This you can actually apply these principles you can actually apply to all visceral aneurysms, especially all branches coming out of the celiac axis.
You can do that with the spleen, you can do that with the hepatic artery, for example. So here you've got a splenic artery aneurysm. Yeah. So ideally, what you wanna do with a splenic artery aneurysm is to actually exclude the aneurysm itself while
maintaining maximum flow to the spleen so you don't kill the spleen, okay? The best approach to that, if you can do that, which is not common, actually quite rare, is to actually put a stint graft across the splenic artery, excluding the aneurysm itself,
and letting it thrombose. That's the ideal situation, which is the rare situation. Rarely you can actually do that. This is more common with older people, middle-age to older people. It is also more common with women,
in childbearing or later stages in life age. With age, our splenic artery actually toils and turns more and more, it actually becomes more and more redundant and ectatic, and becomes more coiled. And it's more common to find coiling and difficult anatomy with women as well.
Theories behind that is pregnancies, estrogen, being kind of a relaxant to muscles, and actually causes more ectasia to the splenic artery. So the older you are, the more likely-- the patient is a woman, the more likely there would be actually tortuosities and this makes it very difficult to
put a stiff platform up there for a stint graft to actually cross over and actually purely exclude the aneurysm and maintaining full flow to the spleen
in that case. The next subject, which is splenic steal syndrome, which is a very complex subject.
Splenic steal syndrome, or NOHAH, that's non-exclusive hepatic artery hyperprofusion basically means that the hepatic artery's open, but there's slow flow in it, so it's not anatomical. This is a hemodynamic problem. It is not an anatomical defect.
It's not a thrombosis, it's not an aneurysm, it is not a stricture, it is not a kink. The artery is a wide open pump, but flow is going through it very slowly. The idea on this is to go as proximal as possible and is to impede flow, slow down the flow,
not necessarily shut it off, but slow down the flow significantly. Go proximal as possible to allow collaterals to keep the spleen alive. It is not a splenic artery embolization where you use particles.
So as you all know, there's many reasons for delays and I'll get to the details of the reasons for delays in our department. There's always lab delays, where patients show up with no labs
or patients have labs that aren't acceptable, leading to delays or cancellation. You have delays in consenting. Patients are not fully clinically optimized to proceed with such procedures. There's always anesthesia.
Nursing care, sometimes we don't have enough staff to do certain procedures. There's always a problem with equipment. Sometimes the physicians are unavailable or they're late. We also have patients' arrival, coming in late because they're not, basically not fully prepared.
So, as you all know, IR is basically, or IR delays are really due to a lot of human and system factors. Our current pre-procedure workflow in IR consists of many steps. Basically, these steps present for
opportunities for delays or cancellations. So one of the weaknesses that we had initially in City of Hope pre-procedure process is we didn't have one. We didn't have a pre-procedure standardized communication procedure process. So a lot of the members of our team assume that
the key steps in the workflow process has been executed without any form of verification. So with that, we had delays that contributed from multiple factors. So in the beginning of the project, I went around to different disciplines of the IR team
to basically figure out what are causing our delays. And basically, we came up with four themes. People, process and policy, equipment, and environment. As you can see, under people, there's some poor role definition among healthcare staff. That basically means that we have
one or two healthcare staff doing the same thing. So that creates a lot of confusion. Poor communication, as far as process and policies, there's always a problem with scheduling. We don't have a standardized data process collection and our workflow process wasn't standardized.
There's always equipment failure that causes delays. And as far as an environment, limited educational activities or really the lack of understanding of the impact of delays. But for the purpose of this project, I really wanted to focus on a couple of things. Because I can't, obviously, fix the whole problem.
So I wanted to focus down on improving our communication and basically standardize our workflow process and improving our data collection process.