Introduction: This study reports our experience with the use of an ethylene vinyl alcohol copolymer (Onyx™) for the treatment of type II endoleak after endovascular repair of abdominal aortic aneurysms (EVAR) in comparison to coils and cyanoacrylate glue. Methods: Clinical data of all patients treated for type II endoleak following EVAR between 2009 and 2017 were retrospectively analyzed. Abdominal aortic aneurysm (AAA) diameter and AAA sac volume during follow-up were measured using computed tomography angiography (CTA). Treatment failure variables were created for the change in sac diameter and volume. An increase in sac diameter ≥ 5 mm was considered a failure, as was an increase ≥ 10% in AAA sac volume. Results: 35 patients underwent treatment for a persistent type II endoleak following EVAR. Of these patients, 18 (51.4%) were treated with Onyx and 17 (48.6%) were treated with coils ± cyanoacrylate glue embolization. There were no significant differences between the 2 groups with regard to demographics. The average volume of Onyx used per treatment was 13.4 ml (range 4.5 ml- 39 ml). There was no difference in efficacy between the Onyx and non-Onyx group. Complications were limited to 1 non-target embolization without significant clinical sequelae. Conclusions: Ethylene vinyl alcohol copolymer (Onyx™) embolization is similarly effective compared to traditional cyanoacrylate glue or coil embolization in the treatment of type II endoleak after EVAR.

Background The mainstay of treatment for pancreatic cancer is surgical resection; however, positive surgical margins remain commonplace. We identified hospitals with higher than predicted rates of positive margins and isolated factors that caused this discordance. Methods This is a retrospective review of patients with head of the pancreas adenocarcinoma in the National Cancer Database between 2004 and 2015. A nomogram was used to calculate the observed to expected positive margin rates (O/E) for facilities. If the O/E differed significantly ( P < .05), it was considered an outlier. Results Among a total of 19 968 patients, 24.3% had positive margins. Among hospitals with lower than expected positive margin rates, 73.6% were academic or research programs, 17% were comprehensive community cancer programs, and none were community cancer programs ( P = .0002). Within the group with higher than expected positive margin rates, 47% were comprehensive community cancer programs and 38.6% were academic or research programs ( P = .0002). The mean hospital volume was higher in the low positive margin group (110.4 vs 48.8, P < .0001). Conclusions Facility type and hospital volume can predict improvement in the O/E ratio for margin positivity in pancreatic adenocarcinoma resection. Surgeons should consider referral to academic or research facilities with higher case volumes for improved surgical resection.

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Conclusions:The natural progression of cAAA is not well-defined, but it has shown to have a high risk of rupture and mortality in young children. Early diagnosis and repair of cAAA are crucial in preventing rupture, and in this case early elective open repair with tubular ePTFE graft was safe and effective. It is important to choose a vascular conduit with the diameter and length to accommodate children's vascular developmental process. More investigation should be undertaken for the natural history of cAAA, new-generation allograft in its repair, and its optimal surveillance timing and method.Objectives: We aim to report our experience with Onyx (ethylene vinyl alcohol copolymer) for embolization of type II endoleak (T2E) after endovascular repair of abdominal aortic aneurysms (EVAR).Methods: Endoleak repairs using Onyx performed from 2010 to 2016, as part of clinical management were retrospectively reviewed. Technical success was defined as absence of fluoroscopic evidence of endoleak at the termination of procedure. Clinical failure (CF) was defined as increase in sac diameter of greater than 5 mm or increase in sac volume of greater than 10% on follow-up computed tomography angiography, at least 3 months after the procedure. Absence of CF was deemed clinical success. The Student t-test was used for statistical analysis. A P value of less than .05 was defined to be statistically significant.Results: A total of 13 patients (mean age, 77 years; 12 males and 1 female) underwent persistent T2E repair following EVAR at our institution in a duration of 6 years. Mean interval between EVAR and endoleak repair was 40.7 months. Translumbar access was used in all patients. The mean volume of Onyx used per treatment was 13.4 mL. Additional targeted coil embolization of a feeding inferior mesenteric artery was performed in one patient. Technical success and clinical success was achieved in all patients; none of the patients had CF. Mean pretreatment diameter and volume were 73 mm and 340 mL, respectively. Mean post-treatment diameter and volume were 71 mm and 320 mL, respectively. There was a trend toward decreased diameter and improved volume after treatment; however, it did not reach statistical significance (P ¼ .11). There were no major postprocedural complications.Conclusions: Our study presents the clinical outcome of the use of Onyx as the main treatment modality on patients with T2E after EVAR. Onyx with or without coils is safe and effective in treatment of T2E after EVAR.Objectives: The study objective was to evaluate the feasibility, safety, efficacy and early technical and clinical success rate of in situ laser stent graft fenestration for repairing retrograde type A dissection during thoracic endovascular aortic repair.Methods: From July 2014 to March 2018, nine patients (six women and three men) with retrograde type A dissection (mean age, 58 years; range, 38-74) were analyzed by means of retrospective analysis. Preoperative, together with intraoperative and postoperative medical data were traced.Results: All...

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