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Papers by Rob Williams
European Journal of Vascular and Endovascular Surgery, 2019
Introduction: Anaemia in elective open general and cardiovascular surgery has been shown to have ... more Introduction: Anaemia in elective open general and cardiovascular surgery has been shown to have a detrimental impact on clinical outcomes and survival. Endovascular aortic repair (EVAR) is the mainstay for the management of complex aortic aneurysms. The relationship to pre-operative haemoglobin (Hb) and anaemia in standard EVAR is associated with a higher mortality. The role of Hb in fenestrated endovascular aortic repair (FEVAR) has not been specifically evaluated. This tertiary centre study explores the impact of anaemia on FEVAR outcomes. Methods: A prospectively populated database of all FEVAR's performed between 2010 and 2018 were analysed. Anaemia was defined as a pre-operative haemoglobin (Hb) of less than 120g/dL for women and < 130g/dL for men as per WHO guidelines. Pre-, intra-and post-operative metrics were analysed to understand if anaemia impacted on clinical outcome. Comparative statistics and regression analyses were performed. Results: Some 130 patients who underwent FEVAR were included. Mean follow-up was 3.7(2.2) years. 38 patients were anaemic with an average Hb of 112(13)g/dL. 95 patients were not anaemic with a Hb of 145(12)g/dL. At baseline groups were comparable for age, AAA diameter, BMI and gender ratio. The anaemic group patients had a lower eGFR (64.1(23.2) vs. 70.9(18.8) mL/min/1.73m 2) (P¼0.022). Intra-operatively the anaemic patients had a longer procedural time of 242(103) minutes vs. 195.4(88) minutes (P¼0.009). There was no difference in the number of fenestrations (P¼0.696). Post-operatively the anaemic group patients had a greater number of cardiac events (4 vs. 2, P¼0.037). Renal function (eGFR) was lower at day 3 and day 7 in the anaemic group (P¼0.23 and 0.027) but this became similar by 3 months (P¼0.517). There was a significantly longer hospital stay in the anaemic patients of 9.2(7.1) versus 6.3(6.8) days (P¼0.001). Overall mortality at the end of follow-up was higher in the anaemic group with 40% deceased compared to 21% in the non-anaemic group (P¼0.041). An increase in Hb by 1g/dL increased the odds of survival by 18.4% (OR 0.816). Conclusion: The presence of anaemia significantly increases the rate of cardiac complications, duration of hospital stay and overall mortality rate following FEVAR for complex aortic repair. This is associated with a poorer renal function. Optimization of pre-operative Hb may lead to improvements in clinical outcomes for those undergoing FEVAR and a study is underway to evaluate this.
Annals of Translational Medicine, 2017
Background: Three-dimensional (3D) printing is a manufacturing process in which an object is crea... more Background: Three-dimensional (3D) printing is a manufacturing process in which an object is created by specialist printers designed to print in additive layers to create a 3D object. Whilst there are initial promising medical applications of 3D printing, a lack of evidence to support its use remains a barrier for larger scale adoption into clinical practice. Endovascular virtual reality (VR) simulation plays an important role in the safe training of future endovascular practitioners, but existing VR models have disadvantages including cost and accessibility which could be addressed with 3D printing. Methods: This study sought to evaluate the feasibility of 3D printing an anatomically accurate human aorta for the purposes of endovascular training. Results: A 3D printed model was successfully designed and printed and used for endovascular simulation. The stages of development and practical applications are described. Feedback from 96 physicians who answered a series of questions using a 5 point Likert scale is presented. Conclusions: Initial data supports the value of 3D printed endovascular models although further educational validation is required.
European Journal of Vascular and Endovascular Surgery, 2019
Introduction: Anaemia in elective open general and cardiovascular surgery has been shown to have ... more Introduction: Anaemia in elective open general and cardiovascular surgery has been shown to have a detrimental impact on clinical outcomes and survival. Endovascular aortic repair (EVAR) is the mainstay for the management of complex aortic aneurysms. The relationship to pre-operative haemoglobin (Hb) and anaemia in standard EVAR is associated with a higher mortality. The role of Hb in fenestrated endovascular aortic repair (FEVAR) has not been specifically evaluated. This tertiary centre study explores the impact of anaemia on FEVAR outcomes. Methods: A prospectively populated database of all FEVAR's performed between 2010 and 2018 were analysed. Anaemia was defined as a pre-operative haemoglobin (Hb) of less than 120g/dL for women and < 130g/dL for men as per WHO guidelines. Pre-, intra-and post-operative metrics were analysed to understand if anaemia impacted on clinical outcome. Comparative statistics and regression analyses were performed. Results: Some 130 patients who underwent FEVAR were included. Mean follow-up was 3.7(2.2) years. 38 patients were anaemic with an average Hb of 112(13)g/dL. 95 patients were not anaemic with a Hb of 145(12)g/dL. At baseline groups were comparable for age, AAA diameter, BMI and gender ratio. The anaemic group patients had a lower eGFR (64.1(23.2) vs. 70.9(18.8) mL/min/1.73m 2) (P¼0.022). Intra-operatively the anaemic patients had a longer procedural time of 242(103) minutes vs. 195.4(88) minutes (P¼0.009). There was no difference in the number of fenestrations (P¼0.696). Post-operatively the anaemic group patients had a greater number of cardiac events (4 vs. 2, P¼0.037). Renal function (eGFR) was lower at day 3 and day 7 in the anaemic group (P¼0.23 and 0.027) but this became similar by 3 months (P¼0.517). There was a significantly longer hospital stay in the anaemic patients of 9.2(7.1) versus 6.3(6.8) days (P¼0.001). Overall mortality at the end of follow-up was higher in the anaemic group with 40% deceased compared to 21% in the non-anaemic group (P¼0.041). An increase in Hb by 1g/dL increased the odds of survival by 18.4% (OR 0.816). Conclusion: The presence of anaemia significantly increases the rate of cardiac complications, duration of hospital stay and overall mortality rate following FEVAR for complex aortic repair. This is associated with a poorer renal function. Optimization of pre-operative Hb may lead to improvements in clinical outcomes for those undergoing FEVAR and a study is underway to evaluate this.
Annals of Translational Medicine, 2017
Background: Three-dimensional (3D) printing is a manufacturing process in which an object is crea... more Background: Three-dimensional (3D) printing is a manufacturing process in which an object is created by specialist printers designed to print in additive layers to create a 3D object. Whilst there are initial promising medical applications of 3D printing, a lack of evidence to support its use remains a barrier for larger scale adoption into clinical practice. Endovascular virtual reality (VR) simulation plays an important role in the safe training of future endovascular practitioners, but existing VR models have disadvantages including cost and accessibility which could be addressed with 3D printing. Methods: This study sought to evaluate the feasibility of 3D printing an anatomically accurate human aorta for the purposes of endovascular training. Results: A 3D printed model was successfully designed and printed and used for endovascular simulation. The stages of development and practical applications are described. Feedback from 96 physicians who answered a series of questions using a 5 point Likert scale is presented. Conclusions: Initial data supports the value of 3D printed endovascular models although further educational validation is required.