42 results found in Aortic
Updated anatomic feasibility of the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE), off-the-shelf multibranched endograft for the treatment of pararenal and thoracoabdominal aortic aneurysms in association with GORE TAG tapered proximal extensions
By: Alessandro Grandi
Objective: To evaluate if the newly released GORE TAG tapered proximal extensions could increase the proportion of pararenal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs) that could theoretically be treated with the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis (TAMBE; W. L. Gore & Associates, Flagstaff, Ariz) off-the-shelf multibranched endograft. Methods: The preoperative computed tomography scans of patients with pararenal aortic aneurysms and TAAAs treated at a single institution between 2007 and 2017 were reviewed. This cohort included both open and endovascular repairs performed in either elective or urgent/emergent settings. These studies were included in a retrospective feasibility study (NCT03213795 and NCT03959670) to verify anatomic feasibility of the TAMBE graft employed within the manufacturer’s investigational instructions for use. The patient cohort was divided into two groups: extended thoracoabdominal aneurysm (E-TAA) extent I, II, and III TAAA; and limited pararenal and thoracoabdominal aneurysm (L-TAA) pararenal aortic aneurysm and extent IV TAAA. The anatomic factors determining the overall theoretical feasibility were further divided into three groups: vascular access feasibility, aortic feasibility, and visceral vessel feasibility. Results: Computed tomography scans of 269 patients with degenerative aneurysms were analyzed, 179 with E-TAA and 89 with L-TAA. In the L-TAA group, 81% of the cases could have been treated with the TAMBE endograft alone. Previous reported aortic feasibility was 51%, which increased to 71% (p<.001) using tapered proximal extensions. In the E-TAA group, only 36% of the cases could have been treated with a TAMBE combined with a GORE CTAG proximal thoracic stent graft, while 90% of cases could have been treated if a tapered GORE CTAG proximal thoracic stent graft is used. Furthermore, the overall feasibility would increase from 33% to 46% (p<.001). Conclusions: The introduction of tapered proximal extensions significantly increased the theoretical feasibility of the TAMBE multibranched endograft in an all-comers cohort of patients with degenerative E-TAA.
AorticEvaluation of Normal Aortic Diameters in Indian Population- A retrospective Study
By: Ayush Mohan
Abdominal aortic aneurysm (AAA) is a condition of growing clinical significance, with rupture being its most catastrophic complication. The definition and diagnostic criteria for AAA rely on reference values of normal aortic diameters, which may vary among populations. Limited data exist for the Indian population, where anthropometric and lifestyle factors differ from Western cohorts. Objectives: To determine the normal abdominal aortic diameters in the Indian population. Methods: This retrospective observational study was conducted at the Christian medical college between january 2025 and december 2025. A total of 300 patients (18–80 years) undergoing computed tomography (CT) scans were enrolled. Individuals with aortic aneurysmal or occlusive disease, or trauma-related scans, were excluded. Aortic diameters were measured at the aortic hiatus, celiac level, infrarenal level, and bifurcation in both anteroposterior and transverse planes. Results- The mean age of participants for males was 58.78 and females 54.9.In our study total 63.3% were males and 36.67 females. Males exhibited significantly larger aortic diameters than females across all levels. AT aortic hiatus males 2.17 and females 1.92. Infrarenal males 1.85 and females 1.73 and at Aortic bifurcation males 1.53 and females 1.35. Discussion- The study establishes that normal infrarenal abdominal aortic diameters in the Indian population are smaller than Western reference values. These findings highlight the need for population-specific reference standards for the diagnosis and monitoring of AAA.
AorticPublic Awareness, Knowledge, and Screening Barriers for Abdominal Aortic Aneurysm: A Cross-Sectional Study from Saudi Arabia
By: Othman Alabdullah
Abstract Aim Abdominal aortic aneurysm (AAA) is an abnormal dilation of the abdominal aorta, with a prevalence ranging from 2% to 12%. It is usually asymptomatic but carries a high risk of rupture, leading to mortality rates of up to 80%. Major risk factors include advanced age, male sex, hypertension, smoking, and family history. Although effective screening programs exist, public awareness of AAA remains low. This study aimed to assess the knowledge and attitudes of Saudi adults toward AAA to guide future educational interventions for its prevention and management Methods This cross-sectional study collected data using an online questionnaire distributed to adult patients attending vascular surgery outpatient clinics at King Khalid University Hospital. The survey assessed participants’ knowledge of abdominal aortic aneurysms, attitudes toward screening, and perceptions of surgical treatment. Results Among 300 participants (mean age = 35.3 years), only 52.7% had heard of abdominal aortic aneurysm (AAA), and 24.0% correctly identified at least one risk factor. A total of 91.0% of respondents demonstrated poor knowledge scores. Awareness and knowledge were significantly higher among healthcare workers (OR = 6.00–12.85), participants with a family history of cardiovascular disease (OR = 2.85–4.45), and individuals with higher educational levels. Although 81.7% believed that AAA screening is important, major barriers included lack of awareness (79.0%) and fear of diagnosis or surgery (64.0%) Conclusion Awareness and knowledge of AAA are markedly insufficient among Saudi adults, despite a high willingness to undergo screening if recommended. Culturally appropriate public health campaigns and primary care initiatives are urgently needed to dispel misconceptions, alleviate fear, and promote early diagnosis
AorticRole of a multidisciplinary meeting for high-risk patients considered for vascular surgery: early and mid-term outcomes for accepted and declined cohorts
By: Anastasia Dean
Objective Patients requiring aortoiliac surgery are often elderly and multimorbid. This study describes pathology, decision-making, short and long-term outcomes for all aortoiliac patients referred to a high-risk multidisciplinary meeting (MDM). Design Retrospective cohort study of all patients referred to a high-risk MDM for consideration of aortoiliac intervention at a tertiary centre between February 2011 and December 2024, with follow up of survival until March 2025. Methods Data were extracted from MDM minutes, electronic records and national mortality database. Post-operative outcomes, including mortality and Days Alive and Out of Hospital within 90 days of surgery (DAOH90), and 2 and 5 year survival for intention for surgery cohort, and those declined. Results Of 381 patients reviewed, 158 were initially accepted, 69 declined and 154 deferred for investigation or optimisation. Declined patients were older (median 80 vs. 73 years; p < 0.001) and had higher rates of cognitive impairment, chronic kidney disease and end-stage renal disease (all p < 0.001). Nine died during optimisation and three awaiting surgery. Post-operative mortality was 3.3% (8) at 30 days and 5.7% (14) at 90 days. A total 242 patients underwent intervention, at a median 54 (IQR 27–115) days from first discussion. Two- and five-year survival in the intention-to-treat cohort were 89.3% and 74.0%, compared with 57.1% and 29.8% for those declined (p < 0.001). Conclusion Formal MDM assessment optimised and cleared 63.5% high-risk patients referred with aortoiliac pathology. Those declined had significantly reduced survival, with the majority dying from comorbidities. Preoperative investigations need to be carefully selected and prioritised, as delays can result in morbidity and mortality.
AorticTransaxillary Branch-to-Branch-to-Branch Carotid Catheterization Technique for Triple-Branch Arch Repair
By: Natasha Hasemaki
Aim: To assess the feasibility and outcomes of the transaxillary branch-to-branch-to-branch carotid catheterization technique for endovascular aortic arch repair. This approach enables complete supra-aortic vessel cannulation without carotid artery cutdown, potentially optimizing procedural efficiency and reducing surgical trauma. Methods: This single-center, retrospective observational study evaluated a novel technique involving a through-and-through guidewire from the right axillary artery to a femoral artery access, enabling left carotid artery cannulation via axillary access by rotating the sheath—thus avoiding cervical exposure. The primary endpoint was technical success, defined as completion of the planned procedure with patent target vessels, absence of intraoperative mortality, and no type I or III endoleaks. Secondary endpoints included all-cause mortality, major and minor strokes, spinal cord ischemia, and freedom from reintervention. Results: Between March 2022 and October 2024, 46 patients underwent endovascular aortic arch repair; 17 were treated using the transaxillary catheterization technique. Technical success was achieved in 13 cases. One patient died intraoperatively; one required secondary carotid cutdown. No major strokes occurred; one minor stroke and one case of delayed paraplegia were observed. Two patients developed endoleaks on final angiography, necessitating immediate coil embolization. Three patients underwent reintervention: one for a type Ic endoleak and two for staged thoracoabdominal aortic repair. Conclusions: This is the first reported series of endovascular aortic arch repair using the transaxillary branch-to-branch-to-branch carotid catheterization technique for complete supra-aortic vessel cannulation. Avoiding cervical access may reduce operative trauma, associated morbidity, and length of hospital stay, supporting the feasibility of this approach in selected patients.
AorticEpidemiological Shifts of Aortic Aneurysm Ruptures and Dissections in Austria between 2009 and 2023: a Longitudinal Observational Study
By: Amun Hofmann
The incidence of rAA decreased by 18.2%, with incidence rates falling from 4.3 to 3.2 per 100,000 (-25.2%) over the study period. In-hospital mortality among rAA patients declined from 38.7% to 34.6%, accompanied by a decrease in major comorbidities and recorded in-hospital complications. The incidence of hospital-admitted AD, however, showed a significant increase of 102.8%, with population adjusted incidence rates rising from 5.2 to 9.6 per 100,000 (+85.6%). In-hospital mortality for aggregated AD cases decreased slightly from 12.1% to 11.0%.
AorticEarly Outcomes of Inner-Branched Endovascular Aortic Repair For Complex Aortic Pathologies: An Australian Experience
By: Haywood Yeung
Inner-branched endovascular repair (iBEVAR) were retrospectively reviewed at a single centre to evaluate early outcomes including operative success and morbidity. Early results indicate promising technical success and acceptable early outcomes out of 22 patients that were enrolled in the last 3 years.
AorticThe role of epidural anaesthesia in elective open abdominal aortic aneurysm repair: secondary analysis of a randomised trial
By: Vincent Jongkind
Objective Using peri-operative epidural anaesthesia (PEA) during elective open abdominal aortic aneurysm (AAA) repair is debated by surgeons and anaesthetists. This study aimed to evaluate the clinical benefits and risks of PEA in patients undergoing elective open AAA repair. Methods This exploratory post hoc analysis of the ACTION-1 trial (NCT04061798), a multicentre, international, single blinded, randomised controlled trial designed to compare heparinisation strategies during elective open AAA repair, assessed outcomes by comparing patients receiving PEA with those managed with a local pain protocol. Primary outcomes included 30 day adverse events and health related quality of life (HRQoL), post-operative pain, and mobility scores one week after surgery assessed using the EQ-5D-5L questionnaire. The secondary outcome was intra-operative heparin dosage. Results The study included 294 patients, with 189 (64.3%) receiving PEA. Bleeding complications were lower in the PEA group (31.7%; n = 60) compared with the control group (48.6%; n = 51; p = .006). Death, pneumonia, length of admission, and other 30 day complications were similar between the groups. No epidural haematomas were reported. Post-operative pain scores were comparable across the first four EQ-5D-5L levels. However, no patient in the PEA group reported extreme pain or discomfort one week post-operatively compared with 3.8% (n = 4) in the control group (p = .014). Mobility was better in the PEA group: 44.9% reported no mobility issues compared with 30% (n = 28) in the control group (p = .019), while severe mobility problems were also less frequent in the PEA group (5.1% vs. 16%; p = .006). HRQoL was statistically significantly better in the PEA group one week (0.73 vs. 0.68; p = .007) and four weeks (0.81 vs. 0.76, p = .007) after surgery. Conclusion PEA was found to be associated with fewer bleeding complications, reduced extreme pain, better mobility, and improved HRQoL one week post-operatively.
AorticAnalysis of stroke and cerebral embolism risk in aortic endovascular treatment: insights from DW-MRI and cerebral protection techniques.
By: Apollonia Verrengia
Aims Endovascular repair of the aortic aneurysm is increasingly adopted as a less invasive alternative to open surgery, yet it carries a significant risk of stroke and cerebral embolism. This study aims to evaluate the incidence of cerebral ischemic lesions detected by diffusion-weighted MRI (DW-MRI) and to assess the effectiveness of cerebral protection strategies in patients undergoing total endovascular aortic arch repair at our institution. Methods: We are conducting a monocentric observational analysis of consecutive patients treated with total endovascular repair of the aortic arch from April 2025 who underwent within 72 hours post-procedural DW-MRI to detect new cerebral ischemic lesions and to evaluate their clinical correlation. Cerebral protection techniques adopted during the procedure to reduce the risk of cerebral ischemia included CO₂ flushing of the endograft before its implantation, using rapid pacing during device deployment, and temporary clamping of the supra-aortic vessels during delivery and deployment of the device. The cerebral oxygenation was monitored using near-infrared spectroscopy. The endoclamping technique was achieved using semi-compliant angioplasty balloons positioned at the origin of the brachiocephalic trunk and left subclavian artery, combined with manual compression of the left carotid artery at the neck; after systemic heparinization, rapid cardiac pacing was initiated and followed by complete simultaneous endoclamping of the three vessels, then the endograft was advanced into the aortic arch and deployed under fluoroscopic guidance; rapid pacing was discontinued after deployment, and declamping was performed after five effective cardiac cycles. Results: From April 2025 to April 2026, 26 patients have been enrolled in the ongoing analysis (14 post-dissection). The mean age was 71.2 years. The endografts used included both off-the-shelf and custom-made fenestrated or branched devices. Technical success was 100%. Postoperative DWI-MRI revealed new cerebral ischemic lesions in 61.5% of patients (16/26), with a total of 110 lesions and a mean of 6.8 lesions per patient. 65% of MRI-positive patients were neurological asymptomatic. All patients with aortic arch involvement developed MRI- detected lesions (100%). Lesions were predominantly distributed in cortical and cerebellar regions and showed a multifocal pattern, supporting an embolic mechanism. Throughout the procedure, NIRS values remained stable without evidence of cerebral desaturation. At mid-term follow-up: overall survival was high (24/26 patients), with stable or reduced aneurysm sac diameter; 19% of patients developed neurological deficits during follow-up, all of whom had previously shown positive MRI findings. Conclusions: Our preliminary monocentric data indicate that cerebral embolization occurs in all patients undergoing total endovascular aortic arch repair as detected by DW-MRI, whereas clinically relevance is less frequent. Cerebral protection strategies, including CO₂ flushing, rapid pacing, and temporary vessel occlusion with NIRS monitoring, may reduce the risk of symptomatic events. These findings underscore the importance of integrating advanced imaging and protective strategies to minimize cerebral risk in aortic arch endovascular interventions. Patient enrolment will continue in the coming months to expand the cohort; ongoing recruitment and follow-up aim to further elucidate the relationship between procedural techniques, imaging-detected embolization, and neurological outcomes. With a larger patient cohort, an artificial intelligence software will be developed to analyze the size and spatial distribution of ischemic lesions detected on MRI.
AorticEarly Lessons Learned After Our First Implantations of an Off-the-Shelf Single-Branch TEVAR in Switzerland – A Case Series
By: Harun Ceyran
Aims Proximal thoracic endovascular aortic repair (TEVAR) often requires preservation of the left subclavian artery (LSA) to prevent stroke or upper limb ischemia. Traditionally, surgical debranching or custom-made devices are used to allow LSA coverage. This study aimed to analyze early surgical outcomes and intraoperative challenges of our first implantations of an off-the-shelf single-branch TEVAR. Methods A retrospective single-centre analysis was conducted from January to September 2025 at the University Hospital Basel, Switzerland, including patients undergoing single-branch TEVAR. Data were collected in a dedicated database and analyzed for procedural characteristics and clinical outcomes. Results Twelve patients were included. Mean age was 68 years (range 48–82); 33% were male and 67% female. Mean BMI was 27.7 kg/m² (range 23.3–36.1). ASA classification was III in 33% and IV in 67%. Indications included aneurysm in 50%, dissection in 33.3%, intramural hematoma (IMH) with aneurysm in 8.3%, and penetrating aortic ulcer (PAU) in 8.3%. Among aneurysm patients, 83% were female and 17% male, with mean diameter 60 mm (range 55–71 mm). Dissections comprised two type B and two non-A/non-B cases. The patient with IMH had also a 58 mm aneurysm, and the patient with progressive PAU (45 mm) required prior LSA transposition onto the left common carotid artery (CCA) for an adequate sealing zone in zone 1. In one case, the left vertebral artery originated directly from the aortic arch between the CCA and LSA and remained patent after graft deployment. Technical success was 100%. CSF drainage was used in one third of patients, requiring a two-day ICU stay. Mean operation time was 110 minutes (range 81–141); mean dose-area product 194.4 Gy·cm² (range 37.8–623.2). Mean hospital stay was 7 days (range 2–22). Two intraoperative problems occurred. After LSA branch deployment, the olive from the delivery system detached and remained in the LSA. A 90 cm 6 F cubital sheath was advanced through the left cubital access, pushing the olive along the through-and-through wire to the femoral access, where it was retrieved with the femoral sheath. Closure of the cubital access with a ProStyle device caused transient hand ischemia, resolved after surgical cut-down and device removal. Four ProStyle closure failures at the femoral access (33%) were managed with an additional 8 F AngioSeal device. One patient (8.3%) had a posterior stroke with multiple small infarcts in the left occipital and parietal regions on the second postoperative day, presenting with diplopia and mild abduction deficit of the left eye, which fully recovered. Another patient developed transient paraparesis following secondary fenestrated endovascular repair (FEVAR) eight weeks after the initial procedure. No reinterventions or 30-day mortality occurred. LSA branch patency was 100%. Three-month follow-up was uneventful, with only one minor femoral hematoma. Conclusions Early experience shows that these first implantations were feasible, safe, and effective, with high technical success and favorable short-term outcomes. Off-the-shelf availability is particularly valuable in emergencies. Awareness of device-specific and access-related complications, such as closure-system failure and detachment malfunctions, is essential. Long-term follow-up will determine branch patency and device durability.
AorticDETERMINANTS OF SURVIVAL IN OCTOGENARIANS PRESENTING WITH ABDOMINAL AORTIC ANEURYSM
By: S Ali Raza Shehrazi
DETERMINANTS OF SURVIVAL IN OCTOGENARIANS PRESENNTING WITH ABDOMINAL AORTIC ANEURYSM M Banihani, Sulaiman S Shoab, I Zeynali, A Shehrazi, I Nasser, T Babiker Introduction: Long term survival is limited in octogenarians presenting with an abdmoinal aortic aneurysm (AAA). Despite that it is possible to achieve moderate survival benefit with intervention. Managing AAA in octogenarians is challenging due to high surgical risk and medical frailty. This study explored factors affecting survival in these patients. Methods: A retrospective survival analysis (of a prospectively maintained database) was performed on 205 octogenarians undergoing CPEX assessment prior to consideration for AAA repair. VSAQ was used to determine the level of physical activity. Survival was measured from the date of CPEX to death or database censoring (April 2024). Cox regression was used to identify predictors of mortality. Results: | Variable | coef | SE | HR | 95% CI | p-value | | ------------------------ | ------- | ------ | --------- | ----------- | ------- | | Age at CPEX | 0.1120 | 0.0286 | **1.118** | 1.057–1.183 | <0.0001 | | COPD | 0.4388 | 0.2202 | **1.551** | 1.007–2.388 | <0.0463 | | EVAR vs Non-Intervention | −0.6794 | 0.2183 | **0.507** | 0.330–0.778 | <0.0019 | | VSAQ | -0.251 | 0.049 | **0.78** | 0.71–0.86 | <0.001 | VSAQ= Veterans Specific Activity Questionnaire Conclusions : In octogenarians with AAA, older age, COPD, VSAQ and inability to record AT during CPEX are associated with worse survival. EVAR offers a survival benefit compared with no repair. VSAQ (especially <5 METs) provides a relatively easy to use parameter for prognostication. These findings highlight the prognostic utility of these factors & may support selective intervention in these patients.
AorticInfrarenal Penetrating Aortic Ulcer Treatment by Endoprosthesis with ActiveSeal Technology
By: Cristina Rocchi
Aims. Aim of the study was to report intraoperative, perioperative, and midterm results of a single-center experience in PAU treated with Endologix®AFX®2 (Endologix, Irvine, CA, USA) Methods. All patients underwent infrarenal penetrating aortic ulcer (PAU) endovascular treatment with Endologix®AFX®2 between September 2021 – May 2025 at the Vascular Surgery Unit, “San Martino” Hospital, Belluno (Italy), were enrolled. Data were prospectively collected and retrospectively analyzed. Primary endpoints were to evaluate technical success, 30-day-morbidity/mortality, and reinterventions. Secondary endpoints were to study type-I/III endoleaks, PAU shrinkage, survival, and freedom from reintervention at midterm ( 24-month). Results. During the study period 36 patients (median age 77.1±6.5; maximum diameter (aorta + PAU): 42.8±8.6mm; PAU deep: 15.1±3.8mm; PAU width: 25±5.2mm) underwent EVAR by Endologix®AFX®2 for PAU. All patients were treated inside the IFU. Technical success was achieved in 100% of cases. 30-day-morbidity/mortality were 0% and no type I/III endoleaks and/or reinterventions was observed. At median follow-up (18, range:1-46 months) 2(5.6%) iliac branch occlusion cases were observed and successful reintervention was performed. Estimated 3-year freedom from reintervention and survival were 95% and 97%, respectively. Fifteen patients (42%) had a follow-up 24 months. Among patients with a follow-up 24 months PAU shrinkage and trombization were observed in 18 (50%) and 36 (100%) cases, respectively. No PAU enlargement, type I/III endoleak, reintervention and PAU-related death occurred in those patients. Conclusion. According with the present data, patients with infrarenal PAU can be treated inside the IFU by Endologix® AFX®2, with 100% of technical success and excellent rate of type I/III endoleak and reintervention at short- and mid-term follow-up, in absence of PAU increase to a follow-up > 24 months.
AorticThe Road Less Travelled: Collateral Pathway Solution for a Celiac Artery Aneurysm
By: Siddhartha Paturi
Aims: To report successful management of a large celiac artery aneurysm through collateral pathway embolization after initial direct endovascular failure in a complex patient with concurrent pancreatic malignancy and metabolic cirrhosis. Methods: Case report of a 59-year-old male presenting with progressive painless jaundice and prompt imaging studies revealing a 4.2 × 3.9 cm fusiform celiac artery aneurysm with a wide neck measuring 2.7cm documented interval enlargement and concurrent pancreatic head mass. Initial direct coil embolization was attempted but failed due to persistent aneurysmal patency and coil migration risk from high aortic flow. Subsequent angiographic evaluation identified robust superior mesenteric artery to celiac collateral circulation, enabling successful alternative embolization approach through systematic coil deployment via collateral branches. Results: Direct celiac artery embolization proved unsuccessful with persistent aneurysmal flow despite coil deployment. Selective superior mesenteric artery angiography demonstrated extensive collateral networks supplying celiac territory. Complete aneurysm exclusion and thrombosis was achieved through systematic embolization via superior mesenteric artery collateral branches using multiple coils. Post-procedural imaging confirmed aneurysm thrombosis with preserved visceral organ perfusion through maintained collateral circulation. The patient remained asymptomatic with excellent clinical outcomes and follow-up imaging demonstrating sustained aneurysm exclusion. Conclusions: Celiac artery aneurysms in patients with pancreatic and hepatic diseases present complex management challenges often refractory to standard direct endovascular approaches. Strategic utilization of collateral arterial pathways enables safe and effective embolization following initial procedural failure. This case demonstrates the importance of comprehensive vascular anatomy assessment and individualized endovascular strategies adapted to specific flow dynamics. Continued imaging surveillance remains critical for detection of potential recurrence.
AorticClinical Characteristics, Predictors anOutcomes of Ruptures after EVAR – A 14-Year Single-Center Experience
By: Rami Hammadi
Objective Rupture after prior endovascular aortic repair (rEVAR) is a serious complication with limited data on risk factors and outcomes. The European Society for Vascular Surgery (ESVS) Guidelines recognize rEVAR as an increasingly observed complication. This study aims to evaluate clinical characteristics, outcomes, and predictors of rEVAR at a single center using an endovascular-first strategy for all ruptured abdominal aortic aneurysms (rAAA). Methods This retrospective single-center study included all patients treated with endovascular repair for rEVAR between October 2009 and September 2023. Demographic and clinical data were collected from medical records and computed tomography angiography images. Cox regression analyses were performed to identify predictors of rEVAR and mortality. Results Among 178 patients with rAAA, 34 (19%) had prior EVAR and constituted the study cohort. Endovascular repair was attempted in 24 (71%), while 10 (29%) were treated conservatively. The mean time from index EVAR to rEVAR was 56 months. At least one instructions for use violation at index EVAR was present in 65% (22/34). Sac expansion occurred in 79% (27/34), of which 12 (44%) underwent reintervention. Type 1A endoleak was the leading cause of rEVAR (59%) and a multivariate cox regression identified conical neck as an independent predictor of early rEVAR (HR 52.5, 95% CI 6.2–440.9; p <.001). All-cause 30-day mortality was 42%. Conclusion The findings demonstrate the challenge of preventing rEVAR even with close surveillance. Conical neck anatomy is a major determinant of early rEVAR, with increased risk persisting even when the proximal 10-15 mm of the neck appears straight. Standard EVAR should therefore be avoided in patients with conical neck anatomy and alternative strategies such as fenestrated and branched EVAR or open repair should be strongly considered in patients with conical neck regardless of whether the conical shape involves the entire neck or only the first 10 mm.
AorticEndovascular Patch Implantation in the Ascending Aorta: First Demonstration of a Minimally Invasive Strategy for Type A Aortic Dissection Repair
By: Yvette Rabadà
Aims: Open surgery remains the current standard of care for type A aortic dissection (TAAD), but less invasive alternatives are urgently needed, particularly for high-risk patients. Despite ongoing investigations into endovascular approaches for the ascending aorta, including novel grafts currently in clinical trials, its demanding anatomical and physiological characteristics continue to pose major challenges to the successful endovascular management of TAAD. In this context, we have developed a novel bioresorbable patch and steerable delivery system designed to address these challenges by specifically targeting the entry tear. Building on promising in vivo results from open surgical implantation in the descending aorta, the complete device was evaluated for the first time for endovascular navigation and implantation in the ascending aorta. Methods: An endovascular procedure was performed to implant the bioresorbable patch in the ascending thoracic aorta of an ovine model. Vascular access was achieved via 20 F transfemoral catheterization, using a double steerable catheter to reach the targeted area. The patch was implanted via a nitinol deployer and secured to the aortic wall with a vascular adhesive. Live monitoring was conducted using transesophageal echocardiography for 30 minutes post-implantation to assess patch stability under physiological conditions. Results: Endovascular navigation and positioning were achieved in the study animals, enabling precise access to the thoracic ascending aorta, and confirming the feasibility of the delivery system for navigating complex vascular anatomy in a clinically relevant animal model. The dual-steerable catheter exhibited excellent maneuverability and was essential for overcoming the tortuous anatomy and curvature of the aortic arch. Despite the dynamic pulsatility of the vessel, the bioresorbable patch was accurately deployed and implanted at the intended location. Post-implantation imaging confirmed that the patch remained securely attached and withstood aortic expansion and pulsatile flow, demonstrating its suitability for a targeted endovascular intervention in this hemodynamically demanding region. Conclusions: This study provided the first evidence of successful implantation of our endovascular patch in the ascending aorta of an ovine model using a dual-steerable catheter system, highlighting its potential as a novel strategy for the endovascular treatment of TAAD.
AorticComparative Outcomes of Native and Endograft Abdominal Aortic Aneurysm Infections: A Retrospective Single-Center Study
By: Sue hyun Park
Background Abdominal aortic aneurysm (AAA) infection is a rare but life-threatening condition associated with high morbidity and mortality. With the increasing use of endovascular aneurysm repair (EVAR), aortic endograft infection (AEI) has emerged as a distinct clinical entity differing from native aneurysm infection (NAI) in etiology, microbiology, and management. Despite advances in surgical and endovascular techniques, mortality remains substantial in both conditions. A direct comparison between AEI and NAI may help clarify prognostic differences and guide optimal treatment strategies. Therefore, this study aimed to compare clinical characteristics and mortality outcomes between patients with AEI and NAI and to identify factors influencing prognosis. Methods This retrospective study included 35 patients who underwent surgery for AAA infection between January 2011 and December 2023 at a tertiary medical center in South Korea. Patients were categorized into two groups: AEI (n = 15) and NAI (n = 20). Clinical data including demographics, comorbidities, surgical approach, postoperative complications, and mortality were analyzed. AEI was defined as infection involving a previously implanted aortic endograft after EVAR, confirmed by imaging or intraoperative findings. NAI was defined as infection of a non-grafted aneurysm consistent with mycotic aneurysm criteria. Most AEI patients underwent open surgical repair with complete graft explantation and in situ or extra-anatomic reconstruction. In one AEI case, only infected aortic wall excision and omentopexy were performed due to poor general condition. Among NAI patients, 10 underwent EVAR and 10 underwent open repair, depending on anatomical feasibility and clinical status. Outcomes were compared between groups using chi-square and Kaplan–Meier methods, with P < 0.05 considered significant. Results The mean age of all patients was 68.3 ± 9.1 years (AEI: 72.7 ± 7.8; NAI: 65.2 ± 8.8). There were no significant differences in demographics or comorbidities between the two groups. Postoperative morbidity occurred in 57.1% of AEI cases and 35.0% of NAI cases (P = 0.296). The overall mortality was 71.4% in AEI and 50.0% in NAI (P = 0.293). Two AEI patients and one NAI patient died within 30 days after surgery. Although AEI tended to show higher morbidity and mortality, statistical significance was not achieved, likely due to the small sample size. Conclusions Patients with aortic endograft infection exhibited a trend toward higher morbidity and mortality than those with native aneurysm infection. However, in-hospital mortality was relatively low in both groups, reflecting improvements in perioperative management and surgical techniques. As graft infection cannot be controlled without source removal, surgical repair remains the cornerstone of treatment and should be pursued whenever feasible, even in high-risk patients. The limited sample size is a major constraint of this study, underscoring the need for larger multicenter analyses to better define optimal management strategies for this rare but devastating condition.
AorticMidterm outcomes of complex endovascular repair after failed endovascular and open surgical aortic aneurysm repair
By: Konstantinos Tzimkas-Dakis
Aims: Reinterventions after failed endovascular aortic aneurysm repair (failed EVAR) have been increasingly recorded, while after failed open surgical repair (failed OSR), despite rarer, remain challenging, with high perioperative morbidity and mortality. Endovascular repair, after failed EVAR and OSR, with involvement of the renovisceral aorta, has been associated to high technical success and good short-term outcomes. This study aimed to present the midterm outcomes of complex endovascular repair after failed EVAR and OSR. Methods: A single centre, retrospective analysis, following the STROBE Guidelines on observational studies, was conducted, including consecutive patients treated with complex endovascular aortic repair for failed EVAR or OSR from 2016 to 2025. Fenestrated and branched devices, as well as cases managed with the parallel graft technique (chimney EVAR) were included. The setting of repair was not an exclusion criterion. Patients with failed EVAR and OSR related to infectious causes were excluded. Baseline information and pre-, intra- and post-operative details were collected and analysed. Thirty-day (technical success, mortality, spinal cord ischemia and reintervention) and midterm outcomes (survival, freedom from reintervention and freedom from endoleak) were assessed, with the latter representing the main findings of the analysis. Results: Thirty-four patients (100% male, mean age: 73.4±2.7 years); 32 (94.1%) after failed EVAR and two (5.9%) after failed OSR, were included. The mean maximum aortic diameter was 89.9±8.2mm while 24 (70.0%) patients were treated for a juxta- or pararenal aneurysm. Twenty-three (67.6%) were asymptomatic and managed electively, while the remaining eleven (32.4%) were treated under urgent setting; with four cases presenting with ruptured AAA after failed EVAR. Both patients with failed OSR, presented with a pseudoaneurysm of the proximal anastomosis. Failed EVAR was related in 25 (78.1%) cases with endoleak type Ia while all patients presented with device migration (100%); in 21 (65.6%) of them, an endograft with suprarenal fixation had been implanted. Branched endovascular aortic repair (bEVAR) was the most common approach applied in 19 patients (56.6%) while ten (29.4%) were treated with chimney EVAR; including all ruptured cases. Five patients received a custom-made fenestrated device. Technical success was 100%, regardless the approach. No mortality or reintervention was recorded during the 30-day follow-up. Spinal cord ischemia affected one (3.3%) patient with a ruptured pararenal aneurysm. The median follow-up was 24 (1-33) months. The survival estimate was 78.9% [standard error (SE) 9.4%] at 24 months, with no aorta-related mortality. Freedom from reintervention was 91% (SE 6%) and freedom from any endoleak at 91% (SE 6%) at 6 months; with no further event recorded. All reinterventions were performed endovascularly during follow-up. Conclusion: Complex endovascular repair of failed-EVAR and OSR is a feasible alternative, with excellent perioperative outcomes and acceptable midterm survival. Endoleak and reintervention rates were low, with all being minimally invasive. Long-term outcomes are warranted for evaluating the durability of the approach in these highly selected cases.
AorticEndovascular Treatment Of Complex Aortic Arch Aneurysms – Different Options, Different Devices
By: Piotr Szopinski
Aims: The management of aortic arch aneurysms remains a clinical challenge. The authors present a different approach to the treatment of complex aortic arch aneurysms based with the use of off-the-shelf and custom made devices. We used various treatment options: paralell grafts, custom made devices with proximal scallop, fenestrations, double and triple branch devices and at least off-the shelf devices. Methods: We treated 26 patients (19M, 7F) for aortic arch aneurysms. In some cases it was necessary to perform additional open procedures. Results: Seven procedures were performed under local anesthesia and remaining cases under general anesthesia from femoral and subclavian access. In three cases we implanted a by-pass between the left carotid and the left subclavian artery and in the remaining nine cases the left subclavian artery was occluded with a vascular plug. In all cases but one technical success was achieved without any neurological complications. In one case a massive ischemic stroke occurred intraoperatively after failed stent-graft expansion followed by emergent sternotomy and stent-graft repositioning and the patient died on 6th postoperative day. The patients were followed up from 1 to 108 months. Four deaths that occurred during follow-up were unrelated to the procedure. In two cases asymptomatic occlusion of the left common carotid artery branches were noticed and left without intervention. No endoleaks were detected during follow-up. Conclusions: Availability of endovascular devices for the treatment of aortic arch lesions is still limited, therefore in case of complex anatomy the operator is pressed to be very flexible in choosing the treatment option.
AorticScroll for more
Showing 18 of 42 submissions