Publications
226 results found
Müller-Hülsbeck S, Fanelli F, Haage P, et al., 2023, Re-analysis of Old Data and New Outcomes Data Do Not Support a Link Between Paclitaxel Coated Balloons and Paclitaxel Eluting Stents and Mortality: These Devices Should be Used in PAD (Peripheral Arterial Disease) Treatment in Femoropopliteal Disease on the Basis of Their Published Efficacy., Cardiovasc Intervent Radiol, Vol: 46, Pages: 977-980
Al-rekabi A, Chen M, Patel N, et al., 2023, Wellbeing and burnout amongst interventional radiologists in the United Kingdom, Cardiovascular and Interventional Radiology, Vol: 46, Pages: 1053-1063, ISSN: 0174-1551
Purpose:To assess the prevalence of burnout amongst Interventional Radiologists (IRs) in the United Kingdom and identify demographic and practice-related stressors that may adversely affect wellbeing.Materials and Methods:A survey of 36 questions were divided into two sections. Section A consisted of 14 questions that assessed demographics and work characteristics; Section B assessed burnout, utilising the 22-item Maslach burnout inventory. Four additional open-ended questions were included to allow participants to voice opinions on the biggest contributors to workplace burnout and plans that could be implemented to alleviate this. The questionnaire was distributed to the British Society of interventional (BSIR) members. The study was conducted between August and September 2022.Results:Moderate to severe scores in emotional exhaustion (EE) were recorded in 65% of participants (moderate 26%; severe 39%) of participants r. Moderate to severedepersonalization (DP) scores were recorded in 46% of participants(moderate 23%; severe 23%). Low-moderate levels of personal accomplishment (PA) scores wererecorded in 77% of respondents (low 50%; moderate 27%). Weekly hours and out-of-hour IR cover were statistically significant in predicting emotional exhaustion. Age, sex (male), time available for teaching, and weekly hours were statistically significant in predicting the depersonalisation score. Age was a predictive factor for personal accomplishment. The most recurring themes in open response to major contributors of burnout were shortage of IR clinicians and supporting staff as well as the increasing IR workload.Conclusions:This survey has demonstrated high prevalence of Burnout amongst Interventional Radiologists in UK. Urgent measures are required to tackle the workforce shortage, recognition of IR workload and control IR resources.
Najafi G, Kreiser K, Abdelaziz MEMK, et al., 2023, Current State of Robotics in Interventional Radiology., Cardiovasc Intervent Radiol, Vol: 46, Pages: 549-561
As a relatively new specialty with a minimally invasive nature, the field of interventional radiology is rapidly growing. Although the application of robotic systems in this field shows great promise, such as with increased precision, accuracy, and safety, as well as reduced radiation dose and potential for teleoperated procedures, the progression of these technologies has been slow. This is partly due to the complex equipment with complicated setup procedures, the disruption to theatre flow, the high costs, as well as some device limitations, such as lack of haptic feedback. To further assess these robotic technologies, more evidence of their performance and cost-effectiveness is needed before their widespread adoption within the field. In this review, we summarise the current progress of robotic systems that have been investigated for use in vascular and non-vascular interventions.
Veličković VM, Carradice D, Boyle JR, et al., 2023, Umbrella review and meta-analysis of reconstructed individual patient data of mortality following conventional endovascular and open surgical repair of infrarenal abdominal aortic aneurysm., Expert Rev Cardiovasc Ther, Vol: 21, Pages: 347-356
OBJECTIVES: This umbrella review aims to quality assess published meta-analyses, conduct a de-novo meta-analysis of the available randomized control trials (RCTs), and test the hypothesis that there is a long-term difference in mortality between OSR and EVAR. METHODS: A systematic search was conducted in MEDLINE and EMBASE's bibliographic databases (June 2022). Data were extracted using standardized extraction forms. The methodological quality of publications was assessed using the ROBIS tool. Data were analyzed with 'one-stage' and 'two-stage' approaches. RESULTS: According to two-stage analysis, EVAR has significantly favorable mortality for up to four years (increasing evidence). Subsequently, until the longest available time period, there is no difference between EVAR and OSR; all the results are statistically non-significant.In one stage analysis, the Cox model demonstrated a non-significant (weak evidence) hazard ratio of 1.03 (95% confidence interval [CI]: 0.94-1.12) in favor of OSR. The best-fitting parametric model (generalized gamma), leads to an hazard ratio of 0.97 (95% CI: 0.93-1.01) in favor of EVAR, with the results approaching significance (weak evidence). CONCLUSION: The results of this umbrella systematic review and meta-analysis failed to demonstrate any difference in long-term mortality following planned EVAR, compared with OSR of infrarenal AAA.
Crockett S, Hanna L, Singh A, et al., 2023, Carbon dioxide flushing versus saline flushing of thoracic aortic stents (INTERCEPTevar): protocol for a multicentre pilot randomised controlled trial., BMJ Open, Vol: 13
INTRODUCTION: Thoracic endovascular aortic repair (TEVAR) carries a 3%-6.1% stroke risk, including risk of 'silent' cerebral infarction (SCI). Stent-grafts are manufactured in room air and retain air. Instructions for use recommend saline flushing to 'de-air' the system prior to insertion, but substantial amounts of air are released when deploying them, potentially leading to downstream neuronal injury and SCI. Carbon dioxide (CO2) is more dense and more soluble in blood than air, without risk of bubble formation, so could be used in addition to saline to de-air stents. This pilot trial aims to assess the feasibility of a full-scale randomised controlled trial (RCT) investigating the neuroprotective benefit against SCI with the use of CO2-flushed aortic stent-grafts. METHODS AND ANALYSIS: This is a multicentre pilot RCT, which is taking place in vascular centres in the UK, USA and New Zealand. Patients identified for TEVAR will be enrolled after informed written consent. 120 participants will be randomised (1:1) to TEVAR-CO2 or TEVAR-saline, stratified according to TEVAR landing zone. Participants will undergo preoperative neurocognitive tests and quality of life assessments, which will be repeated at 6 weeks, or first outpatient appointment, and 6 months. Inpatient neurological testing will be performed within 48 hours of return to level 1 care for clinical stroke or delirium. Diffusion-weighted MRI will be undertaken within 72 hours postoperatively (1-7 days) and at 6 months to look for evidence and persistence of SCI. Feasibility will be assessed via measures of recruitment and retention, informing the design of a full-scale trial. ETHICS AND DISSEMINATION: The study coordination centre has obtained approval from the London Fulham Research Ethics Committee (19/LO/0836) and Southern Health and Disability Ethics Committee (NZ) and UK's Health Regulator Authority (HRA). The study has received ethical approval for recruitment in the UK (Fulham REC, 19/LO/0836)
Goueffic Y, Torsello G, Zeller T, et al., 2022, Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial, CIRCULATION, Vol: 146, Pages: 1564-1576, ISSN: 0009-7322
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Sengupta S, Zhu Y, Hamady M, et al., 2022, Evaluating the haemodynamic performance of endografts for complex aortic arch repair, Bioengineering, Vol: 9, ISSN: 2306-5354
Thoracic endovascular aortic repair (TEVAR) of aortic aneurysms and dissections involving the arch has evolved over the last two decades. Compared to conventional surgical methods, endovascular repair offers a less invasive treatment option with lower risk and faster recovery. Endografts used in TEVAR vary in design depending on the procedure and application. Novel endografts (e.g., branched stent-graft) were developed to ensure perfusion of blood to the supra-aortic vessels, but their haemodynamic performance and long-term durability have not been adequately studied. This review focuses on the use of computational modelling to study haemodynamics in commercially available endografts designed for complex aortic arch repair. First, we summarise the currently adopted workflow for computational fluid dynamics (CFD) modelling, including geometry reconstruction, boundary conditions, flow models, and haemodynamic metrics of interest. This is followed by a review of recently (2010-present) published CFD studies on complex aortic arch repair, using both idealized and patient-specific models. Finally, we introduce some of the promising techniques that can be potentially applied to predict post-operative outcomes.
Johari NH, Hamady M, Xu XY, 2022, Fluid-Structure Interaction Study of The Effect of Stent on Local Hemodynamics Parameters at The Stented Carotid Artery Bifurcation, Journal of Advanced Research in Applied Sciences and Engineering Technology, Vol: 28, Pages: 247-255
Previous fluid-structure interaction (FSI) studies on carotid bifurcation focused on the effect of wall compliance on the predicted hemodynamic features in normal or atherosclerotic carotid arteries. However, FSI study on patient-specific post-stent carotid model is still lacking, and to the authors knowledge no such a study has been reported so far. This study attempts to simulate the full-scale patient-specific post-stent carotid bifurcation geometry with the hope to understand the effect of wall compliance on hemodynamic quantities. The FSI model was based on patient-specific geometry consisting of three components i.e., the carotid artery wall and stent as the solid domain, and blood in the fluid domain. Full FSI simulations incorporating patient-specific boundary conditions at the inlet and outlets, and realistic homogenous incompressible carotid wall and stent were completed to evaluate the flow patterns and wall shear stress. The FSI simulation results were compared with the corresponding rigid-wall model. The quantitative difference in time-averaged wall shear stress (TAWSS) distribution between the FSI and rigid-wall models shows that FSI model predicted 8% less of the area in the low TAWSS band (<0.4%) compared 0.4-1.2 Pa. The results suggest that although the effect of wall compliance on flow patterns in the patient-specific post-stent carotid model is negligible, its quantitative effect on wall shear stress may not be trivial and should be considered in future studies.
Aung EY-S, Khan M, Williams N, et al., 2022, Endovascular Stenting in Superior Vena Cava Syndrome: A Systematic Review and Meta-analysis, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 45, Pages: 1236-1254, ISSN: 0174-1551
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- Citations: 3
Torsello G, Bertoglio L, Kellersmann R, et al., 2022, One-year results of the INSIGHT study on endovascular treatment of abdominal aortic aneurysms, JOURNAL OF VASCULAR SURGERY, Vol: 75, Pages: 1904-+, ISSN: 0741-5214
Sengupta S, Hamady M, Xu X-Y, 2022, Haemodynamic analysis of branched endografts for complex aortic arch repair, Bioengineering, Vol: 9, Pages: 1-17, ISSN: 2306-5354
This study aims to investigate the haemodynamic response induced by implantation of a double-branched endograft used in thoracic endovascular aortic repair (TEVAR) of the aortic arch. Anatomically realistic models were reconstructed from CT images obtained from patients who underwent TEVAR using the RelayPlus double-branched endograft implanted in the aortic arch. Two cases (Patient 1, Patient 2) were included here, both patients presented with type A aortic dissection before TEVAR. To examine the influence of inner tunnel branch diameters on localised flow patterns, three tunnel branch diameters were tested using the geometric model reconstructed for Patient 1. Pulsatile blood flow through the models was simulated by numerically solving the Navier–Stokes equations along with a transitional flow model. The physiological boundary conditions were imposed at the model inlet and outlets, while the wall was assumed to be rigid. Our simulation results showed that the double-branched endograft allowed for the sufficient perfusion of blood to the supra-aortic branches and restored flow patterns expected in normal aortas. The diameter of tunnel branches in the device plays a crucial role in the development of flow downstream of the branches and thus must be selected carefully based on the overall geometry of the vessel. Given the importance of wall shear stress in vascular remodelling and thrombus formation, longitudinal studies should be performed in the future in order to elucidate the role of tunnel branch diameters in long-term patency of the supra-aortic branches following TEVAR with the double-branched endograft.
Hamady M, Tsitsiou Y, Ekpe J, et al., 2021, Use and effectiveness of Pioneer Re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature., CVIR Endovascular, Vol: 4, Pages: 1-8, ISSN: 2520-8934
IntroductionDuring subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre’s experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature.MethodA single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed.A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases.ResultsThe study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4–100% (median = 100%) and complication rate of 0–25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.
Hamady M, McCafferty I, 2021, The rocky road to recognizing interventional radiology as a full clinical speciality, CVIR Endovascular, Vol: 4
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Morgan RA, Loftus I, Ratnam L, et al., 2021, Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series, CVIR Endovascular, Vol: 4
Background: Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. Results: Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5–10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45–90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. Conclusions: This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arte
Morgan R, Cleveland T, Hamady M, et al., 2021, Interventional radiology in the 21st century: planning for the future., Clin Radiol, Vol: 76, Pages: 865-869
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, JOURNAL OF VASCULAR SURGERY, Vol: 74, Pages: 1447-1455, ISSN: 0741-5214
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- Citations: 6
Halliday A, Bulbulia R, Bonati LH, et al., 2021, Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy., Lancet, Vol: 398, Pages: 1065-1073
BACKGROUND: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. METHODS: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. FINDINGS: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs fo
Abdelaziz MEMK, Tian L, Hamady M, et al., 2021, X-ray to MR: the progress of flexible instruments for endovascular navigation, Progress in Biomedical Engineering, Vol: 3, Pages: 1-38, ISSN: 2516-1091
Interventional radiology and cardiology are rapidly growing areas of minimally invasive surgery, covering multiple diagnostic and interventional procedures. Treatment via endovascular techniques has become the go-to approach, thanks to its minimally invasive nature and its effectiveness in reducing hospitalisation and total time to recovery when compared to open surgery. Although x-ray fluoroscopy is currently the gold standard imaging technique for endovascular interventions, it presents occupational safety hazards to medical personnel and potential risks to patients, especially paediatric patients, because of its inherent ionising radiation. Magnetic resonance imaging (MRI), with its unique ability to provide radiation-free imaging, and acquiring morphologic and functional information, holds great promise in the advancement of image-guided navigation through the vasculature. Moreover, MRI has the potential to combine diagnosis, therapy and early evaluation of therapy in the same intervention. However, MR-guided interventions face a major challenge due to the presence of a large magnetic field (1.5/3 Tesla), which limits the set of materials suitable for the construction of key instrumentation (sheaths, catheters and guidewires). Despite these challenges, in recent years, significant progress has been made in the development of interventional devices, which comprise biocompatible, MR safe and MR visible materials. In an attempt to encourage and accelerate the development of MR-guided endovascular instrumentation, we present a systematic and illustrated overview of the plethora of work targeting to overcome the aforementioned limitations which are underpinned by the interdependent advancements in science, technology, engineering, mathematics and medicine (STEMM).
Hanna L, Abdullah A, Gibbs R, et al., 2021, Technical Note: Left Subclavian Artery Scallop Endografts to Facilitate a Proximal Landing Zone and Upper Extremity Access for Branched Endovascular Aortic Repair of Type II Thoracoabdominal Aortic Aneurysms, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 44, Pages: 1657-1662, ISSN: 0174-1551
Amiras D, Hurkxkens TJ, Figueroa D, et al., 2021, Augmented reality simulator for CT-guided interventions, EUROPEAN RADIOLOGY, Vol: 31, Pages: 8897-8902, ISSN: 0938-7994
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Piffaretti G, Czerny M, Riambau V, et al., 2021, Endovascular repair of ascending aortic diseases with custom-made endografts., Eur J Cardiothorac Surg, Vol: 59, Pages: 741-749
OBJECTIVES: The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS: This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS: Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS: Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
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
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- Citations: 6
Hamady M, Müller-Hülsbeck S, 2020, European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia; a word of caution!, CVIR Endovascular, Vol: 3
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Mollier J, Patel NR, Amoah A, et al., 2020, Clinical, Imaging and Procedural Risk Factors for Intrauterine Infective Complications After Uterine Fibroid Embolisation: A Retrospective Case Control Study., Cardiovasc Intervent Radiol, Vol: 43, Pages: 1910-1917
INTRODUCTION: This was a retrospective case-control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection. Cases were patients which developed intrauterine infection post-procedure, and controls were the background UFE population without infection. METHODS: Clinical demographics, presenting symptoms, uterine and fibroid characteristics on imaging and procedural variants were analysed. A p value of less than 0.05 was considered statistically significant. The main outcome measures were presence of infection and requirement of emergency hysterectomy. RESULTS: 333 technically successful UFE procedures were performed in 330 patients. Infection occurred after 25 procedures (7.5%). 3 of these patients progressed to overwhelming sepsis and required emergency hysterectomy. Clinical obesity (BMI > 30) (OR 1.53 [1.18-1.99]) and uterine volume > 1000cm3 (2.94 [1.15-7.54]) were found to increase the risk of infection CONCLUSIONS: UFE is generally safe in patients with symptomatic fibroids. Obese patients (BMI > 30) and those with large volume uteri (> 1000cm3) are at slight increased risk of developing infection and require appropriate pre-procedural counselling, as well as careful post-UFE follow-up. BMI and uterine volume may be useful to assess before the procedure to help to determine post-UFE infection risk.
Makris GC, Burrows V, Lyall F, et al., 2020, Vascular and Interventional Radiology Training; International Perspectives and Challenges, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 44, Pages: 462-472, ISSN: 0174-1551
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- Citations: 5
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
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Staniszewska A, Anwar M, Hamady M, et al., 2020, Hybrid repair of proximal subclavian artery transection, Trauma (United Kingdom), Vol: 22, Pages: 316-319, ISSN: 1460-4086
Although rare, subclavian artery injuries are associated with significant mortality and morbidity, with almost two-thirds of patients dying before reaching hospital. Recent advances in technology have resulted in increasing use of endovascular therapy in management of these injuries. In this report, we present a case of a successful hybrid repair of traumatic left proximal subclavian artery transection. The employment of an Amplatzer Vascular Plug to control a short proximal subclavian artery stump and subsequent ligation of the distal segment of subclavian artery with its anastomosis to the carotid artery resulted in excellent clinical outcome without performing a sternotomy in a young patient.
Hamady M, Bicknell C, 2020, Challenges of Total Endovascular Repair of Chronic Type B Aortic Dissection, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1735-1737, ISSN: 0174-1551
Johari NH, Hamady M, Xu XY, 2020, A computational study of the effect of stent design on local hemodynamic factors at the carotid artery bifurcation, Artery Research, Vol: 26, Pages: 161-169, ISSN: 1872-9312
Background: Previous clinical studies have shown that the incidence of restenosis after carotid and coronary stenting varies with stent design and deployment configuration. This study aims to determine how stent design may affect in-stent hemodynamics in stented carotid arteries by means of Computational Fluid Dynamics (CFD).Methods: A robust computational method was developed to integrate detailed stent strut geometry in a patient-specific carotid artery reconstructed from medical images. Three stent designs, including two closed-cell stents and one open-cell stent, were reproduced and incorporated into the reconstructed post-stent carotid bifurcation. CFD simulations were performed under patient-specific flow conditions. Local hemodynamic parameters were evaluated and compared in terms of Wall Shear Stress (WSS), Oscillatory Shear Index (OSI) and Relative Residence Time (RRT).Results: All simulated stent designs induced some degree of flow disruption as manifested through flow separation and recirculation zones downstream of stent struts and quantified by WSS-related indices. Compared to the simulated open-cell stent, closed-cell stents created slightly larger areas of low WSS, elevated OSI and high RRT, due to a greater number of stent struts protruding into the lumen.Conclusion: Detailed stent design and patient-specific geometric features of the stented vessel have a strong influence on the evaluated hemodynamic parameters. Our limited computational results suggest that closed-cell stents may pose a higher risk for in-stent restenosis (ISR) than open-cell stent design. Further large-scale prospective studies are warranted to elucidate the role of stent design in the development of ISR after CAS.
Rostampour S, Cleveland T, Haslam P, et al., 2020, Response of UK interventional radiologists to the COVID-19 pandemic – survey findings, CVIR Endovascular, Vol: 3, Pages: 1-5, ISSN: 2520-8934
BackgroundThe COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS).Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation.Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19.An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributedto BSIR members by email on 18thApril 2020.A total of 228 responses were received.The survey was open for a 14-day period and the data analysed in Microsoft Excel 365.The response rate was 29% (228/800).ResultsTwo thirds of respondents work in aTertiary unit and 33% deliver IR in a District Hospital.84% have a day-case facility. After the COVID-19 crisis, 81% of respondents were able to maintain 24-7 On-call service.59% of respondents had been required change their day to day practice to allow the on-call service to continue.55% of respondents were involved in providing a central line service.Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic.ConclusionsThis survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties.Availability of a day case facility has possibly influenced the positive response.
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