Sherif Sultan

Assessment of Biocompatibility of the Multilayer Flow Modulator withDiffering Thread Designs

Background: The Multilayer Flow Modulator (MFM) (Cardiatis, Isnes, Belgium) is a self-expandable mesh of cobalt alloy wires used for the treatment of aortic aneurysms. The impact of design thread count and duration of implantation on the biocompatibility of the MFM in porcine animal models was assessed in this study. Methods: Eight mini-piglets received 26 MFM devices (12 with 56 threads, 14 with 80-96 threads) in the iliac, carotid, and renal arteries. Animals were sacrificed and specimens explanted at 1, 3, and 6 months, at which time histological and ultrastructural analyses were carried out. Results: The MFM was successfully deployed in 25 of the 26 implanted cases. The 56 thread devices were well tolerated locally and yielded fewer signs of inflammation and neo intimal hyperplasia. Percentage stenosis was 16.9% ± 5.1% for the 56 thread devices versus 33.4% ± 10.2% for the 80-96 thread devices (p=0.001) at 3 months, and 21.7% ± 9.9% for the 56 thread devices versus 33.6% ± 12.4% for the 80-96 thread devices (p=0.004) at 6 months. The 5 devices selected for SEM examination were well deployed, integrated into the vessel wall and endothelialized, and had patent side branches. Conclusions: No significant stenosis formation or inflammatory response was recorded in any of the implanted animals. The 80-96 thread devices elicited a greater intra-arterial response than the 56 thread devices, although the values for both groups remained within the normal range for stented carotid, renal, or iliac arteries. Further preclinical and clinical studies will extend assessment of the long-term safety and effectiveness of the MFM

Topical Wound Oxygen Versus Conventional Compression Dressings in the Management of Refractory Venous Ulcers

Topical wound oxygen (TWO2) proposes an innovative therapy option in the manage‐ ment of refractory non‐healing venous ulcers (RVU) that aims to accelerate wound healing. TWO2 accelerates epithelialisation. This leads to the development of a higher tensile strength collagen, which lessens scarring and the risk of recurrence. Sixty‐seven limbs with 67 ulcers were managed using TWO2 therapy, and 65 limbs with 65 ulcers were managed using conventional compression dressings (CCD). The proportion of ulcers completely healed by 12 weeks was 76% in patients managed with TWO2, compared to 46% in patients managed with CCD (p < 0.0001). The mean reduction in ulcer surface area at 12 weeks was 96% in the TWO2 therapy group, compared to 61% in patients managed with CCD. The median time to full ulcer healing was 57 days in the TWO2 group, in contrast to 107 days in patients managed with CCD (p < 0.0001). TWO2 patients had a significantly improved Quality‐Adjusted Time Spent Without Symptoms of disease and Toxicity of treatment (Q‐TWiST) compared to CCD patients, denoting an improved outcome (p < 0.0001). TWO2 reduces the time needed for RVU healing and is successful in pain alleviation and MRSA elimination. TWO2 therapy radically degrades recurrence rates. Utilising diffused oxygen raises the capillary partial pressure of oxygen (Po2) levels at the wound site, stimulating epithelialisation, and granulation of new healthy tissue. Taking the social and individual aspects of chronic venous ulceration into account, the use of TWO2 can provide an overwhelmingly improved quality of life for long‐time sufferers of this debilitating disease.

Endovascular Repair of a Type III Renal Artery Aneurysm using the MultilayerFlow Modulator: A Clinical Case Report

Background: Our aim was to describe our experience of the multilayer flow modulator (Cardiatis, Isnes, Belgium) used in the treatment of renal artery aneurysms. Case report: A female patient, aged 42 years underwent treatment of a renal artery aneurysm using the multilayer flow modulator. Contrast-enhanced computed tomography revealed a 23.9 mm type III renal artery aneurysm at the bifurcation of the upper and lower pole vessels, with four side branches. Follow up was assessed by postoperative computed tomography scan at 6 and 19 months postoperatively. There were no immediate postoperative complications or mortality. A normal estimated glomerular filtration rate of > 90 ml/min, which was recorded preoperatively, decreased to 77 ml/min on the day of surgery, and returned to > 90 ml/min 1 day postoperatively. The aneurysm initial decreased in size by 23% at 6 months, and by 16% at 19 months. Overall aneurysm shrinkage was 36% (8.6 mm), with all four side-branches remaining patent throughout follow up. Conclusion: The MFM may provide less operative trauma for patients where complex surgical intervention is the only other feasible treatment option. Longer follow-up, a larger sample size, and comparative studies are required to prove the efficacy of this emerging technology.