These findings suggest that CMI is comparable to acetaminophen and codeine with respect to analgesia and serious side effects. We recommend the use of CMIs as an alternative when pain is poorly controlled in post-operative pediatric neurosurgical patients to prevent the potential adverse consequences of inadequate analgesia.

Objective: Thoracic endovascular aortic repair (TEVAR) and complex endovascular abdominal aortic repair (CEVAR) are performed despite anatomic constraints and complicated aortic disease. Using Heli-FX EndoAnchors (Medtronic, Santa Rosa, Calif) for endograft fixation in the infrarenal aorta has been described. This study was performed to assess the applicability and outcomes of EndoAnchors in TEVAR and CEVAR. Methods: This was a retrospective review of endovascular aortic repairs performed with EndoAnchors between 2012 and 2016. Primary study end points included freedom from migration and type I endoleak requiring reintervention. Results: A total of 101 patients underwent 54 TEVARs and 47 CEVARs with EndoAnchor; 22 patients (21.8%) were treated for thoracic aortic aneurysm, 35 (34.7%) for thoracoabdominal aneurysm, 22 (21.8%) for pararenal aneurysm, and 22 (21.8%) for infrarenal aneurysms with hostile neck anatomy. There were 45 cases (44.6%) performed as index operations, and 56 (55.4%) were redo operations. TEVAR endografts were deployed in zone 0 or 1 in 40.1% of patients, requiring adjunctive procedures (arch debranching, 20; in situ arch fenestration, 9; supra-aortic trunk chimney, 4; visceral debranching, 2). In CEVAR patients, one visceral vessel was treated in 25 patients (24.8%), two in 6 patients (5.9%), three in 24 patients (23.8%), and four in 5 patients (5.0%). EndoAnchors were placed for therapeutic indications in 41.6% of cases and for prophylactic indications in 58.4%. Technical success of deployment was 99.6%. Mean follow-up was 14.3 6 11.0 months. At 2 years, freedom from type I endoleak requiring reintervention was 93.8% for thoracic aneurysms, 100% for thoracoabdominal aneurysms, and 94.1% for abdominal aneurysms, with no significant difference in freedom from type I endoleak between redo (93.7%) and index (96.7%) operations (P ¼ .752). Conclusions: EndoAnchors can be safely used in TEVAR and CEVAR and can decrease rates of graft migration and type I endoleak. Additional data and long-term follow-up are needed to further define the use of this technology.

Objectives: Wire mesh vascular plugs can be difficult to place due to their stiff delivery systems, and they sometimes provide slow or incomplete occlusion. The objective of this study was to evaluate prototypes of the Blockstent Microcatheter, a device designed to overcome these limitations, in a canine artery acute occlusion model.Methods: Metal balloons of 4 mm in diameter and 9 mm in length (n ¼ 4) and 6 mm in diameter and 10 mm in length (n ¼ 4) were made from gold by electroforming and then mounted, folded, wrapped, and compressed onto a 3.5F microcatheter. Two female cross-bred hounds (weight, 20-22 kg; age, 11 months) were sedated and heparinized (activated clotting time >300 seconds). A 7F guide sheath was used to place a 0.018-inch guidewire into the internal thoracic artery (ITA) or the axillary artery (AA). Three 4mm Blockstents were placed in the ITA and four 6-mm Blockstents were placed in the AA through the guide sheath in an over-the-wire (OTW) fashion. The shape and position of the expanded devices and degree of target artery occlusion was evaluated by angiography. Upon completion of procedures, the animals were euthanized and necropsied.Results: The Blockstent Microcatheter demonstrated excellent fluoroscopic visibility and good trackability. Device expansion was achieved with 1 to 3 atm of pressure. Immediate occlusion was achieved in seven of seven arteries upon Blockstent expansion (100%) and was maintained in seven of seven arteries (100%) after Blockstent detachment. Precise placement at the origin of the ITA was easily achieved.Conclusions: The Blockstent Microcatheter is a promising new device for peripheral artery occlusion that offers good OTW trackability, fast and easy placement, precise localization, and rapid occlusion. The Blockstent demonstrated much more rapid occlusion than previously observed with the Amplatzer Vascular Plug II, which took as long as 10 minutes in the axillary artery using this model.Objectives: Gastroduodenal artery aneurysms (GDAA) are rare and comprise a small subset of all visceral artery aneurysms. Clinically, GDAA rupture presents with abdominal pain, gastrointestinal bleeding, or hemodynamic instability due to rupture. A high clinical suspicion is required because GDAA rupture is associated with a high mortality rate. Risk factors include atherosclerosis, pancreatitis, and ethanol abuse. GDAA are detected, often incidentally, by computed tomography (CT). Therapeutic options include selective angiography with coil embolization or covered stent placement coil and operative ligation.Methods: We present a case of a 67-year-old woman presenting with escalating abdominal pain with transient hypotension. CT angiography of the abdomen and pelvis showed intraperitoneal hemorrhage at the region of the GDA. A contained rupture of GDAA was diagnosed, and patient was repaired with operative ligation after attempted endovascular coiling.Results: GDAAs are a subset of visceral artery aneurysms encompassing only 1.5% of all visceral artery aneurysms. CT is often the dia...

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