OBJECTIVE:The optimal timing for elective infrarenal abdominal aortic aneurysm (AAA) repair in men remains uncertain, particularly among patients with varying comorbidities. A microsimulation model was used to evaluate how patient risk and aneurysm behaviour influence survival outcomes when repair is delayed or expedited. METHODS:This was a Monte Carlo simulation study. A ten year microsimulation compared elective endovascular aortic repair (EVAR) and open surgical repair (OSR) in men with an initial infrarenal AAA diameter of 55 mm. Eight scenarios were simulated: four risk groups by age, renal function, and chronic obstructive pulmonary disease, each for EVAR and OSR, with 10 000 patients per scenario. The model incorporated aneurysm growth, rupture risk, and baseline and peri-operative mortality, and evaluated treatment thresholds from 55 - 75 mm. The primary outcome was the diameter threshold minimising all cause mortality; the secondary outcome was maximising cumulative life years (CLYs). RESULTS:Optimal thresholds for minimising mortality were consistent across risk groups, ranging from 56 - 57 mm for EVAR and 55 - 57 mm for OSR. Thresholds maximising CLYs for EVAR remained stable between 55 mm and 57 mm. For OSR, thresholds increased with patient risk, ranging from 57 mm in low risk patients to 64 mm in high risk patients. In high risk patients undergoing OSR, treatment at 55 mm instead of at the CLY optimal threshold of 64 mm resulted in a loss of 2.1% of CLYs (95% confidence interval 1.7% gain to 5.8% loss). Sensitivity analyses demonstrated minimal impact of variation in out of hospital death, peri-operative death, rupture rates, and growth rates on mortality optimal thresholds, while CLY optimal thresholds, particularly for OSR, showed greater variability. CONCLUSION:Optimal elective AAA repair thresholds differ depending on the outcome prioritised. Mortality minimising thresholds were stable across risk groups, whereas CLY optimal thresholds varied substantially, particularly for OSR in high risk patients. Patient life expectancy emerged as the dominant determinant of optimal timing, supporting a more individualised, risk based approach to AAA management.

Background/Objectives: Nuclear receptor corepressors NCOR1 and NCOR2 are key regulators of transcriptional repression, chromatin remodelling, and immunometabolic signalling. While NCOR1 has already been linked to vascular biology, its relevance in abdominal aortic aneurysm (AAA) remains unclear, particularly for NCOR2. This study aimed to investigate the expression, cellular localisation, and molecular interactions of NCOR1/2 in human AAA tissue. Methods: Human AAA samples (elective and ruptured) (n = 45) and non-aneurysmal control aortas (n = 18) were obtained from our Swiss Vascular Biobank. Transcriptomic profiling was performed using ribosomal RNA-depleted RNA sequencing. Differential expression and correlation analyses were performed using DESeq2/EdgeR and Spearman rank correlation with Benjamini-Hochberg correction. Cellular localisation was assessed through immunohistochemistry (IHC). Results: Bulk transcriptomic analyses showed no significant differences in NCOR1 or NCOR2 expression between AAA and controls. IHC revealed that NCOR1 was found in endothelial cells (ECs), smooth muscle cells (SMCs), and inflammatory infiltrates, while NCOR2 was primarily associated with macrophages. Correlation analyses suggest that NCOR1 interacts with various cellular markers, proteolytic enzymes, inflammatory mediators, and epigenetic regulators, including the lncRNA MALAT1. NCOR2 showed distinct associations with remodelling enzymes, TGFB1 signalling, selective epigenetic modifiers, and lncRNA H19. Conclusions: The lack of transcriptional differences in NCOR1 and NCOR2 between AAA and controls does not exclude cell-type-specific regulation or functional relevance. The specific cellular distributions and molecular associations in human AAA imply that NCOR1 and NCOR2 play non-redundant roles in vascular remodelling, inflammation, and epigenetic regulation. Our findings highlight NCOR pathways as potential modulators of AAA pathophysiology and promising targets for future therapies.

Background/Objectives: the study aims to evaluate early outcomes of endovascular aneurysm repair (EVAR) using the ultra-low-profile MinosTM Abdominal Aortic Stent-Graft in elective and emergent infrarenal abdominal aortic aneurysm (AAA), and compare its performance with established EVAR devices. Methods: This retrospective single-centre study included 79 patients treated with the Minos stent-graft between September 2020 and August 2024. Primary endpoints were 30-day mortality and major adverse events (MAEs). Secondary outcomes included technical success, endoleak rates, sac dynamics, reintervention rates, and stent-graft patency. Imaging follow-up was performed on day 1, at 4-6 weeks, at 6-12 months, and annually thereafter. Results: The cohort (mean age 74.6 ± 8.2 years; 83.5% male) included 60 elective and 19 emergent cases, with high cardiovascular comorbidity and challenging anatomy (48.1% with iliac diameters < 7 mm and 16.5% < 5 mm; 20.3% hostile necks). Technical success rate was 93.7% (elective: 95.0%; emergent: 89.5%). Persistent endoleaks occurred in 14.0% of patients (type II 12.7%, type I 1.3%). Clinical success was achieved in 88.6% (elective: 90.0%; emergent: 84.2%). Six-month survival was 96.1% in the elective and 89.5% in the emergent cohort. MAEs were more frequent in emergent cases: acute kidney failure (31.6% vs. 3.3%; p = 0.004) and pneumonia (31.6% vs. 0.0%; p < 0.001). Mean follow-up was 12.5 ± 9.9 months (median 9.3). Reinterventions were required in 16.5% within 30 days, more frequently in emergent cases (31.6% vs. 11.7%, p = 0.041). Sac regression ≥5 mm occurred in 43.0%. No stent-graft migrations or infections were reported. Conclusions: Minos demonstrated reliable performance and safety in elective and emergent EVAR with excellent anatomical applicability due to its ultra-low-profile design.

Background: The parallel stent graft endovascular aortic repair (PGEVAR) technique is an off-the-shelf option used for elective complex abdominal aortic aneurysm repair with acceptable outcome results, as reported so far. The PGEVAR technique, using chimney or periscope parallel grafts, can also be used for patients with ruptured complex abdominal aortic aneurysms. However, only few data about the mid- to long-term outcomes are available. Methods: Data from patients treated between August 2009 and July 2023 with the PGEVAR technique for ruptured complex abdominal aortic aneurysms were analyzed. The endpoints of this study were primary and secondary technical success, perioperative mortality, rate of proximal type 1a (gutter) endoleaks (T1aEL), and overall and aneurysm-related survival. Secondary endpoints were major adverse events, durability of parallel grafts, and factors associated with overall survival. Results: Twenty patients (mean age: 77 ± 9 y; 18 male) with ruptured complex abdominal aortic aneurysm were treated, receiving PGEVAR for ruptured juxtarenal (n = 11), suprarenal (n = 7), or distal thoracoabdominal Crawford IV aortic aneurysms (n = 2) with a mean diameter of 82 ± 18 mm (range 59–120). The patients had PGEVAR with implantation of 39 parallel grafts (1.95 PGs per patient; 23 chimney and 16 periscope) for revascularization of the celiac artery (n = 3), superior mesenteric artery (n = 9), and renal arteries (n = 27). Three patients had delayed PG implantation within 10 days. Primary technical success was 15/20 (75%) with five patients having an early proximal T1aEL, three of them having successful reintervention (secondary success rate: 18/20; 90%), with no persistent bleeding. Two patients had late T1aELs. The presence of an early T1aEL was related to the number of PGs (≥2) implanted (p = 0.038) or insufficient aortic SG oversizing (p = 0.038). In-hospital mortality was 1/20 (5%). Perioperative mortality up to 32 days was 3/20 (15%), with two further late aneurysm-related deaths and eight late aneurysm-unrelated deaths (overall mortality 13/20; 65%) during follow-up (median 34 months; range 1–115). Major adverse events were observed in 11 (55%) patients. Secondary parallel stent graft patency at 1 and 3 years was 97.4 and 94.1%. During follow-up, aneurysm sac behavior was determined in 19 patients, which showed diameter progression (n = 3), stable aneurysm disease (n = 3), and aneurysm diameter regression in 13 (68.4%) patients. Overall survival was 75% after 1 year, and 53% and 22% after 3 and 5 years. Factors associated with overall long-term survival were age < 80 years (p = 0.037), juxtarenal aneurysms (p = 0.023), the absence of major adverse events (p = 0.025), and aneurysm sac regression (p = 0.003). Conclusions: Treatment of ruptured complex abdominal aortic aneurysm with the PGEVAR technique is associated with acceptable perioperative and long-term outcomes with high PG patency rates. Early proximal T1aELs are observed with a relevant frequency, requiring early reintervention with successful sealing of most relevant endoleaks. To note, limitation of the number of parallel stent grafts implanted at the proximal aortic sealing sites, sufficient PG sealing length, and adequate main aortic SG oversizing are most relevant to avoid T1a (gutter) ELs. The selection of juxtarenal aortic aneurysms and evidence for aneurysm sac diameter regression after PGEVAR had a prognostic impact.

Objective: Complex abdominal aortic aneurysms (cAAA) pose a clinical challenge. The aim of this study was to assess the 30 day mortality and morbidity rates for open aneurysm repair (OAR) and fenestrated or branched endovascular aortic repair (F/B-EVAR), and the effect of hospital volume in patients with asymptomatic cAAA in Switzerland. Methods: Retrospective, cohort study using data from Switzerland's national registry for vascular surgery, Swissvasc, including patients treated from 1 January 2019 to 31 December 2022. All patients with asymptomatic, true, non-infected cAAA were identified. The primary outcome was 30 day mortality and morbidity rates reported using the Clavien-Dindo classification. Outcomes were compared between OAR and F/B-EVAR after propensity score weighting. Results: Of the 461 patients identified, 333 underwent OAR and 128 underwent F/B-EVAR for cAAA. At 30 days, the overall mortality rate was 3.3% after OAR and 3.1% after F/B-EVAR (p = .76). Propensity score weighted analysis indicated similar morbidity rates for both approaches: F/B-EVAR (OR 0.69, 95% CI 0.45- 1.05, p = .055); intestinal ischaemia (1.8% after OAR, 3.1% after F/B-EVAR, p = .47) and renal failure requiring dialysis (1.5% after OAR, 5.5% after F/B-EVAR, p = .024) were associated with highest morbidity and mortality rates. Treatment specific complications with high morbidity were abdominal compartment syndrome and lower limb compartment syndrome following F/B-EVAR. Overall treatment volume was low for most of the hospitals treating cAAA in Switzerland; outliers with increased mortality rates were identified among low volume hospitals. Conclusion: Comparable 30 day mortality and morbidity rates were found between OAR and F/B-EVAR for cAAA in Switzerland; lack of centralisation was also highlighted. Organ specific complications driving death were renal failure, intestinal ischaemia, and limb ischaemia, specifically after F/B-EVAR. Treatment in specialised high volume centres, alongside efforts to reduce peri-procedural kidney injury and mesenteric ischaemia, offers potential to lower morbidity and mortality rates in elective cAAA treatment.

Importance: Open surgical repair (OSR) should be prioritized for patients with asymptomatic abdominal aortic aneurysm (AAA) and long life expectancy, whereas endovascular repair (EVAR) is preferred for patients with suitable anatomy and life expectancy less than 2 to 3 years. However, life expectancy estimation and risk stratification are not well established. Objective: To evaluate risk-stratified survival differences between OSR and EVAR following elective AAA treatment. Design, Setting, and Participants: This cohort study used data from Danish national health registries. Patients older than 60 years undergoing elective AAA repair between 2004 and 2023 were categorized into 4 risk groups according to age, estimated glomerular filtration rate, and chronic obstructive pulmonary disease. Follow-up was until March 31, 2024. Exposure: OSR or EVAR for AAA. Main Outcomes and Measures: The primary outcome was overall survival. Secondary outcomes were incidence of AAA rupture and new cancer diagnosis. Comorbidities were balanced using inverse probability weighting. Kaplan-Meier estimators were generated for both treatments and the 4 risk score groups. Results: Of 6891 identified patients, 5757 (83.4%) were men. Women were older (median [IQR] age, 75.4 [70.9-79.3] vs 74.5 [70.5-78.5] years), more often had chronic obstructive pulmonary disease (156 women [13.6%] vs 512 men [8.9%]), and had lower estimated glomerular filtration rate (median [IQR], 68.4 [54.2-80.4] vs 70.4 [56.5-82.4] mL/min/1.73 m2) compared with men. The median follow-up was 8.28 years (95% CI, 8.10-8.50 years). OSR was associated with higher perioperative mortality in all risk groups. In low-risk patients, OSR was associated with a 10-month (95% CI, 2.2-18.3 months; P = .02) longer mean survival time restricted at 15 years compared with EVAR. In moderate-to-high-risk patients, OSR was associated with a 9-month (95% CI, 1.9-16.9 months; P = .008) shorter mean survival time restricted after 12.5 years compared with EVAR. No difference in mean survival time was seen in low-to-moderate-risk and high-risk patients at the study end. No differences in 10-year incidence of secondary AAA ruptures (OSR, 2.6% [95% CI, 1.9%-3.4%] vs EVAR, 2.2% [95% CI, 1.7%-2.7%]; P = .34) or solid malignant tumor (OSR, 18.6% [95% CI, 16.7%-20.5%] vs EVAR, 20.5% [95% CI, 18.9%-22.1%]; P = .35) were detected. Conclusions and Relevance: In this cohort study of 6891 patients with AAA, OSR was associated with higher perioperative mortality in all risk groups, but with longer mean survival only in low-risk patients. Conversely, EVAR was associated with longer mean survival in moderate-to-high-risk patients. These findings highlight the potential benefits of risk stratification when planning AAA treatment.

Baroreflex regulates blood pressure and heartbeat through specific mechanosensitive baroreceptors. However, the current knowledge is derived only from animal experiments. No data about human aortic baroreceptors have been reported so far. Therefore, in this study, we performed extended histological, proteomics and transcriptomics analyses of the aortic arch to identify potential human baroreceptors. Three healthy human aortic arches from autopsies, six abdominal aortic aneurysms and four control abdominal aortic tissue samples from our vascular biobank were analysed. For histological analyses, antibodies against various neuronal markers were used. Laser capture microdissection and macrodissection were performed to selectively analyse nerves in the adventitia of the human aorta using proteomics and RNA sequencing. Histological analysis revealed a heterogeneous distribution of nerves in the adventitia along the entire aortic arch, predominantly in the ascending aorta up to the left subclavian artery. Proteome analysis identified three putative human baroreceptors PIEZO1, TRPV2, and TRPM4. Transcriptomics confirmed that these ion channels do not originate from cells within the aortic wall but presumably from the cell body of the vagus nerve. Interestingly, these ion channels were also detected in the healthy abdominal aorta and abdominal aneurysm without any significant differences in their abundance. Our study identified, for the first time, putative baroreceptors in the human aortic arch. Further studies are necessary to validate our current results and elucidate the role of these putative baroreceptors in the human aortic arch.

BACKGROUND:Ruptured abdominal aortic aneurysms (rAAAs) remain as a great clinical challenge for vascular surgeons and endovascular aortic repair (EVAR), which is currently regarded as the first-line treatment for rAAA in patients with appropriate anatomy. While recommendations for management of type II endoleaks (T2ELs) are well-established in the elective setting, data after rAAAs are limited. METHODS:Between January 2018 and December 2022, all patients who were treated with EVAR for rAAA in three tertiary referral centers from different countries (Germany, Italy, and Switzerland) were screened for inclusion in the study. The patients were divided into two groups based on the presence or absence of early T2EL (at completion angiography or at first postoperative computed tomography angiography). The primary end points for this study were 30-day mortality and long-term survival. RESULTS:Overall, 123 patients were included in the final analysis. Of these, 73 were categorized as not having an early T2EL (group A) and 50 presented an early T2EL (group B). Except for a significantly lower proportion of males in group A as compared with group B (79.5% vs 92%; P = .05), no significant baseline differences were found. At 30 days, the overall mortality rate was not significantly different between study groups (22% vs 16%; P = .16). Using binary regression, the presence of a T2EL was not associated independently with 30-day mortality (odds ratio, 1.712; 95% confidence interval, 0.591-3.964; P = .54). Five-year survival estimates in the whole study cohort did not show any significant difference in patients without a T2EL as compared to those with a T2EL (53% vs 59%; log-rank P = .31). Using Cox proportional hazard regression, the presence of T2ELs was not independently associated with increased risk for long-term mortality (hazard ratio. 1.068; 95% confidence interval, 0.437-2.611; P = .079). CONCLUSIONS:Although the occurrence of a T2EL seems to be a relatively common scenario after EVAR for rAAA, their presence does not seem to be associated with worse outcomes in the immediate perioperative period or to decrease long-term survival. Therefore, careful observation may be warranted in the early phase, with selective treatment only in cases of ongoing hemodynamic decompensation. In the long run, it seems prudent to assume that the same indication for treatment as for standard EVAR could be recommended in the presence of T2EL.

Thoracic endovascular aortic repair (TEVAR) is the standard treatment for pathologies in the distal aortic arch and descending aorta. In up to 50% of cases a landing in Ischimaru zone 2 is necessary to achieve a safe seal, whereby perfusion of the left subclavian artery (LSA) should be maintained to prevent stroke and ischemia. For revascularization of the LSA open surgical procedures, such as a carotid-subclavian/axillary bypass and LSA transposition as well as endovascular approaches, such as branched (bTEVAR) and fenestrated endoprostheses (fTEVAR) are available. Endovascular techniques include custom made (CMD), off the shelf and physician-modified devices (PMD), with the latter being subdivided into ex situ and in situ modifications. Another method is the parallel graft technique. The choice of technique depends on the anatomy of the patient, the technical possibilities and the expertise of the surgeon/interventionalist. The bTEVAR prostheses are technically demanding and often require additional manipulation. The fTEVAR prostheses require a closer alignment to the aortic wall and therefore necessitate a greater distance from the aortic pathology. The CMD prostheses offer maximum precision but are expensive and not always available. Off the shelf and PMD prostheses offer more flexibility, whereby PMDs require special expertise and equipment. The parallel graft technique is used as a bailout strategy. Future developments are aimed at standardized, more cost-effective solutions but long-term results are still lacking. Larger studies are needed to determine the optimal technique. This article provides an overview of current endovascular debranching techniques for LSA and discusses the advantages and disadvantages.

Zusammenfassung Die thorakale endovaskuläre Aortenreparatur (TEVAR) ist die Standardtherapie für Pathologien im distalen Aortenbogen und der Aorta descendens. In bis zu 50 % der Fälle ist eine Landung in der Ischimaru-Zone 2 notwendig, um eine sichere Abdichtung zu erreichen, wobei die Perfusion der linken A. subclavia (LSA) erhalten bleiben sollte, um Schlaganfälle und Ischämien zu vermeiden. Zur Revaskularisierung der LSA stehen offene chirurgische Verfahren wie der karotidosubklaviale/axilläre Bypass und die LSA-Transposition sowie endovaskuläre Ansätze wie gebranchte (bTEVAR) und fenestrierte Endoprothesen (fTEVAR) zur Verfügung. Endovaskuläre Techniken umfassen „custom-made“ (CMD), Off-the-Shelf- und Physician-modified-Devices (PMD), wobei letztere in Ex- und In-situ-Modifikationen unterteilt werden. Eine weitere Methode ist die Parallelgrafttechnik. Die Wahl der Technik hängt von der Anatomie des Patienten, den technischen Möglichkeiten und der Expertise des Behandlers ab. bTEVAR-Prothesen sind technisch anspruchsvoll und erfordern oft zusätzliche Manipulationen. fTEVAR benötigen eine engere Lagebeziehung zur Aortenwand und erfordert daher einen größeren Abstand zur Aortenpathologie. CMD-Prothesen bieten höchste Präzision, sind jedoch teuer und nicht immer verfügbar. Off-the-Shelf- und PMD-Prothesen bieten mehr Flexibilität, wobei PMDs spezielle Expertise erfordern. Die Parallelgraft-Technik wird als Bailout-Strategie eingesetzt. Zukünftige Entwicklungen zielen auf standardisierte, kostengünstigere Lösungen ab, jedoch fehlen noch Langzeitergebnisse. Größere Studien sind notwendig, um die optimale Technik zu bestimmen. Der Artikel gibt einen Überblick über die aktuellen endovaskulären Debranching-Techniken der LSA und diskutiert deren Vor- und Nachteile.

SCOPE:Vascular graft or endograft infection (VGEI) is a severe complication requiring a multidisciplinary approach combining surgery and antimicrobial therapy. This study aimed to develop expert consensus on the management and follow-up of VGEI, with a focus on antimicrobial strategies. METHODS:A modified Delphi method was conducted to reach consensus on key aspects of VGEI care, including antimicrobial treatment, surgical management, and follow-up. An expert panel representing infectious diseases, vascular and cardiothoracic surgery, microbiology, and nuclear medicine participated in four rounds of surveys. Ten general and 35 specific statements were rated using a five-point Likert scale. Statements with ≥75% agreement (agree/strongly agree) were considered to have achieved consensus. Internal consistency across rounds was assessed using Cronbach's alpha (>0.80). QUESTIONS ADDRESSED BY THE DELPHI METHOD AND RECOMMENDATIONS:The panel agreed that empirical antimicrobial therapy should be initiated only in patients with complications (e.g. sepsis and bleeding) or when diagnostic intervention is delayed. Empirical therapy must be individualized based on graft location and risk factors. For abdominal VGEI without aorto-enteric fistula and unknown pathogens, initial coverage should target gram-positive cocci, gram-negative bacilli, and anaerobes, with consideration for Methicillin-Resistant Staphylococcus aureus (MRSA)/Methicillin-Resistant Staphylococcus epidermidis (MRSE) based on risk. For thoracic VGEI without fistula, gram-positive coverage is prioritized, with optional MRSA coverage. Postoperative treatment duration should be individualized. In cases of complete graft removal and replacement with autologous veins, a 6-week antibiotic course is recommended, with early oral switch if bioavailable options are available. If prosthetic material remains, at least 4 to 6 weeks of intravenous therapy followed by oral treatment for a total of 12 weeks is advised. Prolonged therapy should be considered in cases with virulent pathogens, incomplete source control, or persistent inflammatory markers. The study provides practical, expert-based antimicrobial guidance for VGEI management and emphasizes the importance of individualized, microbiologically informed therapy within a multidisciplinary care framework.

Objective: Current guidelines recommend diameter monitoring of small and asymptomatic abdominal aortic aneurysms (AAAs) due to the low risk of rupture. Elective AAA repair is recommended for diameters >= 5.5 cm in men and >= 5.0 cm in women. However, data supporting the efficacy of elective treatment for all patients above these thresholds are diverging. For a subgroup of patients, life expectancy might be very short, and elective AAA repair at the current threshold may not be justified. This study aimed to externally validate a predictive model for survival of patients with an asymptomatic AAA treated by endovascular aneurysm repair (EVAR). Methods: This was a multicentre international retrospective observational cohort study. Data were collected from four European aortic centres treating patients between 2001 and 2021. The initial model included age, estimated glomerular filtration rate (eGFR), and chronic obstructive pulmonary disease (COPD) as independent predictors for survival. Model performance was measured by discrimination and calibration. Results: The validation cohort included 1 500 patients with a median follow up of 65 months, during which 54.6% of the patients died. The external validation showed slightly decreased discrimination ability and signs of overfitting in model calibration. However, a high risk subgroup of patients with impaired survival rates was identified: octogenarians with eGFR < 60 OR COPD, septuagenarians with eGFR < 30, and septuagenarians with eGFR < 60 and COPD having survival rates of only 55.2% and 15.5% at five and 10 years, respectively. Conclusion: EVAR is a valuable treatment option for AAA, especially for patients unsuitable for open repair. Nonetheless, not all these patients will benefit from EVAR, and an individualised treatment recommendation should include considerations on life expectancy. This study provides a risk stratification to identify patients who may not benefit from EVAR using the present diameter thresholds.

Background: Complex endovascular repair with fenestrated or branched stent grafts is a common approach for treating various types of aortic aneurysms. Bridging stent grafts (BSs) are crucial in connecting aortic endoprosthesis to target vessels, yet current options have demonstrated significant complications. Objective: This retrospective single-center study evaluates the initial outcomes and durability of the iCover stent graft (iCover-SG) when used as a BS in fenestrated endovascular aneurysm repair (FEVAR). Methods: Retrospective analysis screened procedures for complex aortic aneurysms between August 2021 and January 2024. Patients who underwent FEVAR with iCover-SG as BS were included. Primary and secondary endpoints focused on freedom from iCover-SG-related target vessel instability, technical success, and postoperative outcomes. Results: Within the cohort of 28 patients, 94 iCover-SGs were used as BS, supplying 87 target vessels. The freedom from iCover-SG-related target vessel instability throughout the study reached 94% (82/87). Technical success rates were notably high, with primary success achieved in 94% of cases and secondary success in 99%. Over the follow-up duration, there were instances necessitating reintervention related to iCover-SG, including 4 cases of endoleak, 2 cases of T1cEL, and 2 cases of T3cEL. In-hospital mortality was 7% (n=4), with 2 cases attributed to intraoperative complications. Importantly, no deaths were directly attributed to iCover-SG-related issues. Conclusion: The iCover-SG demonstrates promising initial outcomes as a BS in FEVAR, with high technical success rates and satisfactory rates of target vessel instability. Continued monitoring and further studies are warranted to assess long-term durability and outcomes. Clinical Impact This study shows that the iCover stent graft achieves satisfactory technical success and target vessel stability in the short- and mid-term when used as a bridging stent graft in FEVAR procedures. Its successful integration into clinical practice broadens the range of available options, providing clinicians with more versatile tools for managing complex endovascular aortic aneurysms. This expanded selection of bridging stent grafts allows for more personalised treatment strategies, improving procedural precision and patient outcomes. The iCover stent graft’s reliable performance highlights its potential as a valuable addition to current endovascular techniques, ultimately enhancing patient care in challenging cases.

Background/Objectives: A popliteal artery aneurysm (PAA) is traditionally treated by an open PAA repair (OPAR) with a popliteo–popliteal venous graft interposition. Although excellent outcomes have been reported in elective cases, the results are much worse in cases of emergency presentation or with the necessity of adjunct procedures. This study aimed to identify the risk factors that might decrease amputation-free survival (efficacy endpoint) and lower graft patency (technical endpoint). Patients and Methods: A dual-center retrospective analysis was performed from 2000 to 2021 covering all consecutive PAA repairs stratified for elective vs. emergency repair, considering the patient (i.e., age and comorbidities), PAA (i.e., diameter and tibial runoff vessels), and procedural characteristics (i.e., procedure time, material, and bypass configuration). Descriptive, univariate, and multivariate statistics were used. Results: In 316 patients (69.8 ± 10.5 years), 395 PAAs (mean diameter 31.9 ± 12.9 mm) were operated, 67 as an emergency procedure (6× rupture; 93.8% severe acute limb ischemia). The majority had OPAR (366 procedures). Emergency patients had worse pre- and postoperative tibial runoff, longer procedure times, and more complex reconstructions harboring a variety of adjunct procedures as well as more medical and surgical complications (all p < 0.001). Overall, the in-hospital major amputation rate and mortality rate were 3.6% and 0.8%, respectively. The median follow-up was 49 months. Five-year primary and secondary patency rates were 80% and 94.7%. Patency for venous grafts outperformed alloplastic and composite reconstructions (p < 0.001), but prolonged the average procedure time by 51.4 (24.3–78.6) min (p < 0.001). Amputation-free survival was significantly better after elective procedures (p < 0.001), but only during the early (in-hospital) phase. An increase in patient age and any medical complications were significant negative predictors, regardless of the aneurysm size. Conclusions: A popliteo–popliteal vein interposition remains the gold standard for treatment despite a probably longer procedure time for both elective and emergency PAA repairs. To determine the most effective treatment strategies for older and probably frailer patients, factors such as the aneurysm size and the patient’s overall condition should be considered.

Comparative sonographic examination of the renal resistance index (RRI) can provide evidence of renal artery stenosis. The extent to which the RRI is changed after stent graft implantation is not known. The aim of this study was to investigate the influence of stent graft implantation into non-diseased renal arteries during endovascular treatment of pararenal aortic aneurysms on the RRI. Sonographic examinations of the kidneys were conducted using a GE ultrasound system. The evaluation was performed according to the European Society for Vascular Surgery (ESVS) 2D standard criteria. RRI values were determined in consecutive patients on the day before and after stent graft implantation and compared for each kidney. A total of 32 consecutive patients (73.9 ± 8.2 years, 5 females, 27 males) were treated with a fenestrated or branched aortic stent graft including bridging stent graft implantations into both renal arteries and received pre- and postinterventional examinations. Sonomorphologically, the examined kidneys were inconspicuous. The arborisation of the renal perfusion was preserved pre- and post-implantation. The RRI did not differ (0.66 ± 0.06 versus 0.67 ± 0.07; p = ns). Successful stent graft implantation into non-stenosed renal arteries did not lead to a relevant change in RRI. Therefore, the RRI is a suitable tool for assessing renal perfusion after fenestrated or branched endovascular aortic therapy.