108 results found
Hanna L, Abdullah A, Kashef E, et al., 2021, Four-year results of the Bolton relay proximal scallop endograft in the management of thoracic and thoracoabdominal aortic pathology with unfavorable proximal landing zone., J Vasc Surg
BACKGROUND: Thoracic endovascular aortic repair with a scallop design (scallop-TEVAR) is a useful treatment strategy to extend the proximal landing zone (PLZ), while maintaining perfusion to one or more of the supra-aortic trunks (SATs) when treating aortic pathology with an unfavorable PLZ. The durability of this approach with the Bolton Relay scallop endograft (Terumo Aortic, Sunrise, Fla) has not been established. METHODS: A retrospective review of prospectively collected data on consecutive patients that received scallop-TEVAR in zones 0 to 2 at a tertiary aortic unit was undertaken. The main outcome was durability, characterized by survival estimates, freedom from reintervention to the thoracic aorta and PLZ, migration and aneurysm sac regression. RESULTS: Between 2009 and 2019, 38 patients (71% male; median age, 70 years) underwent scallop-TEVAR for thoracic aortic pathology (n = 28, 74%) or as a part of thoracoabdominal aneurysm repair (n = 10 [26%]). The use of scallop-TEVAR significantly extended the PLZ (median, 5 mm preoperative PLZ vs 26 mm extended PLZ; P = .0001). A total of 41 SATs were perfused with a scallop, including the left subclavian artery (n = 25), left common carotid artery (n = 6), neo/innominate artery (n = 4), left subclavian artery, and vertebral artery (n = 1), innominate artery, and left common carotid artery (n = 2) in conjunction with 15 extra-anatomical bypasses. The PLZ was at Ishimaru zone 0 and 1 in 6 cases (16%), respectively, and zone 2 in 26 cases (68%). Technical success was 98%. The 30-day mortality was 5% (2/38; 1 death from myocardial infarction and 1 from multiorgan failure). A minor stroke occurred in three patients (8%) and temporary spinal cord ischemia in two patients (5%). The median follow-up was 4.5 years (range, 0-10.53 years) during which two patients (5%) developed type Ia endoleak and required intervention to the PLZ (one from device-related migra
Chan C, Sounderajah V, Normahani P, et al., 2021, Wearable activity monitors in home based exercise therapy for patients with intermittent claudication: a systematic review, European Journal of Vascular and Endovascular Surgery, Vol: 61, Pages: 676-687, ISSN: 1078-5884
OBJECTIVE: Intermittent claudication (IC) can severely limit functional capacity and quality of life. Supervised exercise therapy is the recommended first line management; however, this is often limited by accessibility, compliance and cost. As such, there has been an increased interest in the use of wearable activity monitors (WAMs) in home based telemonitoring exercise programmes for claudicants. This review aims to evaluate the efficacy of WAM as a feedback and monitoring tool in home based exercise programmes for patients with IC. DATA SOURCES: A search strategy was devised. The databases MEDLINE, EMBASE, and Web of Science were searched through to April 2020. REVIEW METHODS: Randomised trials and prospective trials were included. Eligible trials had to incorporate WAMs as a feedback tool to target walking/exercise behaviour. The primary outcome was the change in walking ability. Study quality was assessed with risk of bias tool. RESULTS: A total of 1148 records were retrieved. Of these, eight randomised controlled trials and one prospective cohort study, all of which compared a WAM intervention against standard care and/or supervised exercise, met the inclusion criteria. Owing to heterogeneity between studies, no meta-analysis was conducted. WAM interventions improved measures of walking ability (heterogeneous outcomes such as maximum walking distance, claudication distance and six minute walk distance), increased daily walking activity (steps/day), cardiovascular metrics (maximum oxygen consumption), and quality of life. CONCLUSION: There is some evidence that home based WAM interventions are beneficial for improving walking ability and quality of life in patients with IC. However, existing studies are limited by inadequate sample size, duration, and appropriate power. Achieving consensus on outcome reporting and study methods, as well as maximising device adherence, is needed.
Normahani P, Anwar IY, Courtney A, et al., 2021, Factors associated with infrainguinal bypass graft patency at 1-year; a retrospective analysis of a single centre experience, PERFUSION-UK, ISSN: 0267-6591
Bootun R, Belramman A, Bolton-Saghdaoui L, et al., 2021, Randomized controlled trial of compression after endovenous thermal ablation of varicose veins (COMETA Trial), Annals of Surgery, Vol: 273, Pages: 232-239, ISSN: 0003-4932
Background: The 21st century has witnessed a rise in the use of endovenousthermal ablation. Being highly clinically and cost-effective and improving thequality of life of patients, they are now considered to be the ‘‘gold-standard’’treatment for varicose veins. Post-intervention management, especially interms of postoperative compression, however, remains unclear. As a result, arandomized study was undertaken to investigate the effects of wearingcompression stockings after varicose vein treatment.Method: Patients with saphenous vein reflux undergoing treatment withendothermal ablation (with or without concurrent phlebectomies) wererandomized to receive either 7 days of compression stockings or no stockings.The primary outcome measure for this study was the pain score over the first10 postoperative days. The pain scores, clinical score, time to return to normalactivities, and ecchymosis were assessed. Patients were followed-up at2 weeks and 6 months post-ablation.Results: In total, 206 patients were randomized, 49% of them to thecompression group. The mean age was 49.7 (16) years and approximately51% of the population was male. The median pain score in the compressiongroup using a visual analog scale was significantly lower on days 2–5,compared to the no compression group. Those having concurrent phlebectomies and compression stockings also had significantly better pain scores ondays 1–3, day 5, and day 7. Improvement in the median venous clinicalseverity score was noted at 6-month follow-up, but this was not significant. Nodifference in the generic- or disease-specific quality of life was observed andthe time to return to activities was similar. There were no differences in thedegree of ecchymosis between the 2 groups and both groups had similarocclusion rates.Conclusions: These results indicate that wearing compression stockings afterendothermal ablation is advantageous in the first few days after treatment andis especially benef
Jones B, Riga C, Bicknell C, et al., 2021, Robot-Assisted Carotid Artery Stenting: A Safety and Feasibility Study, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 44, Pages: 795-800, ISSN: 0174-1551
Martin G, Scatling-Birch Y, Balaji S, et al., 2021, Examining the impact of psychological distress on short-term postoperative outcomes after elective endovascular aneurysm repair (EVAR)., Journal of Psychosomatic Research, ISSN: 0022-3999
Kundrat D, Dagnino G, Kwok TMY, et al., 2021, An MR-Safe Endovascular Robotic Platform: Design, Control, and Ex-Vivo Evaluation, IEEE Transactions on Biomedical Engineering, ISSN: 0018-9294
Objective: Cardiovascular diseases are the most common cause of global death. Endovascular interventions, in combination with advanced imaging technologies, are promising approaches for minimally invasive diagnosis and therapy. More recently, teleoperated robotic platforms target improved manipulation accuracy, stabilization of instruments in the vasculature, and reduction of patient recovery times. However, benefits of recent platforms are undermined by a lack of haptics and residual patient exposure to ionizing radiation. The purpose of this research was to design, implement, and evaluate a novel endovascular robotic platform, which accommodates emerging non-ionizing magnetic resonance imaging (MRI). Methods: We proposed a pneumatically actuated MR-safe teleoperation platform to manipulate endovascular instrumentation remotely and to provide operators with haptic feedback for endovascular tasks. The platform task performance was evaluated in an ex vivo cannulation study with clinical experts (N = 7) under fluoroscopic guidance and haptic assistance on abdominal and thoracic phantoms. Results: The study demonstrated that the robotic dexterity involving pneumatic actuation concepts enabled successful remote cannulation of different vascular anatomies with success rates of 90% - 100%. Compared to manual cannulation, slightly lower interaction forces between instrumentation and phantoms were measured for specific tasks. The maximum robotic interaction forces did not exceed 3 N. Conclusion: This research demonstrates a promising versatile robotic technology for remote manipulation of endovascular instrumentation in MR environments. Significance: The results pave the way for clinical translation with device deployment to endovascular interventions using non-ionising real-time 3D MR guidance.
Cheung S, Rahman R, Bicknell C, et al., 2020, Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 15, Pages: 2071-2078, ISSN: 1861-6410
Ramjeeawon A, Sharrock AE, Morbi A, et al., 2020, Using Fully-Immersive Simulation Training with Structured Debrief to Improve Nontechnical Skills in Emergency Endovascular Surgery, JOURNAL OF SURGICAL EDUCATION, Vol: 77, Pages: 1300-1311, ISSN: 1931-7204
Rolls A, Sudarsanam A, Luo X, et al., 2020, COVID-19 and vascular surgery at a Central London teaching hospital, British Journal of Surgery, Vol: 107, Pages: e311-e312, ISSN: 0007-1323
Nguyen A, Kundrat D, Dagnino G, et al., 2020, End-to-End Real-time Catheter Segmentation with Optical Flow-Guided Warping during Endovascular Intervention, Proceedings - IEEE International Conference on Robotics and Automation, Pages: 9967-9973, ISSN: 1050-4729
Accurate real-time catheter segmentation is an important pre-requisite for robot-assisted endovascular intervention. Most of the existing learning-based methods for catheter segmentation and tracking are only trained on smallscale datasets or synthetic data due to the difficulties of ground-truth annotation. Furthermore, the temporal continuity in intraoperative imaging sequences is not fully utilised. In this paper, we present FW-Net, an end-to-end and real-time deep learning framework for endovascular intervention. The proposed FW-Net has three modules: a segmentation network with encoder-decoder architecture, a flow network to extract optical flow information, and a novel flow-guided warping function to learn the frame-to-frame temporal continuity. We show that by effectively learning temporal continuity, the network can successfully segment and track the catheters in real-time sequences using only raw ground-truth for training. Detailed validation results confirm that our FW-Net outperforms stateof-the-art techniques while achieving real-time performance.
Chi W, Dagnino G, Kwok TMY, et al., 2020, Collaborative Robot-Assisted Endovascular Catheterization with Generative Adversarial Imitation Learning, Pages: 2414-2420, ISSN: 1050-4729
Master-slave systems for endovascular catheterization have brought major clinical benefits including reduced radiation doses to the operators, improved precision and stability of the instruments, as well as reduced procedural duration. Emerging deep reinforcement learning (RL) technologies could potentially automate more complex endovascular tasks with enhanced success rates, more consistent motion and reduced fatigue and cognitive workload of the operators. However, the complexity of the pulsatile flows within the vasculature and non-linear behavior of the instruments hinder the use of model-based approaches for RL. This paper describes model-free generative adversarial imitation learning to automate a standard arterial catherization task. The automation policies have been trained in a pre-clinical setting. Detailed validation results show high success rates after skill transfer to a different vascular anatomical model. The quality of the catheter motions also shows less mean and maximum contact forces compared to manual-based approaches.
Salim S, Locci R, Martin G, et al., 2020, Short- and long-term outcomes in isolated penetrating aortic ulcer disease, Journal of Vascular Surgery, Vol: 72, Pages: 84-91, ISSN: 0741-5214
BACKGROUND: The optimum management of isolated penetrating aortic ulceration (PAU), with no associated intramural hematoma or aortic dissection is not clear. We evaluate the short- and long-term outcomes in isolated PAU to better inform management strategies. METHODS: We conducted a retrospective review of 43 consecutive patients (mean age, 72.2 years; 26 men) with isolated PAU (excluding intramural hematoma/aortic dissection) managed at a single tertiary vascular unit between November 2007 and April 2019. Twenty-one percent had PAU of the arch, 62% of the thoracic aorta, and 17% of the abdominal aorta. Conservative and surgical groups were analyzed separately. Primary outcomes included mortality, PAU progression, and interventional complications. RESULTS: Initially, 67% of patients (29/43) were managed conservatively; they had significantly smaller PAU neck widths (P = .04), PAU depths (P = .004), and lower rates of associated aneurysmal change (P = .004) compared with those initially requiring surgery. Four patients (4/29) initially managed conservatively eventually required surgical management at a mean time interval of 49.75 months (range, 9.03-104.33 months) primarily owing to aneurysmal degeneration. Initially, 33% of patients (14/43) underwent surgical management; 7 of the 14 procedures were urgent. Of the 18 patients, 17 eventually managed with surgical intervention had an endovascular repair; 2 of the 17 endovascular cases involved supra-aortic debranching, six used scalloped, fenestrated, or chimney stents. The overall long-term mortality was 30% (mean follow-up, 48 months; range, 0-136 months) with no significant difference between the conservatively and surgically managed groups (P = .98). No aortic-related deaths were documented during follow-up in those managed conservatively. There was no in-hospital mortality after surgical repair. Of these 18 patients, two required reintervention within 30 days for t
John IJ, Choo H, Pettengell CJ, et al., 2019, Patient views on surgeon-specific outcome reporting in vascular surgery: novel validated patient questionnaire study, Annals of Surgery, Pages: 1-8, ISSN: 0003-4932
BACKGROUND: SSMD are used to enhance transparency, improve quality and facilitate patient choice. The use of SSMD is controversial, but patients' views on such data are largely unknown. OBJECTIVES: The aim of this study was therefore to explore the views of patients and to identify their priorities for outcome reporting in vascular surgery. METHODS: A prospective questionnaire study of 165 patients receiving care in a single academic vascular unit was performed. Data on patients' current understanding and use of SSMD, together with future priorities were collected. RESULTS: Of the 165 patients 80% were unaware of SSMD. 72% thought they should be made aware of the data, although 63% thought they were likely to misinterpret the results. The majority recognized the utility of SSMD to inform treatment (60%) and surgeon (53%) choice. The majority prioritize the patient-surgeon relationship (90%) and past experiences of care (71%) when making treatment decisions. A significant majority (66% vs 49%; P < 0.005) would favour hospital-level to surgeon-level data. The main patient priorities for future outcome reporting were waiting list length (56%), the quality of hospital facilities (55%), and patient satisfaction (54%). CONCLUSIONS: The aims of SSMD reporting are not currently being met, and both patients and healthcare professionals have shared concerns over the nature and usefulness of the data. Patients express a preference for hospital-level outcomes and prioritize the experience of receiving care over outcomes when making treatment decisions. Future outcome reporting should include patient-directed hospital-level metrics that are readily accessible and understood by all.
Knighton A, Martin G, Sounderajah V, et al., 2019, Avoidable 30‐day readmissions in patients undergoing vascular surgery, BJS Open, Vol: 3, Pages: 759-766, ISSN: 2474-9842
Background: Vascular surgery has one of the highest unplanned 30-day readmission rates of all surgical specialities. The degree to which these may be avoidable and the optimal strategies to reduce their occurrence is unknown. The aim of this study was to identify and classify avoidable 30-day readmissions in patients undergoing vascular surgery in order to plan targeted interventions to reduce their occurrence, improve outcomes and reduce cost.Methods: A retrospective analysis of discharges over a 12-month period from a single tertiary vascular unit was performed. A multidisciplinary panel conducted a manual case note review to identify and classify those 30-day unplanned emergency readmissions deemed avoidable.Results: An unplanned 30-day readmission occurred in 72/885 (8.1%) admissions. These unplanned readmissions were deemed avoidable in 50.0% (36/72) and were most frequently due to unresolved medical issues (19/36, 52.8%) and inappropriate admission with the potential for outpatient management (7/36, 19.4%). A smaller number were due to inadequate social care provision (4/36, 11.1%) and the occurrence of other avoidable adverse events (4/36, 11.1%). Conclusion: Half of all 30-day readmissions in vascular patients are potentially avoidable. Multidisciplinary coordination of inpatient care and the transition from hospital to community care following discharge need to be improved.
Hanna L, Gibbs R, Fadl A, et al., 2019, Midterm to long-term outcomes of scallop endografts in the management of aortic disease with unfavorable proximal landing zone in the arch, Fall Meeting of the Frank-J-Veith-International-Society / VEITH Symposium, Publisher: Elsevier, Pages: E145-E145, ISSN: 0741-5214
Zheng J-Q, Zhou X-Y, Riga C, et al., 2019, Real-Time 3-D Shape Instantiation for Partially Deployed Stent Segments From a Single 2-D Fluoroscopic Image in Fenestrated Endovascular Aortic Repair, IEEE ROBOTICS AND AUTOMATION LETTERS, Vol: 4, Pages: 3703-3710, ISSN: 2377-3766
Rolls AE, Riga CV, Rahim SU, et al., 2019, The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting, JOURNAL OF VASCULAR SURGERY, Vol: 69, Pages: 1482-1489, ISSN: 0741-5214
Bakhsh A, Martin GFJ, Bicknell CD, et al., 2019, An Evaluation of the Impact of High-Fidelity Endovascular Simulation on Surgeon Stress and Technical Performance, JOURNAL OF SURGICAL EDUCATION, Vol: 76, Pages: 864-871, ISSN: 1931-7204
Dagnino G, Liu J, Abdelaziz M, et al., 2019, Haptic feedback and dynamic active constraints for robot-assisted endovascular catheterization, 2018 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS 2018), Publisher: IEEE
Robotic and computer assistance can bring significant benefits to endovascular procedures in terms of precision and stability, reduced radiation doses, improved comfort and access to difficult and tortuous anatomy.However,the design of current commercially available platforms tends to alter the natural bedside manipulation skills of the operator, so thatthe manually acquired experience and dexterityare not well utilized. Furthermore, most of these systems lackofhaptic feedback, preventing their acceptance and limiting the clinical usability.In this paper a new robotic platform for endovascular catheterization, the CathBot, is presented.It is an ergonomic master-slave system with navigation system and integrated vision-based haptic feedback, designed to maintain the natural bedside skills of the vascular surgeon. Unlike previous work reported in literature, dynamic motion tracking of both the vessel walls the catheter tip is incorporated to create dynamic activeconstraints. The system was evaluated through a combined quantitative and qualitative user study simulating catheterization tasks on a phantom. Forces exerted on the phantom were measured. The results showed a 70% decrease in mean force and 61% decrease in maximum force when force feedback is provided. This research provides the first integration of vision-based dynamic active constraints within an ergonomic robotic catheter manipulator. The technological advances presented here, demonstratesthat vision-based haptic feedback can improve the effectiveness, precision, and safety of robot-assisted endovascular procedures.
Chi W, Liu J, Abdelaziz MEMK, et al., 2019, Trajectory Optimization of Robot-Assisted Endovascular Catheterization with Reinforcement Learning, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 3875-3881, ISSN: 2153-0858
Zhou X-Y, Riga C, Lee S-L, et al., 2019, Towards Automatic 3D Shape Instantiation for Deployed Stent Grafts: 2D Multiple-class and Class-imbalance Marker Segmentation with Equally-weighted Focal U-Net, 25th IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 1261-1267, ISSN: 2153-0858
Abdelaziz MEMK, Kundrat D, Pupillo M, et al., 2019, Toward a Versatile Robotic Platform for Fluoroscopy and MRI-Guided Endovascular Interventions: A Pre-Clinical Study, IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 5411-5418, ISSN: 2153-0858
Molinero MB, Dagnino G, Liu J, et al., 2019, Haptic Guidance for Robot-Assisted Endovascular Procedures: Implementation and Evaluation on Surgical Simulator, IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), Publisher: IEEE, Pages: 5398-5403, ISSN: 2153-0858
Zheng J-Q, Zhou X-Y, Riga C, et al., 2019, Towards 3D Path Planning from a Single 2D Fluoroscopic Image for Robot Assisted Fenestrated Endovascular Aortic Repair, International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 8747-8753, ISSN: 1050-4729
Normahani P, Kwasnicki R, Bicknell C, et al., 2018, Wearable sensor technology efficacy in peripheral vascular disease (wSTEP): a randomized controlled trial, Annals of Surgery, Vol: 268, Pages: 1113-1118, ISSN: 1528-1140
OBJECTIVE: To evaluate the effect of using wearable activity monitors (WAMs) in patients with intermittent claudication (IC) within a single-center randomized controlled trial. BACKGROUND: WAMs allow users to set daily activity targets and monitor their progress. They may offer an alternative treatment to supervised exercise programs (SEPs) for patients with IC. METHODS: Thirty-seven patients with IC were recruited and randomized into intervention or control group. The intervention consisted of a feedback-enabled, wrist-worn activity monitor (WAM) in addition to access to SEP. The control group was given access to SEP only. The outcome measures were maximum walking distance (MWD), claudication distance (CD), and quality of life as measured by the VascuQol questionnaire. Participants were assessed upon recruitment, and at 3, 6, and 12 months. RESULTS: Patients in the WAM group showed significant improvement in MWD at 3 and 6 months (80-112 m, to 178 m; P < 0.001), which was sustained at 12 months. The WAM group also increased CD (40 vs 110 m; P < 0.001) and VascuQol score (4.7 vs 5.8; P = 0.004). The control group saw a temporary increase in VascuQol score at 6 months (4.5 vs 4.7; P = 0.028), but no other improvements in MWD or CD were observed. Significantly higher improvements in MWD were seen in the WAM group compared with that in the control group at 6 months (82 vs -5 m; P = 0.009, r = 0.47) and 12 months (69 vs 7.5 m; P = 0.011, r = 0.52). CONCLUSIONS: The study demonstrates the significant, sustained benefit of WAM-led technologies for patients with IC. This potentially resource-sparing intervention is likely to provide a valuable adjunct or alternative to SEP.
Martin G, Pettengell C, John I, et al., 2018, What Do Patients Want to Know About Their Surgeon? Stakeholder Views of Surgeon-Specific Mortality Data, 45th Annual VEITHSymposium, Publisher: MOSBY-ELSEVIER, Pages: E161-E161, ISSN: 0741-5214
Doyen B, Bicknell CD, Riga CV, et al., 2018, Evidence Based Training Strategies to Improve Clinical Practice in Endovascular Aneurysm Repair, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 56, Pages: 751-758, ISSN: 1078-5884
Zheng J-Q, Zhou X-Y, Riga C, et al., 2018, 3D path planning from a single 2D fluoroscopic image for robot assisted fenestrated endovascular aortic repair, Publisher: arXiv
The current standard of intra-operative navigation during FenestratedEndovascular Aortic Repair (FEVAR) calls for need of 3D alignments betweeninserted devices and aortic branches. The navigation commonly via 2Dfluoroscopic images, lacks anatomical information, resulting in longeroperation hours and radiation exposure. In this paper, a framework forreal-time 3D robotic path planning from a single 2D fluoroscopic image ofAbdominal Aortic Aneurysm (AAA) is introduced. A graph matching method isproposed to establish the correspondence between the 3D preoperative and 2Dintra-operative AAA skeletons, and then the two skeletons are registered byskeleton deformation and regularization in respect to skeleton length andsmoothness. Furthermore, deep learning was used to segment 3D pre-operative AAAfrom Computed Tomography (CT) scans to facilitate the framework automation.Simulation, phantom and patient AAA data sets have been used to validate theproposed framework. 3D distance error of 2mm was achieved in the phantom setup.Performance advantages were also achieved in terms of accuracy, robustness andtime-efficiency. All the code will be open source.
Rolls A, Riga C, 2018, Endovascular robotics The current state and the future direction, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 100, Pages: 14-+, ISSN: 0035-8843
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