Aortic dissection represents a life-threatening vascular emergency with significant morbidity and mortality. Traditional models for predicting aortic thrombosis often depend on complex biochemical parameters, lack clearly defined phase interfaces, and require extensive computational time. Existing porous media algorithms are limited in their ability to accurately capture the dynamic processes of thrombus growth and hemodynamic changes, largely due to imprecise physical formulations. This study presents a novel multiphase porous media approach for predicting thrombus formation in various types of aortic dissection, which is innovatively applied to a large number of patient-specific aortic models. By incorporating an extended Darcy-Brinkman-Stokes (DBS) equation to explicitly model the interaction between solid and liquid phases, and introducing a novel porosity equation to simplify platelet transport and deposition, the method achieves substantial improvements in computational efficiency. Applied to computed tomography-based reconstructions, the algorithm demonstrated high predictive accuracy, achieving a correlation coefficient of 0.97 between predicted and actual thrombus volumes in 12 cases of partial false lumen and 9 cases of complete false lumen. The average prediction time per case was reduced to 40 min, representing a 70 % improvement in efficiency. Furthermore, the study investigated mechanical factors underlying enhanced postoperative recovery in patients with complete false lumens and introduced an acceleration factor to align simulation time with actual thrombus progression. By integrating a mechanically grounded thrombus evolution model, this method enables rapid, dynamic predictions, thereby supporting timely clinical decisionmaking and facilitating the development of personalized treatment strategies for patients with aortic dissection.

BACKGROUND: Aortic dissection (AD) is a life-threatening emergency with high mortality. Although elevated body mass index (BMI) is associated with both AD incidence and mortality, the underlying mechanisms remain unclear. Periaortic adipose tissue (PAAT) increases with BMI, and the PAAT of AD shows marked inflammatory infiltration, suggesting PAAT-driven inflammation may contribute to the development of AD. However, no direct evidence links BMI and PAAT to AD. To further elucidate the obesity-inflammation-AD relationship, we aim to quantify the contributions of BMI, PAAT, and their derived indices to the risk of AD. METHODS: This retrospective multicenter study (June-November 2025) quantified PAAT around the descending thoracic aorta with CT angiography (CTA). Logistic regression analyses were performed to identify AD risk factors. Based on the Boruta algorithm (a machine learning feature selection method) and ROC curve analysis, the variable importance for AD risk was assessed. The dose?response relationship between BMI?Volume-derived metric (BMV) and AD risk was further characterized by quartile stratification and restricted cubic spline (RCS). RESULTS: This study enrolled 376 consecutive participants. After adjusting for potential confounders, BMI, smoking, systolic blood pressure (SBP), diabetes mellitus (DM), TC/HDLC, ApoE, PAAT volume (Volume), PAAT fat attenuation index (FAI), and BMV were identified as independent predictors of AD. Volume was the strongest AD predictor with the highest Z-score. Compared with BMI [AUC 0.627, 95% confidence interval (CI): 0.569?0.687] and Volume (AUC 0.716, 95% CI: 0.662?0.772), BMV showed better discriminatory performance (AUC 0.726, 95% CI: 0.673?0.778). RCS showed an approximately linear positive association between BMV and AD risk (P-overall < 0.001, P-non-linear = 0.09). CONCLUSIONS: In this retrospective multicenter study, BMV, a composite measure integrating systemic and periaortic adipose tissue factor, showed a positive association with AD risk, and improved predictive performance beyond BMI, indicating incremental predictive value, pending external validation. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is a retrospective study and trial registration is not applicable. ### Funding Statement This study was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2024ZD0537800), National Natural Science Foundation of China (grant number: 82270415, and U24A20651), Shanghai Municipal Science and Technology Commission Fund (grant number: 20234Z00120 and 22S31904800), and Shanghai Sailing Program (grant number: 22QA1408600).We declare that the authors and their institutions have not received any payment or services from a third party for any aspect of this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of Chinese PLA General Hospital(S2023-597-01). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from the corresponding author upon reasonable request.

Background Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a relatively rare but potentially life-threatening disease. Optimal medical management strategies remain uncertain. Therefore, developing evidence-based clinical practice guidelines is essential to improve the treatment of SISMAD. Methods The guideline adopted approaches informed by the Grading of Recommendations, Assessment, Development, and Evaluation methodology and the European Society of Cardiology grading system. Recommendations were formulated according to the quality of evidence, categorized as high (level A), moderate (level B), or low (level C). Results After reviewing the literature on eight topics, including clinical presentation, imaging evaluation, classification, medical management strategies, and follow-up, the guideline writing committee issued 19 recommendations based on the currently available evidence. Conclusion Among the 19 recommendations, only a minority were supported by high-quality evidence, underscoring the urgent need for further well-designed clinical studies and prospective research to refine the management of SISMAD.

Introduction: The anatomic suitability of the iliac branch device remains limited, particularly in East Asians, in whom the common iliac arteries (CIAs) are notably short. This study aimed to evaluate the safety and haemodynamic effects of the physician modified inner branch iliac branch device (PM-IIBD) via clinical outcomes and computational fluid dynamics (CFD) analysis. Method: In this observational case series study, clinical safety was evaluated in ten patients treated with the PM-IIBD for internal iliac artery preservation. CFD analyses were performed before surgery and at 12 month follow up to compare haemodynamic changes in four CIA regions. CFD parameters included velocity, pressure, time averaged wall shear stress (TAWSS), relative residence time, oscillatory shear index (OSI), energy loss, and flow distribution ratios. Results: Technical success was 100%, with no peri-operative or follow up adverse events. CFD revealed minimal changes in pressure and velocity after PM-IIBD implantation, with only a slight post-operative decrease in external iliac artery average velocity (0.51 ± 0.12 m/s vs. 0.45 ± 0.16 m/s, p = .039). High oscillatory shear index areas in the CIA region significantly decreased after surgery (0.22 ± 0.14 vs. 0.11 ± 0.07, p = .036). In the PM-IIBD region, both the average TAWSS (0.40 ± 0.45 vs. 0.72 ± 0.22, p = .015) and maximum TAWSS increased statistically significantly (4.47 ± 4.16 vs. 8.44 ± 6.52, p < .001). The PM-IIBD inner branch region showed an increase in high TAWSS areas (0.11 ± 0.39 vs. 0.20 ± 1.44, p = .002). Energy loss decreased significantly after surgery (3.82 ± 2.13 vs. 3.11 ± 1.76, p = .013), with no significant changes in the relative residence time and flow distribution ratio. Conclusion: Preliminary clinical and CFD analyses have demonstrated the efficacy and haemodynamic stability of the PM-IIBD. By reducing spatial demands on the CIA, the PM-IIBD expands anatomic suitability, offering a feasible solution for internal iliac artery preservation in East Asians.

BACKGROUND:Isolated superior mesenteric artery dissection (ISMAD) is a relatively uncommon vascular disease with uncertain optimal management. Multiple imaging-based classifications have been developed, but their ability to predict conservative management failure remains unclear. OBJECTIVES:This study aimed to compare the predictive performance of 8 ISMAD classification systems for conservative management failure. METHODS:This multicenter retrospective study included 156 patients with ISMAD from 3 centers in China (October 2009 to February 2023). The median computed tomography angiography follow-up time was 7.9 months (IQR: 3.7-24.3). Patients were classified using 8 systems and grouped as successful (108 of 156, 69.2%) or failed (48 of 156, 30.8%) conservative management. Performance was evaluated by model fit (Akaike Information Criterion, Bayesian Information Criterion), discrimination (C-statistic), net reclassification improvement, calibration, and decision curve analysis. RESULTS:Compared with the successful group, patients who failed conservative management had a longer duration of abdominal pain before admission (8 [IQR: 3-30] days vs 4 [IQR: 1-11] days; P = 0.0214) and more severe superior mesenteric artery degree of stenosis (0.83 [IQR: 0.69-1.00] vs 0.64 [IQR: 0.52-1.00]; P = 0.00544). Among all classifications, Tan's classification showed good model fit (Akaike Information Criterion = 186; Bayesian Information Criterion = 226), the highest discrimination (C-statistic = 0.750; 95% CI: 0.670-0.830), and the greatest improvement (net reclassification improvement = 0.593; 95% CI: 0.244-0.903). It also demonstrated good calibration and yielded the highest net benefit across clinically relevant threshold probabilities in decision curve analysis. CONCLUSIONS:Tan's classification showed the best overall performance in predicting conservative management failure and may help guide timely interventions.

PURPOSE:Abdominal aortic aneurysm (AAA) with concomitant Horseshoe kidney (HSK) is rare. When open surgery is not feasible, preserving the renal isthmus artery (RIA) during endovascular treatment presents a challenge. CASE REPORT:A 70-year-old male presented with a 57.8 mm × 54.3 mm AAA and type V HSK perfused by a 4.4 mm RIA from the inferior mesenteric artery and a 4.6 mm RIA from the aortic bifurcation. This case report describes an endovascular aortic aneurysm repair (EVAR) performed on an AAA coexisting with a type V HSK. One-year follow-up: the AAA had regressed, and the HSK remained perfused without any endoleak or increase in serum creatinine levels. CONCLUSION:The utilization of EVAR offers a feasible option for AAA combined with type V HSK, particularly in cases of high surgical risk. CLINICAL IMPACT:In Abdominal aortic aneurysm (AAA) with type V horseshoe kidney (HSK), preserving renal isthmus arteries (RIAs) is critical when they provide a substantial portion of the HSK blood supply.When open surgery is not feasible, preserving the RIA during endovascular treatment presents a challenge.The use of EVAR, incorporating a periscope stent and embolization, provides a viable treatment option for patients with AAA and type V HSK, especially in high surgical risk cases.

The anatomical eligibility of the Iliac Branch Device (IBD) remains limited, primarily caused by the additional common iliac artery (CIA) space occupied by its outer branch. Given that East Asian populations typically have smaller CIA diameters and lengths than Western populations, the anatomical eligibility of IBD in East Asians is <30%. Thus, we developed a novel Physician-Modified Inner Iliac Branch Device (PM-IIBD) to reduce CIA spatial demands. The PM-IIBD was used for 10 patients’ internal iliac artery (IIA) reconstruction, achieving a 100% technical success with no perioperative complications. The 12-month postoperative CTA follow-up showed that no type I or III endoleaks and all EIA and IIA were patent. Seven cases showed sac shrinkage, and 3 showed sac stability. This study demonstrates the safety and efficacy of the PM-IIBD in CIA lesions. The PM-IIBD significantly reduces spatial demands on the CIA, expanding the anatomical eligibility for IBD.

BACKGROUND:Endovascular aortic repair was introduced in China in 1997, with domestically produced devices emerging post-2000. Despite progress, treatment of complex aortic pathologies remains limited, necessitating innovative endovascular solutions. METHODS:Our center developed 8 off-the-shelf endovascular innovations, including 3 inner branch stent graft systems for aortic arch reconstruction, 2 branched/fenestrated stent grafts for thoracoabdominal and juxtarenal aortic aneurysms, 1 iliac branch device for internal iliac artery preservation, and 2 novel devices-EndoPatch and EndoSeal (Endonom Medtech)-designed to seal distal tears and occlude false lumen in aortic dissections. These advancements integrate technologies such as steerable delivery systems, preloaded navigation aids, and mixed or inner branch configurations to accommodate anatomical variations. RESULTS:Preliminary clinical applications demonstrated promising technical success rates and acceptable complication profiles. Two devices have been approved by China's National Medical Products Administration for clinical use, while others remain under investigation. Key challenges include anatomical variability, branch vessel patency concerns, and the absence of long-term outcomes for most devices. CONCLUSION:These innovations establish a comprehensive endovascular strategy for extensive aortic pathologies, addressing critical gaps in China's device landscape. Early outcomes demonstrate the feasibility of standardized off-the-shelf solutions for complex anatomies, though multicenter trials and long-term follow-up remain essential to confirm safety and efficacy.

OBJECTIVE:This study aimed to identify the iliac artery characteristics of East Asian patients with abdominal aortic aneurysms (AAAs) and to evaluate anatomical suitability rates with current iliac branch devices (IBDs). METHODS:This was a single centre, retrospective, cross sectional study. Patients diagnosed with AAA between 2008 and 2023 were enrolled. The morphological parameters of the iliac arteries were measured, and their eligibility for four IBDs (Cook ZBIS, Gore IBE, E-Liac IBD, and G-Iliac IBD) was evaluated according to the manufacturer's latest instructions for use (IFU). RESULTS:Among 1 144 AAAs observed in the study, 45.5% (n = 521) presented with concurrent common iliac artery aneurysm (CIAA). In total, 304 patients (26.6%) and 371 iliac arteries necessitated internal iliac artery (IIA) reconstruction. The anatomical suitability rates for the Cook ZBIS, Gore IBE, E-Liac IBD, and G-Iliac IBD were 18.9%, 21.8%, 11.9%, and 22.6%, respectively. The E-Liac IBD exhibited a significantly lower anatomical suitability rate compared with the other three devices (p < .001). The primary IBD exclusion criteria were: a common iliac artery (CIA) length of < 50 mm for Cook ZBIS (n = 211, 56.9%); an IIA diameter of < 6.5 mm or > 13.5 mm for Gore IBE (n = 177, 47.7%); and a CIA bifurcation diameter of < 18 mm both for E-Liac IBD and G-Iliac IBD (n = 244, 65.8%). A total of 198 patients (53.4%) failed to meet the anatomical criteria for any device, while 112 (30.2%) qualified for just one device, 26 (7.0%) for two devices, 25 (6.7%) for three devices, and 10 (2.7%) for all four devices. CONCLUSION:A significant proportion of East Asian patients with AAA present with concurrent CIAA, necessitating substantial IIA reconstruction. IBD techniques show low anatomical suitability rates among the East Asian population, with 53.4% of patients failing to meet anatomical criteria for any IBD based on the manufacturer's IFU.

Blunt thoracic aortic injury (BTAI) is a lifethreatening vascular emergency with high mortality rates, where rapid and accurate diagnosis from computed tomography angiography (CTA) is critical for patient survival. However, the inherent complexity of radiological interpretation and its dependence on clinician expertise often lead to diagnostic delays in acute trauma settings. To address these clinical challenges, we propose a mask-guided multi-task nnU-Net framework for automated BTAI diagnosis and assessment. The framework jointly performs lesion segmentation and subtype classification through a shared encoder architecture, while a novel segmentationguided classification branch leverages spatial lesion information to enhance subtype prediction accuracy. Our method, evaluated on a dataset of 59 cases spanning three BTAI subtypes (intimal tear/dissection, pseudoaneurysm, and intramural hematoma), achieves a classification accuracy (ACC) of 91.7%, a segmentation Dice Similarity Coefficient (DSC) of 88.5%, and an average inference time of just 15 seconds per case. This automated framework demonstrates substantial potential for reducing diagnostic delays in emergency settings while maintaining clinical-grade accuracy, ultimately supporting timely treatment decisions that could improve patient outcomes and reduce BTAI-associated mortality.

Background Abdominal aortic aneurysms (AAAs) are a common vascular disease, and juxtarenal abdominal aortic aneurysms (JRAAs) pose significant challenges for traditional open surgical repair because of their complex anatomical location. In recent years, endovascular aneurysm repair (EVAR) has emerged as a key treatment option for JRAAs, but data on its application in Chinese patient populations remain limited. This study was conducted to evaluate the safety and efficacy of the Zenith fenestrated endovascular graft in treating JRAAs in Chinese patient population.Methods Clinical data from 30 consecutive patients (86.7% men; mean age, 68 +/- 8 years) treated for JRAAs with the Zenith device at 9 institutions in China between 21 February 2011 and 31 August 2014 were retrospectively analyzed. Postoperative follow-up included clinical examination, abdominal duplex ultrasound, and computed tomography at hospital discharge, 3, 6, and 12 months, and annually thereafter.Results The procedure achieved a 100% technical success rate, with 5 large fenestrations cannulated to the superior mesenteric artery and 52 small fenestrations targeting the renal arteries. Steep angulation made cannulation difficult in five patients. Over a mean follow-up period of 42 +/- 18 months (range, 8-56 months), outcomes included three deaths, none related to aneurysmal rupture or conversion; one dissection at the edge of a left renal covered stent secondary to arterial rupture during implantation; right renal artery migration due to preoperative hematoma compression in one patient; and among 55 targeted renal arteries, two occlusions and five stenoses across four patients (13.3%). Secondary interventions were required in seven patients (23.3%) for Type II (n = 6) and Type I (n = 1) endoleaks.Conclusions Endovascular repair of JRAAs using the Zenith device appears to be safe and effective in selected patients treated at experienced centers, with low associated mortality and morbidity. However, long-term data on device integrity and branch vessel patency are needed.

Aortic aneurysm and dissection (AAD) are vascular disorders with high mortality. Previous evidence has suggested an elevated risk of AAD associated with the use of phosphodiesterase 5A (PDE5A) inhibitors. PDE5A, a cGMP‐hydrolyzing enzyme, is enriched in vascular smooth muscle cells (SMCs), but the role of SMC‐specific PDE5A in the pathogenesis of AAD is still unclear. In this study, PDE5A expression in human and mouse aortic tissues was analyzed by single‐cell RNA sequencing (scRNA‐seq), western blotting, immunofluorescence, and immunohistochemistry staining. SMC‐specific PDE5A knockout (PDE5A SMC−/− ) and PDE5A‐overexpressing (PDE5A SMC‐OE ) mice were constructed and utilized, along with an AAD mouse model induced by a high‐fat diet and angiotensin II (Ang II) infusion. In vivo imaging and histological analyses were performed to assess aortic pathologies. PDE5A expression was reduced in human and mouse AAD aortic tissues, primarily in SMCs. Pharmacological inhibition or genetic knockout of PDE5A in SMCs exacerbated aortic wall dilatation and elastin fiber degradation, increasing AAD incidence. In contrast, the AAD phenotype was rescued in challenged PDE5A SMC‐OE mice. Mechanistically, PDE5A expression influenced myosin light chain (MLC) phosphorylation, a key regulator of SMC contractility. In AAD tissues from PDE5A SMC−/− mice, increased cGMP‐dependent protein kinase (PKG) activation and decreased MLC phosphorylation indicate enhanced aortic relaxation. In conclusion, our findings suggest that PDE5A downregulation or inhibition plays a causative role in exacerbating AAD likely by potentiating cGMP/PKG‐mediated aortic SMC relaxation. Our findings highlight the need for caution in the clinical use of PDE5 inhibitors in patients at risk of aortic diseases. © 2025 The Pathological Society of Great Britain and Ireland.

Background:Isolated superior mesenteric artery dissection (ISMAD) is a rare arterial disease, and its exact cause is still not well understood. This study aimed to investigate the potential role of anatomical factors in the development of ISMAD. Methods:This case-control study included patients diagnosed with ISMAD via computed tomography angiography from two major medical centers in China. An equal number of age-sex and body mass index matched patients without aortic and superior mesenteric artery disease were selected as controls. Several anatomical parameters were compared between the ISMAD group and the control group. Significant parameters were identified through univariate and multivariate analyses, and models were evaluated using receiver operating characteristic (ROC) curve analysis. A p-value < 0.05 was considered statistically significant. Results:A total of 60 patients with isolated superior mesenteric artery dissection and 60 age-sex (52.6 ± 6.1 vs. 52.2 ± 13.5, p = 0.82) and body mass index (24.3 ± 2.5 vs. 24.0 ± 4.0, p = 0.72) matched normal controls from two major hospitals in China were included in the study. Compared with normal controls, the multivariate analysis revealed that curvature (OR 1.239, 95% CI 1.122-1.369, p < 0.001) and tortuosity (OR 0.002, 95% CI, 0.000-0.083, p = 0.001) were independent predictors of ISMAD occurrence. Conclusion:Patients with ISMAD exhibited higher levels of curvature and lower levels of tortuosity compared to normal control group.

Fast virtual stenting (FVS) is a promising preoperative planning aid for thoracic endovascular aortic repair (TEVAR) of aortic dissection. It aims at digitally predicting the reshaped aortic true lumen (TL) under specific operation plans (stent-graft deployment region and radius) to assess and avoid reoperation risk, but has not yet been applied clinically due to the difficulty in achieving accurate and time-dependent predictions. In this work, we propose a deep-learning-based model for FVS to solve the above problems. It models the FVS task as a time-dependent prediction of inner wall (TL surface) deformation and leverages outer wall (entire aortic surface) to improve it. Two point clouds (PCiw and PCow) are generated to represent the walls, where patient information, operation plan, and post-operative time are set as the attributes of PCiw. Afterwards, graphs are constructed based on the PCs and processed by a graph deep network to predict a point-wise inner wall deformation for generating the time-dependent reshaped TL. Our model successfully perceives and utilizes the virtual setting of operation plan and achieves the time-dependent predictions for 108 patients (269 real follow-up visits). Compared with the existing rule-based FVS model, it predicts the long-term reshaped TL with 9%, 5%, and 2% lower mean relative error of volume, surface area, and centerline length, respectively, and supports more accurate clinical measurements of poor outcome risk factors. Overall, our model may be of great significance for predicting reoperation risk, optimizing operation plan, and eventually improving the effectiveness and safety of TEVAR.

OBJECTIVES:This study aimed to assess the midterm outcomes of a novel embedded modular single-branched stent-graft (EMSBSG) designed to preserve the left subclavian artery (LSA) of type B aortic dissection (TBAD). METHODS:From December 2020 to November 2021, a total of 120 patients with TBAD treated with an EMSBSG were enrolled in a multicenter prospective clinical trial at 18 Chinese tertiary hospitals. Follow-up computed tomography angiography scanning was conducted at 1, 6, and 12 months postprocedure. RESULTS:The technical success rate was 99.17% (n = 119/120), with only 1 technical failure attributed to aortic intimo-intimal intussusception. The 30-day mortality rate was 0.83% (n = 1). Thirty-day major complications included 2 cases (1.67%) of retrograde type A aortic dissection (RTAD), 3 cases (2.50%) of stroke, and 6 cases (5.22%) of Type Ia endoleaks. The median follow-up time was 12.84 (range, 11-16) months. The 1-year mortality rate was 4.17% (n = 5/120), and the follow-up patency rate of the branch section was 99.09% (n = 109/110). The overall 12-month reintervention rate was 4.17% (n = 5), including 3 RTAD cases, 2 Type I endoleaks, and 1 stent-induced new entry. CONCLUSION:For patients with TBAD involving the LSA, the midterm outcomes are encouraging for EMSBSG as a relatively safe, effective, and noncustomized endovascular option. However, long-term outcomes warrant attention and further investigation.Clinical ImpactThe midterm outcomes indicate that EMSBSG offers a safe, and effective endovascular option for preserving the LSA in patients with TBAD. The EMSBSG achieves LSA preservation through a non-customized endovascular solution, making it particularly suitable for emergency procedures. The core innovation of EMSBSG lies in its flexible, modular Embedded design, which adapts to the anatomical characteristics of TBAD in patients.

Background: To assess the mid-term outcomes of using bovine pericardium patch(BPP)compared to great saphenous vein patch (GSVP) in femoral angioplasty for iliofemoral occlusive diseases. Methods: A retrospective study was carried out at the First Medical Center of the Chinese PLA General Hospital from January 2013 to July 2023 to assess the efficacy of femoral angioplasty in patients with iliofemoral occlusive disease. Technical success, early outcomes, 24-month primary patency, and freedom from restenosis at the patch site were evaluated. Propensity score matching was employed to improve comparability between the BPP and GSVP groups. Results: A total of 81 patients (91 limbs) were included in the study; 2 groups were created according to the type of patch used with 35 patients (42 limbs) in the BPP group and 46 patients (49 limbs) in the GSVP group. Common femoral angioplasty was a fixed step in all cases. Technical success was achieved in all cases, with no perioperative mortality. The perioperative complication rate was 14.3%. Kaplan-Meier curves showed comparable primary patency and freedom from restenosis between the BPP and GSVP groups with or without propensity score matching. Conclusion: It may be a viable option to choose BPP in femoral angioplasty for patients who cannot provide GSVP.

ObjectivesRenal artery aneurysm (RAA) is a rare condition among visceral aneurysms, often asymptomatic and incidentally discovered through imaging. Surgical or interventional procedures are utilized for treatment, depending on the aneurysm's size, morphology, and the patient's physical condition, to prevent rupture.MethodsA patient was admitted with a giant asymptomatic RAA, measuring a maximum diameter of 11 cm on a serendipitous occasion.ResultsWe successfully accomplished a full embolization treatment for the aneurysm, exclusively utilizing inflow tract embolization techniques. Six months post-treatment, a follow-up abdominal ultrasound examination demonstrated a notable decrease in the aneurysm's diameter, signifying the positive outcome of our intervention.ConclusionsThis approach offers a feasible alternative in challenging cases, especially when traditional surgical methods are not feasible or carry significant risks.

The chimney technique (ChEVAR) allows to reconstruct chimney arteries for endovascular repair of ruptured abdominal aortic aneurysms (rAAAs). The present study aimed to assess ChEVAR outcomes for rAAA repair. All ChEVAR cases performed on patients deemed unfit for open repair and admitted exclusively through the emergency department at two university hospitals from December 2013 to November 2021 were included. Procedure-related and all- cause mortality and intervention rates were assessed. Thirty-three patients (30 male; mean age 67.3 years, range 30–83 years) were included. Five patients accepted ChEVAR after EVAR. Thirty-two aortic stent-grafts (SGs) were selected, including four types in all cases. Branch arteries included renal (n=50, 69.4%), superior mesenteric (SMA; n=17, 23.6%), and coeliac (n=5, 6.9%). Visceral reconstruction encompassed the renal artery (n=15, 46.9%), SMA (n=3, 9.4%), coeliac artery (n=1, 3.1%), renal artery + SMA (n=10, 31.2%), and SMA + renal artery + celiac trunk (n=4, 12.5%). In-hospital mortality was 12.5% (n=4). Five patients developed renal insufficiency, while sepsis, pneumonia, and type IV endoleak occurred in one patient (each). Seven patients died during follow-up. The estimated patient survival rate was 87.8%, 82.3%, 75.4%, and 64.7% at 12, 48, 60, and 72 months, respectively. Reintervention rate was 100%, 93.6% and 87.1% at 24, 36 and 48 months, respectively. Although rAAA patients may experience complications such as aortic-related mortality and renal dysfunction after chimney procedures, their long-term prognosis appears favorable and acceptable. ChEVAR may thus be an optimal treatment option for patients with rAAAs undergoing emergent intervention.