The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Konstantina Masoura - One of the best experts on this subject based on the ideXlab platform.

  • inferior Epigastric Artery as a landmark for transfemoral tavi optimizing vascular access
    Catheterization and Cardiovascular Interventions, 2013
    Co-Authors: Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios A Vrachatis, Maria Kariori, Vasilios Voudris, Konstantinos Aznaouridis, Carmen Moldovan, Sophia Vaina, G Lazaros, Konstantina Masoura
    Abstract:

    OBJECTIVES: This study sought to investigate whether the site of common femoral Artery (CFA) cannulation in regard to the inferior Epigastric Artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). BACKGROUND: Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. METHODS: A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral Artery puncture site position, in regards to the most inferior border of the IEA. RESULTS: Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441-16.168; P = 0.011). CONCLUSIONS: In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications.

  • inferior Epigastric Artery as a landmark for transfemoral tavi optimizing vascular access
    Catheterization and Cardiovascular Interventions, 2013
    Co-Authors: Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios A Vrachatis, Maria Kariori, Vasilios Voudris, Konstantinos Aznaouridis, Carmen Moldovan, Sophia Vaina, G Lazaros, Konstantina Masoura
    Abstract:

    Objectives This study sought to investigate whether the site of common femoral Artery (CFA) cannulation in regard to the inferior Epigastric Artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). Background Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. Methods A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral Artery puncture site position, in regards to the most inferior border of the IEA. Results Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441–16.168; P = 0.011). Conclusions In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications. © 2013 Wiley Periodicals, Inc.

Michel Saintcyr - One of the best experts on this subject based on the ideXlab platform.

  • vascular anatomy of the deep inferior Epigastric Artery perforator flap a systematic review
    Plastic and Reconstructive Surgery, 2014
    Co-Authors: Jordan E Ireton, Chrisovalantis Lakhiani, Michel Saintcyr
    Abstract:

    BACKGROUND: The deep inferior Epigastric Artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap. METHODS: The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy. RESULTS: The perforators originating from the deep inferior Epigastric Artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course ( 4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection. CONCLUSIONS: The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.

  • vascular anatomy of the deep inferior Epigastric Artery perforator flap a systematic review
    Plastic and Reconstructive Surgery, 2014
    Co-Authors: Jordan E Ireton, Chrisovalantis Lakhiani, Michel Saintcyr
    Abstract:

    BACKGROUND: The deep inferior Epigastric Artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap. METHODS: The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy. RESULTS: The perforators originating from the deep inferior Epigastric Artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course ( 4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection. CONCLUSIONS: The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.

  • the short and ultrashort pedicle deep inferior Epigastric Artery perforator flap in breast reconstruction
    Plastic and Reconstructive Surgery, 2012
    Co-Authors: Shannon Colohan, Munique Maia, Claude Jean Langevin, Andrea Donfrancesco, Arash Shirvani, Andrew P Trussler, Michel Saintcyr
    Abstract:

    Background:Breast reconstruction using the deep inferior Epigastric perforator (DIEP) flap is becoming more common and can help reduce donor site morbidity. The authors proposed that dissection of the deep inferior Epigastric Artery (DIEA) and vein (DIEV) to their external iliac source may not be re

  • arterial and venous anatomies of the deep inferior Epigastric perforator and superficial inferior Epigastric Artery flaps
    Plastic and Reconstructive Surgery, 2008
    Co-Authors: Mark Victor Schaverien, Michel Saintcyr, Gary Arbique, Spencer A. Brown
    Abstract:

    Background:This study uses three- and four-dimensional computed tomographic angiography and venography to evaluate the microvascular anatomy and perfusion of the deep inferior Epigastric Artery perforator (DIEP) and superficial inferior Epigastric Artery (SIEA) flaps.Methods:Ten DIEP flaps harvested

Manolis Vavuranakis - One of the best experts on this subject based on the ideXlab platform.

  • inferior Epigastric Artery as a landmark for transfemoral tavi optimizing vascular access
    Catheterization and Cardiovascular Interventions, 2013
    Co-Authors: Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios A Vrachatis, Maria Kariori, Vasilios Voudris, Konstantinos Aznaouridis, Carmen Moldovan, Sophia Vaina, G Lazaros, Konstantina Masoura
    Abstract:

    OBJECTIVES: This study sought to investigate whether the site of common femoral Artery (CFA) cannulation in regard to the inferior Epigastric Artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). BACKGROUND: Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. METHODS: A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral Artery puncture site position, in regards to the most inferior border of the IEA. RESULTS: Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441-16.168; P = 0.011). CONCLUSIONS: In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications.

  • inferior Epigastric Artery as a landmark for transfemoral tavi optimizing vascular access
    Catheterization and Cardiovascular Interventions, 2013
    Co-Authors: Manolis Vavuranakis, Konstantinos Kalogeras, Dimitrios A Vrachatis, Maria Kariori, Vasilios Voudris, Konstantinos Aznaouridis, Carmen Moldovan, Sophia Vaina, G Lazaros, Konstantina Masoura
    Abstract:

    Objectives This study sought to investigate whether the site of common femoral Artery (CFA) cannulation in regard to the inferior Epigastric Artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). Background Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. Methods A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral Artery puncture site position, in regards to the most inferior border of the IEA. Results Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441–16.168; P = 0.011). Conclusions In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications. © 2013 Wiley Periodicals, Inc.

Mark W Ashton - One of the best experts on this subject based on the ideXlab platform.

  • the importance of the superficial venous anatomy of the abdominal wall in planning a superficial inferior Epigastric Artery siea flap case report and clinical study
    Microsurgery, 2011
    Co-Authors: Warren M Rozen, Daniel Chubb, Iain S Whitaker, Mark W Ashton
    Abstract:

    The importance of the venous drainage of the anterior abdominal wall to free tissue transfer in deep inferior Epigastric Artery perforator flap surgery has been highlighted in several recent publications in this journal, however the same attention has not been given to superficial inferior Epigastric Artery (SIEA) flaps, in which the flap necessarily relies on the superficial venous drainage. We describe a unique case, in which the presence of two superficial inferior Epigastric veins (SIEVs) draining into separate venous trunks was identified. The use of only one trunk led to a well-demarcated zone of venous congestion. A clinical study was also conducted, assessing 200 hemiabdominal walls with preoperative computed tomographic angiography imaging. The presence of more than a single major SIEV trunk was present in 80 hemiabdominal walls (40% of overall sides). There was considerable variability in the source of drainage of the SIEV, draining variably into the deep inferior Epigastric vein, the great saphenous vein, the saphenous bulb, a common trunk with the superficial circumflex iliac vein or a common trunk with a second branch of the SIEV. These findings highlight the considerable variation in the number of SIEV trunks as well as their source of regional drainage, and show the importance of consideration of such variation. V C 2011 Wiley-Liss, Inc. Microsurgery 31:454–457, 2011. The importance of the venous drainage of the anterior abdominal wall to free tissue transfer in deep inferior Epigastric Artery perforator (DIEP) flap surgery has been highlighted in several recent publications in this journal. 1–3 This has mirrored previous clinical, imaging and anatomical studies that have also highlighted this anatomy as paramount to success in DIEP flap surgery, with venous problems the more frequently encountered vascular complications seen. 4–9 To this end, many authors have

  • modifying techniques in deep inferior Epigastric Artery perforator flap harvest with the use of preoperative imaging
    Anz Journal of Surgery, 2009
    Co-Authors: Warren M Rozen, Mark W Ashton
    Abstract:

    New techniques in the harvest of deep inferior Epigastric Artery perforator (DIEP) flaps have become introduced as a result of modern imaging technologies that can allow virtual surgery to be achieved preoperatively. With computed tomographic angiography, individual anatomy can be appreciated in detail to a level not previously appreciated. These imaging techniques can be successfully used to guide DIEP flap surgery. ‘Optimal’ perforators can be selected based on size, location, intramuscular and subcutaneous course, and their association with motor nerves. Flap design can be safely achieved based on the cutaneous distribution of perforators. Abdominal wall closure can be improved based on the abdominal contour seen with imaging. Preoperative planning can aid patient selection, plan all aspects of the operative technique, reduce operating time and improve operative outcomes.

  • deep superior Epigastric Artery perforators anatomical study and clinical application in sternal reconstruction
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Eldon Mah, Mark W Ashton, Warren M Rozen, Stephen Flood
    Abstract:

    [Extract] Perforators of the deep superior Epigastric Artery traverse the rectus abdominis muscle to supply the upper abdominal wall integument. These perforators have been used in the past as the basis for vertical and transverse rectus abdominis myocutaneous flaps,1–4 and for thoracoEpigastric fasciocutaneous flaps. Although flaps based on deep superior Epigastric Artery perforators have been described in a range of clinical settings, we would like to share our experience in applying this flap for sternal reconstruction. Sternal wound dehiscence is a challenging reconstructive problem, with reconstructive options including rectus abdominis muscle, pectoralis major muscle, and omentum, but situations exist where these are not feasible and other options are sought. The current study contributes to this list of options by reporting our experience with the deep superior Epigastric Artery perforator/thoracoEpigastric flap for difficult sternal reconstructions. In developing this flap, we undertook an anatomical study with clinical computed tomographic angiography studies to improve flap design. Although previous cadaveric studies have delineated some of this anatomy, in vivo clinical studies of this anatomy have been sparse.

  • the absent inferior Epigastric Artery a unique anomaly and implications for deep inferior Epigastric Artery perforator flaps
    Journal of Reconstructive Microsurgery, 2009
    Co-Authors: Warren Matthew Rozen, Nicholas D Houseman, Mark W Ashton
    Abstract:

    The abdominal wall is particularly advantageous as a donor site due to the reliability of its vascular supply. Although the cutaneous perforators of the deep inferior Epigastric Artery (DIEA) and the superficial inferior Epigastric Artery (SIEA) may show significant individual variability, the DIEA itself has been shown to be ever-present as a vascular pedicle and to be highly dependable. The increasing use of preoperative computed tomographic angiography (CTA) has led to increasing reports of anatomic variability. With the use of preoperative CTA, we describe a unique case of a completely absent DIEA in patient who had not previously undergone any open abdominal surgery. The absence of the DIEA had led to vascular changes throughout the abdominal wall, including dilatation of both SIEAs and the ipsilateral deep superior Epigastric Artery. Preoperative CTA in this setting helped us identify this anomaly and aided surgical planning. The incidence of this anomaly was subsequently reviewed in 150 consecutive CTA scans performed at our institution.

  • advances in the pre operative planning of deep inferior Epigastric Artery perforator flaps magnetic resonance angiography
    Microsurgery, 2009
    Co-Authors: Warren Matthew Rozen, Damien L Stella, Ian G Taylor, James Bowden, Mark W Ashton
    Abstract:

    : Imaging of the abdominal wall vasculature prior to deep inferior Epigastric Artery (DIEA) perforator (DIEP) flaps has been shown to significantly improve surgical outcomes. Although computed tomography angiography (CTA) has been shown to be highly accurate, it is associated with radiation exposure, and as such modalities without radiation exposure have been sought. Magnetic resonance angiography (MRA) has been proposed as such an option. We conducted a pilot study comparing MRA with CTA and with operative findings in six consecutive patients undergoing DIEP flaps for breast reconstruction. The DIEA, superficial inferior Epigastric Artery (SIEA) and perforators were all assessed with each modality. We found that the DIEA and SIEA were accurately imaged with both CTA and MRA, but that while MRA could identify some major perforators, CTA was more accurate than MRA for perforator mapping. As such, while MRA does have a role in the imaging of DIEA perforators, CTA is still the preferred modality. On the basis of these findings, a larger study into the role for MRA in this setting is warranted.

Warren M Rozen - One of the best experts on this subject based on the ideXlab platform.

  • enhanced preoperative deep inferior Epigastric Artery perforator flap planning with a 3d printed perforasome template technique and case report
    Plastic and reconstructive surgery. Global open, 2018
    Co-Authors: Michael P Chae, David J Huntersmith, Marie Rostek, Julian A Smith, Warren M Rozen
    Abstract:

    : Optimizing preoperative planning is widely sought in deep inferior Epigastric Artery perforator (DIEP) flap surgery. One reason for this is that rates of fat necrosis remain relatively high (up to 35%), and that adjusting flap design by an improved understanding of individual perforasomes and perfusion characteristics may be useful in reducing the risk of fat necrosis. Imaging techniques have substantially improved over the past decade, and with recent advances in 3D printing, an improved demonstration of imaged anatomy has become available. We describe a 3D-printed template that can be used preoperatively to mark out a patient's individualized perforasome for flap planning in DIEP flap surgery. We describe this "perforasome template" technique in a case of a 46-year-old woman undergoing immediate unilateral breast reconstruction with a DIEP flap. Routine preoperative computed tomographic angiography was performed, with open-source software (3D Slicer, Autodesk MeshMixer and Cura) and a desktop 3D printer (Ultimaker 3E) used to create a template used to mark intra-flap, subcutaneous branches of deep inferior Epigastric Artery (DIEA) perforators on the abdomen. An individualized 3D printed template was used to estimate the size and boundaries of a perforasome and perfusion map. The information was used to aid flap design. We describe a new technique of 3D printing a patient-specific perforasome template that can be used preoperatively to infer perforasomes and aid flap design.

  • the importance of the superficial venous anatomy of the abdominal wall in planning a superficial inferior Epigastric Artery siea flap case report and clinical study
    Microsurgery, 2011
    Co-Authors: Warren M Rozen, Daniel Chubb, Iain S Whitaker, Mark W Ashton
    Abstract:

    The importance of the venous drainage of the anterior abdominal wall to free tissue transfer in deep inferior Epigastric Artery perforator flap surgery has been highlighted in several recent publications in this journal, however the same attention has not been given to superficial inferior Epigastric Artery (SIEA) flaps, in which the flap necessarily relies on the superficial venous drainage. We describe a unique case, in which the presence of two superficial inferior Epigastric veins (SIEVs) draining into separate venous trunks was identified. The use of only one trunk led to a well-demarcated zone of venous congestion. A clinical study was also conducted, assessing 200 hemiabdominal walls with preoperative computed tomographic angiography imaging. The presence of more than a single major SIEV trunk was present in 80 hemiabdominal walls (40% of overall sides). There was considerable variability in the source of drainage of the SIEV, draining variably into the deep inferior Epigastric vein, the great saphenous vein, the saphenous bulb, a common trunk with the superficial circumflex iliac vein or a common trunk with a second branch of the SIEV. These findings highlight the considerable variation in the number of SIEV trunks as well as their source of regional drainage, and show the importance of consideration of such variation. V C 2011 Wiley-Liss, Inc. Microsurgery 31:454–457, 2011. The importance of the venous drainage of the anterior abdominal wall to free tissue transfer in deep inferior Epigastric Artery perforator (DIEP) flap surgery has been highlighted in several recent publications in this journal. 1–3 This has mirrored previous clinical, imaging and anatomical studies that have also highlighted this anatomy as paramount to success in DIEP flap surgery, with venous problems the more frequently encountered vascular complications seen. 4–9 To this end, many authors have

  • modifying techniques in deep inferior Epigastric Artery perforator flap harvest with the use of preoperative imaging
    Anz Journal of Surgery, 2009
    Co-Authors: Warren M Rozen, Mark W Ashton
    Abstract:

    New techniques in the harvest of deep inferior Epigastric Artery perforator (DIEP) flaps have become introduced as a result of modern imaging technologies that can allow virtual surgery to be achieved preoperatively. With computed tomographic angiography, individual anatomy can be appreciated in detail to a level not previously appreciated. These imaging techniques can be successfully used to guide DIEP flap surgery. ‘Optimal’ perforators can be selected based on size, location, intramuscular and subcutaneous course, and their association with motor nerves. Flap design can be safely achieved based on the cutaneous distribution of perforators. Abdominal wall closure can be improved based on the abdominal contour seen with imaging. Preoperative planning can aid patient selection, plan all aspects of the operative technique, reduce operating time and improve operative outcomes.

  • deep superior Epigastric Artery perforators anatomical study and clinical application in sternal reconstruction
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Eldon Mah, Mark W Ashton, Warren M Rozen, Stephen Flood
    Abstract:

    [Extract] Perforators of the deep superior Epigastric Artery traverse the rectus abdominis muscle to supply the upper abdominal wall integument. These perforators have been used in the past as the basis for vertical and transverse rectus abdominis myocutaneous flaps,1–4 and for thoracoEpigastric fasciocutaneous flaps. Although flaps based on deep superior Epigastric Artery perforators have been described in a range of clinical settings, we would like to share our experience in applying this flap for sternal reconstruction. Sternal wound dehiscence is a challenging reconstructive problem, with reconstructive options including rectus abdominis muscle, pectoralis major muscle, and omentum, but situations exist where these are not feasible and other options are sought. The current study contributes to this list of options by reporting our experience with the deep superior Epigastric Artery perforator/thoracoEpigastric flap for difficult sternal reconstructions. In developing this flap, we undertook an anatomical study with clinical computed tomographic angiography studies to improve flap design. Although previous cadaveric studies have delineated some of this anatomy, in vivo clinical studies of this anatomy have been sparse.

  • raising perforator flaps for breast reconstruction the intramuscular anatomy of the deep inferior Epigastric Artery
    Plastic and Reconstructive Surgery, 2007
    Co-Authors: Warren M Rozen, Mark W Ashton, Ian G Taylor
    Abstract:

    Background:The deep inferior Epigastric Artery (DIEA) perforator flap is used increasingly for breast reconstruction, preferred as a muscle-sparing operation over traditional transverse rectus abdominis musculocutaneous (TRAM) flaps. Complications related to the inclusion of rectus abdominis include