Jerry Chen

Comparison of a novel real-time SonixGPS needle-tracking ultrasound technique with traditional ultrasound for vascular access in a phantom gel model

OBJECTIVE Ultrasound-guided percutaneous vascular access for endovascular procedures is well established in surgical practice. Despite this, rates of complications from venous and arterial access procedures remain a significant cause of morbidity. We hypothesized that the use of a new technique of vascular access using an ultrasound with a novel needle-guidance positioning system (GPS) would lead to improved success rates of vascular puncture for both in-plane and out-of-plane techniques compared with traditional ultrasound. METHODS A prospective, randomized crossover study of medical students from all years of medical school was conducted using a phantom gel model. Each medical student performed three ultrasound-guided punctures with each of the four modalities (in-plane no GPS, in-plane with GPS, out-of-plane no GPS, out-of-plane with GPS) for a total of 12 attempts. The success or failure was judged by the ability to aspirate a simulated blood solution from the model. The time to successful puncture was also recorded. A poststudy validated NASA Task Load Index workload questionnaire was conducted to assess the students perceptions of the two different techniques. RESULTS A total of 30 students completed the study. There was no significant difference seen in the mean times of vascular access for each of the modalities. Higher success rates for vascular access using the GPS for both the in-plane (94% vs 91%) and the out-of-plane (86% vs 70%) views were observed; however, this was not statistically significant. The students perceived the mental demand (median 12.0 vs 14.00; P = .035) and effort to be lower (mean 11.25 vs 14.00; P = .044) as well as the performance to be higher (mean 15.50 vs 14.00; P = .041) for the GPS vs the traditional ultrasound-guided technique. Students also perceived their ability to access vessels increased with the aid of the GPS (7.00 vs 6.50; P = .007). The majority of students expressed a preference for GPS (26/30, 87%) as opposed to the traditional counterpart. CONCLUSIONS Use of the novel SonixGPS needle-tracking ultrasound system (UltraSonix, Richmond, BC, Canada) was not associated with a higher success rate of vascular puncture compared with the traditional ultrasound-guided technique. Assessment of mental task load significantly favored the use of the ultrasound GPS over the traditional ultrasound technique.

Open vs endovascular repair of blunt traumatic thoracic aortic injuries

A 42-year-old female is involved in a motor vehicle accident and presents with a number of injuries. She is hemodynamically stable and is found to have multiple rib fractures, a hemopneumothorax, and several uncomplicated long bone fractures. A CT scan of her chest reveals a traumatic injury to her proximal descending thoracic aorta with evidence of pseudoaneurysm formation and surrounding hematoma (Fig 1). The following debate attempts to resolve whether open repair remains the gold standard for the treatment of blunt thoracic aortic injuries.

Endovascular Repair of Extent II-IV Thoracoabdominal Aortic Aneurysms

Two type II endoleaks were present but did not require reintervention. The composite outcome was achieved in 83% of cases (5 of 6). Conclusions: Off-the-shelf bifurcated-bifurcated aneurysm repairs for aortoiliac aneurysm disease can be safely and efficiently performed in a majority of cases to maintain IIA perfusion and to avoid pelvic ischemic complications. Attention should be directed at purpose-built bridging stents for the general purpose of branch vessel preservation. Comparison to historical controls with IIA embolization is warranted.

Standard Thoracic Endovascular Aortic Repair Compared With Provisional Extension to Induce Complete Attachment in Aortic Dissection

Objective: We compared the management of patients with symptomatic, unruptured aortic aneurysms (sxAAAs) treated at a tertiary care center between two decades. This 20-year period encapsulated a shift in surgical approach to aortic aneurysms from primarily open to primarily endovascular, and we sought to determine the impact, if any, of this shift. Methods: A consecutive 2380 patients treated at a tertiary care hospital by six staff surgeons were reviewed between 1995 and 2005 (period 1) and 2005 and 2015 (period 2). Of those patients, 156 (6.5%) were treated for sxAAAs and were included in our study. Patient demographics, operative approach, and outcomes were analyzed and compared for each period. Results: Period 1 included 72 patients treated for sxAAA (80.6% infrarenal, 15.3% juxtarenal, 2.8% thoracic aortic aneurysm type IV, and 1.8% endoleak after endovascular aneurysm repair); 70.8% of patients were treated with open repair, and 29.2% were treated with an endovascular repair. Period 1 patients had an average age of 74.9 6 9.4 years and were made up of 63.9% men. In-hospital mortality during this period was 4.2% (5.9% for open cohort and 0% for endovascular). Period 2 included 84 patients treated for sxAAA (72.6% infrarenal, 15.5% juxtarenal, 7.1% thoracic aortic aneurysm type IV, and 4.8% endoleak after endovascular aneurysm repair); 32.1% were treated with open repair, and 67.9% underwent endovascular repair. The average age in this cohort was 73.0 6 9.8 years, and 76.2% were men. In-hospital mortality was 1.2% (3.7% for open cohort and 0% for endovascular). Period 2 had a significantly higher rate of endovascular repair compared with period 1 (P < .0001) and a trend toward decreased mortality and increased aneurysm complexity. The length of hospital stay was significantly longer in the open cohort compared with endovascular for both periods (P < .02). Conclusions: To our knowledge, this is the largest singleinstitution cohort of symptomatic unruptured aortic aneurysms. As to be expected, we found a significant change in the approach to these patients from a primarily open to a primarily endovascular technique between decades, associated with decreased mortality and increased operative complexity. Overall, however, the incidence and mortality for both periods appear to be lower than previously published. Standard Thoracic Endovascular Aortic Repair Compared With Provisional Extension to Induce Complete Attachment in Aortic Dissection Kyle Arsenault, MD, Darren Klass, MD, Joel Price, Michael Janusz, Joel Gagnon, Jerry Chen, Jason Faulds. Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada