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A Simulator for Training in Endovascular Aneurysm Repair: The Use of Three Dimensional Printers
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Abstracts
Journal of Vascular Surgery September 2017
(79.1%) was significantly different (90.0% [vein group] vs 62.9% [HePTFE group]; P = .021). Survival was similar between the groups (47.3% vs 42.9%; P = .582) as well as MALE free survival (69.4% vs 55.0%; P = .348). Conclusion: Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.
Systematic Review and Meta-Analysis of the Association Between C-Reactive Protein and Major Cardiovascular Events in Patients with Peripheral Artery Disease Singh TP, Morris DR, Smith S, Moxon JV, Golledge J. Eur J Vasc Endovasc Surg 2017;54:220-33. Background: Patients with peripheral artery disease (PAD) are at substantial risk of cardiovascular events. There is interest in using blood markers, such as C-reactive protein (CRP), to monitor prognosis and treatment efficacy in PAD patients. The aim of this meta-analysis was to assess the association between CRP and major cardiovascular events in PAD patients. Method: Studies evaluating the association between CRP and major cardiovascular events (myocardial infarction, stroke, cardiac revascularisation and mortality) were identified using MEDLINE and the Cochrane library. Studies that did not include participants with PAD, measure CRP, or follow-up patients for cardiovascular events were excluded. Meta-analyses of published adjusted hazard ratios (HR) were conducted using an inverse variance-weighted random effects model, and heterogeneity was assessed with the I2 index. Results: A total of 16 studies involving 5041 participants met the inclusion criteria for the systematic review. Eight studies were included in the meta-analyses. Summary effect estimates were reported as HR comparing higher and lower quantiles, and HR per unit increase in logeCRP. PAD patients with higher CRP had a significantly greater risk of major cardiovascular events compared with those with lower CRP (HR 2.26, 95% CI 1.65e3.09, P < 0.001). The HR for major cardiovascular events was 1.38 (95% CI 1.16e1.63, P < 0.001) per unit increase in logeCRP. Conclusions: The present findings suggest that high circulating CRP is predictive of major cardiovascular events in PAD patients.
A Simulator for Training in Endovascular Aneurysm Repair: The Use of Three Dimensional Printers Torres IO, De Luccia N. Eur J Vasc Endovasc Surg 2017;54:247-53. Objectives: To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil. Methods: This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered. Results: Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40e58 vs 33 min, 95% CI 26e42 [P < .01]), total procedure time by 29% (mean 292 min [95% CI 235e336] vs 207 [95% CI 173e247]; P < .01), and volume of contrast used by 25% (mean 87 mL [95% CI 73e103] vs 65 mL [95% CI 52e81]; P = .02). The residents considered the training useful and realistic, and reported that it increased their self confidence. The 3D printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost. Conclusion: An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents’ surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence.
Abstracts
Journal of Vascular Surgery September 2017
(79.1%) was significantly different (90.0% [vein group] vs 62.9% [HePTFE group]; P = .021). Survival was similar between the groups (47.3% vs 42.9%; P = .582) as well as MALE free survival (69.4% vs 55.0%; P = .348). Conclusion: Bypasses to the below knee popliteal artery show good results in patients with CLI unsuitable for endovascular therapy. Vein is still the first line graft material.
Systematic Review and Meta-Analysis of the Association Between C-Reactive Protein and Major Cardiovascular Events in Patients with Peripheral Artery Disease Singh TP, Morris DR, Smith S, Moxon JV, Golledge J. Eur J Vasc Endovasc Surg 2017;54:220-33. Background: Patients with peripheral artery disease (PAD) are at substantial risk of cardiovascular events. There is interest in using blood markers, such as C-reactive protein (CRP), to monitor prognosis and treatment efficacy in PAD patients. The aim of this meta-analysis was to assess the association between CRP and major cardiovascular events in PAD patients. Method: Studies evaluating the association between CRP and major cardiovascular events (myocardial infarction, stroke, cardiac revascularisation and mortality) were identified using MEDLINE and the Cochrane library. Studies that did not include participants with PAD, measure CRP, or follow-up patients for cardiovascular events were excluded. Meta-analyses of published adjusted hazard ratios (HR) were conducted using an inverse variance-weighted random effects model, and heterogeneity was assessed with the I2 index. Results: A total of 16 studies involving 5041 participants met the inclusion criteria for the systematic review. Eight studies were included in the meta-analyses. Summary effect estimates were reported as HR comparing higher and lower quantiles, and HR per unit increase in logeCRP. PAD patients with higher CRP had a significantly greater risk of major cardiovascular events compared with those with lower CRP (HR 2.26, 95% CI 1.65e3.09, P < 0.001). The HR for major cardiovascular events was 1.38 (95% CI 1.16e1.63, P < 0.001) per unit increase in logeCRP. Conclusions: The present findings suggest that high circulating CRP is predictive of major cardiovascular events in PAD patients.
A Simulator for Training in Endovascular Aneurysm Repair: The Use of Three Dimensional Printers Torres IO, De Luccia N. Eur J Vasc Endovasc Surg 2017;54:247-53. Objectives: To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil. Methods: This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered. Results: Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40e58 vs 33 min, 95% CI 26e42 [P < .01]), total procedure time by 29% (mean 292 min [95% CI 235e336] vs 207 [95% CI 173e247]; P < .01), and volume of contrast used by 25% (mean 87 mL [95% CI 73e103] vs 65 mL [95% CI 52e81]; P = .02). The residents considered the training useful and realistic, and reported that it increased their self confidence. The 3D printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost. Conclusion: An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents’ surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence.