Day 2 :
- Vascular Imaging and Diagnostic Testing
University of Sao Paulo
Sergio Brasil is neurosurgeon and neurosonologist. He currently is engaged in research in the field of cerebral hemodinamics and transcranial Doppler.
Organ transplantation depends more often of donation from brain dead (BD) individuals. Several complications make the diagnosis of BD medically challenging and a complimentary method is needed for confirmation. Additionally, in many countries around the world, the complimentary diagnosis is mandatory by law, despite there are still many areas where these methods are not available. In this context, computed tomography angiography (CTA) could represent a valuable alternative, because of its widespread presence. However, the reliability of CTA for confirming brain circulatory arrest remains unclear. Methods: A systematic review was performed to identify relevant studies regarding the use of CTA as ancillary test for BD confirmation. Guidelines for online search were followed, and the QUADAS 2 tool was used to verify study quality. Data from the studies retrieved were extracted aiming to perform the metaanalysis. Results: Ten low quality studies were found. Due to the absence of controls in all studies, specificity could not be calculated. Three hundred twenty-two patients were eligible for the metaanalysis, which exhibited 84,7% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. Conclusions: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to verify intracranial circulatory arrest. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide. Considering the importance of this subject, high quality studies are currently missing and needed.
Department of Radiology, Military hospital of Tunis, Tunisia
He has completed his PhD at the age of 26 years from medicine faculty of Monastir, Tunisia.Associate professor of radiology at university school of medicine of Tunis, Tunisia.Works in radiology department of the military hospital of Tunis where he has conducted research in vascular imaging in cooperation with vascular surgeons, resuscitator about the contribution of multidetector CT in the dysfunction of hemodialysis arteriovenous fistulas. He is directing researchs on network venous upper limb. He has published more than 15 papers.
Prospective study conducted over a period of thirty months until December 2015 in the department of radiology of the military hospital of Tunis. It has interested 57 patients with chronic renal failure at the stage of dialysis explored by upper limbs veinography and CT veinography. Both techniques were first compared for their quality. Thereafter, we compared their sensibilities and specificities in detecting various venous segments of upper limbs and in studying venous feature
The tow the tow tech were comparable for the detection of superficial venous system of the upper limbs (p= 0.240) and for their quality (p=0.065), which was excellent in 66.6 % of CT veinography. There was a statistically significant difference between the sensitivities of the two techniques in the in detecting distal (p<10-3) and proximal deep venous system (p=0,010), in studying reports and in highlighting certain anatomical variants (p=0,001). The CT veinography was less irradiating with a reduction in the contrast medium injected dose by 83% compared to veinography.
The upper limbs CT venography is a non invasive technique easly performed and interpreted. It is a reliable and reproducible imaging technique with high sensitivity and specificity offering a complete upper limb venous mapping before creating an AVF for hemodialysis.
- Pediatric Vascular Medicine
- Vascular Surgery
Prof. Petr Stadler, M.D., Ph.D., Head Department of Vascular Surgery, Na Homolce Hospital in Prague, Czech Republic. He was certified as a console surgeon for the da Vinci surgical system in August, 2005 at the University of California, Irvine. Dr. Stadler is a member of the Czech Association of Cardiovascular Surgery, the ESVS, the ISMICS, the SRS and a founding member of the International Endovascular and Laparoscopic Society. He has also received a few prestigious honors from the Czech Association of Cardiovascular Surgery for the best publications in 2004 and 2006, the Letter of Appreciation from Korean Society of Endoscopic and Laparoscopic Surgeons in May 2008, the price of the Czech Society of Angiology for the publication in the year 2007 and the best audiovisual presentation in 2009 in USA (ISMICS) and in 2013 in USA (SCVS). He performed also the robot-assisted vascular operations in South Korea, Russia, Poland and India
The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively unknown. The feasibility of laparoscopic aortic surgery with robotic assistance has been sufficiently demonstrated. Our clinical experience with robot-assisted vascular surgery performed using the da Vinci system is herein described.
Between November 2005 and September 2015, we performed 342 robot-assisted vascular procedures. 245 patients were prospectively evaluated for occlusive diseases, 70 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, five for a splenic artery aneurysm, one for a internal mammary artery aneurysm five for hybrid procedures, three for median arcuate ligament release and nine for endoleak II treatment post EVAR.
327 cases (95,6%) were successfully completed robotically, one patient's surgery (0,3%) was discontinued during laparoscopy due to heavy aortic calcification. In fourteen patients (4%) conversion was necessary. The thirty-day mortality rate was 0,3%, and early non-lethal postoperative complications were observed in six patients (1,75%).
Vice director of Neurosurgery department, Director of interventional neuroradiology department, Director of NICU,
Qing Huang, male, 46 years old, Chinese, M.D.
Vice director of Neurosurgery department,
Director of interventional neuroradiology department,
Director of NICU,
Associate Senior Doctor, Department of Neurosurgery, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R.China. 101149
Committee member of the Professional Committee of China Gerontological Society of cardiovascular and cerebrovascular disease,
Committee member of the Professional Committee of China Gerontological Society of hypertension disease,
Committee member of the American Congress of Neurological Surgeons,
Contributing editor of Chinese Journal of clinicians (Electronic Edition)
Member of National Science and technology expert database of Ministry of science and technology,
evaluation experts of Beijing Natural Science Foundation
Objective: To analysis the operative treatment of ruptured posterior circulation aneurysms in acute period. Methods: Retrospective analysis the clinical materials of 11 cases with 13 posterior circulation aneurysms in acute period of subarachnoid hemorrhage(SAH), which were management in our department during January,2014 to August, 2015. Including 2 aneurysms on the tip of basilar artery, one aneurysm of basilar-posterior cerebral artery, 5 aneurysms of posterior cerebral artery, one aneurysm of superior cerebellar artery, one aneurysm of anterior inferior cerebellar artery, 3 aneurysms of posterior inferior cerebellar artery. 2 cases were arteriovenous malformation(AVM) with blood flow correlation aneurysms, one case was moyamoya disease with blood flow correlation aneurysm. Four cases were treated by microsurgery clipping, four cases were treated by endovascular embolization, and the other three cases were treated by endovascular embolization plus microsurgery clipping. Results: The operations were successfully finished in all cases. The grades of Glasgow Outcome Scale(GOS) were evaluated after one month of operation, and 5 cases with grade 5, 4 cases with grade 4, one case with grade 3, one case with grade 1.Conclusion: Individualized treatment should be used in ruptured posterior circulation aneurysms. The relatively satisfactory curative effects could be achieved in both of the two methods, endovascular embolization and microsurgery clipping. But very poor prognosis would be received in ruptured posterior circulation aneurysms with high grade of Hunt-Hess scale.
Key words: posterior circulation aneurysms; acute period; microsurgery clipping; endovascular embolization
- Advance Approaches to Vascular Disorders
Department of Neurosurgery, Korea University medical Center Ansan Hospital
Sungkon Ha M.D., PhD. is an associate professor of Department of Neurosurgery, Vascular divison, Korea University Medical Center, Ansan Hospital. Professor Ha completed his M.D. in 1999 and Ph.D. in 2009 at Korea university. He certified board of Neurosurgery in 2004 and board of endovascular surgery in 2013 in republic of Korea. He was a visiting scholar at the department of neurosurgery, Kyoto university, Japan in 2010 and clinical observor at the department of neurosurgery, UC Irvine, USA in 2015.
STA-MCA anastomosis has been used as a potential treatment option for the occlusive cerebrovascular disease. On postoperative CTA, MRA and DSA can show the patency of donor artery. However, these study were more expensive and invasive than ultrasound study. After the STA-MCA anastomosis, the flow rate of donor artery would be increased and this is the indirect evidence of patency of donor artery. We analyze the bilateral STA flow change at the pre and post-operative periods for the evaluation of relationship between donor artery patency and flow change.
- Vascular Bleeding Disorders
- Vascular oncology