February 2025
European Journal of Vascular and Endovascular Surgery
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February 2025
European Journal of Vascular and Endovascular Surgery
February 2025
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55 Reads
European Journal of Vascular and Endovascular Surgery
January 2025
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6 Reads
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1 Citation
European Journal of Vascular and Endovascular Surgery
January 2025
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1 Read
Introduction Management of patients with large aortic arch aneurysms who are considered high risk for frozen elephant trunk technique have been challenging, especially when they have a dilated ascending aorta (AA) that precludes total endovascular branched repair (arch BEVAR). A viable option in our armamentarium is wrapping of the AA (AW), and zone 0 Ishimaru TEVAR. Methods Retrospective analysis of our aortic database from 2013 to 2024 to select high-risk patients with aortic arch aneurysm that had an AW and TEVAR. We performed CTA analysis before and after wrapping and TEVAR, and last available CTA. The primary end points were 30-day mortality and stroke. Results A total of 12 patients had AA wrap and TEVAR, with supra-aortic vessels (SAVs) debranching (open or endovascular). In 9 patients, the indication for treatment was a large arch atherosclerotic aneurysm, and in 3 patients a dissecting arch aneurysm depicted during follow-up of AW initially performed for acute type A dissection (51.5 months on average between the wrap and the TEVAR). Average age was 72.9 years. Ascending aorta wrap and TEVAR were performed concomitantly in 3/12 patients, including 2 patients with rupture. It was staged in the other 9 patients. The average diameter of the AA pre-wrap was 47.7 (41.3-57), and post-wrap 35.6 (31.9-43) mm. The wrap provided an average seal length of 68.5 (38.4-97.4) mm. A total of 34 SAV were successfully debranched. No type 1 or 3 endoleaks were depicted on completion angiogram. Within the first 30 days, no strokes were diagnosed, and 1 patient with Horton disease died of cardiac arrest on postoperative day 7. Three patients required early reinterventions, including redosternotomy in 2 patients. Mean follow-up (FU) was 28 months (1-75). During FU, 1 patient developed a left vertebral artery steal phenomenon requiring a carotid subclavian bypass, and another patient died of an unknown cause. Conclusion Ascending aorta wrap technique with debranching of the SAVs and zone 0 TEVAR might be a good option in patients at high risk for open replacement of the AA and with unfavorable proximal seal zone for a total endovascular repair. Clinical Impact In the current study, we describe the treatment of aortic arch aneurysms in patients considered at high risk for open replacement of the aortic arch and also not candidate for complete endovascular arch repair (arch BEVAR). Ascending aorta wrap with surgical or endovascular debranching of SAVs and zone 0 TEVAR was performed in 12 patients with favorable outcomes. It should thus be considered a treatment option in this subset of fragile patients with unfavorable proximal seal zone for total endovascular repair. This technique does not require cardiopulmonary bypass (CPB) support, neither aortic cross-clamping
January 2025
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5 Reads
European Journal of Vascular and Endovascular Surgery
December 2024
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2 Reads
Annals of Vascular Surgery
December 2024
Annals of Vascular Surgery
December 2024
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19 Reads
Journal of Vascular Surgery
November 2024
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33 Reads
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1 Citation
European Journal of Vascular and Endovascular Surgery
November 2024
Journal of Vascular Surgery Cases and Innovative Techniques
... In addition, the pre-operative comorbidities' profile of the patients should be taken into consideration when evaluating the early mortality outcomes, with 30% of them having a known history of coronary artery disease and 25% presenting with chronic obstructive pulmonary disease (COPD). All these factors added to the hemodynamic instability and the acute nature of rAAA may be able to justify the mortality-related findings [42]. Recent data evaluating the mortality after EVAR for rAAA showed a significant decrease in early mortality through a timespan of 15 years; inversely proportional to increasing experience [43]. ...
July 2024
Journal of Vascular Surgery
... Current guideline recommends the preservation of accessory renal arteries with a diameter greater than 4 mm [4]. There is a lack of data regarding the optimal management of accessory viscerals. ...
April 2024
Journal of Vascular Surgery
... These are mainly focused on whether the aortic anatomy was hostile (i.e., at higher risk for long-term stent-graft-related complications) and the absence or presence of endoleaks on first postoperative CTAs; additional considerations also play a role such as, for instance, whether the stent-graft was delivered within the manufacturer's instructions for use or not. The role of aneurysm sac regression, which after eEVAR is considered to be correlated with the incidence of reintervention, rupture and mortality, has not yet been investigated for rEVAR [46], but could be identical. To date, there is no evidence for a worse long-term outcome in patients with T2EL after rEVAR that would justify a closer follow-up than usually conducted after eEVAR. ...
March 2024
Journal of Vascular Surgery
... A large proportion (up to 80%) of patients suffering from BTAI die before receiving sufficient treatment [5]. BTAI most commonly results from sudden deceleration, with motor vehicle accidents being the predominant mechanism described [2,3,[5][6][7]. The age distribution of BTAI is broad, with a mean age of 35 to 45 years, and there is a male predominance [1][2][3]7]. ...
February 2024
... Especially for the right or bilateral UEA, the complication rate is estimated as five times higher compared to left UEA, including a higher risk for stroke [6]. Conversely, previous studies have demonstrated that TFA is associated with reduced radiation exposure and fluoroscopy time, decreased blood loss, shorter operative time, and lower stroke rates, especially regarding the steps related to target vessel catheterization and stenting during bEVAR [7][8][9]. ...
February 2024
Journal of Vascular Surgery
... Given that the primary objectives of most studies are to evaluate patient outcomes and clinician workflows, a prospective evaluation of AI models is preferable, particularly in vascular surgery, where patients frequently undergo high-risk and urgent interventions (22). The generalizability of results is limited when conducting retrospective data analysis within a single institution, constraining its applicability to specific clinical scenarios or populations (20 from two reference aortic centres (38). ...
February 2024
Journal of Vascular Surgery
... Additionally, in cases where the stent graft extends to the external iliac artery, internal iliac artery occlusion is typically combined to prevent type 2 endoleaks [4]. Long-term postoperative followup is necessary to monitor for potential complications [5][6][7]. ...
February 2024
European Journal of Vascular and Endovascular Surgery
... CoA, but the debate between self-expanding and balloon-expandable types continues due to their unique advantages and disadvantages. 6,7 Here, we used a balloon-expandable covered stent. This particular stent is a growth-friendly device that can be staged with differentsized BIB balloons for phased dilation of localized aortic coarctation. ...
November 2023
European Heart Journal
... Custom-made devices (CMD), as the name suggests, are specifically ordered, individually tailored, designed and manufactured based on measurements from a patient's pre-operative CT angiography imaging as opposed to the use of combining standard available devices [6,[10][11][12]. ...
October 2023
... AI-driven models can predict postoperative outcomes, including mortality and complications after EVAR, by analysing large datasets to identify predictive patterns [31,32]. AI tools such as augmented radiology for vascular aneurysm (ARVA) provide accurate preoperative and postoperative assessments of aortic diameter, reducing the need for time-intensive manual measurements [33]. Moreover, AI tools might improve endoleak visualisation. ...
October 2023