Purpose: To compare short- and long-term outcomes of bare-metal (BMS) vs covered (CS) balloon-expandable stents in transplant renal artery stenosis (TRAS). Materials and Methods: This retrospective study evaluated patients who underwent elective stent placement for TRAS between 2016 and 2023. Short-term efficacy was assessed by clinical improvement (resolution of resistant hypertension/hypervolemia) and reduction in serum creatinine (sCr) within 14 days post-procedure. Long-term outcomes included Doppler ultrasound parameters – peak systolic velocity (PSV), acceleration time (AT) and resistive index (RI) – and restenosis/occlusion rates requiring or not intervention. Graft survival at the latest follow-up was recorded. Results: A total of 40 patients (mean age 58 ± 13 years, 68% male) were treated with BMS (n = 31) or CS (n = 9). Clinical improvement was observed in 71% of BMS and 83% of CS patients ( P = 1.00). Median sCr decreased by 26% and 33% in BMS and CS patients, respectively ( P = .30). At a median follow-up of 29 months, there were no statistically significant differences between groups in median PSV reduction (47% BMS vs 47% CS; P = .44), AT improvement (36% BMS vs 25% CS; P = .38) or RI increase (15% BMS vs 33% CS; P = .12). In the BMS group, 2 cases of in-stent restenosis occurred (6.5%). In the CS group, 1 stent occlusion occurred (11%), resulting in graft loss. At final follow-up, overall graft survival was 85%. Conclusion: In this pilot study, BMS and CS showed no significant differences in TRAS outcomes. Further studies are warranted to better guide stent selection. Clinical Impact In transplant renal artery stenosis, balloon-expandable covered stents achieved clinical, biochemical and Doppler outcomes comparable to bare-metal stents, despite being used in more complex, atherosclerotic and longer lesions. This first direct comparison suggests that covered stents may be a reasonable option when heavy calcification, a friable wall or mural thrombus raise concern for embolisation or rupture, while bare-metal stents remain appropriate for most lesions. The single late covered-stent occlusion with graft loss highlights the need for careful platform selection and antiplatelet management. These pilot data should inform adequately powered multicentre registries rather than directly change practice.
Background: Ruptured abdominal aortic aneurysm (rAAA) represents a vascular surgical emergency with high mortality. Endovascular aneurysm repair (EVAR) using the bifurcated Endurant stent graft system is widely employed; however, data specifically addressing its performance in infrarenal rAAA remain limited. Methods: We conducted a retrospective, multicenter study including 121 patients with confirmed infrarenal rAAA treated exclusively with bifurcated Endurant II or IIs (Medtronic Inc., Minneapolis, Minnesota) devices across 5 Italian tertiary vascular centers from January 2014 to October 2024. Primary endpoints were technical success and 30-day all-cause mortality. Secondary outcomes included long-term survival, incidence of endoleaks, and reintervention rates. Patients receiving alternative stent grafts or hybrid procedures were excluded to ensure cohort homogeneity. Results: A total of 121 patients were enrolled during the study period. The cohort had a mean age of 75.3 ± 8.2 years, with 91.7% male predominance. Technical success was achieved in 96.7%. The 30-day mortality rate was 15.7%. Multivariate logistic regression identified abdominal compartment syndrome (ACS) (odds ratio [OR], 29.8; 95% confidence interval [CI], 2.8-317.7; P = .005) and use of an aortic occlusion balloon (AOB) (OR, 16.4; 95% CI, 2.5-106.2; P = .003) as independent predictors of early mortality. At a median follow-up of 33.6 months (interquartile range, 4.9–72.3), 5-year survival was 65.4%, freedom from any endoleak was 92.6%, and freedom from reintervention was 91.6%. Late type Ia endoleaks occurred in 2.5% of patients. Conclusions: In this large, strictly defined infrarenal rAAA cohort, bifurcated Endurant stent grafts demonstrated high technical success and favorable early and mid-term clinical outcomes, including in patients with hostile neck anatomy. Early identification and management of ACS and judicious use of AOBs may improve survival. These findings reinforce current EVAR-first guidelines and emphasize the importance of device-specific outcome assessment in emergent rAAA repair. Clinical Impact This multicenter study provides one of the largest device-specific evaluations of bifurcated Endurant stent grafts for infrarenal ruptured abdominal aortic aneurysms in a rigorously defined Italian cohort, demonstrating high technical success (96.7%) and low 30-day mortality (15.7%) despite a high prevalence of hostile neck anatomy (54.5%). Abdominal compartment syndrome and the use of an aortic occlusion balloon emerged as independent predictors of early mortality, highlighting the critical role of perioperative management. Mid-term outcomes were favorable, with a 5-year survival rate of 65.4%, a low incidence of type Ia endoleak (2.5%), and high freedom from reintervention (91.6%). Overall, these findings support the use of Endurant devices in emergent settings for anatomically suitable patients and reinforce EVAR-first strategies in the management of ruptured abdominal aortic aneurysms.
Background: Lower-extremity bypass graft occlusion is associated with recurrent ischemia and potential limb loss. This study evaluated the technical and clinical outcomes of AngioJet™ rheolytic thrombectomy for occluded bypass grafts in a single-center retrospective cohort. Methods: Consecutive patients undergoing AngioJet™ thrombectomy as the primary strategy for occluded bypass grafts (2014-2024) were reviewed. Technical success was defined as <30% residual stenosis. Outcomes included Rutherford category improvement, complications, 30-day mortality, major amputation, target lesion revascularization, and primary patency. Follow-up was available for 38/40 (95.0%) 30-day survivors. Results: Forty-one procedures were analyzed. Technical success was achieved in 38/41 (92.7%; 95% confidence interval [CI]: 80.1%-98.5%). Periprocedural complications occurred in 4 patients (9.8%; 95% CI: 2.7%-23.1%). Thirty-day mortality was 2.4% (1/41; 95% CI: 0.1%-12.9%) and major amputation was 4.9% (2/41; 95% CI: 0.6%-16.5%). Rutherford category improvement at 30 days was 43.9% (18/41; 95% CI: 28.5%-60.3%). Primary patency at final follow-up was 63.4% (26/41; 95% CI: 46.9%-77.9%) in the overall cohort (intent-to-treat) and 68.4% (26/38; 95% CI: 51.3%-82.5%) among technically successful cases. Conclusion: AngioJet™ thrombectomy is a technically feasible endovascular option for occluded bypass grafts with low 30-day mortality (2.4%) and amputation rates (4.9%). Prospective comparative studies are needed to define its role relative to surgical and alternative endovascular approaches. Clinical Impact Occluded lower-extremity bypass grafts often cause limb-threatening ischemia in patients at high surgical risk. In this single-center cohort, AngioJet rheolytic thrombectomy achieved technical success in 92.7% of procedures, with 30-day mortality of 2.4% and major amputation of 4.9%. These findings support AngioJet-assisted thrombectomy as a minimally invasive option for carefully selected patients with crossable grafts and treatable inflow or outflow disease. Clinicians should anticipate adjunctive interventions, monitor for compartment syndrome, and provide structured surveillance because reintervention remains common. Prospective comparative studies are needed before routine first-line use.
