Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients

Objectives Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients. Methods During a 10-year period, consecutive patients treated by the ascending WT, SADB and TEVAR in zone 0 were included. All patients were considered at high risk for conventional surgery. Measured outcomes included perioperative deaths and morbidity, maximal aortic trans…

Endovascular treatment of large and wide aortic neck: case report and literature review

Large (24–34 mm) and wide (≥35 mm) aortic necks are a contraindication to endovascular aneurysm repair (EVAR). A 63-year-old man, unfit for conventional surgery, presented a 79 mm abdominal aortic aneurysm with 36.5 mm aortic neck and a 62 mm right common iliac artery aneurysm. He was treated endovascularly with standard commercially available stent-graft using the so-called ‘funnel technique’; by placing a thoracic stent-graft inside a bifurcated device to achieve proximal sealing. The completion angiography and the 6 months follow-up with computed tomography showed no stent-graft migration, limb occlusion or endoleak. The literature review reported 179 cases of large aortic neck managed w…

Endograft (VORTEC) reconstruction of aortic branches allowing endovascular treatment of aortic aneurysm.

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, r…

Efficacy and one-year outcomes of Luminor® paclitaxel-coated drug-eluting balloon in the treatment of popliteal artery atherosclerosis lesions

Purpose: Reporting outcomes with a new generation paclitaxel eluting balloon (Luminor®; iVascular, Vascular, S.L.U., Barcelona, Spain) in the popliteal district. Endovascular treatment of popliteal artery atherosclerotic disease is still debated without definitive evidences. Methods: From January to June 2019, patients’ data presenting popliteal artery atherosclerotic diseases and treated with the Luminor® (iVascular) drug eluting balloon (DEB) were prospectively collected. Critical limb ischemia (CLI) or severe claudication associated with popliteal artery stenosis >50% were the inclusion criteria. Measured outcomes were technical success, early and late results; including mortality, mo…

Use of the directional atherectomy for the treatment of femoro-popliteal lesions in patients with critical lower limb ischemia

Femoro-popliteal PTA for the treatment of critical limb ischemia is frequently associated with unsatisfactory procedural success rates while directional atherectomy (DCA) has improved success rate since claudicant patients undergoing percutaneous treatment of femoro-popliteal obstructive disease. The aim of this prospective study is to evaluate the safety, efficacy and procedural success of DCA, at one year, in the percutaneous treatment of femoro-popliteal obstructive disease in patients with critical limb ischemia.Methods. From March 2012 to March 2013 18 consecutive patients with critical limb ischemia were treated with DCA (Turbohawk/ Covidien-ev3 Endovascular Inc., North Plymouth, Minn…

Popliteal Artery Aneurysm Repair in the Endovascular Era: Fourteen-Years Single Center Experience

Abstract To compare outcomes of popliteal artery aneurysm (PAA) repair by endovascular treatment, great saphenous vein (GSV) bypass, and prosthetic bypass. Single center retrospective analysis of patients presenting PAA from 2000 to 2013. Patients were divided into endovascular treatment (group A); GSV bypass (group B); and prosthetic graft bypass (group C). Outcomes were technical success, perioperative mortality, and morbidity. Survival, primary and secondary patency, and freedom from reintervention rate were estimated. Differences in ankle-brachial index (ABI), in-hospital length of stay (InH-Los), red blood cell (RBC) transfusion, and limb loss were reported. Mean follow-up was 49 (medi…

Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure

Objective The aim was to report on chimney and periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent…

Penetrating aortic ulcer post migration of thoracic aortic endoprosthesis: Case report

Introduction Thoracic endovascular aortic repair (TEVAR) is the first treatment option for many thoracic aortic pathologies. Especially after aortic dissections, it is possible to have progression during follow-up with appearance of new lesions on arterial wall. Herein, we report a case of Penetrating Aortic Ulcer (PAU) post release of Thoracic endoprosthesis. Presentation of case A 67-years-old male with hypertension and diabetes mellitus was followed at our hospital after an emergency procedure for Type B aortic dissection (TBAD) complicated by symptomatic large infrarenal AAA and treated with a proximal TEVAR plus chimney for left subclavian artery and PETTICOAT with EVAR for abdominal a…

Cinical outcomes of Endurant II stent-graft for infrarenal aortic aneurysm repair: comparison of on-label versus off-label use.

Purpose We aimed to compare the outcomes of the Endurant II (Medtronic) stent-graft used under instructions for use versus off-label in high-risk patients considered unfit for conventional surgery. Methods Data from patients treated with the Endurant II stent-graft between December 2012 and March 2015 were retrospectively analyzed. Sixty-four patients were included. Patients were assigned to group A if treated under instructions for use (n=34, 53%) and to group B if treated off-label (n=30, 47%). Outcome measures included perioperative mortality and morbidity, survival, freedom from reintervention, endoleak incidence, in-hospital length of stay, and mean stent-graft component used. Mean fol…

Carotid Artery Disease in the Era of Biomarkers: A Pilot Study

The intima-media thickness (IMT) and its irregularities or ulcerations in the common carotid artery (CCA) are useful tools as sentinel biomarkers for the integrity of the cardiovascular system. Total homocysteine and lipoprotein levels are the most commonly used elements in cardiovascular risk stratification. Duplex ultrasound (DUS), associated with serum biomarkers, can be used simply to assess the degree of atherosclerotic disease and cardiovascular risk. This study highlights the role of different kinds of biomarkers, showing their usefulness and potentiality in multi-district atherosclerotic patients, especially for early diagnosis and therapy effectiveness monitoring. A retrospective a…

CEA vs CAS

Objectives: Last years registered an increment in the number of endovascular procedures. Traditional carotid endoarterectomy (CEA) is the most performed surgical treatment for carotid stenosis. In symptomatic patients CEA reduces significantly absolute relative risk of stroke and death. In asymptomatic patients AHA guidelines recommend CEA for stenosis 60–99%, if the risk of perioperative stroke or death is <3%. According to 2007 Clinical Expert Consensus Document Carotid Artery Stenting (CAS) should be used in patients at high-risk for CEA or into controlled trials and Cochrane Database of Systematic Reviews does not support a widespread change in clinical practice away from recommending C…

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assess…

Attualità in Chirurgia Vasolare.

Surgical conversion with graft salvage as a definitive treatment for persistent type II endoleak causing sacenlargement

Objective The goal of this study was to present open surgical conversion with graft salvage or "semiconversion" as a definitive and safe treatment for untreatable and persistent type II endoleaks causing sac enlargement after endovascular aneurysm repair. Methods Between January 2001 and December 2014, 25 of 1623 endovascular aortic repair (EVAR) patients were selected as candidates for open semiconversion. The indication was persistent type II endoleak in 13 patients (12 of whom received previous attempts of embolization), type I and II endoleak in 2 patients, and sac growth without imaging evidence of endoleak in the other 10. After the infrarenal aorta was prepared (via a retroperitoneal…

Subintimal recanalization plus protegè Everflex stenting in superficial femoral artery occlusions with critical limb ischemia

Predilation technique with balloon angioplasty to facilitate percutaneous groin access of large size sheath through scar tissue

Purpose Percutaneous remote access for endovascular aortic repair is an advantageous alternative to open access. Previous surgery in the femoral region and the presence of synthetic vascular grafts in the femoral/iliac arteries represent major limitations to percutaneous remote access. The aim of this study was to evaluate an original technique used for enabling percutaneous remote access for thoracic or abdominal endovascular aortic repair in patients with scar tissue and/or a vascular graft in the groin. Methods Twenty-five consecutive patients with a thoracic (11/25; 44%) or an aortic aneurysm (14/25; 66%) and with a synthetic vascular graft in the groin (16/25; 64%) or a redo groin acce…

TEVAR and periscope graft technique to treatment of huge aneurysm of aortic isthmus: Case report

Introduction Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the periscope graft technique to preserve patency in left s…

Symptomatic Deep Femoral Artery Pseudoaneurysm Endovascular Exclusion. Case Report and Literature Review.

Deep femoral artery pseudoaneurysms (DFAPs) are rare and generally occur after penetrating trauma or surgical procedures. A 36-year-old obese man presented with pain in correspondence of the anterior-lateral thigh after 6 months from gunshot wound. Duplex and computed tomography (CT) showed a bilobed right DFAP (maximal diameter 12.9 cm). The patient was managed urgently, under local anesthesia, by placement in the distal DFA of a Viabahn 8 × 100-mm stent graft (W L Gore & Associates, Inc). The postoperative course was uneventful, and the 24-month CT showed regular stent-graft patency and 20-mm DFAP shrinkage. The literature review reported 8 cases of DFAPs; of these 6 were managed by endo…

Basal Cerebral Computed Tomography as Diagnostic Tool to Improve Patient Selection in Asymptomatic Carotid Artery Stenosis

One-hundred patients were included to evaluate the role of cerebral computed tomography (CT) to improve patient selection in asymptomatic internal carotid stenosis. Symptomatic patients were assigned to group A, asymptomatic patients to group B. A cerebral CT pattern A was observed in groups A and B in 60% and 20%, respectively ( P &lt; .0001). Between A and B groups, type 6 plaques were found, respectively, in 26.7% and 7.5% of patients ( P = .01); a type 5 in 51.7% and 45% ( P = .32) of patients; and a type 4 in 21.7% and 47.5% of patients, respectively ( P = .006). Within B group, the association of CT pattern A and histological plaque level 4, 5, and 6 was, respectively, 25% ( P = .15)…

A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring

Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were …

The Gore Hybrid Vascular Graft in renovisceral debranching for complex aortic aneurysm repair.

Objective This study reports our initial experience with the Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) for staged hybrid open renovisceral debranching and endovascular aneurysm repair in patients affected by thoracoabdominal aortic aneurysms and pararenal abdominal aortic aneurysms (PAAAs). Methods Between December 2012 and December 2013, we analyzed outcomes of 13 patients who underwent open surgical debranching of renovisceral vessels for thoracoabdominal aortic aneurysm and PAAAs. All patients were considered at high risk for conventional surgery. Inclusion criterion was treatment by open surgical debranching of at least one visceral artery (renal artery…

Outpatient endovascular aortic aneurysm repair: Experience in 100 consecutive patients

OBJECTIVES:: To present the safety, feasibility, costs, and patient satisfaction of outpatient endovascular aneurysm repair (EVAR). BACKGROUND:: Our experience in more than 1000 patients indicated that in technically uncomplicated EVAR procedures, the only need for hospitalization was for access vessel complications (bleeding or occlusion) requiring secondary procedures. These complications could always be identified within the first 3 hours after EVAR. METHODS:: Two-center retrospective analysis of prospectively gathered data on 100 consecutive elective outpatient EVAR cases (Outpt EVAR). Inclusion criteria for Outpt EVAR were as follows: asymptomatic clinical state, informed consent, trav…

SS8. Chimney and Periscope Grafts: Mid-term Results in 77 Consecutive Patients with Complex Aortic Aneurysms

Author Disclosures: N. D. Andersen: Nothing to disclose; G. Hughes: W.L. Gore and Associates,Research Grants W.L. Gore and Associates, Consulting fees or other remuneration (payment) W.L. Gore and Associates, Speaker’s bureauMedtronic Vascular, Consulting fees or other remuneration (payment) Medtronic Vascular, Speaker’s bureauVascutek Terumo, Consulting fees or other remuneration (payment) Vascutek Terumo, Speaker’s bureau; R. L. McCann: Nothing to disclose; A. A. Shah: Nothing to disclose; J. B. Williams: Nothing to disclose.

Endograft connector technique to treat popliteal artery aneurysm in a morbid obese patient.

Surgical repair of popliteal artery aneurysm in morbid obese patients poses additional challenges. We report a morbid obese patient who had a 59 mm right popliteal artery aneurysm which was successfully treated with the endograft connector technique. This technique was used to perform the distal anastomosis of the below-knee femoro-popliteal bypass. A 10 mm Dacron graft was used as a main graft bypass and an 11 mm/10 cm stentgraft as endograft connector. Following the respective tunnel of the Dacron graft, an end-to-side proximal anastomosis was performed at distal femoral artery. The aneurysm exclusion was obtained through a proximal and a distal ligation. Postoperative duplex showed adeq…

Acute aortic dissection

An acute aortic syndrome with simultaneous presence of a penetrating aortic ulcer, an intramural haematoma, a thoracic aortic dissection and an abdominal aortic aneurysm rupture has not previously been reported. Herein, we describe our experience with a patient treated by endovascular means with an 8-year follow-up.

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case-control study.

Aim To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1…

La sindrome del compartimento addominale (ACS) dopo chirurgia degli aneurismi dell'aorta addominale (AAA)

Endoluminal Stent-Graft Relining of Visceral Artery Bypass Grafts to Treat Perigraft Seroma

PURPOSE: To describe the endovascular treatment of intra-abdominal perigraft seromas associated with small-caliber expanded polytetrafluoroethylene (ePTFE) grafts. CASE REPORTS: Two patients who underwent hybrid repair of thoracoabdominal aortic aneurysms in which renovisceral bypass grafts were implanted presented with large, symptomatic perigraft seromas. The 5- to 8-mm-diameter ePTFE bypass grafts believed to be involved in the seromas were successfully relined with self-expanding Viabahn stent-grafts in percutaneous procedures. The patients' symptoms were relieved, and imaging follow-up (18 and 10 months, respectively) has shown near complete resorption of the seromas. CONCLUSION: It is…

Position Paper on Young Vascular Surgeons Training of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS): State of the Art and Perspectives

ABSTRACT The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty.

Chimney and periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms

^ ^Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasp…

Inquadramento clinico del paziente vasculopatico

Le patologie vascolari sono uno dei più rilevanti problemi per la sanità nazionale e quindi rappresentano una importante branca della medicina. I segni, le manifestazioni e le evoluzioni delle malattie vascolari vanno spesso integrati con altre patologie capaci di influenzarne il percorso. L’aumento della durata della vita, con il conseguente invecchiamento della popolazione, rende il paziente vasculopatico una figura presente costantemente negli ambulatori di medicina. I dati dell’Istituto Nazionale di Statistica (ISTAT) riportano che in Italia l’età media della popolazione è di 44,9 anni e che la fascia di popolazione con età superiore a 65 anni è del 22,3%. Inoltre l’Italia è il Paese ch…

Rationale for VORTEC and Chimney techniques

A New Off-Pump Hybrid Open and Endovascular Repair to Treat Ductus Botalli and Ascendens Aneurysms

To report a combined ascending aorta and aortic arch hybrid repair, we performed off-pump with no aortic graft replacement. A 65-year-old man, developing progressive recurrent laryngeal nerve paralysis, underwent a computed tomography (CT) angiography detecting nonpatent residual ductus Botalli aneurysm and ascending aorta aneurysm. Due to severe multimorbidities, a less-invasive alternative was elaborated. In a first step, appropriate proximal landing zone for aortic stent grafting was achieved by ascending aorta diameter reduction, with epiaortic wrapping, and debranching the supra-aortic trunks. In the second step, endovascular stent grafts were deployed from proximal ascending aorta to…

Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms

Renal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for the treatment of RAAs. Here, we aimed to report three cases of wide-necked complex renal artery aneurysms treated endovascularly using stent-assisted coil embolization with self-expandable stent nitinol Solitaire AB and Concerto Axium coils. In addition, we describe the use of the waffle-cone technique in a case of wide-necked sa…

European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia

Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overvi…

Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair

Summary: Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30 cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath…

A popliteal artery aneurysm presenting with ab extrinseco popliteal vein occlusion and compartment syndrome

INTRODUCTION: Aneurysms of popliteal artery are the most frequently reported aneurysm after abdominal aorta. An unusual presentation is compression to adjacent structure. CASE PRESENTATION: A 67 years old caucasian man presenting deep vein thrombosis signs to the right leg including functional impotence was admitted in emergency setting to Vascular Surgery Unit. A pulsing mass was present in the popliteal cave at inspection. The computed tomography angiography demonstrated a 53.2 mm popliteal artery aneurysm causing an ab extrinseco compression of the popliteal vein and a dislocation of popliteal nerve. A surgical open reconstruction with a reinforced Dacron graft was performed via a poster…

Patient-Specific Rehearsal Feasibility Before Endovascular Repair of Ruptured Abdominal Aortic Aneurysm.

Purpose: To evaluate the feasibility of a patient-specific rehearsal (PsR) before emergency endovascular aneurysm repairs (eEVAR) and its influence on the operation. Materials and Methods: From February 2016 to October 2016, 10 consecutive patients (mean age 75 +/- 7.4 years; 9 men) presenting with a ruptured abdominal aortic aneurysm (rAAA) suitable for standard EVAR were enrolled in the study. A 3-dimensional (3D) model of the abdominal aorta was generated on a virtual reality simulator based on the patient's computed tomography (CT) images. Following the patient-specific simulation setup, PsR was conducted during patient admission or in parallel with the preoperative eEVAR workup. Measur…

Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report

Introduction Type 2 endoleaks (T2EL) occur after 10%–25% of endovascular abdominal aortic aneurysm repairs and increase the risk factor of endograft repair failure and rupture. Herein we report a case of endovascular treatment of T2EL where we performed a trans-limb embolization. Presentation of case A 63-years-old male previously treated for AAA with endovascular aortic aneurysms repair (EVAR), showed an angio-CT scan followup with a type 2 endoleak fed from inferior mesenteric artery (AMI) with growth of AAA greater of 1 cm than preoperative CT-scan and increase of chronic lumbar pain. Due to high risk of rupture was performed a trans-limb embolization with complete sealing. The 6 months …

Identification of optimal device combinations for the chimney endovascular aneurysm repair technique within the PERICLES registry

Abstract Objective The ideal stent combination for chimney endovascular aneurysm repair remains undetermined. Therefore, we sought to identify optimal aortic and chimney stent combinations that are associated with the best outcomes by analyzing the worldwide collected experience in the PERformance of chImney technique for the treatment of Complex aortic pathoLogiES (PERICLES) registry. Methods The PERICLES registry was reviewed for patients with pararenal aortic disease electively treated from 2008 to 2014. Eleven different aortic devices were identified with three distinct subgroups: group A (n = 224), nitinol/polyester; group B (n = 105), stainless steel/polyester; and group C (n = 69), n…

Efficacy of TachoSil patches in controlling Dacron suture-hole bleeding after abdominal aortic aneurysm open repair

Abstract Purpose The aim of this study is evaluate the efficacy of TachoSil® patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft. Materials and methods Patients undergoing elective replacement of infrarenal AAA with Dacron grafts were prospectively randomized to TachoSil® patches (Group I) or standard compression with surgical swabs (Group II). We evaluated time to haemostasis, blood loss during the operation, blood loss after cross-clamp removal, duration of operation, drain volume, requirement for blood transfusion and surgeons rating of efficacy. Results Twenty patients were randomized (10 patients in each tr…

Trans-catheter thrombolysis and endovascular relining to treat acute stent graft limb occlusion: technical report

Endovascular treatment options for complex abdominal aortic aneurysms

Abstract Purpose To report short-term and midterm outcomes of endovascular aneurysm repair (EVAR) of complex aneurysms requiring revascularization of visceral arteries. Materials and Methods Prospective data were collected from patients deemed unsuitable for conventional EVAR and conventional surgery who were treated with different endovascular approaches according to the clinical presentation of the aneurysm. Custom-made fenestrated endovascular aneurysm repair (CM f-EVAR) was used in the elective setting, homemade fenestrated endovascular aneurysm repair (HM f-EVAR) or HM f-EVAR combined with chimney endovascular aneurysm repair (ch-EVAR) was used in the emergent setting in patients with …

Less invasive (common) femoral artery aneurysm repair using endografts and limited dissection

Objective We report our experience with the treatment of femoral artery aneurysms (FAAs) under local anaesthesia with limited dissection, using endografts to facilitate the proximal anastomosis and some distal anastomoses. Method Between January 2006 and December 2010, six males, mean age 72 years (range, 65–80 years) with FAAs were treated at the University Hospital of Zurich. All operations were performed under local anaesthesia with analgosedation, except for one performed under spinal anaesthesia. After limited dissection and puncture of the anterior wall of the FAA, a sheath and a self-expanding endograft were introduced over a guide wire and with fluoroscopy they were guided intralumi…

Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry

Juxtarenal aortic aneurysms (JAAs) pose significant challenges for endovascular aneurysm repair (EVAR). A short or absent infrarenal neck typically excludes standard EVAR as a viable or reasonable treatment option. In this context, the use of chimney grafts (chEVAR) is gaining in popularity and applicability. These grafts are designed to course in the aortic lumen outside the main stent-graft to maintain normal perfusion to the involved target branches. As such, they may represent a promising and less resource-intensive option for management of JAAs. However, this technical strategy is not without challenges of its own, particularly the inevitable creation of “gutters” that result from the …

Iliac-femoral stent-graft infection after hybrid procedure redo: Case report

Introduction Stent-graft infection in peripheral arteries is rare and potentially dangerous. The use of hybrid procedures, in complicated patients previously treated, involves an increase of infective risk especially in no collaborative patients. Presentation of case We report a case of rare stent-graft infection in a patient treated for a Rutherford IV Multiple Peripheral Arterial Disease (MPAD) involving the right iliac-femoral axis with stenosis on deep femoral artery due to a previously stenting procedure for Superficial Femoral artery (SFA) stenosis. The first simultaneous hybrid intervention consisted of an endovascular iliac stent-graft placement and a surgical common femoral patch a…

IF01. Collected Worldwide Experience From the PERICLES Registry With the Use of Chimney Grafts in the Treatment of Type I Endoleaks After Previous Endovascular Aneurysm Repair Shows Reproducible Results

Endoluminal stent-graft relining of visceral artery bypass grafts to treat perigraft seroma.

Purpose: To describe the endovascular treatment of intra-abdominal perigraft seromas associated with small-caliber expanded polytetrafluoroethylene (ePTFE) grafts. Case Reports: Two patients who underwent hybrid repair of thoracoabdominal aortic aneurysms in which renovisceral bypass grafts were implanted presented with large, symptomatic perigraft seromas. The 5- to 8-mm-diameter ePTFE bypass grafts believed to be involved in the seromas were successfully relined with self-expanding Viabahn stentgrafts in percutaneous procedures. The patients’ symptoms were relieved, and imaging follow-up (18 and 10 months, respectively) has shown near complete resorption of the seromas. Conclusion: It is …

Transcervical approach for carotid artery stenting with transitory reversal flow: Case report

Introduction Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach. Presentation of case A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic,…

Mechanical rotational thrombectomy in long femoropopliteal artery and stent occlusion in COVID-19 patient: Case report

Abstract Introduction Coronavirus disease-19 (COVID-19) has been increasingly associated with thromboembolic complications. COVID-19 infection has a thrombogenic potential for stents. Herein, we report a case of stent thrombosis in diabetic obese patient COVID-19 positive where was previously released a Multilayer Flow Modulator stent (MFM) for large popliteal aneurysm. Case report A 78-year-old male was referred to our hospital for fever and acute pain in the left leg. At history, the same patient had endovascular procedure for a large symptomatic popliteal aneurysm, treated through release of three MFM. The pulmonary CT scan showed COVID-19 infection with confirm of rhino-laryngeal swab. …

Insufficienza Celiaco Mesenterica

L’insufficienza celiaco-mesenterica (ICM) è una sindrome clinica in cui il sintomo cardine è rappresentato dal dolore addominale che insorge nella fase post-prandiale, e che è provocata dall’inadeguata vascolarizzazione di uno o più settori dell’apparato digerente. Essa insorge per la presenza di lesioni ostruttive a carico delle tre principali arterie splancniche: il tripode celiaco (TC), l’arteria mesenterica superiore (AMS) e quella inferiore (AMI). Esistono due forme di ICM, una acuta e una cronica, che differiscono dal punto di vista fisiopatologico, oltre che per eziologia e clinica, sottolineando peraltro la possibile evoluzione improvvisa da cronica in acuta, fino all’evoluzione in …

Complete renovisceral debranching and EVAR for thoracoabdominal aneurysm

Open graft repair of thoracoabdominal aortic aneurysms (TAAA) is an incredibly complex and challenging procedure with acceptable results achieved only by a few centers worldwide. Contemporary outcome analysis of TAAA repair performed in the United States showed greater operative mortality and morbidity rates than commonly reported. Moreover, a recent European long-term follow-up study showed that survival remains suboptimal, especially in the early years after TAAA repair. Complete renovisceral debranching combined with EVAR offers many advantages in regard to open surgical repair with comparable or better results, especially in the high-risk patient. Although this hybrid procedure will not…

Simultaneous endovascular treatment of synchronous symptomatic acute type B aortic dissection and large infrarenal aortic aneurysm. Technical tips and case report

Highlights • Acute type B aortic dissection associated with AAA, has a high rupture risk. • This complicated dissection must be considered for treatment as quickly. • This approach can be performed endovascularly when supraaortic trunks are involved. • Totally endovascular solution to address both disease is feasible.

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 da…

Incidence and prognostic factors related to major adverse cerebrovascular events in patients with complex aortic diseases treated by the chimney technique

Abstract Objective Endovascular aneurysm repair (EVAR) with the chimney technique (ch-EVAR) has been used for the treatment of aortic aneurysms as an alternative approach to fenestrated endografting or open repair. Nonetheless, the need for an upper extremity arterial access may contribute to a higher risk for periprocedural cerebrovascular events. This study reports on the perioperative cerebral and major adverse cardiac and cerebrovascular events (MACCE) after ch-EVAR. Methods The PERICLES registry (PERformance of the chImney technique for the treatment of Complex aortic pathoLogiES) is an international, retrospective multicenter study evaluating the performance of ch-EVAR for the treatme…

Endovaskularni tretman aortoilijač-Nih aneurizmi (EVAR) i erektilna disfunkcija: metode za očuvanje protoka Kroz unutrašnju ilijačnu arteriju. [Endovascular treatment of aortoiliac aneurysms (EVAR) and erectile dysfunction: methods to preserve circulation to internal iliac artery]

Spontaneous Symptomatic Common Carotid Artery Pseudoaneurysm: Case Report and Literature Review

Spontaneous common carotid artery pseudoaneurysm (CCAP) is rare but potentially lethal disease. A 78-year-old man presented with pain in correspondence of right neck side and slight right eye ptosis. No previous surgery, trauma, or venous catheterizations in the neck region were reported. The computed tomographic angiography (CTA) showed a 4-cm saccular CCAP. The patient was managed emergently with surgical CCAP excision. At 6-month follow-up, the patient is neck pain-free with complete ptosis regression, and the CTA shows no pathologic findings. The literature review reported 7 cases of pseudoaneurysm of carotid district. All these cases were managed by surgical approach, and in 1 case, an…

Inflammatory abdominal aortic aneurysm (IAAA).

Purpose: The aim of this study is to report our experience about the inflammatory abdominal aortic aneurysm (IAAA). Methods: Between January 1999 and January 2008 we treated 8 cases of IAAA. Two patients underwent surgery in emergency. The preoperative diagnostic procedures were ultrasound (US), computed tomography (CT) and intravenous urography (IVU). In 6 elective patients the diagnosis of IAAA was obtained preoperatively. In one case a left hydroureteronephrosis was demonstrated by intravenous urography (IVU). All patients underwent open surgery with midline incision and transperitoneal access. Results: No 30-days mortality occurred. A case of pancreatitis was treated with conservative t…

Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and …

UEG916681 Supplemental Material - Supplemental material for European guidelines on chronic mesenteric ischaemia – joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia

Supplemental material, UEG916681 Supplemental Material for European guidelines on chronic mesenteric ischaemia – joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia by Luke G Terlouw, Adriaan Moelker, Jan Abrahamsen, Stefan Acosta, Olaf J Bakker, Iris Baumgartner, Louis Boyer, Olivie…

Carotid artery stenting with contralateral carotid occlusion in a rare aortic arch configuration

We present the case of a 47-year-old man admitted to our department with an episode of aphasia. Duplex scan showed an occluded right internal carotid artery and severe left internal carotid artery stenosis. Contrast-enhanced computer tomography demonstrated a common trunk for both common carotid arteries anterior to the trachea and aberrant right subclavian artery posterior to the esophagus. The patient was considered to be a high risk for carotid endarterectomy and, consequently, we performed stenting of the left carotid artery. To our knowledge, this is the first case reporting the combination of these two aortic arch anomalies and the concomitant endovascular treatment of atherosclerotic…

A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks.

Purpose: To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2–179). All patients had proximal/distal landing zones precluding any standa…

Intraoperative cell salvage in ruptured abdominal aortic aneurysms

Aim. The aim of this study was to evaluate the impact of intraoperative cell salvage (ICS) on the early outcome after open repair (OR) of ruptured abdominal aortic aneurysm (rAAA). Methods. This is a retrospective review of 73 consecutive patients who underwent emergency OR of infrarenal rAAA with ICS between 2005 and 2008 (Group I), compared to 51 repairs from 2002-2004 with no ICS (Group II). In addition, a transfusion protocol of platelets and fresh frozen plasma (FFP) administration on admission and during surgery was adopted in patients in Group I to maintain coagulation competence. Results. ICS reduced bank blood demand by 63.6% (from 11 to 4 units, P<0.001) compared to controls, and …

sj-docx-1-jet-10.1177_15266028221118507 – Supplemental material for Outcome Analysis From a Multicenter Registry on Unibody Stent-Graft System for the Treatment of Spontaneous Infrarenal Acute Aortic Syndrome (MURUSSIAS Registry)

Supplemental material, sj-docx-1-jet-10.1177_15266028221118507 for Outcome Analysis From a Multicenter Registry on Unibody Stent-Graft System for the Treatment of Spontaneous Infrarenal Acute Aortic Syndrome (MURUSSIAS Registry) by Felice Pecoraro, Pietro Volpe, Luca Boccalon, Bruno Migliara, Nicola Rivolta, Antonino Silvestro, Piero L. M. Trabattoni, Mafalda Massara, Domenico A. Diaco, Ettore Dinoto, Francesca Urso, Antonino Alberti, Giovanni Feriani, Marco Franchin, Matteo L. Ravini and Claudio Saccu in Journal of Endovascular Therapy

Overcoming Anatomic Limitations to EVAR With Chimney and Periscope Grafts

EVAR IN OUT CLINIC PATIENTS: IS IT FEASIBLE AND SAFE?

Introduction Only little is known about endovascular aneurysm repair (EVAR) performed as an outpatient procedure. We report here a two-center (Middelares Hospital, Antwerp (Deurne), Belgium and University Hospital Zurich, Switzerland) experience in 104 EVAR patients of which a group of 52 patients have been treated on an outpatient (out-EVAR) basis and compared to a matched group of 52 patients that have been treated as inpatients (in-EVAR). Methods Selection criterions for out-EVAR were: informed consent, travel time to the hospital if readmission was required of <30-60 minutes, and technically uncomplicated EVAR. Most out-EVAR has been treated percutaneous. In-EVAR patients consisted in a…

Single staged hybrid approach for multilevel aortic-iliac-femoral-popliteal disease

Highlights • Multilevel peripheral arterial disease in diabetic patients is cause of amputation. • Herein we report a case of critic limb ischemia addressed by hybrid procedure. • Hybrid procedure outcomes seem to be as good as with open revascularization. • Hybrid procedure show less morbidity and shorter intensive care and hospital stay.

Chronic Mesenteric Ischemia: Critical review and guidelines for management

Background CMI is caused by chronic occlusive disease of mesenteric arteries. In such an uncommon disease, clear recommendations are strongly needed. Unfortunately, treatment options for symptomatic CMI are still controversial and no guidelines exist. Methods A systematic literature review of the last 25-years was conducted through MEDLINE, Embase, and Cochrane Review/Trials register to identify studies reporting on CMI treatment with more than 10 patients. Primary outcomes were perioperative mortality and morbidity rates. Secondary outcomes were survival rates, primary and secondary patency rates, vessels treated, CMI recurrence, follow-up (FU), technical success (TS), and in-hospital leng…

Simultaneous appearance of leukemoid reaction and phlegmasia cerulea dolens

A leukemoid reaction is an extreme form of reactive leukocytosis defined as granulocytic leukocytosis above 50 × 109/L produced by normal bone marrow, mostly in response to systemic infection or cancer. The mechanism as to how the haematopoetic system is altered to elevate production of myeloid cells is not known. A 69-year-old man presented with phlegmasia cerulea dolens caused by massive iliofemoral thrombosis. His workout at admission revealed absolute white blood cell count of 73.4 × 109/L, with neutrophil granulocyte of 68.5 × 109/L. The new increase in white blood cell count happened at day 5 after admission, when the haematoma of the anteromedial thigh was evacuated in general anaes…

Hypotensive Hemostasis in Patients Presenting with Ruptured Aortic Aneurysm

Hypotensive hemostasis in aortic rupture has been showed to be feasible and advantageous, especially in trauma patients. To date, there are no randomized studies on hypotensive hemostasis in patients with ruptured abdominal aortic aneurysm (rAAA), but observational studies indicate similar advantages when hypotensive hemostasis is used for endovascular aneurysm repair (EVAR) as in trauma patients. Actually, in EVAR for rAAA, a target systolic blood pressure of 90 mmHg or even lower is considered safe in conscious patients. Fluids should be administrated judiciously with the sole aim of maintaining adequate cardiac output and tissue oxygenation, whereas vasoactive pressors or dilatators may …

Results of chimney endovascular aneurysm repair as used in the PERICLES Registry to treat patients with suprarenal aortic pathologies

Background: The prevailing evidence calls for using chimney/snorkel endovascular repair (ch-EVAR) with one or two chimney grafts. No studies up to now focus on its applicability and results for the treatment of suprarenal aortic pathologies (SRAP). Hence, we evaluated the clinical and radiologic results of ch-EVAR treatment for SRAP placing three or more chimney grafts within the PERICLES Registry. Methods: Data from 517 patients suffering complex aortic pathologies treated by ch-EVAR between 2008 and 2014 at 13 European and U.S. centers were retrospectively reviewed and analyzed. Results: Sixty-seven ch-EVAR-treated patients (12.9% of the entire PERICLES cohort) presented SRAP (83.5% elect…

Late, giant brachial artery aneurysm following hemodialysis fistula ligation in a renal transplant patient: case report and literature review.

Brachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21 years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft.

Traumi Vascolari.

INFLAMMATORY ANEURYSM OF ABDOMINAL AORTA

Type 1A endoleak detachable coil embolization after endovascular aneurysm sealing: Case report

Introduction Endovascular aneurysm sealing (EVAS) with the Nellix system was introduced to reduce endovascular aneurysm repair (EVAR) perioperative complications, especially endoleaks. Herein we report a case of successful type 1A endoleak managed with detachable coils embolization after EVAS. Presentation of case A 77-year-old male was referred for abdominal pain. The angio-CT scan confirmed the previous EVAS procedure and showed a type Is2 endoleak below the right renal artery resulting in a 2.5 cm aortic blister with contrast medium filling the space between the aortic wall and the endobags. The patient was considered unfit for conventional open surgery and an endovascular approach with …

Computational Fluid Dynamics (CFD) and Finite Element Analysis (FEM) of a Customized Stent-Graft for Endovascular (EVAR) Treatment of Abdominal Aortic Aneurism (AAA)

Background: The treatment of abdominal aortic aneurysm (AAA) is today commonly treated by inserting a stent-graft by the endovascular route, without resorting to open surgery. However, some clinical cases do not allow this less invasive approach, meaning that the stent-graft cannot be inserted and open surgery is used. Methods: In the study, we propose a fluid–structure interaction (FSI) analysis of an aneurysmatic aorta that could not be treated with Endovascular Aneurysm Repair (EVAR). The vessel is reconstructed through segmentation from CT scans and subsequently modeled on CAD software to create the surface and thickness of the vessel itself. Subsequently, we proceeded to carry out Comp…

Early outcomes with a single-sided access endovascular stent

Abstract Objective The objective of this study was to report the 1-year follow-up study results of the new Horizon stent graft (Endospan, Herzliya, Israel) from two different prospective consecutive trials. The Horizon abdominal aortic aneurysm stent graft system is a 14F profile system requiring only a single access site. It consists of three modules, introduced separately: base limb (iliac to iliac limb); distal aortic limb; and proximal aortic limb with a bare suprarenal crown and active fixation. Methods Data from the first in man (FIM) clinical study with 10 patients enrolled and the pivotal study with 30 patients were analyzed. Outcomes measured were freedom from major adverse events …

A rare case of infrarenal aortic coarctation in a young female

Abstract Introduction Infrarenal abdominal aortic coarctation (AAC) is an extremely rare disease. It can be associated with renal artery stenosis determining secondary renal hypertension. Presentation of case We report a case of AAC in young female patient presenting systemic hypertension non-responder to medical treatment. Diagnostics revealed the involvement of the right renal artery as the cause of hypertension. The management consisted of percutaneous renal artery stenting and close surveillance for the aortic segment. The treatment was uneventful with resolution of the hypertensive condition. Discussion AAC etiology is unknown. There are no studies comparing the long-term treatment out…

STRUMENTO MEDICO PER INSERIMENTI INTRALUMINALI

La presente invenzione trova applicazione nel settore dei dispositivi medici inseribili all’interno del corpo umano ed ha particolarmente per oggetto uno strumento medico per inserimenti intraluminali, quali dispositivi per incannulazione o cateterizzazione del sistema vascolare.

Surgical repair of popliteal artery aneurysms remains a safe treatment option in the endovascular era: a 10-year single-center study

Introduction: Endovascular popliteal artery aneurysm repair has emerged recently as a feasible alternative to standard surgical repair. However the evidence from the literature is still limited, with only case reports, case series and one small randomized trial. Currently these data suggest the use of stent-grafts in patients at very high surgical risk. The purpose of this study is to present our surgical experience in popliteal artery aneurysm repair in an era of endovascular philosophy. Materials and Methods: Data from 36 consecutive patients who were admitted to our hospital from January 2000 to April 2010, were analyzed retrospectively. Twenty-six patients underwent surgical treatment t…

Endovascular treatment of spontaneous isolated abdominal aortic dissection

Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomati…

CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies

PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and th…

Evoluzione della chirurgia vascolare ed endovascolare

Chimney and Periscope Grafts Observed Over 2 Years After Their Use to Revascularize 169 Renovisceral Branches in 77 Patients With Complex Aortic Aneurysms

Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in the endovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelf devices. Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; mean age 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch to visceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiring chimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned in advance and were not used as bailout. A standardized follow-up protocol including computed tomographic angiography, laboratory testing, and clinical examination…

Abdominal Aortic Aneurysm

Abdominal Compartment Syndrome (ACS) After Surgical Abdominal Aortic Aneurysm (AAA) Repair

Subintimal stenting for superficial femoral artery long occlusion in patients with critical limb ischemia

Introduction: Subintimal recanalization of chronic totally occluded superficial femoral arteries (SFA) has gained increasing attention as an effective approach for limb salvage in patients with critical limb ischemia (CLI). Use of stents in treating SFA lesions has increased with the intention to improve arterial patency. Our aim was to evaluate the feasibility and mid-term outcomes of subintimal stenting in long occlusions of the SFA in patients presenting CLI. Methods: A retrospective review of consecutive patients admitted to our unit with chronic occlusion of the SFA and CLI between september 2008 and september 2010 was performed. Within this group, the subintimal angioplasty with prima…

Composite femoro-tibial bypass as alternative solution in complicated revascolarization: Case report

Introduction Peripheral Arterial Disease (PAD) in diabetic patients is a significant cause of Morbility. Long arterial occlusion in patient previously treated can require unusual and complex solution. Herein we report a case of complicated bypass in diabetic patient with history of bypass for bilateral popliteal aneurysm. Presentation of case A 51-year-old male, smoker, with hypertension and diabetes mellitus was referred to our hospital for rest pain in left limb and peripheral cyanosis. Ultrasound doppler (US) showed an occlusion after common femoral artery with patency of Anterior-tibial artery (ATA) two centimeters after the origin. The unavailability of adequate autologous conduit nece…

Chimney and periscope grafts to facilitate endovascular treatment of aortic transection in a patient with aberrant right subclavian artery

Purpose: To report the use of parallel grafts to extend the proximal landing zone for stentgraft repair of aortic transection involving an aberrant right subclavian artery (ARSA). Case Report: A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month aft…

Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.

To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3.From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endografts were sized 1 …

Treatment of isolated ascending aortic aneurysm by off-pump epiaortic wrapping is safe and durable.

OBJECTIVES: Isolated ascending aortic aneurysm (iAA) is usually treated by open graft repair requiring sternotomy, cardiopulmonary bypass (CPB) and cardioplegia. This approach carries significant mortality in older patients or those presenting with comorbidities. We report an original series of patients presenting with iAA and treated with epiaortic wrapping by using a synthetic mesh. This less invasive aortic repair technique allows reducing the aortic diameter to a predefined value and is performed without CPB. METHODS: Data from patients presenting with an iAA and treated with the wrapping technique (WT) by polypropylene/polyester mesh from November 2006 to July 2015 were collected. The …

Periscopes, chimneys, sandwich and VORTEC to facilitate abdominal and thoracoabdominal aortic aneurysm repair

The VORTEC (VIABAHN open revascularization technique) and the chimney graft technique are tools with which to maintain or restore blood flow to the aortic branches and can be used intentionally or as a bailout procedure in open surgery or endovascular procedures. VORTEC is a stent graft-based vascular connection technique that achieves end-to-end anastomosis configuration; it is especially useful when the traditional suture technique proves (can be) cumbersome. It is also a speedy tool with virtually no blood flow interruption and no anastomotic bleeding, and patency rates compare favorably with sutured anastomosis. The chimney/periscope, as well as the sandwich graft technique (CHIMPES), i…

Akute Gefäßerkrankungen in der Gastroenterologie. Der Gastroenterologe - Acute gastroenterologic vascular diseases

Acute gastroenterologic vascular emergencies are common situations in emergency departments and the clinical consequences range from trivial to life-threatening. Only the early recognition of these symptom patterns and prompt use of the appropriate diagnostic tools lead to a correct diagnosis with subsequent potentially life-saving treatment. To decrease the high mortality rate of acute mesenteric ischemia (50%), aorto-enteric fistula (30–40%), visceral artery aneurysms (10– 100%) and Budd-Chiari syndrome new strategies with an endovascular approach are gaining importance and are partially replacing established diagnostic and therapeutic algorithms. This article provides a review of the dia…

Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients

Purpose Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB). Methods Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed. Results Fort…

Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms

Purpose: To report midterm outcomes after urgent endovascular repair of ruptured pararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimney grafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion. Methods: Nine consecutive men (mean age 72614 years, range 40–88) presenting with ruptured thoracoabdominal (n56), pararenal (n52), or infrarenal (n51) aortic aneurysm underwent urgent endovascular repair with at least 1 periscope graft delivered via a transfemoral access; chimney grafts were installed from an axillary access. In all, 17 periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries in the 9 patients. The…

carotid endarterectomy versus stenting in patients with contralateral carotid artery occlusion

Chimney endografting for pararenal aortic pathologies using transfemoral access and the lift technique

Purpose: To present a technique for transfemoral implantation of parallel grafts into the renal arteries in patients with anatomy or morphology that blocks standard antegrade chimney graft delivery. Technique: In a totally percutaneous approach, a 5-F pigtail angiographic catheter is passed into the aorta above the renal arteries via a 0.035-inch hydrophilic guidewire, followed by an 8-F sheath. The target vessel is cannulated with the hydrophilic wire followed by a 5-F reverse curve catheter; the wire is changed for a Rosen wire. The main stent-graft body is delivered and parked at the level of the aortic bifurcation. The Viabahn chimney endograft is advanced ~1 to 2 cm into the target ren…

The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience

Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with …

Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms…

Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era

The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a co…

THE POSTERIOR APPROACH IN THE REPAIR OF POPLITEAL ARTERY ANEURYSMS: A TWO CENTER EXPERIENCE

Objective: Popliteal artery aneurysms (PAA) are most frequent among peripheral aneurysms. The most commonly performed surgical repair is proximal and distal ligation with a saphenous vein bypass. We aim to report the early and mid-term outcome of surgical repair of popliteal artery aneurysms via a posterior approach. Methods: A retrospective review of consecutive patients who underwent surgical PAA repair in two vascular surgery units between 1998 and 2009 was performed. Within this group, the posterior approach was used in 28 repairs in 26 patients (25 men). All patients had an ultrasound examination. Eighteen patients underwent conventional angiography while CT angiography with 3-D recons…

RS12. Sustained Late Branch Patency and Low Incidence of Persistent Type Ia Endoleaks Following Snorkel/chimney EVAR Shown in the Updated PERICLES Registry

A Multicenter Experience of Three Different "Iliac Branched" Stent Grafts for the Treatment of Aorto-Iliac And/Or Iliac Aneurysms

Background: The aim of study was to assess the safety and effectiveness of 3 different commercial iliac branch devices (IBDs): the Zenith Branch Iliac Endovascular Graft; the Gore Excluder Iliac Branch System and the E-liac Stent Graft System for the treatment of aorto-iliac or iliac aneurysms. Methods: From January 2017 to February 2020, a retrospective reviewed was conducted on a total of 96 patients. Primary endpoint was IBD instability rate at 24 months. Secondary endpoints included onset of any endoleaks, buttock claudication, IBD-related reintervention and all-death rates, postoperative acute kidney, and changes in maximum diameter from baseline of the aortic aneurysmal sac. Results: …

A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring

Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were p…

Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks.

Background To present the clinical experience of consecutive series with use of balloon-expandable and self-expanding chimney endografts (balloon-expandable covered stent group [BECS] vs self-expanding covered stent group [SECS]) in the endovascular treatment of challenging aortic pathologies requiring renal and/or visceral revascularization. Methods Between January 2009 and May 2011, data for 37 high-risk patients from one center and 35 patients from another institution, with pararenal aortic pathologies treated by the chimney endovascular technique, were prospectively collected. The chimney-graft technique is based on the deployment of a covered or bare-metal stent parallel to the aortic …

Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.

Purpose: To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods: From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 7068 years, range 56–87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (.2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endo…

Staged acute mesenteric and peripheral ischemia treatment in COVID-19 patient: Case report

Introduction COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). Presentation of case An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombec…

Branch ligatures and blood aspiration for post-traumatic superficial temporal artery pseudoaneurysm: surgical technique

The aim of this study is to report a new minimally invasive technique of superficial temporal artery (STA) pseudoaneurysm treatment. Several surgical options have been employed to treat STA pseudoaneurysms. To address this rare condition, the employed techniques are ligation and excision of the aneurysm, endovascular coil embolization or percutaneous ultrasound-guided thrombin injection. Between techniques no significant differences are reported in terms of outcomes. The decision to adopt a technique depends on STA pseudoaneurysm morphology and surgeon preference. In the present report, STA pseudoaneurysm afferent and efferent branches were identified by ultrasound in a 92-year-old female. …

Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin.

A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conven- tional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobac- tam. Patient management consisted of fistula drainage, systemic antibiotic the…

Tips and tricks to make the ascending aorta accessible to EVAR

The ascending aorta is gaining increasing interest for endovascular specialists, as it opens the door to a potentially better way to treat aortic arch pathologies. Landing safely a stentgraft into the ascending aorta allows downgrading significantly the invasiveness of conventional open repair of the ascending aorta and/or aortic arch. Unfortunately, accessibility to the ascending aorta, in order to perform EVAR, can be challenging as the transfemoral approach might be cumbersome, or because the ascending aorta might not be appropriate for stentgraft landing. This paper will present some technical tips and tricks to achieve successful stentgraft landing in zone 0.

Collected Transatlantic Experience From the PERICLES Registry: Use of Chimney Grafts to Treat Post-EVAR Type Ia Endoleaks Shows Good Midterm Results

Purpose: The aim of this retrospective analysis was to evaluate the performance of the chimney (ch) technique in the treatment of type Ia endoleaks after standard endovascular aneurysm repair (EVAR). Methods: Between January 2008 and December 2014, 517 chEVAR procedures were performed in 13 US and European vascular centers (PERICLES registry). Thirty-nine patients (mean age 76.9±7.1 years; 33 men) were treated for persistent type Ia endoleak and had computed tomography angiography or magnetic resonance angiography follow-up at &gt;1 month. Endurant abdominal stent-grafts were used in the 20 cases. Single chimney graft placement was performed in 18 (46%) patients and multiple in 21 (54%). O…

Multilevel diabetic foot revascularization in COVID 19 patient: Case report

Abstract Introduction Coronavirus 2019 (COVID-19) has been associated with endothelial dysfunction. This hypercoagulable state coming from the endothelial injury pones COVID-19 patients to a higher risk for thrombosis. COVID 19 diabetic patients are more exposed to peripheral vascular disease progression. Multilevel peripheral arterial disease is the main cause of critical limb ischemia. Vascular interventions are required to increase distal blood flow and reduce the risk of amputation. Presentation of case We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection. The patient presenting a Peripheral arterial is…

Early endovascular aneurysm repair after percutaneous coronary interventions

Objective The objective of this study was to report long-term results of early endovascular aortic aneurysm repair after percutaneous coronary intervention (PCI). Methods This was a retrospective analysis of all patients presenting with abdominal aortic aneurysm and coronary artery disease treated during the same hospitalization by endovascular aortic aneurysm repair performed soon after PCI. Primary outcomes were perioperative mortality, perioperative complications, survival after treatment, and freedom from reintervention. Results A total of 20 patients were included, and all completed both procedures. No deaths or abdominal aortic aneurysm ruptures occurred between the PCI and the aortic…

Carotid endarterectomy versus stenting in patients with contralateral carotid artery occlusion

Aim. The aim of this prospective study was to compare outcomes after CEA and CAS in patients with contralateral carotid artery occlusion. Methods. Between 2004 and 2009, 527 consecutive patients underwent CEA (N.=281) or CAS (N.=246) for severe stenosis of internal carotid artery (ICA). Of them, 85 (16.1%) were identified with contralateral carotid artery occlusion. CEA was performed in 31(36.4%) patients with contralateral ICA occlusion, and 15 (48.4%) were symptomatic. Intraoperative shunts were placed in 12% versus 41.9% (P<0.001) patients with patent (N.=250) or occluded contralateral ICA (N.=31). Fifty-four (63.5%) patients with contralateral ICA occlusion underwent CAS with distal pro…

Sustained Late Branch Patency and Low Incidence of Persistent Type Ia Endoleaks Following Snorkel/chimney EVAR Shown in the Updated PERICLES Registry

Single-centre experience and preliminary Results of intravascular ultrasound in endovascular aneurysm repair

Background Intravascular ultrasound (IVUS) has been introduced as diagnostic adjunct to provide new insights into the diagnosis and therapy of vascular disease. Herein, we compared the outcomes of conventional endovascular aneurysm repair (EVAR) and EVAR with IVUS in patients presenting with infrarenal abdominal aortic aneurysm using a propensity-matched cohort. Methods From May 2013 to August 2017, 221 patients were retrospectively analyzed. Of that, 122 patients were eligible for inclusion and underwent propensity score matching. Perioperative mortality and morbidity, renal function impairment, endoleak incidence, mean contrast medium usage, operative time, radiation exposure (including f…

Outcome Analysis From a Multicenter Registry on Unibody Stent-Graft System for the Treatment of Spontaneous Infrarenal Acute Aortic Syndrome (MURUSSIAS Registry)

Purpose: This study reports the outcomes from a Multicenter Registry on unibody stent-graft system for the treatment of spontaneous infrarenal acute aortic syndrome (MURUSSIAS registry). Materials and methods: The retrospective MURUSSIAS registry included spontaneous infrarenal acute aortic dissection (IAAS) managed with the unibody stent-graft system (AFX endovascular AAA system; Endologix Inc., Irvine, California) outside the current instruction for use. IAAS considered aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Indications to IAAS treatment were symptoms, associated dilated abdominal aorta (&gt;3 cm), rapidly-growing (&gt;0.5 cm/6 months) aorta…

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