OBJECTIVE:To evaluate whether adjunctive mini-cuff use is associated with a reduced risk of postoperative target vessel instability (TVI) after physician-modified endograft (PMEG)-based fenestrated/branched endovascular aortic repair (FB-EVAR). METHODS:This single-center retrospective cohort study included 216 patients with complex aortic diseases treated with PMEG-based FB-EVAR between January 2018 and June 2024. Patients were divided into two groups based on the use of the mini-cuff technique: the FB-EVAR with mini-cuff group (FM group; n = 79) and the FB-EVAR without mini-cuff group (FB group; n = 137). A total of 666 target vessels were analyzed at the branch level, including 193 reconstructed with adjunctive mini-cuff and 473 without mini-cuff. The primary end point was TVI, a composite of target vessel occlusion, >70% stenosis, reintervention, or type Ic/target vessel-related type III endoleak. Time-to-event data were analyzed using Cox proportional hazards regression with robust standard errors to account for within-patient clustering of vessels. Key covariates were prespecified and forced into the multivariable model, including pathology (degenerative vs postdissection), prior aortic endovascular surgery, aneurysm neck-to-sac β-angle of >60°, adverse target vessel condition, and age. RESULTS:The FM group had a higher prevalence of prior aortic endovascular surgery (48.1% vs 16.1%) and postdissection pathology (65.8% vs 27.7%); at the branch level, adverse anatomical conditions were also more frequent in the FM group (26.4% vs 19.2%). In the unadjusted branch-level analysis, TVI occurred less often with mini-cuffs (10.9% vs 16.3%), although this difference did not attain statistical significance (P = .074). Because mini-cuffs were selectively used in higher-risk anatomies, multivariable adjusted analyses were performed. In the multivariable Cox model with robust standard errors, mini-cuff use was independently associated with a lower hazard of TVI (adjusted hazard ratio, 0.882; 95% confidence interval, 0.802-0.969; P = .009). At 24 months, the Kaplan-Meier-estimated branch-level TVI risk was approximately 20% with mini-cuffs vs 25% without, corresponding with an absolute risk reduction of approximately 5% and an estimated number needed to treat of approximately 21. Perioperative outcomes were similar between the groups. CONCLUSIONS:In this retrospective PMEG-based FB-EVAR cohort, adjunctive mini-cuff use was independently associated with improved midterm target vessel stability without increased perioperative risk. However, given the nonrandomized design and selective use in higher-risk anatomies, residual confounding and selection bias cannot be excluded.

OBJECTIVE:This multicentre, retrospective, comparative cohort study aimed to evaluate whether three dimensional (3D) printing guidance was associated with procedural efficiency and midterm outcomes of physician modified endovascular graft (PMEG) fenestrated and or branched endovascular aortic repair (FBEVAR) compared with traditional measurement guided planning. METHODS:Consecutive patients undergoing PMEG FBEVAR at three centres (January 2018 - June 2024) were analysed: 318 with 3D printing guided (PG) and 195 with traditional measurement guided. The primary endpoint was target vessel instability (TVI), a composite of target vessel occlusion, > 70% stenosis, target vessel related re-intervention, or type Ic or III endoleak. Time to event outcomes were assessed using Kaplan-Meier analysis with log rank tests. TVI was evaluated using centre stratified Cox regression and centre adjusted logistic regression with pre-specified covariables including procedure year; a sensitivity analysis additionally adjusted for bridging strategy (balloon expandable covered bridging stent [CBE] only vs. non-CBE only). RESULTS:Technical success and thirty day outcomes were similar. PG was associated with shorter EVAR duration (109.8 ± 34.9 vs. 120.9 ± 45.4 minutes; p = .003), shorter fluoroscopy time (73.6 ± 24.9 vs. 85.7 ± 21.4 minutes; p = .001), lower contrast volume (116.0 ± 34.1 vs. 119.1 ± 38.1 mL; p = .029), and lower radiation dose (1 683.4 ± 536.4 vs. 1 900.8 ± 597.3 mGy; p = .001). At a median follow up of 26 months, TVI occurred less frequently in PG (27.0% vs. 35.4%; p = .046), with fewer target vessel related endoleaks (5.7% vs. 10.8%; p = .034) and target vessel related re-interventions (19.8% vs. 28.7%; p = .028). Freedom from TVI was higher in PG (log rank p = .028). In adjusted analyses, PG was associated with a lower TVI hazard (adjusted hazard ratio 0.75, 95% confidence interval [CI] 0.58 - 0.97; p = .030); the logistic model showed a directionally similar association (adjusted odds ratio 0.70, 95% CI 0.48 - 1.03; p = .069). Aortic angulation > 60°, severe abdominal aortic calcification, and dissection pathology were associated with higher TVI risk. CONCLUSION:In this retrospective, multicentre, cohort study, 3D printing guided planning in PMEG FBEVAR was associated with greater procedural efficiency and favourable midterm target vessel outcomes. The findings should be interpreted as associations, given the non-randomised design.

BACKGROUND:Abdominal aortic aneurysm (AAA) is a prevalent and potentially fatal cardiovascular disease, yet the precise therapeutic mechanism of the bioactive compound Senkyunolide I (SEI) against AAA is not fully understood. METHODS:Utilizing an elastase/BAPN-induced AAA mouse model, this study employed integrated network pharmacology, proteomics (LiP-MS), and biophysical validation (molecular docking, MST) to identify and confirm PARP-1 as a direct target of SEI. The therapeutic effect of SEI was evaluated in vivo by monitoring aortic dilation and histopathology, and its inhibitory effect on TNF-α-induced macrophage migration was assessed in vitro. The functional role of the SEI-PARP-1 axis was further verified using PARP-1 inhibitors and macrophage-targeted PARP-1 overexpression. RESULTS:In the elastase/BAPN-induced AAA model, which mimics human AAA progression and rupture risk, SEI treatment attenuated disease progression by reducing aortic dilation, collagen deposition, and elastin degradation. SEI directly bound to and downregulated PARP-1 expression in both AAA tissues and large peritoneal macrophages (LPMs). It dose-dependently suppressed TNF-α-induced LPMs migration in vitro and restored the AAA-induced reduction in peritoneal LPMs proportion in vivo, an effect also seen with pharmacological PARP-1 inhibition. In contrast, macrophage-specific PARP-1 overexpression abolished SEI's protection and promoted LPMs migration into aortic lesions. CONCLUSION:This study demonstrates that SEI attenuates AAA progression by targeting PARP-1 and inhibiting the migration of LPMs from the peritoneal cavity to the aortic lesion. These findings elucidate a novel pharmacological mechanism of SEI and underscore PARP-1 as a promising therapeutic target for AAA.

BACKGROUND:To assess perioperative safety and mid-term durability of open surgical repair (OSR) as a salvage therapy for endoleaks after failed endovascular aneurysm repair. METHODS:A single-center retrospective analysis was performed on 23 consecutive patients (21 males, 2 females; mean age 65.6 ± 10.6 years) undergoing OSR for persistent endoleaks at Nanjing Drum Tower Hospital between May 2018 and July 2023. Endoleak subtypes included type I (n = 7), type II (n = 14), type III (n = 1), and type IV (n = 1). Primary end points were 30-day mortality and major adverse events, with secondary end points encompassing 3-year survival and reintervention rate. RESULTS:The 30-day mortality of the cohort reached 13.0% (3/23), attributed to pulmonary infection (n = 1), circulatory collapse (n = 1), and septic shock (n = 1). Notably, 34.8% (8/23) developed pulmonary complications, whereas 21.7% (5/23) experienced acute kidney injury. At a median follow-up of 30.6 months (interquartile range 25.4-38.9), the 3-year overall survival rate was 86.9%. No aorta-related deaths occurred during the follow-up; only 1 patient (4.3%) required secondary intervention for distal iliac artery redilation. CONCLUSION:OSR constitutes a definitive solution for endoleak management postendovascular aneurysm repair , demonstrating acceptable perioperative risk and durable mid-term outcomes. Although pulmonary and renal complications remain noteworthy short-term concerns, the technique offers low reintervention rates and stable survival trajectories, particularly in the absence of aorta-related mortality.

BackgroundFenestrated/Branched Thoracic Endovascular Aortic Repair (F/B-TEVAR) has emerged as a cornerstone treatment for various acute and subacute complex aortic arch diseases, but the high complication rate of F/B-TEVAR surgery continues to plague many patients.MethodsA retrospective analysis was conducted on 246 patients with aortic arch lesions who underwent F/B-TEVAR across 4 hospitals from February 2018 to December 2024. Case information and follow-up outcomes were analyzed using multivariate correlation calculation and multivariate logistic regression to summarize the risk factors associated with postoperative complications.ResultsPostoperative complications were observed in 53 cases (21.5%). Statistically significant risk factors (all P < 0.05) included history of previous cerebral infarction, history of smoking, lesions involving branch arteries, and the aortic wall pathology (aortic atherosclerotic plaque, minute intermural hematomas, mural thrombus).ConclusionsThis study identifies key independent risk factors for complications post F/B-TEVAR, emphasizing the potential benefit of 3D printing-assisted technology in reducing these risks. Further research is needed to validate these findings, which can help clinicians identify high-risk patients and implement appropriate interventions.

Background: Thoracoabdominal aortic pathologies involving visceral arteries pose complex challenges for endovascular repair. This study aimed to evaluate the clinical outcomes and identify risk factors for adverse events in patients with complex thoracoabdominal aortic aneurysms (CTAAA) who underwent fenestrated-branched endovascular aortic repair (f/b EVAR) using physician-modified endografts (PMEG). Methods: In this single-center retrospective case-control study, 105 patients undergoing f/b EVAR with at least one visceral artery reconstruction between January 2018 and December 2019 were analyzed. Follow-up was conducted for a median of 36 months. Baseline clinical and imaging characteristics, procedural details, and long-term follow-up data were collected. The primary outcome was patient mortality. Secondary outcomes included technical success, complications, and reinterventions. Results: The technical success rate was 94.3%, with a 30-day mortality rate of 2.86%. During follow-up, 11 patients (10.5%) died, and 15 (14.3%) required reintervention. Analysis of prognostic factors revealed that visceral artery dissection was an independent factor affecting patient survival and positive aortic remodeling, while preoperative renal failure was closely associated with reintervention. Patient age, aortic calcification, and maximum aortic diameter were significant factors influencing endoleak development. Conclusions: f/b EVAR with PMEG is a safe and effective treatment for CTAAA, with low perioperative mortality and acceptable mid- to long-term outcomes. Preoperative renal function and visceral artery dissection are important predictors of prognosis. Larger studies are needed to further validate these findings.

Aortic arch aneurysm is a life-threatening cardiovascular disorder that requires timely medical intervention. Aneurysms in Zone 1 typically involve multiple branch arteries, making repair challenging. Open surgical repair often results in significant surgical trauma, massive blood loss, and prolonged operative time. With advancements in endovascular technology, fenestrated/branched thoracic endovascular aortic repair (F/B TEVAR) has been employed for aortic arch repair and branch artery reconstruction. Stent grafts for F/B TEVAR require personalized modification and fabrication based on patient anatomy. Physician-modified fenestrated endografts (PMEGs) offer a feasible approach for personalized aortic arch aneurysm repair in Zone 1. However, fabricating PMEGs demands a thorough understanding of anatomy and extensive experience, making it challenging for most surgeons. To simplify this process, three-dimensional printing is used to assist in precise fenestration. PMEGs guided by three-dimensional printing enhance branch artery patency and reduce post-operative endoleaks following F/B TEVAR. Further follow-up is necessary to assess the long-term benefits and efficacy of this technique.

(1) Background: Renal artery occlusion after F/B EVAR for abdominal aortic aneurysm is a serious complication that may require re-intervention, and understanding the hemodynamic mechanisms by which it occurs is essential to optimize the surgical procedure. (2) Methods: We used computational fluid dynamics (CFD) to analyze the impact of various parameters on blood flow. Theoretical vascular models were constructed based on the common dimensions and angles of aortic stents and branch arteries in clinical practice. Actual case models were constructed from CT image data of six patients treated with F/B-EVAR. Data were collected for analysis after simulation and calculation by FLUENT software. (3) Results: Theoretical model simulations showed that a larger tilt angle of the branch stent, smaller branch entry depth, and larger branch stent diameter were beneficial for blood flow. In the case models, a significant difference in the tilt angle of the renal artery stents was observed between the high- and low-flow groups, while the differences in entry depth and branch stent diameter were not significant. Occluded renal arteries had lower WSS values than patent ones. (4) Conclusions: This study offers valuable guidance for optimizing stent placement in F/B EVAR to mitigate renal artery occlusion risk.

A 68-year-old male patient was hospitalized with a giant arch aneurysm. Using 3D printing guidance, the aneurysm was successfully sealed, but post-surgery, he developed severe complications. He remained in the intensive care unit for 52 days for observation and was discharged for rehabilitation. During follow-up, recurrent blood in sputum prompted a computed tomography scan revealing intracavitary leakage. After multiple treatments and assessments, it was determined that type IV endoleak resulted from the proximal bare stent graft puncturing the membranous portion of the aortic stent. Subsequent stent graft procedures and precise embolization successfully closed the leakage, resolving the symptoms.

OBJECTIVE:Physician-modified stent grafts (PMEGs) are widely used to treat complex pathologies in the aortic arch, but featured by varied preparation methods. This study was conducted to investigate the differences in operative characteristics and postoperative outcomes of PMEGs prepared using 2 methods: 3D printed models (Group A) and traditional measurement (Group B). METHODS:This retrospective study included 201 patients treated with multiple fenestrated/branched endovascular repair in the aortic arch at 3 vascular centers in China. This study was designed to establish 2 groups based on different preparation methods, including Group A (3D printed models) and Group B (traditional measurement). Both groups matched (1:3) using propensity scoring for subsequent analysis based on age, history of aortic surgery, type of aortic lesion, number of stent fenestrations, and brand of aortic stent. This study further clarified differences in demographic characteristics, procedure characteristics, 30-day outcomes, and 1-year outcomes between 2 groups. RESULTS:A total of 143 patients were enrolled and matched from February 2018 to February 2024, with 91 in Group A and 52 in Group B. Group A had significantly shorter duration of intervention, less contrast use, and lower rate of postoperative renal dysfunction than those in Group B. In addition, no significant differences were observed in the rest of the operative characteristics and postoperative outcomes. CONCLUSION:The use of 3D-printed models may contribute to reducing endovascular intervention time and contrast use, and decreasing the incidence of postoperative renal dysfunction. However, traditional measurement remains a necessary skill for surgeons in case of emergency procedures with short preparation time.Clinical ImpactThis study demonstrates that 3D-printed model-assisted PMEGs preparation significantly reduces endovascular operating time and contrast volume compared to traditional measurement, particularly in triple-fenestrated aortic arch repairs. For clinicians, it provides a validated approach to minimize renal impairment risk and enhance procedural efficiency in elective cases. The innovation lies in leveraging patient-specific 3D anatomy to optimize fenestration positioning. While traditional methods remain essential for emergencies, this technique standardizes complex endovascular reconstruction, potentially reducing reintervention rates.

Purpose:Stanford Type B Aortic Dissection (TBAD), a critical aortic disease, has exhibited stable mortality rates over the past decade. However, diagnostic approaches for TBAD during routine health check-ups are currently lacking. This study focused on developing a model to improve the diagnosis in a population. Patients and Methods:Serum biomarkers were investigated in 88 participants using proteomic profiling combined with machine learning. The findings were validated using ELISA in other 80 participants. Subsequently, a diagnostic model for TBAD integrating biomarkers with clinical indicators was developed and assessed using machine learning. Results:Six differentially expressed proteins (DEPs) were identified through proteomic profiling and machine learning in discovery and derivation cohorts. Five of these (GDF-15, IL6, CD58, LY9, and Siglec-7) were further verified through ELISA validation within the validation cohort. In addition, ten blood-related indicators were selected as clinical indicators. Combining biomarkers and clinical indicators, the machine learning-based models performed well (AUC of the biomarker model = 0.865, AUC of the clinical model = 0.904, and AUC of the combined model = 0.909) using relative quantitation. The performance of the three models was verified (AUC of biomarker model = 0.866, AUC of clinical model = 0.868, and AUC of combined model = 0.886) using absolute quantitation. Crucially, the combined models outperformed individual biomarkers and clinical models, demonstrating superior efficacy. Conclusion:Using proteomic profiling, we identified serum IL-6, GDF-15, CD58, LY9, and Siglec-7 as TBAD biomarkers. The machine-learning-based diagnostic model exhibited significant potential for TBAD diagnosis using only blood samples within the population.

OBJECTIVE:This study aimed to evaluate the peri-operative and follow up results of multicentre 3D printing assisted fenestrated thoracic endovascular repair for aortic arch diseases in zones 0 and 1. METHODS:A multicentre retrospective study of patients undergoing 3D printing assisted multi-fenestrated endovascular arch repair was conducted. The primary endpoints included death, complications, and technical success. Statistical analysis was performed using SPSS version 26, and Kaplan-Meier survival analysis was employed to calculate mid to long term outcomes. RESULTS:The study included 149 patients (mean age 62 ± 13 years; 87.9% men). Diagnoses included thoracic aortic dissection (50.3%, n = 75), aortic aneurysm (46.3%, n = 69), and penetrating aortic ulcer (3.4%, n = 5). The technical success rate was 94.0% (n = 140). Two patients died during the operation. The thirty day post-operative mortality rate was 2.7% (n = 4), while the incidence of cerebral infarction was 8.8% (n = 13), and spinal ischaemia occurred in 2.7% (n = 4). The median follow up was 28 months, during which nine died, two of which were aortic related. The overall endoleak rate was 7.0% (n = 10), comprising four type Ia, four type Ic, and two type IIIa endoleaks; nine underwent re-intervention. The one, two, and three year survival rates were 93.5% (standard error [SE] 2.1%), 90.0% (SE 2.7%), and 87.5% (SE 3.1%), respectively. CONCLUSION:For patients with complex aortic arch disease unfit for open surgery, 3D printing assisted fenestrated thoracic endovascular repair in zones 0 or 1 demonstrated a technically feasible solution with high success and acceptable 30 day mortality and complication rates. Broader validation with larger cohorts and extended follow up is required to establish the durability and safety of this technique as a viable alternative for aortic arch repair.

Objective:Fenestrated/branched endovascular repair (F/B EVAR) has emerged as a frontline treatment for complex aortic diseases, yet multiple studies have reported high reintervention rates postoperatively. This study aims to discuss strategies for improving patient prognosis by analyzing the reintervention status following F/B EVAR in a single-center patient cohort. Methods:This is a single-center retrospective study that collected clinical data and follow-up information from patients who underwent F/B EVAR for complex thoracoabdominal aortic aneurysms between January 2018 and June 2024. The study investigated risk factors leading to reintervention, the association between reintervention and postoperative complications and mortality, and other related aspects. Results:A total of 103 patients were included, with 21 patients undergoing a total of 35 reinterventions during the follow-up period. Among these, 19 reintervention events occurred within 12 months after F/B EVAR (19/103, 18.4%). The reintervention group had significantly higher rates of hypertension, prior endovascular surgery, larger maximum aneurysm diameters, longer operative durations, and more postoperative ICU days compared to the non-reintervention group (P < 0.05). Hypertension (OR: 10.239, 95% CI: 0.999-104.916), maximum aneurysm diameter (OR: 1.591, 95% CI: 1.035-2.446), and operative duration (OR: 1.010, 95% CI: 1.004-1.017) were independent risk factors for reintervention. The most common reintervention methods were SMA branch stent implantation (4/35, 11.4%) and embolization of aortic endoleaks (4/35, 11.4%). The primary indication for reintervention was type IIIc endoleak (12/35, 34.3%). Most patients undergoing reintervention were discharged after interventional or open treatment, with 2 deaths post-intervention (2/21, 9.5%), a higher mortality rate than the non-reintervention group (3/82, 3.7%), but the difference was not statistically significant (P = 0.269). Conclusion:Hypertension, maximum aneurysm diameter, and operative duration were independent risk factors for reintervention. Type IIIc endoleak was the primary indication for unplanned postoperative reintervention, and interventional treatment was the most common reintervention method. Early postoperative follow-up is crucial, and personalized follow-up strategies and surgical approach selection are key to improving long-term prognosis.

ObjectivesThis study aims to improve fenestrated/branched endovascular aortic repair (F/B EVAR) through fabricating physician-modified stent grafts (PMSG) with short bridging stent to treat complex aortic dissection.MethodsFrom November 2018 to January 2024, a total of 82 aortic dissection patients were treated by F/B EVAR combined with short bridging stents, including 19 aortic arch dissection patients and 63 thoracoabdominal aortic dissection patients. Inner or outer short bridging stents were applied to fabricate PMSG with the help of 3D-printing models intraoperatively. All patients underwent postoperative evaluation by enhanced computed tomography in follow-up.ResultsAll aortic dissections were successfully repaired. In aortic arch group, the average operative time was 289.2 ± 88.8 min. The perioperative mortality rate was 5.3%. The total reintervention rate was 5.3%. The average follow-up duration of 36.2 ± 9.5 months. The total incidence of endoleak after surgery was 15.8%. In thoracoabdominal aorta group, the average operative time was 345.5 ± 112.0 min. The perioperative mortality rate was 1.6%. The total reintervention rate was 1.6%. The average follow-up duration of 32.4 ± 19.2 months. The total incidence of endoleak after surgery was 11.1%.DiscussionThe application of short bridging stents has shown promising results in reducing endoleak rates after F/B EVAR. 3D-printing is a feasible way to assist the precise fenestration and design of short bridging stents. However, the safety and reliability of this method need to be further validated.

Venous thromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism, is the third most common vascular disease in the world and seriously threatens the lives of patients. Currently, the effect of conventional treatments on DVT is limited. Endothelial progenitor cells (EPCs) play an important role in the resolution and recanalization of DVT, but an unfavorable microenvironment reduces EPC function. Non-coding RNAs, especially long non-coding RNAs and microRNAs, play a crucial role in improving the biological function of EPCs. Non-coding RNAs have become clinical biomarkers of diseases and are expected to serve as new targets for disease intervention. A theoretical and experimental basis for the development of new methods for preventing and treating DVT in the clinic will be provided by studies on the role and molecular mechanism of non-coding RNAs regulating EPC function in the occurrence and development of DVT. To summarize, the characteristics of venous thrombosis, the regulatory role of EPCs in venous thrombosis, and the effect of non-coding RNAs regulating EPCs on venous thrombosis are reviewed. This summary serves as a useful reference and theoretical basis for research into the diagnosis, prevention, treatment, and prognosis of venous thrombosis.

OBJECTIVES:To evaluate the efficacy and clinical outcomes of accurate embolization of endoleaks after fenestrated thoracic endovascular aortic repair (F-TEVAR) for thoracic aortic dissections. METHODS:Twenty patients with endoleaks (17 type I and 3 type II) after fenestrated thoracic endovascular aortic repair (F-TEVAR) were embolized using detachable and ordinary coils. We assessed the success rate and complications of the operation, and its effects, through clinical and CT follow-up. RESULTS:The mean clinical follow-up duration was 25.68 ± 11.07 months (3-44 months). During follow-up, all endoleaks were completely embolized and aortic remodeling was improved. Secondary endoleaks occurred in four patients who were embolized twice. No other complications or death were reported. CONCLUSION:Embolization using detachable and ordinary coils is effective and safe for the treatment of endoleaks after fenestrated thoracic endovascular aortic repair.

To explore the value of treatment choice and clinical prognosis for Riolan’s arch in chronic superior mesenteric artery (SMA) ischaemic disease in vascular surgery. The clinical data of 215 patients with SMA ischaemic disease (41 cases with Riolan’s arch and 174 cases without) admitted to the Department of Vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University (China) from January 2019 to April 2023 were reviewed. Clinical characteristics, imaging findings, treatment, perioperative complications, and patient follow-up data were analysed to observe the impact of Riolan’s arch on the prognosis of patients with SMA ischaemic disease. There were significant differences in body mass index (Riolan’s arch group: 22.82 ± 3.28 vs 24.03 ± 4.26 in non-Riolan’s arch group, P = 0.049), Takayasu’s arteritis (4.9