Background:The simplified delivery frozen elephant trunk (SD-FET) technique enables a one-step repair of type A acute aortic dissection (AAD) with stent proximalisation and very short normothermic circulatory arrest. This study reports early and 1-year clinical outcomes together with aortic remodelling in the residual dissected aorta. Methods:Thirty consecutive patients underwent SD-FET for AAD between 2018 and 2023. Preoperative, postoperative, 1-year follow-up computed tomography scans were analyzed. True lumen (TL), false lumen (FL), and total aortic diameters were measured in four segments (proximal descending, distal descending, coeliac trunk, infra-renal) using the centerline method. Aortic remodelling was classified as positive, stable, or negative. Early and mid-term outcomes were assessed, including mortality, neurologic complications, and aortic reinterventions. Results:Four patients (13%) died in-hospital, and four (13%) sustained postoperative stroke; no spinal cord injury occurred. During follow-up, one patient died of an aortic event and two required secondary reinterventions for downstream enlargement, yielding an overall 1-year freedom from reintervention of 92.5% [95% confidence interval (CI): 83-100%]. At the proximal descending aorta, TL increased and FL decreased significantly at 3 months and 1 year (P<0.001), with 92% of patients showing positive or stable remodelling. At the distal descending aorta and coeliac level, positive/stable remodelling was observed in 53% and 63% of cases, respectively, whereas infra-renal changes were limited. Conclusions:SD-FET simplifies total arch repair for AAD, reduces circulatory arrest under normothermia, and achieves acceptable early results. One-year clinical outcomes and remodelling are comparable to conventional FET, may supports its safety and efficacy, though larger cohorts and longer follow-up remain warranted.

Objective:Fenestrated and branched endovascular aortic repair (F/BEVAR) is increasingly used to treat complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs) because of their minimally invasive nature compared with open repair. However, data on outcomes in young patients remain limited. The aim of this study was to report 24-month outcomes in patients ≤65 years of age who underwent F/BEVAR. Methods:This retrospective bicenter cohort study included consecutive patients treated for complex abdominal aortic aneurysm or TAAA with F/BEVAR between 2016 and 2023 at Nantes and Rennes University Hospitals. Preoperative, intraoperative, and postoperative data were prospectively collected. Data were compared between patients ≤65 years of age and those >65 years of age. Follow-up analyses were performed at 24 months. Results:Among the 254 patients included, 24.8% were aged ≤65 years (n = 63). In the preoperative assessment, patients ≤65 years more frequently had TAAA (44.4% vs 19.9%; P < .001), a history of aortic dissection (19.0% vs 4.2%; P < .001), and prior aortic surgery (43.0% vs 28.0%; P = .046). Primary technical success was similar between the groups (96.8% vs 94.2%; P = .632). Thirty-day all-cause mortality was 3.2% in patients ≤65 years, similar to that observed in patients >65 years (4.2%; P = .90). Rates of postoperative medical complications within 30 days were also comparable, including acute kidney injury (7.9% vs 8.4%) and paraplegia (1.6% vs 0%). Surgical complications were mainly access related (6.3% vs 4.7%), with no significant difference between groups (P = .57). At 2 years, rates of endoleaks, stent occlusion, and reintervention for any cause were similar between groups. However, endovascular reintervention for branch stent placement was more frequent in patients ≤65 years (30.2% vs 10.5%; P < .001). Twenty-four-month mortality was 13.0% (11.1% vs 13.6%; P = .620). A trend toward greater aneurysm sac regression was observed in younger patients (-10.1% vs -4.4%; P = .10). Conclusions:Overall, outcomes after F/BEVAR were similar in patients ≤65 years of age compared with older patients, despite more extensive aneurysmal disease at baseline. The need for close surveillance of target vessels in these patients is confirmed, consistent with the higher prevalence of underlying and progressive aortic dissection.

OBJECTIVE:The aim of this study was to assess the use and early and midterm outcomes of carotid bypass surgery in a large, multicentre, real world cohort. METHODS:This retrospective multicentre study included consecutive patients who underwent carotid bypass surgery in 12 French centres between January 2010 and October 2023. The primary endpoint was the thirty day composite of any stroke and or death. Secondary endpoints included procedure related complications, midterm primary patency, and ipsilateral ischaemic stroke. RESULTS:Four hundred and fifty-nine patients were analysed (mean age 70 years; 80.4% men). Carotid bypass was performed intra-operatively as a bailout during carotid endarterectomy in 51.2% of cases and was scheduled pre-operatively in 48.8% for complex carotid lesions, including re-stenosis, long lesions, associated aneurysms, or post-radiation stenosis. The primary endpoint occurred in 5.8% (27 of 459), including stroke in 4.3% and death in 2.8%; 5.4% of asymptomatic and 6.9% of symptomatic patients experienced the primary endpoint. Prosthetic grafts were used in 69.7% of cases and autologous vein grafts in 30.1%. Use of prosthetic material (odds ratio [OR] 5.35, 95% confidence interval [CI] 1.19 - 24.14; p = .046) and diabetes (OR 2.41, 95% CI 1.01 - 5.73; p = .048) were independently associated with increased risk of thirty day stroke and or death, whereas statin therapy was protective (OR 0.26, 95% CI 0.11 - 0.66; p = .005). During follow up (median 2.7 years, interquartile range 0.8, 5.7), the cumulative Kaplan-Meier estimate of primary patency was 100%, 98.2%, and 97.1% at 1, 3, and 5 years, respectively. CONCLUSION:In this multicentre cohort, carotid bypass surgery was used in selected complex situations and appeared to be associated with a potentially unacceptable excess risk in asymptomatic patients. In symptomatic patients, outcomes slightly exceeded guideline recommended benchmarks but may remain clinically acceptable; accordingly, its use should be restricted to selected cases, primarily as a bailout strategy or when standard revascularisation is unfeasible in those at highest risk of neurological recurrence.

BACKGROUND:Fenestrated and branched endovascular aortic repair (F-BEVAR) is a safe and effective treatment for complex aortic aneurysms. However, the risk of postoperative renal impairment in patients with a solitary functional kidney (SFK) remains unclear. The aim of this study was to evaluate the mid-term outcomes after F-BEVAR in this patient group. METHODS:Consecutive patients who underwent F-BEVAR between 2016 and 2021, including nine patients with SFK, were included from a prospectively managed database. Endpoints were the occurrence of acute kidney injury (AKI) according to the RIFLE criteria, deterioration of renal function, initiation of dialysis, and mortality between the two groups. Predictive factors were determined by univariate and multivariate analyses. RESULTS:A total of 124 patients (65.3% male, 71.4 ± 8.6 years old), including nine patients with one SFK (7.3%) and 115 (92.7%) with two functioning kidneys, were analyzed. Stage III and IV chronic kidney disease (CKD) was significantly more common in the SFK group (77.8% vs. 26.1%, P = 0.003), with a significantly higher number of patients with stage IV CKD (22.2% vs. 2.7%, P = 0.004). Postoperative AKI incidence was similar in the SFK and control groups (22.2% vs. 21.7%, P = 0.973). At a mean follow-up of 24 months, deterioration of renal function (>25% decrease in eGFR) occurred in 44.4% of SFK patients vs. 20.9% of the control group (P = 0.120)); permanent dialysis was significantly more frequent in the SFK group (22.2% vs. 0.9%, P = 0.0001); and survival at 1 and 3 years did not differ significantly between groups. SFK was not predictive of AKI within the first 30 days or during follow-up. Postoperative AKI was a significant predictor of progression of CKD and mid-term mortality. CONCLUSION:The study found similar rates of postoperative acute renal failure and mortality between patients with a single functioning kidney (SFK) and those with two kidneys, but long-term dialysis was more frequent in SFK patients. Postoperative acute renal failure predicted chronic kidney failure and long-term mortality, suggesting that renal outcomes are more closely related to baseline kidney function than kidney volume.

PURPOSE:To analyse predictors of aortic complications (ACs) and outcomes of patients admitted for acute type B intramural haematoma (IMH-B). METHODS:A retrospective analysis of data of patients diagnosed with acute IMH-B from 7 French tertiary centres between December 2003 and December 2019 was conducted. Baseline demographics, initial anatomical features, indication and treatment modality during the acute phase including either thoracic endovascular aortic repair (TEVAR) and optimal medical therapy (OMT) or OMT alone were recorded. The primary endpoint was the occurrence of any AC during follow-up, defined as a composite criterion including aortic rupture, ulcer-like projection, aortic dissection or aneurysmal degeneration. Secondary endpoints included freedom from all-cause mortality and from aortic-related intervention. RESULTS:Eighty-one patients (52% male, median age 72 [62-77]) were included. Medical therapy initiated during the acute phase included more than 2 antihypertensive drugs in 39 (48%) patients. Nine patients (11%) underwent urgent (<24 hours) TEVAR for frank or impending rupture. Fourteen (19%) underwent TEVAR within 30 days for OMT failure. Of these, 8 were AC-related including 6 patients treated for rapid aortic growth. The overall 30-day mortality was 4.9% (n = 4), 2 patients died after TEVAR. The median follow-up was 34 months (7-53). Overall, 43 ACs occurred at a median time of 6 months (1-36). The 1- and 3-year estimate survival and freedom from AC were 88% (81-96) and 86% (78-95), and 60% (50-73) and 53% (42-67), respectively. By Cox regression analysis, previous aortic surgery (hazard ratio [HR] = 3.5 [1.2-10.3]; P = .025) and the maximum aortic true lumen diameter at admission (HR [per 1 mm increment] = 1.07 [1.02-1.13]; P = .009) were predictors of AC. CONCLUSION:After acute type B IMH, ACs are most prevalent within the first year, mandating close early clinical and imaging follow-up. Larger presenting aortic lumen maximum diameter is associated with increased likelihood of AC.Clinical ImpactIntramural haematoma (IMH) is a rare condition. While invasive treatment with thoracic stent-grafts has become the standard of care for complicated cases, treatment indications during the acute phase remain a matter of debate, and the natural history of the condition is not fully understood. This study, which included 81 patients with type B IMH (IMH-B), suggests that a presenting aortic lumen diameter greater than 27 mm and a history of aortic surgery are predictive for the risk of ACs after acute IMH-B, mandating closer imaging and clinical monitoring.

Persistent false lumen perfusion of the remaining dissected aorta after open or endovascular aortic repair remains a major determinant of late aneurysmal growth and reintervention, often driven by complex and sometimes unexpected haemodynamic mechanisms. This case involves a 77-year-old man with progressive false lumen enlargement following staged hybrid repair of a chronic type A aortic dissection. Despite apparently successful gutter embolisation around a Candy Plug, intraoperative transoesophageal echocardiography (TEE) revealed persistent false lumen flow. Careful TEE assessment identified an unexpected proximal intercostal artery as the source of reperfusion. Selective catheterisation and coil embolisation of this artery were successfully performed under combined TEE and fusion imaging guidance, achieving immediate and durable exclusion. This case highlights the unique value of intraoperative TEE as a real-time haemodynamic imaging tool that can detect endoleaks missed by angiography and directly guide therapeutic decision-making in complex aortic dissections.

Several different forms of endovascular arch repair are available in practice today. Custom-made devices, represented by fenestrated and branched endografts, have emerged as the first line in endovascular repair and offer broad applicability. Off-the-shelf devices are becoming more common, but emergent repair is still most likely to use in situ fenestration or physician-modified endograft techniques. The current outcomes of these devices are encouraging, even if total endovascular arch repair presents limitations. Careful patient selection, based on anatomical features and previous medical history, and the presence of a well-developed aortic team are the 2 key factors that ensure good outcomes after endovascular repair.

Buts de l’étude La chirurgie carotidienne par endartériectomie est actuellement remise en cause à la fois par l’amélioration des traitements médicamenteux mais aussi par les techniques endovasculaires. Nous avons réalisé une étude multicentrique (TREC) à la recherche de facteurs de risques chirurgicaux de resténoses carotidiennes par hyperplasie myo-intimale. Le but de cette présentation est de rapporter les principaux résultats de cette étude dont le taux cumulé de morbi-mortalité (TCMM) et les taux de resténoses précoces. Matériel et méthodes Après accord du Comité d’éthique (2021-133), nous avons inclus tous les patients opérés d’une endartériectomie carotidienne par éversion dans 8 hôpitaux publics français entre septembre 2021 et novembre 2022. Nous avons recueilli les données démographiques et indications opératoires, ainsi que les complications opératoires dont les décès précoces et accidents vasculaires cérébraux (AVC) définissant le TCMM, ainsi que les taux de resténoses précoces à 1 an. Résultats Nous avons inclus 601 patients dont 417 hommes (70 %) de 73 ans±9 d’âge moyen. Ils ont été opérés pour des sténoses carotidiennes quantifiées<50 %, entre 50 et 69 % et>70% dans 2 %, 15 % et 83 % des cas respectivement. Celles-ci étaient symptomatiques et asymptomatiques dans 36,3 % et 63,7 % des cas. Durant la période des 30 jours postopératoires, 2 décès et 9 AVC ont été recensés. Ces 11 complications majeures sont toutes survenues chez des patients opérés pour des sténoses symptomatiques sauf 1 avec 1 AVC controlatéral à j28 chez un patient initialement asymptomatique. Aussi le TCMM global de l’étude était de 1,8 %, le TCMM pour les patients symptomatiques était de 4,5 % et celui des patients asymptomatiques de 0,2 %. À 1 an nous avons observé 46 (9 %) resténoses>50 % et 11 (2,2 %) resténoses>70 %. Conclusion Même s’il ne s’agissait que d’un critère de jugement secondaire, le TCMM de l’étude TREC est bien inférieur aux diverses recommandations. Les taux de resténoses précoces sont ici également plus faibles que ceux rapportés dans la littérature. Ces résultats reflètent la qualité de la chirurgie carotidienne française et permettent de justifier la compétitivité de l’endartériectomie particulièrement pour les sténoses asymptomatiques.

BACKGROUND:Sex discrepancies in outcomes after fenestrated and branched endovascular aortic repair (FBEVAR) have recently been reported, with female sex being an independent predictor for worse perioperative outcomes. The aim of this study was to investigate sex-related outcomes after complex aortic aneurysm repair and factors associated with target vessel instability (TVI). METHODS:Retrospective analysis of a prospectively maintained database of patients treated with FBEVAR at a single tertiary center between January 2016 and December 2022. The primary endpoint was sex-specific morbidity at 30 days and target vessel instability after FBEVAR during follow-up. The secondary endpoint was factors independently associated with target vessel instability during follow-up. RESULTS:One hundred sixty-nine patients were included: 21 (12.4%) females and 148 (87.6%) males, mean age of 72.3 ± 9.6 and 73.0 ± 8.9 years, respectively. 30-day mortality was 1 patient in each group (4.7% vs. 0.6% P = 0.23). During the study period, deaths occurred in 4 (19.0%) females (including 1 aorta-related death) and 39 (26.4%) males (including 8 aorta-related deaths) (P = 0.81). The global cumulative incidence of TVI was 2.2% (95% confidence interval (CI) 1.2-3.8%) at 1 year, 6.3% (95% CI 4.3-9.0%) at 2 years and 10.5% (95% CI 7.7-14.3%) at 5 years with no significant differences between males and females. In multivariate analysis, longer stent length was independently associated with TVI for left renal artery and superior mesenteric artery (SMA), thoracoabdominal aneurysm for right renal artery and previous endovascular surgery for SMA. CONCLUSION:Similar results were reported for male and female after FBEVAR, with sex having no significant effect on TVI. Longer stent length, thoracoabdominal aneurysm rather than pararenal, FEVAR rather than BEVAR and previous endovascular surgery were factors independently associated with target vessel instability.

BACKGROUND:Carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) are the 2 surgical options for revascularization of the left subclavian artery (LSA) prior to coverage during thoracic endovascular aneurysm repair (TEVAR) in zone 2. This helps to prevent spinal cord injury by maintaining blood flow to the spine via the vertebral artery. The aim was to compare CSB with SCT prior to TEVAR regarding vertebral patency and surgical outcomes. METHODS:Bicentric retrospective comparative study of consecutive patients who underwent CSB or SCT for thoracic aortic disease (dissection, aneurysm, lusoria) from 2017 to 2022. RESULTS:Eighty-six patients were included: 41 bypasses and 49 transpositions. Median follow-up was 27 and 24.8 months, respectively. Indications for TEVAR were aneurysm (42.2%) and aortic dissection (57.8%). The complication rate was 24.4% for CSB versus 8.2% for SCT, including stroke (2.4 vs. 2%) and spinal cord injury (4.9 vs. 2%). At 2 years, 6 (14.6%) vertebral arteries and 3 (7.3%) grafts occluded in the CSB group, and 2 (4%) vertebral arteries occluded without LSA event among the SCT. CONCLUSION:In our experience, CSB prior to LSA coverage by TEVAR shows a higher rate of postoperative complications and a nonsignificant higher incidence of vertebral and LSA occlusion as compared to SCT.

Chronic venous obstruction affects thousands worldwide and may lead to severe long-term complications such as post-thrombotic syndrome (PTS), marked by pain, swelling, skin changes, and venous ulcers. Endovenous stenting has become a cornerstone in restoring venous outflow, yet surveillance strategies to detect stent dysfunction early remain unstandardized. Doppler ultrasound (DUS), widely available and non-invasive, holds potential as a monitoring tool, but lacks validated markers to guide long-term follow-up. In this retrospective study of 161 patients and over 1,100 DUS assessments, we examined the predictive value of hemodynamic parameters for stent dysfunction and PTS. Stent patency was assessed using DUS or CT venography, and PTS was defined by a Villalta score ≥ 5 at last follow up. Hemodynamic parameters were compared using univariate and multivariable logistic regression models. Significant stent stenosis or occlusion (≥ 50%) was more common in younger patients (mean age 37.7 vs. 48.2 years, p = 0.003), with risk increasing by 4.4% per year decrease in age (OR = 1.044, p = 0.008). Loss of respiratory modulation was strongly associated with stent dysfunction (p < 0.001). Patients who had PTS at last follow up, had lower venous flow (297 vs. 463 mL/min, p = 0.047), reduced peak velocity (p = 0.003), and impaired respiratory modulation (p = 0.017). These findings support using DUS-derived parameters for early, non-invasive detection of stent-related complications to improve long-term patient outcomes.

Objective: Aortic aneurysms (AAs) and intracranial aneurysms (IAs) are two serious conditions that occur together in 7.2% and 11.8% of cases, respectively. The aim of this study was to find common risk factors between AAs and IAs that could be used for targeted screening of combined disease. Methods: Retrospective data were collected from consecutive patients with a combined condition (AA + IA, target group, taken from our Biomedical Data Warehouse from 2012 to 2020) and compared with two control groups: a first control group of patients operated on for an AA without IA (taken from a prospectively maintained database) and a second control group of patients with IA only (taken from the national ICAN database). Univariate and multivariate analyses were performed to compare the target group with each control group. Results: We included 67 patients with combined disease, 153 with isolated AA and 128 with isolated IA. In patients with AA, the patient characteristics associated with an increased risk of also having IA were peripheral arterial occlusive disease (odds ratio [OR], 3.02; P = .007) and multiple sites of AA (OR, 2.97; P = .002). Among patients with an IA, the following characteristics were associated with an increased risk of also having an AA: hypertension (OR, 3.28; P = .0005), coronary artery disease (OR, 12.07; P < .0001), and peripheral artery disease (OR, 4.14; P = .0001). The location of IA in the anterior communicating artery tended to lead to an increased risk of having AA (OR, 1.92; P = .09). Conclusions: This pilot study identifies several characteristics that could be used to select patients at risk for a combined aneurysmal disease (AAs and IAs) for screening. A prospective study is required to confirm these data.

Objectives: Non-A Non-B (NANB) aortic dissections (ADs) are uncommon. Because of their rarity, their therapeutic pathway is not yet standardized, and anatomic or goal-directed treatments are not reported in current practices. We reviewed the treatment strategies of NANB AD across Europe, aiming to identify factors associated with increased mortality and the need for intervention, outlining optimal management pathways for future care. Methods: This multicentre cohort study was carried out in four European aortic centres, retrospectively including patients affected by NANB AD over the last 10 years. Patients' anatomical clinical and treatment data were collected with the aim of investigating the factors associated with their need for intervention and increased mortality, comparing the characteristics of those requiring surgery with those who responded to medical treatment alone. Results: Thirty-eight NANB patients (26, 68.4% men; mean age 60.6 ± 12.87) were included. The primary entry tear was identified in Ishimaru zone 1 or 2 in most cases (24, 63.2%) and the dissection extended distally to the ilio-femoral arteries in half of the patients (21, 55.3%). Surgical repair was indicated in 21 (55.3%) cases within 90 days of acute onset for end-organ ischemia, impending aortic rupture, or retrograde extension of the dissection (including 11 emergent/urgent operations), with most patients requiring surgery within 15 days of acute onset (17, 44.7%). The mean aortic diameter among patients requiring surgery was significantly higher in both zone 1 (7 37 IQR 3 versus 34 IQR 7, p = 0.043) and 2 (36 IQR 6 versus 32.5 IQR 7, p = 0.044) when compared with patients who underwent medical treatment alone. An increased in-hospital mortality rate was noted among patients with indication for surgery after medical treatment (0% versus 30.8%, p = 0.023). Conclusions: This cohort provides an additional description of clinical aspects and current practices in the treatment of NANB in Europe. Most patients of this series had an indication for surgery within two weeks of acute onset, demonstrating a frequently complicated course; moreover, this raises questions surrounding the most appropriate timing for interventional management. Although a diameter threshold was not identified, the baseline enlarged aortic diameter in zones 1 and 2 seemed to be associated with a need for early intervention. Further study is needed to fully refine the indications for treatment in NANB patients; this will support the study of the independent risk factors for increased mortality risk and complications among this group, and will allow the identification of subgroups of patients that may benefit from more aggressive treatment from acute onset.

Vascular calcification (V) is an independent risk factor for all-cause and cardiovascular mortality. Vascular smooth muscle cells (VSMCs) play a major role in VC as they can acquire mineralizing properties when exposed to osteogenic conditions. Despite its clinical impact, there are still no dedicated therapeutic strategies targeting VC. To address this issue, we used human calcified and non-calcified atherosclerotic arteries (ECLAGEN Biocollection) to screen and identify microRNA (miR) associated with VC. We combined non-biased miRNomic (microfluidic arrays) and transcriptomic analysis to select miR candidates and their putative target genes with expression associated with VC and ossification. We further validated miR functional regulation and function in relation to cell mineralization using primary human VSMCs. Our study identified 12 miRs associated with VC in carotid and femoral arteries. Among those, we showed that miR136, miR155, and miR183 expression were regulated during VSMC mineralization and that overexpression of these miRs promoted VSMC mineralization. Cross-analysis of this miRNomic and a transcriptomic analysis led to the identification of CD73 and Smad3 pathways as putative target genes responsible for mediating the miR155 pro-mineralizing function. These results highlight the potential benefit of miR155 inhibition in limiting VC development in peripheral atherosclerotic arteries.

OBJECTIVE:This study aimed to report the midterm results of fenestrated endovascular aortic repair (FEVAR) and open surgical repair (OSR) following failed endovascular aneurysm repair with type Ia endoleak. METHODS:An observational multicentre study was conducted in 13 French university centres, with 88 FEVARs and 120 OSRs in 208 patients. After propensity score matching, 136 matched patients were analysed. RESULTS:The thirty day mortality rate was higher in the OSR group than the FEVAR group (7% vs. 3%; p = .24). Thirty day complications were statistically significantly higher in the OSR group for kidney injury (p = .001) and respiratory failure (p = .029). The rate of paraplegia was statistically significantly higher after FEVAR (6% vs. 0%, p = .042). Type Ia endoleak treatment was achieved in 67 of 68 FEVAR patients and in all OSR patients. Survival at two years was comparable between groups, being 88 ± 4% for OSR and 94 ± 3% for FEVAR (p = .83). Re-intervention free survival at two years was higher in the OSR group vs. the FEVAR group (86 ± 4% vs. 73 ± 6%; log rank, p = .037). Irrespective of the technique used, freedom from late re-intervention at two years was statistically significantly higher in patients without persistent type II endoleak (T2EL) (84 ± 6%) compared with those with persistent T2EL (43 ± 9%) (log rank, p < .001). Re-interventions occurred in 36 patients (26.5%), 30 of 68 (44%) in the FEVAR group and six of 68 (9%) in the OSR group (p < .001). Following FEVAR, aneurysm sac thrombosis was achieved in 16 of 68 patients (24%). Cox proportional hazards showed that OSR was associated with a lower probability of late re-interventions compared with FEVAR (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.11 - 0.69; p = .006) and that persistent T2EL had a greater probability of re-intervention (HR 3.09, 95% CI 1.49 - 6.41; p = .002). CONCLUSION:In this multicentre study with propensity matching, death and complications at 30 days were higher in the OSR group, and FEVAR was associated with more late re-interventions, particularly in patients with concomitant persistent T2EL.