251 results found
Tsitsiou Y, Velan B, Ross R, et al., 2024, Correction to: National UK Survey of Radiation Doses During Endovascular Aortic Interventions., Cardiovasc Intervent Radiol, Vol: 47
Tsitsiou Y, Velan B, Ross R, et al., 2024, National UK Survey of Radiation Doses During Endovascular Aortic Interventions., Cardiovasc Intervent Radiol, Vol: 47, Pages: 92-100
PURPOSE: Endovascular aortic repair (EAR) interventions, endovascular abdominal aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR), are associated with significant radiation exposures. We aimed to investigate the radiation doses from real-world practice and propose diagnostic reference level (DRL) for the UK. MATERIALS AND METHODS: Radiation data and essential demographics were retrospectively collected from 24 vascular and interventional radiology centres in the UK for all patients undergoing EAR-standard EVAR or complex, branched/fenestrated (BEVAR/FEVAR), and TEVAR-between 2018 and 2021. The data set was further categorised according to X-ray unit type, either fixed or mobile. The proposed national DRL is the 75th percentile of the collective medians for procedure KAP (kerma area product), cumulative air kerma (CAK), fluoroscopy KAP and CAK. RESULTS: Data from 3712 endovascular aortic procedures were collected, including 2062 cases were standard EVAR, 906 cases of BEVAR/FEVAR and 509 cases of TEVAR. The majority of endovascular procedures (3477/3712) were performed on fixed X-ray units. The proposed DRL for KAP was 162 Gy cm2, 175 Gy cm2 and 266 Gy cm2 for standard EVAR, TEVAR and BEVAR/FEVAR, respectively. CONCLUSION: The development of DRLs is pertinent to EAR procedures as the first step to optimise the radiation risks to patients and staff while maintaining the highest patient care and paving the way for steps to reduce radiation exposures.
Johari NH, Menichini C, Hamady M, et al., 2023, Computational modeling of low-density lipoprotein accumulation at the carotid artery bifurcation after stenting, International Journal for Numerical Methods in Biomedical Engineering, Vol: 39, ISSN: 1069-8299
Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection-diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear-dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre- and post-stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open- and closed-cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post-stent carotid models and the relatively normal contralateral model reconstructed from patient-specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post-stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open-cell stents, the closed-cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow-up data, it can help elucidate the role of stent strut design in the development of in-stent restenosis after CAS.
Morgan RA, Müller-Hülsbeck S, Fanelli F, et al., 2023, Correction to: The Current Use of Drug-Eluting Balloons and Stents in Peripheral Arterial Disease: An Online Survey by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)., Cardiovasc Intervent Radiol, Vol: 46, Pages: 1773-1774
Morgan RA, Müller-Hülsbeck S, Fanelli F, et al., 2023, The Current Use of Drug-Eluting Balloons and Stents in Peripheral Arterial Disease: An Online Survey by the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)., Cardiovasc Intervent Radiol, Vol: 46, Pages: 1743-1747
PURPOSE: To assess the current use of drug-eluting devices for peripheral arterial disease (PAD) among interventional radiologists following the controversy caused by the 2018 meta-analysis suggesting an increased mortality risk for paclitaxel-eluting devices. METHODS: An anonymous survey was sent to 7035 CIRSE members via email; only complete responses were included and statistically analysed. RESULTS: Three hundred and seven members (4.4%) completed the survey. Among these, 95.8% indicated that they personally perform peripheral vascular procedures. Thirty-eight percentage of respondents did not see any change of practice since 2018, while 47% reported that the use of drug-eluting devices decreased; for 13%, the use stopped altogether, while it increased in 3% of responses. 45.6% of respondents also felt the impact of the controversy in terms of pricing, availability or directives from hospital administration. A large majority of respondents (83.7%) who perform peripheral vascular procedures consider the use of these devices as safe, 12.9% were undecided and 3.4% did not consider them as safe. Among the respondents who do not perform endovascular procedures, 77% considered these devices as safe and 23% were undecided. CONCLUSION: Although the 2018 meta-analysis had a disruptive impact on the use of drug-eluting devices in PAD, with the increasing body of evidence available, a majority of respondents continue to believe in the safety of these devices for use in femoropopliteal disease.
Rawf F, 2023, Identifying Healthcare Errors in Adult Patients Undergoing Interventional Radiology Procedures - A Systematic Approach
This PhD thesis systematically assesses and addresses the gap in the understanding of the healthcare errors within the Interventional Radiology (IR) pathway. The thesis encompasses several studies including a systematic review, observation studies by field notes and by using error capture tool, questionnaire studies, and the development and validation of innovative tools such as the FERERI ( Failure estimation Record in Radiology Intervention) error-capture tool and the FARADION ( FAst RADiology InterventiON) mobile application (app).A lack of studies on healthcare errors and patient safety in IR is highlighted requiring systematic assessment via validated tools.Different approaches were taken to assess healthcare errors, such as field-note-based observation to map out and identify errors within the IR pathway. Further evaluation of these errors and pathways was needed via questionnaire studies and validated error-capturing tools.Mixed models were used in a questionnaire to evaluate the perception of various healthcare professionals regarding the failure modes within the IR pathways.This work resulted in the triangulation of the FERERI tool which was then validated and used to assess the whole IR pathway in elective, urgent and ITU patients. This showed that healthcare errors, especially non-technical errors are prevalent within the IR pathway. The most common errors are safety awareness, communication, and equipment-related errors.Evaluating the WHO checklist, themes emerged related to compliance and correct use. A simple pragmatic intervention through a structured task allocation to the IR consultant showed a significant improvement in the rate of the compliance which impacted positively the overall rate of errors.The need to address the communication inefficiencies within the IR led to the FARADION app development which was recommended by the teams to enhance patient safety.Overall, this thesis presents valuable awareness of healthcare errors in IR procedures. Mu
Mahay U, Jenkins P, Watkins L, et al., 2023, Interventional radiology training in the UK: a view from within-a national survey., Br J Radiol, Vol: 96
OBJECTIVE: Interventional radiology (IR) training in the UK has evolved since recognition as a subspecialty in 2010 and introduction of a new curriculum in 2021. The changing landscape, increasing workload and COVID-19 have affected training. The purpose of this study was to review trainees' perspectives on training and develop strategies to further improve training. METHODS: Online survey approved by the British Society of Interventional Radiology Council distributed to British Society of Interventional Radiology Trainee members between 9 March 22 and 25 March 2022. The survey was open to all UK based ST4-6 IR trainees and fellows. Descriptive and thematic analysis was undertaken. RESULTS: 43 responses were received from 17/19 UK training regions. Females represented 10% (4/41) and 5% (2/43) less than full time (LTFT) trainees. 82% (31/38) felt their curriculum was suitable for their training and 28/38 (74%) were satisfied with IR training. Vascular IR, Interventional Oncology, paediatrics and stroke thrombectomy were identified as areas of training desiring improvement. 45% (18/40) stated exposure to IR led clinics and 17.5% (7/40) to IR led ward rounds. Only 6/38 (15.7%) received structured IR teaching at least once a month. Approximately, a third of respondents (13/38) stated training opportunities were significantly compromised secondary to COVID-19. CONCLUSION: This survey shows overall good satisfaction with IR training. However, improved training opportunities in vascular IR, interventional oncology, paediatric IR and stroke thrombectomy are required. In addition, access to clinics, ward rounds and protected time for research is needed to improve training quality. ADVANCES IN KNOWLEDGE: New national UK IR training survey.
Patel P, Thomas R, Hamady M, et al., 2023, EMBIO trial study protocol: left gastric artery embolisation for weight loss in patients living with obesity with a BMI 35-50 kg/m², BMJ Open, Vol: 13, ISSN: 2044-6055
Introduction Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 services for obesity. EMBIO is a National Institute for Health Research funded trial, a multicentre double-blinded randomised controlled trial between Imperial College National Health Service Trust and University College London Hospital, comparing LGAE versus Placebo procedure. The key aims of the trial is to evaluate LGAE efficacy on weight loss, its mechanism of action, safety profile and obesity-related comorbidities.Methods and analysis 76 participants will be recruited from the existing tier-3 database after providing informed consent. Key inclusion criteria include adults aged 18–70 with a body mass index 35–50 kg/m2 and appropriate anatomy of the left gastric artery and coeliac plexus on CT Angiogram. Key exclusion criteria included previous major abdominal and bariatric surgery, weight >150 kg, type 2 diabetes on any medications other than metformin and the use of weight modifying medications. Participants will undergo mechanistic visits 1 week prior to the intervention and 3, 6 and 12 months postintervention. Informed consent will be received from each participant and they will be randomised in a 1:1 ratio to left gastric artery embolisation and placebo treatment. Blinding strategies include the use of moderate doses of sedation, visual and auditory isolation. All participants will enter a tier-3 weight management programme postintervention. The primary analysis will estimate the difference between the groups in the mean per cent weight loss at 12 months.Ethics and dissemination This trial shall be conducted in full conformity with the 1964 Declaration of Helsinki and
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.
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
Sahloul M, Hamady M, Ahmed A, 2023, Laparoscopic Sleeve Gastrectomy and Splenectomy, Publisher: SPRINGER, Pages: S143-S143, ISSN: 0960-8923
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.
Velickovic 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 REVIEW OF CARDIOVASCULAR THERAPY, ISSN: 1477-9072
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, ISSN: 2044-6055
Haslam P, McCafferty I, Lakshminarayan R, et al., 2023, Physician associates in interventional radiology: a worrying paradigm, Clinical Radiology, ISSN: 0009-9260
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
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
Patel P, Thomas R, Hamady M, et al., 2022, O102 We know about left gastric artery embolisation and will embio provide the next solution to treat obesity?, Annual Scientific Meeting of the Surgical-Research-Society, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323
Patel P, Thomas R, Hamady M, et al., 2022, What we know about left gastric artery embolisation and will EMBIO provide the next solution to treat obesity?, Publisher: SPRINGER, Pages: 26-27, ISSN: 0960-8923
Patel P, Thomas R, Hamady M, et al., 2022, Simulation training to create the gold standard framework to run the EMBIO trial (left gastric artery embolisation vs placebo), a double blinded, multi-centre, randomised controlled trial., 13th Annual Scientific Meeting of the British-Obesity-and-Metabolic-Surgery-Society (BOMSS), Publisher: SPRINGER, Pages: 27-27, ISSN: 0960-8923
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
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
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
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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