,TEVAR with bare metal stent ,endovascular reinterventions ,Medicine (General) ,R5-920 - Abstract
Background and Objectives: Provisional extension to induce complete attachment (PETTICOAT) is suggested as being associated with a lower incidence of aorta-related events and fewer reinterventions compared to thoracic endovascular aortic repair (TEVAR) in patients with complicated acute, and subacute type B aortic dissections. Materials and Methods: This article is a systematic review and meta-analysis following the PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were searched, starting on 21 February 2022 and ending on 22 June 2022, to identify studies that investigated the rate of postoperative complications in patients treated with the PETTICOAT compared to the TEVAR. A random effects meta-analysis was performed. Of 2350 studies, 5 studies involving 360 patients were included: 143 patients after the PETTICOAT procedure and 217 after the TEVAR. Results: The meta-analysis of all studies showed that the rate of secondary endovascular reinterventions was smaller in patients treated with the PETTICOAT (n = 3 studies; OR, 0.30; 95% CI, 0.10 to 0.94; p = 0.04). The results of other postoperative complications (30-day mortality, mortality during follow-up, paraplegia, stroke, and occurrence of endoleak) were lower in the PETTICOAT group but were not statistically significant. The rate of postoperative renal failure was lower in patients treated with the TEVAR (n = 4; OR, 1.08; 95% CI, 0.46 to 2.51; p = 0.86). Conclusion: This meta-analysis suggests that the PETTICOAT procedure is related to the lower rate of secondary endovascular reinterventions for complicated acute, and subacute type B aortic dissections.
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- 2023
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8. The Influence of Individualized Three-Dimensional Holographic Models on Patients’ Knowledge Qualified for Intervention in the Treatment of Peripheral Arterial Disease (PAD)
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Patryk Skórka, Michał Kargul, Diana Seemannová, Bartosz Gajek, Piotr Gutowski, Arkadiusz Kazimierczak, and Paweł Rynio
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augmented reality ,mixed reality ,HoloLens ,peripheral artery disease ,percutaneous transluminal angioplasty ,patient education ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We sought to determine the role of the patient-specific, three-dimensional (3D) holographic vascular model in patient medical knowledge and its influence on obtaining a more conscious informed consent process for percutaneous balloon angioplasty (PTA). Patients with peripheral arterial disease who had been scheduled for PTA were enrolled in the study. Information regarding the primary disease, planned procedure, and informed consent was recorded in typical fashion. Subsequently, the disease and procedure details were presented to the patient, showing the patients their individual model. A patient and medical supervisor equipped with mixed reality headsets could both simultaneously manipulate the hologram using gestures. The holographic 3D model had been created on a scale of 1:1 based on computed tomography scans. The patient’s knowledge was tested by the completion of a questionnaire before and after the interaction in a mixed reality environment. Seventy-nine patients manipulated arterial holograms in mixed reality head-mounted devices. Before the 3D holographic artery model interaction, the mean ± standard deviation score of the knowledge test was 2.95 ± 1.21 points. After the presentation, the score had increased to 4.39 ± 0.82, with a statistically significant difference (p = 0.0000) between the two scores. Using a Likert scale from 1 to 5, the patients had scored the use of the 3D holographic model at 3.90 points regarding its usefulness in comprehending their medical condition; at 4.04 points regarding the evaluation of the holograms as helpful in understanding the course of surgery; and rated the model at 1.99 points in reducing procedure-related stress. Using a nominal scale (know or don’t know), the patients had self-assessed their knowledge of the procedure before and after the 3D model presentation, with a score of 6.29 ± 2.01 and 8.39 ± 1.54, respectively. The study group tolerated the use of head-mounted devices. Only one patient had nausea and dizziness, while four patients experienced transient eye pain. The 3D holographic arterial model aided in the understanding of patients’ knowledge regarding the disease and procedure, making the informed consent process more conscious. The holograms improved the patient’s self-consciousness. Mixed reality headset-related complications were rare and within acceptable rates.
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- 2023
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9. Beyond Diameter: Enhancing Abdominal Aortic Aneurysm Surveillance with Volumetric Assessments after Endovascular Aneurysm Repair (EVAR)
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Michał Kargul, Patryk Skórka, Piotr Gutowski, Arkadiusz Kazimierczak, Ireneusz Wiernicki, and Paweł Rynio
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sac enlargement ,growth of sac volume ,endoleaks ,aorta ,abdominal aortic aneurysm ,volume measurement ,Medicine - Abstract
This study aimed to investigate the relationship between maximum transverse diameter (MTD) and volume measurements in patients who underwent reoperations after endovascular aneurysm repair (EVAR), and their association with the occurrence of endoleaks. The study included 51 patients who underwent EVAR and subsequent re-operations caused by endoleaks type I–III. In some number of events, multiple re-operations were needed. MTD was measured using the Horos software, and segmentations of the AAA were performed using 3D Slicer. This study first evaluated post-operative computed tomography angiography (CTA) to measure MTD and volume. Then, similar measurements were made in the control scan for re-operation qualification. Negative remodeling (increase in MTD and/or volume) was observed in 40 cases using MTD, and 48 cases using volume measurements. The volume measurement showed lower missed negatives than MTD, indicating its effectiveness in screening for negative remodeling (p < 0.001). Combining both methods identified 51 negative remodeling cases and 8 positive changes, with a higher sensitivity compared to MTD alone. The volume of the sac did not predict specific endoleak types. Decreases in MTD were observed in smaller sacs, with smaller volume changes. Volume measurement is a valuable screening tool, and combining MTD and volume enhances sensitivity. However, sac volume does not predict endoleak type.
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- 2023
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10. Physician-modified endograft in ruptured aortic arch
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Tomasz Jędrzejczak, Michał Żołnierczuk, Maciej Molski, Paweł Rynio, Anita Rybicka, and Arkadiusz Kazimierczak
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physician-modified endograft ,fenestrated thoracic endovascular aortic repair ,ruptured aortic arch. ,Medicine - Abstract
We present the case of a 27-year-old motorcyclist after a multi-organ trauma. He suffered a rupture of the aortic arch located in zone 2 and was disqualified from surgical replacement of the aortic arch due to active bleeding from parenchymal organs. Instead, he was provided with a physician-modified endograft (PMEG) to complete fenestrated thoracic endovascular aortic repair as a damage control procedure. No reports in the world literature are found regarding the use of PMEG technology in truly ruptured post-traumatic pseudo-aneurysm on the border of zone 1 and 2 of the aortic arch in emergency settings. The surgery provided temporary supply of the aorta and allowed all of the other surgical and orthopedic procedures to be completed. Endovascular treatment of aortic arch damage with PMEG is possible and can be effectively used for urgent indications when an open operation is not possible.
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- 2022
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11. Pilot Study: FSHR Expression in Neuroendocrine Tumors of the Appendix
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Dariusz Starzyński, Sylwia Rzeszotek, Agnieszka Kolasa, Marta Grabowska, Barbara Wiszniewska, Aleksandra Kudrymska, Katarzyna Karpińska, Aleksandra Tołoczko-Grabarek, Agnieszka Janiec, Aleksandra Myszka, Paweł Rynio, Anhelli Syrenicz, and Elżbieta Sowińska-Przepiera
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appendix neuroendocrine neoplasm ,ANEN ,FSHR ,endothelial cells ,Medicine - Abstract
Appendix neuroendocrine neoplasm (ANEN) treatment is based on tumor size and proliferation markers. Recently, the role of the follicle-stimulating hormone receptor (FSHR) from the clinical perspective has also been increasingly discussed. The FSHR is expressed in the endothelial cells of both intratumoral and peritumoral blood vessels, where it contributes to neoangiogenesis and blood vessel remodeling. FSHR expression is associated with a range of tumor types, such as gastrointestinal tumors, and it is not detected in healthy tissues located more than 10 mm from the tumor site or in tumor lymphatics. In this study, we evaluated the expression of FSHR and CD31 in the blood vessels of ANENs in females and males with confirmed histopathology. We conducted a quantitative analysis of the immunohistochemical reactions and found a higher number of microvessels in the mucosa and submucosa of neuroendocrine tumors in the appendix. A higher level of FSHR expression was observed in women. Future research should consider whether an elevated number of blood vessels along with a strong pattern of FSHR expression may influence future treatment strategies.
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- 2023
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12. Externalized transapical guidewire technique after artificial aortic valve replacement during complete endovascular aortic arch repair
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Tomasz Jędrzejczak, Paweł Rynio, Maciej Lewandowski, and Arkadiusz Kazimierczak
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artificial aortic valve replacement ,externalized transapical guidewire technique ,physician-modified endograft ,thoracic endovascular aortic repair ,Medicine - Abstract
An externalized transapical guidewire (ETAG) technique has been used for safe delivery of high-profile devices through a tortuous aorta to zone 0, which is currently precluded after mechanical artificial aortic valve replacement (AVR). The aim of the study was to report one center’s experience (based on 3 cases) of a unique modification to the ETAG technique used for the first time during total endovascular aortic arch repair after AVR. This report contains technical notes regarding a new method of steering the guidewire from the apex inside the artificial aortic valve during total endovascular aortic arch repair after AVR and the details crucial in preparation for this mini-invasive procedure. As a conclusion, the ETAG technique could be performed after mechanical AVR with active positioning of the guidewire carried out under the control of transesophageal echocardiography.
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- 2020
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13. Utility of dual longitudinal diameter-reducing ties in aortic arch thoracic endovascular aortic repair
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Arkadiusz Kazimierczak, Paweł Rynio, Tomasz Jędrzejczak, Maciej Lewandowski, and Piotr Gutowski
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Medicine - Published
- 2019
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14. Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis
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Natalia Niklas, Michalina Malec, Piotr Gutowski, Arkadiusz Kazimierczak, and Paweł Rynio
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inferior mesenteric artery ,embolization ,type II endoleak ,Medicine - Abstract
Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis following PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were used to identify studies that investigated the effect of IMA embolization on the occurrence of type II endoleaks and secondary interventions in a group of patients with abdominal aortic aneurysm who underwent EVAR compared with results after EVAR procedure without embolization. A random effects meta-analysis was performed. Of 3510 studies, 6 studies involving 659 patients were included. Meta-analysis of all studies showed that the rate of secondary interventions was smaller in patients with IMA embolization (OR, 0.17; SE, 0.45; 95% CI, 0.07 to 0.41; p < 0.01; I2 = 0%). The occurrence of type II endoleaks was also smaller in the embolization group (OR, 0.37; SE, 0.21; 95% CI, 0.25 to 0.57; p < 0.01; I2 = 16.20%). This meta-analysis suggests that IMA embolization correlates with lower rates of type II endoleaks and secondary interventions.
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- 2022
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15. Initial Experience with Fenestrated Physician-Modified Stent Grafts Using 3D Aortic Templates
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Paweł Rynio, Tomasz Jedrzejczak, Anita Rybicka, Ross Milner, Piotr Gutowski, and Arkadiusz Kazimierczak
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fenestrated endovascular repair ,physician-modified stent graft ,3D printing ,3D model ,3D template ,complex aortic procedure ,Medicine - Abstract
The goal of this study was to describe the surgical results of physician-modified endografts (PMEG) utilizing a 3D aortic template in a center with no prior experience in complex endovascular aortic repairs. Forty-three patients underwent physician-modified graft stent implantation using a 3D aortic model. The inclusion criteria were juxtarenal and suprarenal aortic aneurysms, type IV thoracoabdominal aneurysms, and type IA endoleak after endovascular aortic repair. In asymptomatic patients, the diameter threshold for aneurysm repair was 5.5 cm in males and 5.0 cm in females. 3D aortic templates were prepared from the patient’s computed tomography angiography scans and sterilized before use in the operating suite. Forty-three stent grafts were modified with the use of a 3D printing template. A total of 162 reinforced fenestrations (37 celiac, 43 right renal, 39 left renal, 43 superior mesenteric) with a mean of 3.8 per patient were performed. All PMEGs had a posterior reducing-diameter tie and a preloaded guidewire. The mean modification time was 86 ± 12 min. The mean follow-up was 14 ± 12 months. The 30-day mortality was 12%. During the follow-up period, the patency rate was 95% per the superior mesenteric artery, 93% per right renal artery, 95% per left renal artery, and 89% per celiac trunk. Twelve (28%) patients had endoleak, of which type I or III was present in 5 (12%) patients, and type II in 7 (16%). 3D printing can be successfully integrated into the physician’s everyday practice of stent graft modification. However, the use of this approach in centers without experience performing complex aortic procedures results in worse surgical metrics than those previously reported.
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- 2022
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16. Effects of Sterilization Methods on Different 3D Printable Materials for Templates of Physician-Modified Aortic Stent Grafts Used in Vascular Surgery—A Preliminary Study
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Paweł Rynio, Katarzyna Galant, Łukasz Wójcik, Bartłomiej Grygorcewicz, Arkadiusz Kazimierczak, Aleksander Falkowski, Piotr Gutowski, Barbara Dołęgowska, and Miłosz Kawa
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sterilization ,3D printing ,aortic template ,physician-modified stent graft ,surgical guide ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Three-dimensionally-printed aortic templates are increasingly being used to aid in the modification of stent grafts in the treatment of urgent, complex aortic disorders, often of an emergency nature. The direct contact between the aortic template and the stent graft implies the necessity of complete sterility. Currently, the efficacy of sterilizing aortic templates and the effect of sterilization on the geometry of tubular aortic models are unknown. A complex case of aortic arch dissection was selected to prepare a 3D-printed aortic arch template, which was then manufactured in six popular printing materials: polylactic acid (PLA), nylon, polypropylene (PP), polyethylene terephthalate glycol (PETG), and a rigid and flexible photopolymer resin using fused deposition modeling (FDM) and stereolithography (SLA). The 3D models were contaminated with Geobacillus stearothermophilus broth and Bacillus atrophaeus. The sterilization was performed using three different methods: heat (105 °C and 121 °C), hydrogen peroxide plasma, and ethylene oxide gas. Before and after sterilization, the aortic templates were scanned using computed tomography to detect any changes in their morphology by comparing the dimensions. All sterilization methods were effective in the elimination of microorganisms. Steam sterilization in an autoclave at 121 °C caused significant deformation of the aortic templates made of PLA, PETG, and PP. The other materials had stable geometries, and changes during mesh comparisons were found to be submillimeter. Similarly, plasma, gas, and heat at 105 °C did not change the shapes of aortic templates observed macroscopically and using mesh analysis. All mean geometry differences were smaller than 0.5 mm. All sterilization protocols tested in our study were equally effective in destroying microorganisms; however, differences occurred in the ability to induce 3D object deformation. Sterilization at high temperatures deformed aortic templates composed of PLA, PETG, and PP. This method was suitable for nylon, flexible, and rigid resin-based models. Importantly, plasma and gas sterilization were appropriate for all tested printing materials, including PLA, PETG, PP, nylon, flexible and rigid resins. Moreover, sterilization of all the printed models using our novel protocol for steam autoclaving at 105 °C was also 100% effective, which could represent a significant advantage for health centers, which can therefore use one of the most popular and cheap methods of medical equipment disinfection for the sterilization of 3D models as well.
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- 2022
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17. Abdominal Aortic Aneurysm Morphology as an Essential Criterion for Stratifying the Risk of Aneurysm Rupture
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Natalia Niklas, Piotr Gutowski, Arkadiusz Kazimierczak, and Paweł Rynio
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abdominal aortic aneurysm ,aneurysm risk rupture ,aneurysm wall structure ,Medicine - Abstract
The current stratification model of aneurysm rupture seems to be insufficient in some clinical cases. In our study, we determined the differences in wall structure between ruptured and unruptured aneurysms. We obtained computed tomography angiograms and categorized them into the following three groups, consisting of 49 patients each: the group with ruptured abdominal aortic aneurysms (rAAA), symptomatic (sAAA), and asymptomatic (aAAA). The three-dimensional AAA anatomy was digitally reconstructed for each patient through semi-automatically obtained segmentation, and each aneurysm was distinguished by the following three parameters: AFL (aneurysm flow lumen), ILT (intraluminal thrombus), and calcifications. The AFL volume was greater in rAAA compared with aAAA (p = 0.004), the ILT volume was greater in aAAA than in rAAA (p = 0.013), and the AFL/ILT surface ratio was bigger in rAAA than in aAAA (p < 0.001), sAAA than in aAAA (p = 0.033), and rAAA than in sAAA (p = 0.016). AFL/ILT surface*100 was defined as an independent predictive factor of rAAA to aAAA (OR 1.187; 95% CI 1.099–1.281), to sAAA (OR 1.045; 95% CI 1.004–1.087), and in sAAA vs. aAAA (OR 1.067; 95% CI 1.017–1.119). Consequently, the wall of rAAA differs significantly from unruptured aneurysms. The AFL/ILT surface ratio might indicate an increased risk of aneurysm rupture and the occurrence of symptoms in AAA.
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- 2022
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18. Impact of Carotid Endarterectomy on Choroidal Thickness and Volume in Enhanced Depth Optical Coherence Tomography Imaging
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Elżbieta Krytkowska, Monika Masiuk, Miłosz P. Kawa, Aleksandra Grabowicz, Paweł Rynio, Arkadiusz Kazimierczak, Krzysztof Safranow, Piotr Gutowski, and Anna Machalińska
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Ophthalmology ,RE1-994 - Abstract
Purpose. Carotid endarterectomy (CEA) is considered an effective therapeutic method for improving ocular circulation. The choroid is a predominantly vascular tissue; thus, systemic and local vascular alterations may influence its morphology and function. The aim of the current study was to analyse changes in choroidal thickness and volume in patients with significant internal carotid artery stenosis (ICAS) before and after unilateral CEA. Methods. The 42 eyes of the 21 asymptomatic patients included in the study were divided into two groups: those ipsilateral (EIE) and those contralateral (ECE) to CEA. All participants underwent a complete ophthalmologic examination, including enhanced depth imaging-optical coherence tomography (EDI-OCT). A comparative analysis of subfoveal thickness (CT) and choroidal volume (CV) measured in nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields at baseline, on the 2nd day after CEA, and in the 3rd month after CEA was performed. Results. In the EIE and ECE groups, no significant differences in either CT or CV values before and on the 2nd day after the CEA were observed. In the EIE group, a significant increase in CT and CV in the 3rd month after CEA compared to baseline was noted in the specific ETDRS region. Changes in CT and CV after surgery were positively correlated with the participants’ physical activity status and diastolic blood pressure and negatively correlated with the participants’ age and smoking status. Additionally, the analysis of changes in CV after CEA showed a positive correlation between the EIE and ECE groups. Conclusions. CT and CV fluctuations in the central and perifoveal areas visualized with EDI-OCT enabled the observation of the processes of tissue adaptation to variable blood flow conditions.
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- 2020
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19. The Impact of a Simplified Hydrostatic Bypass Flow Technique on Error Detection during Surgical Limb Revascularization
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Anita Rybicka, Paweł Rynio, Rabih Samad, Halina Szumiłowicz, Paweł Szumiłowicz, Sebastian Kazimierczak, Tomasz Zakrzewski, Piotr Gutowski, Elżbieta Grochans, Agata Krajewska, and Arkadiusz Kazimierczak
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chronic limb-threatening ischemia ,auto-vein bypass ,error detection ,blood flow measurement ,Medicine - Abstract
Technical errors have an impact on the results of surgical lower limb revascularization. Use of ultrasound scanning or angiography on the operating table is inconvenient and, in case of angiography, carries a certain risk of radiation and contrast exposure. A simpler method of screening for errors is required. This study assessed the accuracy of a new simple hydrostatic bypass flow technique during surgical limb revascularization. In all, 885 patients were included in the retrospective study. All were treated for Chronic Limb-Threatening Ischemia (CLTI) with a femoropopliteal bypass. Preoperatively, the radiological Vascular Surgery/International Society of Cardiovascular Surgery (SVS/ISCVS) score was used to assess the complexity of the anatomical changes. The surgeon made a subjective runoff assessment for every surgery. In 267 cases, the hydrostatic bypass flow (HBF) technique was used, and, in 66 cases, a digital subtraction angiography (DSA) was used. In each case, a postoperative Doppler ultrasound (DUS) examination was performed following the HBF. Good early results were achieved in 89.46%, and 154 errors (17.4%) were detected (85 were detected on the operating table, including 57 technical errors). Independent efficacy in error detection was proven with a postoperative Doppler examination (Aera Under Curve (AUC) = 0.89; criterion mid-graft peak systolic velocity (PSV) p = 0.00001) and hydrostatic bypass flow (AUC = 0.71, criterion HBF < 53 mL/min, p = 0.00001) during surgery. The hydrostatic bypass flow technique is an effective intraoperative screening method in bypass surgery. Algorithmic use of HBF, DSA if needed, and DUS postoperatively improves the outcome. HBF sufficiently reduced the need for on-table angiography.
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- 2020
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20. Simulation and Training of Needle Puncture Procedure with a Patient-Specific 3D Printed Gluteal Artery Model
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Paweł Rynio, Aleksander Falkowski, Jan Witowski, Arkadiusz Kazimierczak, Łukasz Wójcik, and Piotr Gutowski
- Subjects
3d printing ,simulation ,endovascular procedure ,gluteal artery ,endoleak ,needle puncture ,vascular access ,Medicine - Abstract
The puncture of the gluteal artery (GA) is a rare and difficult procedure. Less experienced clinicians do not always have the opportunity to practice and prepare for it, which creates a need for novel training tools. We aimed to investigate the feasibility of developing a 3D-printed, patient-specific phantom of the GA and its surrounding tissues to determine the extent to which the model can be used as an aid in needle puncture planning, simulation, and training. Computed tomography angiography scans of a patient with an endoleak to an internal iliac artery aneurysm with no intravascular antegrade access were processed. The arterial system, including the superior GA with its division branches, and pelvic area bones were 3D printed. The 3D model was embedded in the buttocks-shaped, patient-specific mold and cast. The manufactured, life-sized phantom was used to simulate the GA puncture procedure and was validated by 13 endovascular specialists. The printed GA was visible in the fluoroscopy, allowing for a needle puncture procedure simulation. The contrast medium was administered, simulating a digital subtraction angiography. Participating doctors suggested that the model could make a significant impact on preprocedural planning and resident training programs. Although the results are promising, we recommend that further studies be used to adjust the design and assess its clinical value.
- Published
- 2020
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