Robotic Assisted Laparoscopic Splenic Artery Aneurysm Resection.

Splenic artery aneurysms (SAA) are the most common visceral aneurysm and may develop significant risk for rupture and life-threatening complications when more than 3 cm, in pregnancy, or if resembling pseudoaneurysms. Traditional treatment options of open surgical repair and endovascular repair have been extensively studied, but the role of robotic-assisted laparoscopic surgery in definitively managing SAA is emerging as a promising minimally invasive alternative in select pathology. This case aims to present the technical details, challenges, and outcomes of an SAA in a young woman treated with robotic-assisted laparoscopic resection, highlighting the feasibility and efficacy of this approach.

Zone-0 Thoracic Branched Endograft Implantation in a Previously Debranched Aorta for Symptomatic Type 1A Endoleak.

Bird-beak configuration after endovascular arch repair refers to a gap between the proximal stent and the lesser curvature of the aortic arch that can potentially lead to life-threatening complications through the formation of a 1A endoleak. This case describes a patient who developed a symptomatic type 1A endoleak due to bird-beaking, years after thoracic endovascular aneurysm repair and a complex supra-aortic debranching. The case was further complicated by a stenosis of the left common carotid artery diagnosed with duplex ultrasound and intraoperative transcranial Doppler exam.

Early Concepts in CT Image-Guided Robotic Vascular Surgery: The Displacement of Retroperitoneal Structures During Simulated Procedures in a Cadaveric Model.

Background: CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance.

Feasibility of a sutureless anastomotic technique in robot-assisted vascular surgery.

While other specialties embraced robotic technology, vascular surgery was revolutionized by endovascular techniques. The combination of open surgical techniques with endovascular solutions became standard practice; however, it is considered an unexplored frontier in the evolving field of robotic vascular procedures. One of the criticisms against robotics is the difficulty of vascular anastomosis.

Optimizing cadaveric models for endovascular training through effective preparation techniques.

Objective: This study highlights how a thorough preparation process is crucial to achieving successful cadaveric models for endovascular training. By sharing our descriptive report of procedural experiments and detailed preparation techniques, we demonstrate the importance of this process in creating high-fidelity models that enhance training effectiveness.

Methods: Two fresh frozen cadavers (FFCs) were prepared for a high-fidelity vascular training model.

CT-guided biopsy in heterotopic heart transplant: A case report.

Background: Heterotopic heart transplantation is a surgical technique that has not been embraced broadly. In this historic technique, the donor heart is sutured in parallel to the recipient heart with both hearts in place.

Case Summary: We report a patient who received a heterotopic heart transplant at our institution more than 15 years ago with preserved cardiac function and who needed a myocardial biopsy due to heart failure symptoms.

Cinematic Rendered Computed Tomography Imaging Enhances 3D Visualization of Upper Extremity Arteriovenous Malformation.

Inspired by the quality of computer-rendered images in the animated movie industry, cinematic rendering (CR) is a novel image visualization technique using proprietary rendering algorithms that simulate the propagation and interaction of light rays passing through 3-dimensional (3D) volumetric data, resulting in a photorealistic representation of bodily organs and vasculature. Due to its more realistic representative and intuitive format, it has become part of medical education, especially 3D anatomy teaching, patient education, and communication. It also plays an important role in the diagnostics and treatment planning for complex vascular pathologies, especially malformations.

Cadaveric training model for the management of type B aortic dissection using thoracic endovascular aortic repair along with the PETTICOAT technique.

This model gives residents and fellows practice in the surgical repair of a type B aortic dissection using thoracic endovascular aortic repair implantation by the Provisional Extension To Induce Complete Attachment (PETTICOAT) technique. A human cadaveric model was created to simulate the procedure. A Dacron graft was pulled into the aorta distal to the left subclavian artery using two glidewires.

Retrospective Comparison of Stiff Wire-Based 2D3D, Traditional 3D3D Image Fusion, and Non-Image Fusion Techniques and Their Role in Thoracic Aortic Endovascular Repair.

: The aim of this study was to compare the outcomes of stiff wire-based 2D3D, 3D3D image fusion (IF), and non-image fusion techniques for simple zone 2 and zone 3 TEVAR cases in terms of radiation exposure, contrast dose, and fusion and projection accuracy. : A single-center retrospective observational study was conducted based on data gathered from patients who underwent TEVAR between 2016 and 2023 at our tertiary aortic referral center. Those who underwent Z2 and Z3 TEVAR during the indicated period were included.

An Artificial Intelligence-Based Automatic Classifier for the Presence of False Lumen Thrombosis After Frozen Elephant Trunk Operation.

Objective: To develop an unsupervised artificial intelligence algorithm for identifying and quantifying the presence of false lumen thrombosis (FL) after Frozen Elephant Trunk (FET) operation in computed tomography angiographic (CTA) images in an interdisciplinary approach.

Methods: CTA datasets were retrospectively collected from eight patients after FET operation for aortic dissection from a single center. Of those, five patients had a residual aortic dissection with partial false lumen thrombosis, and three patients had no false lumen or thrombosis.

Pulmonary Embolism: Webcast June 13 2024.

This 61-minute webcast features a conversation about "Pulmonary Embolism"-the focus of Issue 20.3. Hosted by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles.

Optimal Cerebral Protection Confirmed by Transcranial Doppler During Transcarotid Artery Revascularization.

Transcarotid artery revascularization (TCAR) is a novel method to treat severe stenosis of the carotid artery with minimal embolization. During TCAR, flow reversal system redirects blood from the internal, external, and common carotid arteries into the femoral vein through a filter system to prevent debris and microparticles from entering the cerebral circulation. Transcranial Doppler (TCD) monitoring allows real-time detection of blood flow in the cerebral arteries during the operation and informs the surgeon of flow changes or possible emboli.

Robotic right lower lobectomy for a persistent large pulmonary arteriovenous malformation following repeated coil embolization.

Pulmonary arteriovenous malformations create continuous shunting of unoxygenated blood through the lungs into the systemic circulation. These malformations are asymptomatic if small, but cause serious symptoms as they grow in size. Treatment primarily consists of endovascular embolization; lobectomy is preserved for recurring or endovascularly untreatable cases.

Internal Carotid Artery Hypoplasia Misidentified as Internal Carotid Artery Dissection.

Agenesis or hypoplasia of the internal carotid artery (ICA) may easily be confused with dissection or occlusion. We report a case of a 24-year-old female with complaint of acute left-hand hypoesthesia and a history of occasional intermittent numbness of her right hand with myoclonic jerking. Because previous imaging studies over 2 years were interpreted as occlusion of the left ICA secondary to carotid dissection, the treating physician had prescribed anticoagulant therapy.

Employing magnetic resonance histology for precision chronic limb-threatening ischemia treatment planning.

Objective: Recent randomized controlled trials have demonstrated a notable prevalence of immediate technical failures in percutaneous vascular interventions (PVIs) for complex arterial lesions associated with chronic limb-threatening ischemia. Current imaging modalities present inherent limitations in identifying these lesions, making it challenging to determine the most suitable candidates for PVI. We present a novel preprocedural magnetic resonance imaging (MRI) histology protocol for identifying lesions that might present a higher rate of immediate and midterm PVI failure.

Robot-assisted vascular surgery: literature review, clinical applications, and future perspectives.

Although robot-assisted surgical procedures using the da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) have been performed in more than 13 million procedures worldwide over the last two decades, the vascular surgical community has yet to fully embrace this approach (Intuitive Surgical Investor Presentation Q3 (2023) https://investor.intuitivesurgical.com/static-files/dd0f7e46-db67-4f10-90d9-d826df00554e .

A Rare Case of Internal Jugular Venous Malformation Treated by Surgical Excision.

This paper reports a case of an internal jugular venous malformation (IJVM) and route of treatment in a patient with limited symptoms. After history and imaging studies, a determination of surgical excision was made to rule out possible malignancy and future problems such as thrombosis. The mass was resected, and part of the IJVM was ligated.

Pulmonary Embolism and Cardiovascular Care: Revolutionary Advances for the Decade Ahead.

Introductory overview for Issue 20.3 on Pulmonary Embolism, written by the issues' guest editors.

Longitudinal Magnetic Resonance Imaging-Based Superficial Femoral Artery Velocity Measurements in Diabetic and Nondiabetic Patients With Peripheral Artery Disease.

Background: Longitudinal associations of noninvasive 2-dimensional phase-contrast magnetic resonance imaging (2D-PC-MRI) velocity markers of the superficial femoral artery (SFA) were analyzed along with the characteristics of peripheral artery disease (PAD). We hypothesized that the 2-year differences in MRI-based measures of SFA velocity were associated with longitudinal changes in markers of PAD.

Methods: A total of 33 (11 diabetic, 22 nondiabetic) patients with PAD with baseline and 2-year follow-up MRI scans were included in this secondary analysis of the Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial (ELIMIT).

Image Guidance Techniques and Treatment Approach Optimization in the Management of Type-II Endoleak After Endovascular Aortic Aneurysm Repair.

Background: Over the past 3 decades endovascular aortic aneurysm repair emerged as the primary approach for abdominal aortic aneurysm management, however the occurrence of endoleak following endograft implantation imposes a high toll on patients and hospitals alike. The early diagnosis and appropriate treatment of endoleaks is associated with better outcomes, which calls for more advanced imaging and a standardized approach for endoleak diagnosis and management following endovascular aortic aneurysm repair. Although conventional strategy with non-targeted deployment of coils and embolic material in the aneurysm sac is considered to be the standard approach in many hospitals, it may not prove to be a viable option, given that it affects any further follow-up imaging in the event of sub-optimal therapy and consequent recurrence.

Endovascular retrieval of a fractured Optease inferior vena cava filter using endobronchial forceps and intraoperative cone-beam computed tomography guidance.

Endovascular retrieval of fractured inferior vena cava (IVC) filters after the manufacturer recommended indwelling time can be challenging and require advanced retrieval techniques. We describe an endovascular retrieval technique of a fractured Optease IVC filter in a 57-year-old woman using endobronchial forceps and intraoperative cone-beam computed tomography guidance. Following incomplete filter retrieval, the location and orientation of fractured strut was confirmed by cone-beam computed tomography venography.

Emerging Applications for Computer Vision and Artificial Intelligence in Management of the Cardiovascular Patient.

Artificial intelligence and telemedicine promise to reshape patient care to an unprecedented extent, leading to a safer and more sustainable work environment and improved patient care. In this article, we summarize how these emerging technologies can be used in the care of cardiovascular patients in such ways as fall detection and prevention, virtual nursing, remote case support, automation of instrument counts in the operating room, and efficiency optimization in the cardiovascular suite.