This review synthesizes advances in preoperative simulation for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). While EVAR is the first-line therapy, its success is critically dependent on precise planning. Conventional 2D imaging often fails to address complex anatomical variations. Preoperative simulation integrates 3D reconstruction, computational mechanics (FEA/CFD/FSI), and artificial intelligence to enable personalized treatment. AI accelerates image segmentation to the minute-level and enhances the accuracy of rupture risk prediction, while 3D printing and VR/AR optimize procedural rehearsal and training. Clinical implementation demonstrates that this technology guides precise stent-graft sizing, reduces contrast agent usage, and predicts complications. Although software platforms such as Mimics, Abaqus, and Endosize have proven valuable, challenges persist regarding high computational demands, insufficient dynamic physiological modeling, and interdisciplinary barriers. Future efforts should focus on fully automated segmentation algorithms and digital twin frameworks to transition preoperative simulation from an auxiliary tool to a core decision-making infrastructure in precision vascular surgery.

Background: Platelet (PLT) count changes after endovascular aneurysm repair (EVAR) have been associated with postoperative outcomes. However, interindividual heterogeneity in dynamic PLT trajectories remains insufficiently characterized, and predictive models for individualized trajectory estimation are lacking. Methods: This retrospective study included patients who underwent EVAR between January 2000 and February 2024. PLT trajectories over the first 7 postoperative days were identified using latent class growth modeling combined with growth mixture modeling. Feature selection was performed using the Boruta algorithm. Multiple machine learning models were developed and internally validated. SHapley Additive exPlanations (SHAP) were used to interpret model outputs. Results: A total of 1,911 patients were included. Four distinct PLT trajectories were identified: severe decrease, moderate decrease, mild decrease, and increase. Key predictors included preoperative platelet count, fibrinogen, prealbumin, platelet distribution width, plateletcrit, white blood cell count, neutrophil count, lymphocyte count, mean platelet volume, and D-dimer. Among the evaluated models, logistic regression demonstrated relatively better overall performance, with macro-average and weighted-average AUCs of 0.772 and 0.751, respectively. Conclusions: Distinct platelet trajectories exist after EVAR and can be predicted using routinely available clinical variables. These findings provide insight into postoperative platelet dynamics and may assist in risk stratification. Further external validation is warranted.

Objective: This study aimed to assess whether patients with hostile aortic neck (HAN) anatomy achieve comparable outcomes to those with standard aortic neck (SAN) following endovascular aneurysm repair (EVAR). Additionally, developed and externally validated an anatomical risk score model based on the entire cohort to guide access-prepared neck embolization for intraoperative type Ia endoleak (IaEL). Methods: A multicenter retrospective cohort study was conducted in two phases. Phase I compared baseline characteristics, intraoperative endoleaks, and strategies, as well as technical and clinical success between groups. Phase II identified independent anatomical predictors using multivariate logistic regression and developed a score model to facilitate intraoperative IaEL risk stratification for preoperative planning. Results: A total of 326 patients were included. The overall technical success rate was 98.2%, with no significant difference between groups ( P = 1.000). HAN cases had longer procedure times (85.0 vs. 71.0 min; P < 0.001). The overall survival (86.6% ± 6.7% vs 88.4% ± 5.8%; mean ± standard error), freedom from reintervention (92.8% ± 2.7% vs 91.9% ± 2.6%), and clinical success (91.5% ± 2.8% vs 90.9% ± 2.7%) were comparable between patients with HAN and those with SAN over 48 months (all P > 0.05). Intraoperative IaEL occurred more often in HAN (37.1% vs 2.5%, P < 0.001). Neck length, infrarenal angulation, and conical neck were assigned weighted points to construct a six-point scoring system for intraoperative IaEL. The score model demonstrated robust discrimination (AUC = 0.853 in training and 0.842 in validation) and may serve as a tool for intraoperative risk stratification and procedural planning. Conclusions: EVAR in HAN patients can achieve outcomes comparable to those in SAN patients when intraoperative procedures are performed. The risk score offers a practical tool for preoperative risk stratification and anatomy-based procedural planning.

Background: Patient-specific simulation may improve thoracic endovascular aortic repair planning, but existing approaches are limited by large deformation and evolving device–tissue contact. Objectives: To develop and clinically validate an incremental potential contact (IPC)-based framework for single-branched stent-graft deployment in type B aortic dissection. Methods: Of 552 retrospectively screened patients, 30 with complete preoperative computed tomography angiography (CTA), intraoperative digital subtraction angiography (DSA), and postoperative CTA formed the validation cohort. Four additional patients with adverse events underwent exploratory biomechanical analysis. Virtual deployment reproduced crimping, delivery, sequential main-body release, and branch release. IPC resolved nonpenetrating contact among the stent framework, graft, aortic wall, and intimal flap. Simulated configurations were compared with intraoperative DSA and 3- or 6-month CTA. Results: The mean Dice coefficient was 0.90 ± 0.03, with an average surface distance of 10.76 ± 3.78 pixels. Branch position, branch angulation, and proximal bird-beak angle were similar between simulated and implanted devices (all P ≥ 0.658). Mean spatial deviations at 3 months were 1.52 ± 0.48 mm at the branch, 2.20 ± 0.85 mm proximally, and 7.69 ± 1.20 mm distally; corresponding 6-month values were 1.60 ± 0.51, 2.32 ± 0.89, and 8.07 ± 1.26 mm. Exploratory simulations identified stress concentration, nonapposition, inadequate fixation, and device–anatomy mismatch concordant with observed adverse events. Conclusions: IPC-based simulation reproduced clinically sequenced single-branched stent-graft deployment and the principal implanted configuration. This framework may support patient-specific mechanical risk assessment and preprocedural planning.

Abdominal aortic aneurysm (AAA) is a common cardiovascular disease resulting in high mortality rate due to rupture. Intraluminal thrombus (ILT) is involved in AAA progression via both biomechanically protective and biochemically destructive properties. In this study, we utilized multiplex immunofluorescence and GeoMx Digital Spatial Profiler to explore the following issues: (a) Is ILT associated with the phenotypic switching of vascular smooth muscle cells (VSMCs) in aortic aneurysms? (b) Does ILT enrich macrophage-like VSMCs in aortic aneurysms? (c) What role do macrophage-like VSMCs play in aortic aneurysms? We found that the proportion of CD68 + SMA+ double-positive cells was significantly increased in AAA with thrombus. Differential gene expression, gene set enrichment and gene signature analyses were performed, in which enrichments were mainly related to VSMC phenotypic switching, matrix remodeling and inflammatory response. The cell-type identification by estimating relative subsets of RNA transcripts (CIBERSORT) was used to quantify the proportions of immune infiltration and the result was that the proportions of naive B cells, M1-type macrophages, and neutrophils were significantly higher in macrophage-like VSMC-rich areas of AAA with ILT. Furthermore, we predicted IL-6 and IL-1β as feature genes which displayed a positive correlation with neutrophil activation. Further, through in vitro assays, we showed that neutrophil extracellular traps (NETs) induce the phenotypic switching of VSMCs through the NF-κB signaling pathway. This study, based on cutting-edge GeoMx Digital Spatial Profiling technology, systematically revealed the cellular and molecular mechanisms underlying the phenotypic switching of VSMCs into macrophage-like cells in AAA associated with ILT. This discovery provides a novel cellular biology perspective for understanding the destructive role of ILT.

Background Previous research identifies the atherosclerotic index of plasma (AIP) as a key marker for cardiovascular risk, but its role in predicting outcomes in type B aortic dissection (TBAD) patients after thoracic endovascular aortic repair (TEVAR) is uncertain. This study aimed to investigate the association between AIP and long-term outcomes in TBAD patients after TEVAR. Methods This retrospective cohort study included 1335 patients with TBAD who underwent TEVAR. Patients were stratified into tertiles based on AIP levels. The primary endpoints were aortic-related adverse events (ARAEs) at 1 and 5 years after TEVAR. Cox regression analyses were used to evaluate the independent effect of AIP on outcomes. Kaplan-Meier (KM) analysis was conducted to compare the incidence of ARAEs among different groups. Restricted cubic spline (RCS) models were utilized to investigate the nonlinear relationship between AIP and ARAEs, and subgroup analyses assessed the stability of this association. Time-dependent receiver operating characteristic (ROC) curves were applied to assess the predictive accuracy of AIP for ARAEs over a 5-year period. Results The KM analysis revealed a significantly higher incidence of ARAEs in the high AIP group compared to the low AIP group (P < 0.001). However, no statistically significant differences were found in all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCEs) (all P > 0.05). Cox regression analysis demonstrated that a high level of AIP was associated with an increased risk of ARAEs (all P < 0.001). Additionally, RCS analysis indicated a linear relationship between AIP and the risk of ARAEs. In subgroup analyses, the timing of operation showed a significant interaction with 1-year ARAEs (P for interaction = 0.008). Time-dependent ROC analysis demonstrated an area under the curve approaching 0.8 throughout the 5-year period. Conclusion Our research indicates that AIP is independently associated with 1-year and 5-year ARAEs in patients with TBAD following TEVAR, providing a novel metabolic perspective for the prognostic evaluation of this population.

BACKGROUND:Current guidelines recommend retrievable inferior vena cava filters (RIVCFs) placement prior to endovascular intervention (EI) for deep vein thrombosis (DVT), yet the impact of EI on RIVCF-related thrombosis/trapped embolus (T/TE) remains controversial. METHODS:In this prospective registry-based study (ChiCTR1800014252), 2,773 patients undergoing RIVCF placement across 103 Chinese centers (2018-2019) were stratified into EI (n = 1,472) and no-EI (n = 1,301) groups. Propensity score matching (1:1) balanced 23 baseline variables (e.g., DVT acuity and anticoagulation). The primary end point was RIVCF T/TE (defined as inferior vena cava obstruction or thrombus >5 cm above the filter), validated by core-lab adjudicated imaging (computed tomography/angiography). All treating physicians from the 103 participating centers received unified standardized training on the clinical selection criteria for EI and non-EI therapy prior to the study initiation, ensuring consistent intercenter decision-making. The selection of therapeutic modalities was further based on individualized clinical characteristics, including the anatomical location of DVT, thrombus burden, presence of procedural contraindications, and patient's informed consent after full risk-benefit explanation. RESULTS:After matching (n = 1,007 per group), EI was associated with a 46% lower risk of RIVCF T/TE (8.9% vs. 14.0%, P < 0.001; odds ratio = 0.54, 95% confidence interval: 0.41-0.71). Symptomatic pulmonary embolism rates were comparable (1.2% vs. 2.8%, P = 0.07). No brand-specific differences in T/TE incidence were observed (P = 0.32). CONCLUSION:This study challenges the necessity of routine RIVCF placement before EI, demonstrating that EI itself reduces thrombosis risk. These findings advocate for selective filter use, potentially sparing patients from device-related complications.

Background: The study aims to evaluate the preliminary outcomes and hemodynamic implications of a novel unibody triple-branched stent-graft system in patients with complex aortic arch pathologies. Methods: The single-centre, prospective study, conducted from December 2022 to August 2023, included 11 consecutive patients with aortic arch lesions, all of whom were deemed high surgical risk and suitable for endovascular intervention. All patients underwent total endovascular aortic arch repair with a novel unibody triple-branched stent-graft system. Follow-up was conducted at 30 days, 6 months, and 12 months postoperatively. The primary outcomes were 30-day major adverse cardiovascular events and all-cause mortality. Secondary outcomes included technical and clinical success, 6-month and 12-month aortic-related mortality, neurologic complications, branch stent patency, secondary interventions, and endoleak. Hemodynamic assessments were conducted for cases with aortic aneurysm and dissection. Results: The study included 11 male patients with an average age of 63.2 +/- 9.8 years. The technical and clinical success rates were both 100%, with no 30-day major adverse cardiovascular events or all-cause mortality. At a median 15-month follow-up, there were no procedure-related deaths, neurologic issues, or reinterventions. Only one case of Type II endoleak was observed. Hemodynamic analysis revealed that the stent graft facilitated improvements in the hemodynamics of the aortic arch lesion area while maintaining the integrity of normal aortic segments. Conclusions: The novel unibody triple-branched stent-graft system demonstrates preliminary safety and efficacy in total endovascular aortic arch repair. It shows potential for treating complex aortic arch lesions, improving hemodynamics, and reducing neurologic complications. Clinical Trial Registration: ChiCTR2400089245.

Objective This study evaluated the efficacy of fibrin sealant (FS) sac filling in reducing Type II endoleaks (T2EL) and improving postoperative outcomes during ruptured endovascular aneurysm repair (rEVAR). Methods A multicenter retrospective analysis of 69 patients undergoing rEVAR between July 2016 and December 2022 was conducted. Patients were divided into two groups: FS sac filling (n = 34) and standard rEVAR (n = 35). Clinical, anatomical, and procedural variables were compared, along with postoperative outcomes, including the incidence of T2EL and 12-month event-free survival. Subgroup analysis was performed based on ROC analysis and Fine-Gray competing risks regression. Results Patients in the FS group had significantly larger aneurysms (65.21 ± 18.22 mm vs. 55.11 ± 21.81 mm, p = 0.041) and more irregular aneurysm neck morphologies. Despite these challenges, the FS group had a significantly lower incidence of T2EL (2 cases vs. 8 cases, p = 0.045). Kaplan-Meier analysis showed no significant difference in 12-month event-free survival between groups (p = 0.62). However, subgroup analysis revealed that in patients with short proximal necks (<23 mm), T2EL was an independent predictor of adverse events (HR = 48.84, 95% CI: 2.66–898.68, p = 0.0089). Conclusions FS sac filling effectively reduces T2EL in rEVAR and may offer particular benefit in anatomically complex cases with short proximal necks. While no overall survival difference was observed, the strong association between T2EL and adverse events in this high-risk subgroup supports targeted use of FS. Further prospective studies are warranted.

BACKGROUND:The aim of this study is using interpretable machine learning (ML) methods to construct models by combing routine laboratory examination biomarkers and clinical characteristics to identify acute aortic dissection (AAD) patients from other sudden chest pain patients referring to acute myocardial infarction (AMI), acute pulmonary embolism, and abdominal aortic aneurysm. METHODS:The research encompassed a cohort of 832 individuals, with 515 of them diagnosed as AAD patients. Patients were randomly assigned to training and test groups for model development and evaluation, with data collected from medical records and validated by study physicians. Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection in the study, which utilized 9 ML algorithms for model development. The DeLong test compared area under the curve (AUC) values among models. Optimal parameters were found through grid search on the training set with 5-fold cross validation. The SHapley Additive exPlanation (SHAP) method ranks input feature importance and explains model outcomes to address model opacity. RESULTS:Utilizing the LASSO regression technique, 8 variables were pinpointed for their nonlinear significance. Evaluation of these models using test set data yielded AUC values between 0.72 and 0.77, suggesting promising utility in differential diagnosis. The Random Forest method demonstrated noteworthy sensitivity, specificity, and F1 Score. The internal validation set consistently yielded results with an AUC ranging from 0.71 to 0.77. The SHAP method was utilized to assess the influence of features on the model, identifying neutrophil (N.L) and age as the most significant variables. CONCLUSION:In this prognostic study, a ML model was created to assist in differentiating patients with aortic dissection from those presenting with chest pain. The use of interpretable ML techniques allows for the prioritization of key features, showcasing significant potential for application in supporting the prompt diagnosis and treatment of aortic dissection differentials.

Background: The aim of this study was to construct a model by combining routine laboratory biomarkers and clinical characteristics to distinguish acute aortic dissection (AAD) patients from other sudden chest pain patients with AMI, APE and AAA. Methods and Results: Qualified patients were randomly divided into training and validation cohorts. Independent predictive factors for differentiating AAD were filtered out via backward stepwise logistic regression. A nomogram containing the included factors was constructed. The discrimination and calibration abilities were verified via receiver operating characteristic (ROC) curves and calibration curves. The clinical use of the nomogram was evaluated via DCA. A total of 860 eligible patients were randomly allocated to the training (602) and validation (258) cohorts. The WBC count, Baso%, NLR, age, DD and alcohol status were established as independent factors for patients with AAD after multiple logistic regression analysis. A nomogram was constructed. The AUC values were 0.775 (0.733--0.817) and 0.709 (0.637--0.781) for the training and validation cohorts, respectively. The Hosmer–Lemeshow test revealed no significant difference (P>0.05), indicating that the nomogram was reliable. DCA showed favorable clinical benefit. Conclusion. This study constructed a prediction model for AAD. Validation revealed excellent discrimination and calibration, indicating that the nomograms may provide clinical reference information and increase the diagnostic efficiency of AAD.

Objective:To evaluate the outcome of TEVAR for TBAD and revascularization of LSA with Castor single-branched stent-graft.Summary background data:One-stage thoracic endovascular aortic repair (TEVAR) and revascularization of left subclavian artery (LSA) of type B aortic dissection (TBAD) with off-the-shelf stent-graft is limited.Methods:A multicenter study consisting of consecutive patients from four different centers in China treated with Castor single-branched stent-graft for TBAD was conducted. Rate of technical success, mortality, complications, and reinterventions were evaluated.Results:Between September 2018 and April 2022, 180 consecutive patients with TBAD received TEVAR with Castor single-branched stent-graft. Technical success was achieved in all patients. The mean oversize ratio at the proximal landing zone was 4.9 +/- 3.8% (median, 3.7; IQR, 2.0-6.9%). Five patients died within the first 30 days after the operation or during hospitalization. Early reintervention was performed in one case. The median follow-up was 18.0 months (IQR, 13-24 months). Five patients died during follow-up, including three cases of respiratory failure, one case of immune thrombocytopenia purpura, and one case of a cerebral hemorrhage. Three patients had reintervention. In total, three cases of stroke were recorded, which were all within 30 days after the operation. Image data at 1 year presented complete thrombosis in 97.1% cases for the false lumen covered by the stent-graft.Conclusions:TEVAR with Castor device for treatment of TBAD and revascularization of LSA is a feasible and safe technique. The deployment procedure is safe, easy, and accurate. Castor devices meets the hemodynamical and biomechanical requirement of elastic aorta and could restore the physiological blood flow pattern of LSA.

To evaluate the safety and feasibility of thoracic endovascular repair (TEVAR) of type B aortic dissection (TBAD) with Cratos branched stent-graft. A prospective, multicenter study consisting of consecutive TBAD patients across 12 centers in China who were treated with the Cratos branched stent-graft was conducted. Outcomes were reported using descriptive statistics. Overall survival, freedom from reintervention, and branch artery patency were estimated using Kaplan-Meier estimates. The first enrollment started from January 2022 and ended in July 2023, with a total of 89 patients finally enrolled. All patients were diagnosed with TBAD and underwent TEVAR using the Cratos branched stent-graft. Technical success was achieved in all patients. One patient (1.1

Background: This study evaluated the feasibility and safety of thoracic endovascular aortic repair (TEVAR) for aortic arch penetrating atherosclerotic ulcer (PAU) using Castor single-branched stent-graft with zone 2 landing. Methods: Between May 2020 and April 2022, a total of 25 aortic arch PAU patients were treated by TEVAR with Castor single-branched stent-graft. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and patency of left subclavian artery (LSA). Results: All patients had aortic arch PAU with intramural hematoma (IMH). The proximal landing zone for all patients was in zone 2, which was between the distal edge of the left common carotid artery and proximal edge of LSA, in all cases. Technical success was achieved in all cases. During hospitalization after the operation, 1 patient died of gastrointestinal bleeding, and 2 patients (8.0%) had ischemic stroke. At a median follow-up of 29 months (interquartile range [IQR], 24-30 months), 2 (8.0%) patients died, including 1 ischemic stroke and 1 hemorrhagic stroke. One patient (4.0%) had reintervention owing to retrograde type A aortic dissection (RTAD) 2 months after the operation, and was successfully treated with aortic root remodeling, ascending aorta and total aortic arch replacement and frozen elephant trunk procedure. No endoleak or LSA occlusion occurred. The maximal diameter of aorta at proximal (30.2±2.4 mm vs 31.2±3.0 mm; p>0.05) and distal (25.7±2.8 mm vs 24.5±2.3 mm; p>0.05) landing zone showed no significant difference before and after the operation. Conclusions: The TEVAR for aortic arch PAU using Castor single-branched stent-graft is a safe and efficient option with zone 2 landing. Clinical Impact For patients with diagnosis of PAU with IMH, TEVAR with Castor single-branched stent-graft presents low mid-term mortality and morbidity rate, which should be considered as an optimal option when proximal landing zone is insufficient and revascularization of left subclavian artery (LSA) is needed. With Castor single-branched stent-graft, LSA could be revascularized easily and accurately.

BACKGROUND:To evaluate the outcomes of thoracic endovascular aortic repair (TEVAR) with fenestrated physician-modified stent-grafts (f-PMSG) or Castor unibody single-branched stent-graft to revascularize left subclavian artery (LSA) in type B aortic dissection (TBAD) patients. METHODS:A retrospective analysis was conducted of TBAD patients treated f-PMSG (n = 37) or Castor unibody single-branched stent-graft (n = 43) from January 2019 to July 2022. The primary endpoints at 30 days and during follow-up were overall mortality, aortic-related mortality, and major complications. The secondary endpoints were endoleak, reintervention, and branch artery patency. RESULTS:Technical success was 100% in both groups. No patient had early mortality in f-PMSG group, and 1 (2.3%) patient died of multiorgan failure during hospitalization in Castor group. The median follow-up was 53.6 months (range, 34-60 mouths) and 41 months (range, 24-42 months) in f-PMSG and Castor group, respectively. In f-PMSG group, 4 (10.8%) patients died, including 1 aortic-related mortality. In Castor group, 4 (9.3%) patients died of unknown reason. At 1 year after the operation, the branch artery patency rate was 92.0% and 88.4% in f-PMSG and Castor group, respectively. CONCLUSION:For patients with TBAD, TEVAR with Castor single-branched stent-graft or f-PMSG is optimal treatment option when proximal landing zone is insufficient. Compared with f-PMSG, Castor single-branched stent-graft was an off-the-shelf product indicated for TBAD and revascularization.

BACKGROUND:The geriatric nutritional risk index (GNRI) is a reliable indicator of patients' nutrition status and has been shown to be valuable in predicting the outcome of patients with various cardiovascular diseases. This study explored the association between perioperative GNRI and the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). METHODS:A total of 1,157 consecutive patients who underwent TEVAR between January 2007 and August 2019 were included, with data from 789 patients analyzed. The GNRI was used to measure nutritional status. Patients were categorized into five groups based on the GNRI quintile. The study's endpoints included all-cause mortality, aortic-related adverse events (ARAEs), and major adverse cardiovascular and cerebrovascular events (MACCEs) at 30 days, 1 year, and 5 years. The univariate and multivariate Cox regression analyses the effect of GNRI on the endpoints. Kaplan-Meier survival analysis was conducted to assess the incidence of these endpoints across the five groups, and restricted cubic spline (RCS) analysis was used to examine the non-linear relationship between GNRI and all-cause mortality. RESULTS:The Kaplan-Meier survival analyses revealed that the risk of 1-year and 5-year all-cause mortality was highest in the Q1 group among the five groups (P = 0.009 and P = 0.002, respectively). However, there was no significant difference in 1-year and 5-year ARAEs and MACCEs (all P > 0.05). Multivariate Cox analysis showed that continuous GNRI was independently associated with 5-year all-cause death (HR = 0.97, 95% CI: 0.95-1.00; P = 0.027). Compared with the Q1 group, the Q2 (HR = 0.22, 95% CI: 0.06-0.80; P = 0.021) and Q4 groups (HR = 0.26, 95% CI: 0.08-0.81; P = 0.020) had lower risks of 1-year all-cause mortality. The Q2 group (HR = 0.38, 95% CI: 0.18-0.83; P = 0.015) and Q3 group (HR = 0.46, 95% CI: 0.22-0.96; P = 0.039) were also observed to have a lower risk of 5-year all-cause mortality than the Q1 group. In the subgroup analyses, chronic kidney disease (CKD) showed significant interaction (P-interaction < 0.001). Besides, the RCS analysis identified a "U"-shaped relationship between GNRI and all-cause mortality of TBAD patients following TEAVR. CONCLUSIONS:TBAD patients undergoing TEVAR showed a strong correlation between perioperative low GNRI and higher risks of 1-year and 5-year all-cause mortalities. TBAD patients with a too low GNRI should receive particular attention.

Background Previous research identifies the atherosclerotic index of plasma (AIP) as a key marker for cardiovascular risk, but its role in predicting aorta-related adverse events (ARAEs) in type B aortic dissection (TBAD) patients post-thoracic endovascular aortic repair (TEVAR) is uncertain. This study investigates the link between AIP and ARAEs at 1-year and 5-year intervals in TBAD patients after TEVAR, suggesting a new prognostic indicator for TBAD outcomes. Methods This retrospective cohort study involved 1,335 TBAD patients who underwent TEVAR, with clinical data extracted from electronic records. AIP was calculated as log (triglycerides/high-density lipoprotein cholesterol [TG/HDL-C]), and patients were categorized into three AIP tertiles. The primary endpoints were ARAEs at 1 and 5 years post-TEVAR. Cox regression identified variables linked to endpoints and assessed AIP's independent impact on ARAEs. Kaplan-Meier curves and log-rank tests compared ARAE incidence across groups. RCS models examined the AIP-ARAEs dose-response relationship, while subgroup analyses confirmed the association's stability. Time-dependent ROC curves evaluated AIP's predictive power for ARAEs over five years. Results Kaplan-Meier analysis showed higher incidence of ARAEs in AIP High group compared to Low group (1 year: 19.51% vs. 5.81%; 5 years: 24.39% vs. 10.32%; both P < 0.05). Cox analysis showed AIP High group had higher ARAE risk (1-year HR = 4.63, 95% CI: 2.57–8.34; 5-year HR = 2.59, 95% CI: 1.78–3.78; all P < 0.001). Furthermore, RCS analysis indicated a continuous positive linear relationship between AIP and ARAEs. Time-dependent ROC showed the area under the curve (AUC) surpassing 80% throughout the five-year duration. Subgroup analysis revealed higher AIP-related ARAEs risk in subacute surgery patients (1 year: HR = 6.78; 5 years: HR = 2.96) and lower risk in chronic surgery patients (1 year: HR = 0.02; 5 years: HR = 0.24). In the 5-year subgroup analysis, patients without chronic kidney disease (CKD) had a notably higher risk of AIP compared to those with CKD (HR = 2.09 vs. HR = 0.41) (P-interaction = 0.082). Conclusion AIP serves as an independent influencing factor for both the short term (1 year) and the long term (5 years) following TEVAR in patients with TBAD, demonstrating a linear relationship between the two timeframes. These findings highlight the significance of AIP as a crucial risk biomarker, providing a simple yet effective method for identifying the risk of ARAEs in this patient population.

ABSTRACT Endovascular surgical robots have advanced vascular surgery through the integration of automatic programs for complex interventions. However, current systems still lack full procedural automation capabilities. This single‐center single‐arm study explores the feasibility and safety of automatic robotic‐assisted endovascular aortic repair (EVAR) using a novel surgical algorithm with in vitro and in vivo experiments. The EVAR process was deconstructed into surgical steps and programmed into an endovascular surgical robot, which executed the steps automatically based on parameters derived from image processing software. In vitro experiments using 3D‐printed vascular models demonstrated millimeter‐level precision, with reduced operation time, fluoroscopy time, and radiation exposure compared to manual robotic control. In vivo evaluations in four patients with abdominal aortic aneurysms achieved 100% technical and clinical success, with no major adverse events. Operation time averaged 110 ± 47 min, fluoroscopy time was 19 ± 6 min, and patient‐side radiation exposure was 1251 ± 389 mGy. Surgeon‐side radiation exposure was 4 ± 1 mGy. The results indicate that automatic robotic‐assisted EVAR can be performed with acceptable accuracy and safety to provide standardized therapies, shorten operation time, and reduce radiation exposure of patients.

Purpose: Postpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation. Methods: This was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients' medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± standard deviation when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients’ survival. Results: Pancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively. Conclusions: With suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.

Background: Superior Mesenteric Artery (SMA) lesions present a significant challenge in endovascular surgery. Both the transbrachial (TBA) and the transfemoral (TFA) approaches have been employed for the treatment of these lesions, but the comparative effectiveness of these methods remains unclear. Materials and methods: A retrospective analysis was conducted on patients who underwent TBA and TFA at a tertiary center between June 2020 and February 2023. Key parameters including technical success, procedural details, and complication rates were examined. Results: In a study of 99 patients, 66 underwent Transfemoral Approach (TFA) and 33 underwent Transbrachial Approach (TBA). No significant age or gender differences were noted between groups. TFA procedures were longer (90.0 vs 63.5 min, p = 0.002) and had higher fluoroscopy times (59.0 vs 43.0 min, p = 0.02) and selective SMA times (366.0 vs 245.0 min, p = 0.038) compared to TBA, especially with a smaller aortomesenteric angle (<90°). Technical success rates were high in both groups (TFA 97%, TBA 93.9%, p = 0.60). Complication rates were similar between groups, with no significant predictors for access site complications identified. Conclusion: Both the TBA and the TFA are effective for the treatment of SMA lesions, with TBA potentially offering advantages in terms of efficiency and patient recovery, particularly in cases with certain anatomy. No significant differences in complication rates were found between the two groups. Further research, including prospective randomized trials, is needed to confirm these findings.