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Objective: The objective of this study was to evaluate the effect of image fusion (IF) technology in thoracic endovascular aortic repair (TEVAR) on reducing radiation exposure (dose and time), amount of injected iodinated contrast medium needed, and procedure time. Methods: We performed a review of our institutional endovascular aortic database of patients who had undergone TEVAR between2008and2016 beforeandafter the installation of a three-dimensional (3D) IFcomputedtomographysystem in our hybrid operating room. All patients were operated on using the same radiologic equipment with or without IF. Results: The 146 patients who had undergone elective or emergent TEVAR with preoperative computed tomography angiography done in 1-mm-thick slices were divided into two groups: the IF group (98 patients), in which TEVAR was performed using intraoperative IF with the two-dimensional-3D registration method; and 48 controls without the use of IF. The IF group received a significantly reduced dose of contrast material, with a median of 70 mL (interquartile range [IQR], 50-101 mL) compared with controls receiving 104 mL (IQR, 69-168 mL; P <.001). Patients who underwent hybrid TEVAR had a significantly reduced procedure time under IF guidance (n = 25) compared with controls (n = 11; median, 162 minutes [IQR, 139-199 minutes] vs 213 minutes [IQR, 189-298 minutes]; P =.015). In addition, the intraoperative fluoroscopy time was reduced to 9 minutes (IQR, 6-13 minutes) vs 23 minutes (IQR, 12-45 minutes; P <.005). However, the radiation dose (dose-area product) was similar for the two groups (P =.37). In patients who underwent plain TEVAR (n = 74) without a carotid-subclavian bypass, the IF group needed significantly less contrast material (median, 64 mL [IQR, 43-81 mL]) compared with the control group (median, 98 mL [IQR, 60-180 mL]; P =.003), whereas intraoperative radiation exposition, procedure time, and fluoroscopy time did not statistically significantly differ between the two

Background: Peripheral arterial disease (PAD) is one of the major manifestations of general atherosclerosis and strongly associated with increased cardiovascular morbidity and mortality. Because only few epidemiologic studies are available concerning the prevalence of PAD in inhabitants >= 80 years of age, we screened inhabitants of nursing care homes in Germany for PAD and cardiovascular diseases and to assess the one year mortality. Patients and methods: We conducted a prospective cohort study, screening inhabitants of 42 nursing homes for PAD. Demographic data, comorbidities, cardiovascular risk factors and daily medication were collected. PAD was defined as ankle-brachial index <0.9. During a follow up period of one year, cardio- and cerebrovascular events and mortality were recorded. as well as the rate of falls and major amputation. Results: 1.329 probands (391 men, 938 women) >60 years were eligible for further analysis. The mean age was 84.1 years (range 61-107 years) and the prevalence of PAD was 31.5%. Media sclerosis was found in up to 17 %. and an existing diagnosis of PAD (in case of pathological ABI) and undertreatment was common. Probands with PAD were less likely to be treated according to guideline recommendations (antiplatelet therapy, beta blockers, statins) than probands with coronary artery disease (CAD). The overall one-year mortality was 19.8 % (n = 236), significantly higher than for a gender and age matched German population (p < 0.001). Conclusions:The current study shows a high prevalence of PAD in German nursing care homes. The one year mortality was not significantly different between probands with PAD and those with severe PAD (defined as an ABI of <= 0.5), whereas a media sclerosis was associated with an increased risk in probands with CAD in comparison to those without. Use of anti-diabetic agents and aspirin in monotherapy was associated with a reduced one-year mortality risk.

Purpose: To investigate the long-term outcomes of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of infrarenal abdominal aortic aneurysm in octogenarian patients and to compare them with the overall expected survival based on a sex-and age-matched German population. Methods: A total of 177 patients (median age 82 years; 149 men) >= 80 years old (range 80-92) who underwent primary elective repair of an infrarenal aortic aneurysm (>= 5 cm) between 1998 and 2015 were identified in a database search. Two groups of patients were formed based on the type of procedure: 131 EVAR patients (median age 83 years; 114 men) and 46 OSR patients (median age 82 years; 35 men). Results: The median follow-up was 5 years for the OSR group and 4.5 years for the EVAR group. Kaplan-Meier analysis showed no significant difference in survival between the EVAR and OSR groups at 78 months. The observed survival of all study patients was not statistically different from the expected survival of a sex-and age-matched German population, which was true separately for women and men. Conclusion: The patients in this study seemed to reach normal life expectancy in comparison to the age-and sex-matched general population with a similar cumulative survival in both study groups over 5 years of follow-up.