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Background Historically, the transfemoral approach (TFA) has been the most common access site for cerebral intraoperative angiography (IOA). However, in line with trends in cardiac interventional vascular access preferences, the transradial approach (TRA) and transulnar approach (TUA) have been gaining popularity owing to favorable safety and patient satisfaction outcomes. Objective To compare the efficacy and safety of TRA/TUA and TFA for cerebral and spinal IOA at an institutional level over a 6-year period. Methods Between July 2016 and December 2022, 317 angiograms were included in our analysis, comprising 60 TRA, 10 TUA, 243 TFA, and 4 transpopliteal approach cases. Fluoroscopy time, contrast dose, reference air kerma, and dose-area products per target vessel catheterized were primary endpoints. Multivariate regression analyses were conducted to evaluate predictors of elevated contrast dose and radiation exposure and to assess time trends in access site selection. Results Contrast dose and radiation exposure metrics per vessel catheterized were not significantly different between access site groups when controlling for patient position, operative region, 3D rotational angiography use, and different operators. Access site was not a significant independent predictor of elevated radiation exposure or contrast dose. There was a significant relationship between case number and operative indication over the study period (P<0.001), with a decrease in the proportion of cases for aneurysm treatment offset by increases in total cases for the management of arteriovenous malformation, AVF, and moyamoya disease. Conclusions TRA and TUA are safe and effective access site options for neurointerventional procedures that are increasingly used for IOA. [ABSTRACT FROM AUTHOR]

Background: Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures., Methods: A retrospective chart review was conducted on patients who received a free flap at the Kapsowar Hospital in 2022-2023. Captured parameters included age, sex, relevant medical history, etiology of wound, flap performed, intraoperative time, complications, surgical revisions, and length of stay. Billing information for all domestic patients who received free flaps were audited, and disability-adjusted life years was calculated., Results: Nineteen free flaps were performed on 17 patients. The most common flap performed was the anterolateral thigh flap (n = 11). Flap survival rate was 94.7%. The surgical cost associated with performing an anterolateral thigh flap was $548 ± $35. The total cost associated with other free flap performances was $863 ± $269. The cost per disability-adjusted life years averted was $121, indicating that the procedure was very cost-effective., Conclusions: Despite obstacles, microsurgical practices can be safely established in limited-resource African settings. Free flaps can be performed with greater cost-efficiency when performed by local teams. Surgical mission trips should emphasize educational components and ultimately transition care to local surgeons., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: Few patients in South Sudan have access to cleft lip repair due to limitations in health care facilities, personnel and road infrastructure. Samaritan's Purse is a non-governmental organization that provides chartered flights from road inaccessible regions to a single central hospital in this nation's capital. This study's purpose was to describe the chartered flight model for conducting nationwide cleft lip mission trips., Methods: The authors performed a retrospective chart review of all patients who received cleft lip surgery at Juba Teaching Hospital during mission trips from 2011 to 2023. Patient sex, age, cleft characteristics, and home location were retrieved. Disability-adjusted life years (DALYs) were calculated and compared with the GDP/capita to assess cost-effectiveness using World Health Organization (WHO) standards., Results: Chart review identified 1085 patients who received cleft lip surgery. The average age of patients decreased from a high of 14.0 years in 2013 to a low of 8.2 years in 2023 (P<0.001). Patients were flown to Juba from all 10 states of South Sudan. The number of patients treated correlated with the state population (P<0.001). Each mission utilized an average of 14 flight paths. The cost of intervention per DALY averted was less than the GDP/capita of South Sudan, indicating the procedure was very cost-effective by WHO standards., Conclusions: Flight chartered mission trips in South Sudan have significantly decreased the backlog of patients with cleft lip in that country and are very cost-effective according to WHO standards. Investigating this model's utility for other surgical missions while continuing to build local surgical capacity is warranted., Competing Interests: C.R. is a consultant for Becton Dickinson and Johnson & Johnson;, however, neither of these companies was involved in the content of this study. The remaining authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)