Colin D Bicknell

• Clinical Senior Lecturer at Imperial College London

On 26 April 2023, past and present members of the department of surgery and cancer as well as those of wider supporting medical specialties of St Mary’s Hospital (SMH), London, congregated at the Royal Society under the headship of Professor Ara Darzi to celebrate 100 years since the establishment of an academic chair of surgery at SMH. The day als...

Introduction Survivorship encompasses the physical, psychological, social, functional and economic experience of living with a chronic condition for both patients and their caregivers. It comprises 9 distinct domains and remains understudied in non-oncological pathologies, including infra-renal abdominal aortic aneurysmal disease (IRAAA). This revi...

Endovascular repair of the thoracic aortic aneurysms (TEVAR) has broadened the available therapeutic options, allowing more patients to be definitively managed than was previously possible. This minimally invasive approach avoids thoracotomy and cross-clamp of the descending aorta with left heart bypass, and hence recovery is shorter, and short-ter...

Purpose: To review short-term and midterm results of the fenestrated Anaconda stent graft in management of patients with pre-existing endovascular aortic stent graft and persistent type 1a endoleak. Materials and methods: This single-center retrospective study assessed all consecutive patients with type 1a endoleak and pre-existing endovascular...

Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a sim...

Background: Silent cerebral infarction is brain injury detected incidentally on imaging; it can be associated with cognitive decline and future stroke. This study investigated cerebral embolization, silent cerebral infarction and neurocognitive decline following thoracic endovascular aortic repair (TEVAR). Methods: Patients undergoing elective o...

Objective: A systems approach to patient safety proposes that a wide range of factors contribute to surgical outcome, yet the impact of team, work environment, and organisational factors, is not fully understood in arterial surgery. The aim of this systematic review is to summarize and discuss what is already known about the impact of system facto...

Objective/background: To develop a procedure specific global rating scale for assessment of operator competence in endovascular aortic repair (EVAR). Methods: A Delphi approach was used to achieve expert consensus. A panel of 32 international experts (median 300 EVAR procedures, range 200-3000) from vascular surgery (n = 21) and radiology (n = 1...

OBJECTIVE: Patient specific rehearsal (PsR) prior to endovascular aneurysm repair (EVAR) enables the endovascular team to practice and evaluate the procedure prior to treating the real patient. This multicentre trial aimed to evaluate the utility of PsR prior to EVAR as a pre-operative planning and briefing tool. MATERIAL AND METHODS: Patients with...

Objective: Patient specific rehearsal (PsR) prior to endovascular aneurysm repair (EVAR) enables the endovascular team to practice and evaluate the procedure prior to treating the real patient. This multicentre trial aimed to evaluate the utility of PsR prior to EVAR as a pre-operative planning and briefing tool. Material and methods: Patients w...

Purpose The aim of this paper is to report our experience of type II endoleak treatment after endovascular aneurysm repair with intra-arterial injection of the embolizing liquid material, Onyx liquid embolic system. Methods From 2005 to 2012, we performed a retrospective review of 600 patients, who underwent endovascular repair of an abdominal aor...

Background: Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary ai...

Objective/background: To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. Methods: A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additiona...

In this paper we investigate the performance of a recently developed robotic catheterization platform in comparison to conventional surgical equipment. Transcather aortic valve implantation (TAVI) was chosen as the test case and 12 interventionists (6 experts and 6 novices) participated in experiments with a silicon aorta model. Video sequences of...

Despite increased use of remote-controlled steerable catheter navigation systems for endovascular intervention, most current designs are based on master configurations which tend to alter natural operator tool interactions. This introduces problems to both ergonomics and shared human-robot control. This paper proposes a novel cooperative robotic ca...

Background: To examine the associations between teamworking processes and error rates during vascular surgical procedures and then make informed recommendations for future studies and practices in this area. Methods: This is a single-center observational pilot study. Twelve procedures were observed over a 3-week period by a trained observer. Err...

Endovascular intervention has revolutionized the treatment of aortic disease, extending the cohort of patients eligible for repair. Accurate planning for endovascular aortic repair is essential. Recent advances in modern software have demonstrated potential for improving outcomes and enhancing the decision making process beyond 3D measurements and...

We describe a novel use of an Amplatzer III plug device (St. Jude Medical, St. Paul, Minn) in the treatment of a traumatic arteriovenous fistula between the innominate vein and the origin of the left common carotid artery causing symptomatic right heart failure. A review of the literature indicates this is the first case to describe the use of the...

Fenestrated stent grafting has become increasingly popular as a means to manage complex aortic pathology, including juxta- and pararenal aneurysms. The design of a recently developed custom-made fenestrated stent graft, in theory, confers advantages when managing anatomically challenging aortic morphology. This study evaluated its feasibility in an...

Healthcare professionals can be seriously affected when they are involved in major clinical incidents. The impact of such incidents on staff is of particular relevance to surgery, as the operating room is one of the highest-risk areas for serious complications. This qualitative study aimed to assess the personal and professional impact of surgical...

The use of transcatheter aortic valve implantation (TAVI) is rapidly increasing with advances in technology and improved clinical outcomes. Adoption of robotic catheter technologies could have a role in TAVI, in different stages of the procedure, to improve endovascular tool manipulation and potentially reduce the risk of cerebral embolization. The...

This study evaluates a fully immersive simulated angiosuite for training and assessment of technical endovascular and human factor skills during a crisis scenario. Virtual reality (VIST-C, Mentice) simulators were integrated into a simulated angiosuite (ORCAMP, Orzone). Teams, lead by experienced (N = 5) or trainee (N = 5) endovascular specialists,...

Evaluation of variation in descending thoracic aortic aneurysm (dTAA) diameters measured on CT scans in different planes and by different observers and the potential impact on treatment decisions. CT angiography of dTAA (N = 20) were assessed by three specialists, with measurements repeated after 1 month. Calliper measurements of maximum external d...

Despite rapid growth of robot assisted catheterization in recent years, most current platforms are based on master-slave designs with limited operator-robot collaborative control and automation. Under this setup, information concerning subject specific behavior and context-driven manoeuvre is not re-utilized for subsequent intervention. For endovas...

The improvements to catheter manipulation by the use of robot-assisted catheter navigation for endovascular procedures include increased precision, stability of motion and operator comfort. However, navigation through the vasculature under fluoroscopic guidance is still challenging, mostly due to physiological motion and when tortuous vessels are i...

Non-typhoidal Salmonella infections typically cause self-limiting gastroenteritis. However, extraintestinal focal infections, including mycotic aneurysms of the aorta, can also occur. We present the case of a 71-year-old man with chronic lymphocytic leukemia (CLL) and a large type V thoracoabdominal mycotic aneurysm infected with Salmonella enterit...

Purpose To investigate the quality of stent-graft fenestrations created in vitro using different needle puncture and balloon dilation angles in different commercial endografts. Methods Fenestrations were made in a standardized fashion in 3 different endograft types: Talent monofilament twill woven polyester, Zenith multifilament tubular woven poly...

Surgical technology has led to significant improvements in patient outcomes. However, failures in equipment and technology are implicated in surgical errors and adverse events. We aim to determine the proportion and characteristics of equipment-related error in the operating room (OR) to further improve quality of care. A systematic review of the p...

Still uncertainty about the need for treatment

To asses whether Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are underused in patients with aortic disease due to concerns regarding flow limiting (>70%) renal artery stenosis (RAS). A prospective analysis of patients admitted for aortic surgery was performed (January-July 2009). Co-morbidity, ACEI/ARB...

Endografting for the treatment of thoracic aortic pathology continues to gain popularity; in some countries, numbers of endovascular aortic repairs now exceed those of open surgical cases. The skills and understanding of open surgical teams are not always translated into endovascular intervention teams, which may be led by cardiologists or vascular...

OBJECTIVES: Accurate assessment and credentialing of physicians is essential. Objective motion analysis of guide-wire/catheter manipulation to assess proficiency during endovascular interventions remains unexplored. This study aims to assess its feasibility and its role in evaluation of technical ability. MATERIALS AND METHODS: A semi-automated cat...

A 67-year-old man underwent robot-assisted three-vessel fenestrated endovascular aneurysm repair (FEVAR) for a 7.3-cm juxtarenal aneurysm. The 6-F robotic catheter was manipulated from a remote workstation, away from the radiation source. Robotic cannulation of the left renal artery was achieved within 3 minutes. System setup time was 5 minutes. Th...

Purpose To evaluate the in vitro performance of an electromagnetic navigation system (ENS) in aortic arch branch cannulation and describe its role for fenestrated endograft deployment. Methods Reconstructed multidetector computed tomography images of silicone phantoms representing the aortic arch and a thoracoabdominal aortic aneurysm were uploade...

BACKGROUND: The unique and complex vascular and endovascular theatre environment is associated with significant risks of patient harm and procedural inefficiency. Accurate evaluation is crucial to improve quality. This pilot study attempted to design a valid, reproducible tool for observers and teams to identify and categorise errors. METHODS: Rele...

This report describes a patient with pseudoxanthoma elasticum (PXE) who presented with an incidental finding of a renal artery aneurysm. PXE is a rare genetic condition. It is associated with calcification of elastin fibers and is characterized by skin, eye, and cardiovascular complications. Our patient was previously treated for retinal and gastro...

Carotid artery stenting (CAS) is an important development in the treatment of carotid artery stenosis and prevention of stroke. However, despite advances in technology, including embolic protection devices (EDPs), there are concerns that the embolic stroke risk is still too high in many reports, including a number of randomized controlled trials. R...

Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR) is an uncommon phenomenon. The sequelae from this specific complication are severe; consequently, the topic of renal artery coverage is a pertinent issue. We present a case series of patients undergoing EVAR with unintentional renal artery coverage, review the tre...

Despite increased use of robotic catheter navigation systems for endovascular intervention procedures, current master-slave platforms have not yet taken into account dexterous manipulation skill used in traditional catheterization procedures. Information on tool forces applied by operators is often limited. A novel force/torque sensor is developed...

IntroductionWe present a young female with Marfan's Syndrome and aortic dilatation between two previous dacron grafts of the descending thoracic and abdominal aorta after type B dissection.ReportOpen retrograde visceral revascularisation was undertaken and a single bespoke stent-graft used to exclude the aneurysm. A custom-made stent overcame some...

To design a tool to explore current leadership teaching in an undergraduate curriculum, using the medical leadership competency framework (MLCF) DESIGN: An online questionnaire was designed based on the MLCF competences and sent to all course leads at Imperial College, London in Autumn 2011 Imperial College, London Sixty-nine course leads were invi...

To attempt to quantify the effect of varying degrees of iliac tortuosity on maneuverability and "torquability" of endovascular catheters in the visceral segment, comparing conventional and robotic cannulation techniques. In a fenestrated endograft within a pulsatile phantom, 10 experienced operators cannulated the renal arteries via three different...

To determine the type and frequency of errors during vascular interventional radiology (VIR) and design and implement an intervention to reduce error and improve efficiency in this setting. Ethical guidance was sought from the Research Services Department at Imperial College London. Informed consent was not obtained. Field notes were recorded durin...

Purpose To assess the incidence of errors before and after implementation of a structured mental rehearsal prior to the endovascular phase of combined open/endovascular arterial procedures. Methods Over 6 weeks, 15 combined open/endovascular procedures (7 abdominal aorta and 8 thoracic aorta) lasting 58 hours were evaluated by a trained observer....

Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes. An initial 'path finding' study was performed to evalu...

Increasing evidence implicates IgG autoantibodies against oxidized forms of low density lipoprotein (oxLDL) in the pathophysiology of atherosclerotic arterial disease. However, insufficient knowledge of their structure and function is a key gap. Using an elderly LDL receptor-deficient atherosclerotic mouse, we isolated a novel IgG3k against oxLDL (...

The development of atherosclerosis has been shown to correlate with regions of low wall shear stress and seemingly reduced mass transport. The local tortuosity of the arteries and local secondary flow oscillation also seem to be negatively correlated with the local occurrence of the disease. However there is currently no tool or physiological param...

We describe a novel approach to arterial cannulation using the StealthStation(®) Guidance System (Medtronic, USA). This uses electromagnetic technology to track the guidewire, displaying a 3D image of the vessel and guidewire. The study was performed on a 'bench top' simulation model called the Cannulation Suite comprising of a silicone aortic arch...

The aim of this paper is to review the potential role of endovascular interventions for young patients with lower-limb ischaemia. A literature search was performed of PubMed and Medline databases using appropriate search terms and limits. Case reports, retrospective studies, and prospective studies evaluating treatment of lower-limb ischemia in pat...

We have offered subjects with diabetes and toe gangrene in whom initial antibiotic treatment of associated infection has resulted in a well-demarcated, dry gangrenous digit, the choice of surgical amputation or awaiting autoamputation. We performed a retrospective cohort study to assess the effectiveness of the strategy of awaiting autoamputation b...

In recent years, steerable catheter systems have been introduced into clinical practice for cardiac mapping and ablation procedures. As endovascular therapy is becoming more complex, more advanced and versatile catheter designs utilizing robotic technology may have a role in aortic and peripheral arterial interventions. This article discusses alter...

Conventional catheter instability and embolization risk limits the adoption of endovascular therapy in patients with challenging arch anatomy. This study investigated whether arch vessel cannulation can be enhanced by a remotely steerable robotic catheter system. Seventeen clinicians with varying endovascular experience cannulated all arch vessels...

This report describes endovascular stenting of an acute mycotic ascending aortic aneurysm. An eighty-three year old lady presented nine weeks after aortic valve surgery and subsequent thyroidectomy with sternal pain secondary to a mycotic ascending aortic pseudoaneurysm. The pseudoaneurysm was visible through the unhealed sternum. Open repair was c...

Advanced endovascular procedures require a high degree of skill with a long learning curve. We aimed to identify differential increases in endovascular skill acquisition in novices using conventional (CC), manually steerable (MSC) and robotic endovascular catheters (RC). 10 novices cannulated all vessels within a CT-reconstructed pulsatile-flow arc...

The objective of this study is to examine contemporary management of primary mycotic aortic aneurysms in a single center. We have previously reported the management of mycotic aortic aneurysms in 15 patients between 1991 and 2001, and we hypothesized that management would change in the light of the evolution of endovascular aortic repair. A review...

Emerging robotic technologies are increasingly being used by surgical disciplines to facilitate and improve performance of minimally invasive surgery. Robot-assisted intervention has recently been introduced into the field of vascular surgery to potentially enhance laparoscopic vascular and endovascular capabilities. The objective of this study was...

Endovascular treatments are limited in cases of thoracic aortic aneurysms extending up or proximal to the origin of the left subclavian artery (LSCA). In such cases, the LSCA is usually either occluded or revascularised. We report our first experience of four patients who underwent thoracic aneursym treatment with new custom-made grafts with a scal...

To investigate failures in patient safety for patients undergoing vascular and endovascular procedures to guide future quality and safety interventions. Single centre prospective observational study. 66 procedures (17 thoracoabdominal and 23 abdominal aortic aneurysms, 4 carotid and 22 limb procedures) were observed prospectively over a 9-month per...

The past 4 decades have witnessed tremendous strides in the evolution of endovascular technology with increased operator experience, greater availability of more sophisticated and versatile endovascular devices, and advances in imaging modalities. In an attempt to limit the physiologic derangements associated with aortic crossclamping and extensive...

To establish a method to assess amputation incidence that addresses the problems matching a numerator with an appropriate denominator in London and to demonstrate low amputation incidence associated with the activity of our multidisciplinary diabetic foot clinic. Hospital-coded inpatient data was examined to derive the numerator: the number of non-...

Patient-specific virtual reality (VR) simulation is a technologic advancement that allows planning and practice of the carotid artery stenting (CAS) procedure before it is performed on the patient. The initial findings are reported, using this novel VR technique as a tool to optimize technical and nontechnical aspects of this complex endovascular p...

To evaluate the outcome of hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair in a selected group of patients with complex disease. Case series study with retrospective analysis of prospectively collected non-randomised data. Patients with hybrid repair of complex arch disease at a single centre ov...

Aortic dissection is the most common acute catastrophic event affecting the thoracic aorta. The majority of patients presenting with an uncomplicated type B dissection are treated medically, but 25% of these patients develop subsequent aneurysmal dilatation of the thoracic aorta. This study aimed at gaining more detailed knowledge of the flow pheno...

Objective: Fenestrated stent grafting has allowed the treatment of complex thoraco-abdominal aneurysm disease via a totally endovascular approach, but the procedure can be technically challenging and time consuming. We investigated whether this procedure may be enhanced by remotely steerable robotic endovascular catheters. Methods: A four-vessel...

Thoraco-abdominal aortic aneurysm repair remains a formidable challenge to vascular surgeons. The traditional repair of thoraco-laparotomy with aortic cross-clamping is associated with a high morbidity and mortality despite significant advances in perioperative critical care, anaesthetic and surgical techniques. The advent of the endovascular revol...

Acute type A aortic dissection can be complicated by visceral malperfusion and is associated with a significant surgical morbidity and mortality. We describe a case of successful management of a complex acute type A dissection with mesenteric and lower limb ischemia treated with endovascular thoracic stenting and femoro-femoral crossover bypass gra...

Paraplegia affects up to 22% of patients undergoing thoarcoabdominal aneurysm surgery, producing long-term morbidity and a significant burden to healthcare. This article discusses the mechanisms that may lead to paraplegia during open and endovascular repair from an anatomical and physiological perspective. There are many adjuncts that must be cons...

Purpose To report the initial clinical use of a robotically steerable catheter during endovascular aneurysm repair (EVAR) in order to assess this novel and innovative approach in a clinical setting. Technique Following a series of in-vitro studies and procedure rehearsals using a pulsatile silicon aneurysm model, a 78-year-old man underwent robot-...

Aims: Abnormal haemodynamic conditions are implicated in the development of anastomotic myointimal hyperplasia (MIH). We have investigated in vivo inter-patient variation in the geometry of distal graft anastomoses, which may strongly influence local flow conditions, MIH formation and clinical outcome.Methods: The distal anastomotic geometry was ac...

Complex aortic dissections with subsequent dilatation may be managed by using a visceral hybrid approach. In some cases, however, there is substantial retrograde blood flow into the false lumen, leaving a pressurized aneurysmal segment. The authors describe a novel treatment method whereby successful seal of a distal type 1 endoleak was achieved wi...

To describe our experience of treating juxtarenal (JRAAA's <4mm neck) and thoracoabdominal aortic aneurysms (TAAA's) using fenestrated and branched stent graft technology. Prospective single centre experience. Since 2005, 29 fenestrated/branched procedures have been performed. 15 patients are studied with JRAAAs (n=7; median neck length 0mm (IQR 0-...