: Background: Blunt thoracic aortic injury (BTAI) is a life-threatening condition. Comprehensive nationwide data from European healthcare systems are limited. This study aims to analyse temporal trends in hospital incidence, treatment strategies, and outcomes of BTAI in Germany. Materials and methods: This retrospective secondary analysis used nationwide German Diagnosis-Related-Groups hospital episode statistics. All BTAI cases between 2010 and 2023 were included. Treatment strategies were classified as open repair, endovascular repair or conservative management based on Operations and Procedures Classification codes. Primary outcome was in-hospital mortality. Adjusted multivariable logistic regression was performed. Age, sex, Elixhauser comorbidity score, treatment modality, treatment period, and treatment in a vascular surgery department were included in the statistical model. Results: In total 3,530 cases were identified (Mdnage 58 years; 70.1% male). TEVAR was performed in 30.5%, open repair in 16.4%, and 53.1% were managed conservatively. Overall, in-hospital mortality was 24.4% (16.0% after endo, 25.8% after open repair and 28.7% in not-treated cases). Increasing age (adjusted odds ratio [aOR] 1.12 per 10 years, 95% Confidence interval [CI] 1.07-1.17) and higher comorbidity burden (aOR 1.03 per point, CI 1.02-1.04) were independently associated with mortality. Both endo (aOR 0.55, CI 0.44-0.68) and open repair (aOR 0.69, CI 0.54-0.89) were associated with lower mortality compared with conservative management. Conclusions: In Germany, BTAI hospital incidence showed temporal variation with pandemic-related decline. Endovascular repair was the predominant active treatment and was associated with lower in-hospital mortality. Outcomes were strongly influenced by age, comorbidity, and specialised vascular care.
: Background: Stent thrombosis (ST) is a rare but serious complication following peripheral endovascular interventions. The prognostic role of high on-treatment platelet reactivity (HTPR) and the optimal antithrombotic strategy, including adjunctive anticoagulation, remain unclear. To evaluate (I) the prognostic value of ADP-induced platelet function in femoropopliteal ST compared to matched controls, and (II) the impact of post-ST oral anticoagulation (OAC) on clinical outcomes. Materials and methods: In this retrospective cohort study, 148 endovascular procedures in 67 patients with documented femoropopliteal ST were compared to 492 matched procedures without ST. Propensity-score-matching for age, sex, and lesion length/type yielded 113 pairs. ADP-induced platelet aggregation was assessed and compared between groups. Within the ST cohort, 12-month outcomes were additionally stratified according to the postprocedural antithrombotic regimen, with or without oral anticoagulation (OAC). Time-to-reintervention was analysed via Kaplan-Meier and Cox regression. Results: ADP-induced platelet reactivity did not differ significantly between ST and control groups (p = .58). Additionally, among ST patients, postprocedural OAC use had no significant impact on 12-month target lesion revascularization (TLR) rates (HR 0.96; 95% CI 0.57-1.62; p = .90), with consistent findings across subgroups (VKA, standard-/low-dose NOAC). Conclusions: In this matched cohort, ADP-induced platelet reactivity did not differ significantly in patients with femoropopliteal stent thrombosis compared to controls. Similarly, no consistent benefit of specific anticoagulation strategies on 12-month target lesion revascularization was observed. Therefore, these findings do not support routine platelet function testing or intensified anticoagulation solely based on a history of ST.
Background: The Fenestrated TREO (R) is a new custom-made device for fenestrated endovascular aortic repair (FEVAR). Its 19Fr low-profile delivery system may be effective for patients with low-calibre or hostile access vessels (AV), reducing trauma risk, improving limb perfusion during percutaneous procedures, and broadening FEVAR indications. This study evaluates short- and mid-term outcomes of the device and its viability in patients with hostile AV. Materials and methods: Only patients with hostile AV treated with the Fenestrated TREO (R) between 2022 and 2025 at a tertiary-care university centre were included. The primary endpoint was technical success. Secondary endpoints included AV-related intraoperative procedures, short- and mid-term morbidity, mortality, reintervention rate, AV-related complications and reinterventions, and stability of target vessels (TV). A sub-analysis compared patients with AV calibre >6.3 mm (group A) and <6.3 mm (group B). Results: Twenty-eight patients were included: 18 in group A and 10 in group B. Technical success was 100%, with target vessel cannulation achieved in 99.1% (one failure). Additional intraoperative AV preparation/adjunctive procedures were required in eight patients (28.6%; 1 vs. 7, p < .001). No perioperative or late deaths occurred. AV reinterventions were required in four patients (14.3%; 2 vs. 2, p = .561). Major complications occurred in four patients (14.3%), and three of 4 AV reinterventions were observed in this subgroup. One major reintervention was necessary. Early TV instability occurred in two patients (7.1%; 1 vs. 1, p = .712). During a median follow-up of 13 months, no late deaths or reinterventions were observed. Conclusions: In patients with hostile AV, the Fenestrated TREO (R) graft showed high technical success rates and favourable short-term outcomes, with acceptable complication rates and excellent TV stability, aligning with results of other well-established endografts. Its low-profile design may be advantageous in complex AV anatomies. Additional intraoperative AV-related procedures mainly occurred in cases of very narrow AV (group B), while postoperative AV-related complications and reinterventions were similar between groups.
Summary: Background: Peripheral artery disease (PAD) is associated with a high burden of cardiovascular and limb events, yet guideline-directed medical therapy remains suboptimal. The START-SIAPAV-PAD registry was designed to describe characteristics, management and clinical history of patients with PAD in Italy. Baseline characteristics and treatment are reported. Patients and methods: START-SIAPAV-PAD is a prospective, multicentre, observational registry enrolling consecutive adults with PAD managed at 20 Italian Vascular centres, starting in February 2023. Standardised electronic case-report forms collect demographics, risk factors, comorbidities, haemodynamic parameters, vascular anatomy, therapies. Follow-up is planned for a minimum of 3 years. PAD severity is classified according to the Leriche-Fontaine scale, and risk-factor targets follow the 2024 ESC guidelines. Results: The present analysis includes 517 patients (72.0% male; median age 71 years) with a high prevalence of hypertension (79.2%), dyslipidaemia (85.0%), diabetes (36.9%), smoking (96.1% current or former) and chronic kidney disease (21.2%). Nearly half reported a walking distance <200 m, 77.5% had a resting ankle–brachial index ≤.80, and 17.2% presented with Leriche-Fontaine stage IV. Femoropopliteal disease was most frequent (69.8%), with multilevel involvement in 43.4%. Previous revascularisation was common, major amputation was rare. LDL cholesterol target (<55mg dL) was achieved in 27.9% of patients despite lipid-lowering therapy in 82.1%. Dual pathway inhibition, advanced lipid-lowering therapies, supervised exercise and structured smoking-cessation programmes were insufficiently adopted. Conclusions: In a population with advanced PAD and multiple risk factors we observed a substantial gap between guideline recommendations and real-world practice. Longitudinal follow-up will assess outcomes and opportunities to improve PAD management.
