Infection of a ruptured prosthetic femoral graft or native femoral artery secondary to drug injection is a complication associated with high post-operative morbidity, mortality, and risk of limb loss.1 This prospective study reports the outcomes of femoral reconstruction both in native and graft related femoral infection in patients who have undergone emergency replacement with a xenopericardial patch (XP) between July 2020 and July 2023 (Clinical Trial NCT05881954) at Toulouse University Hospital (Toulouse, France).

The evolution of the treatment of complex aortic pathologies was revolutionized by the use of hybrid prostheses, and the Frozen Elephant Trump (FET) technique offers a landing zone for a secondary procedure. The aim of our study was to evaluate the technical feasibility and the mid and long term results of the connection between the Thoraflex module and a thoracic stentgraft.

BACKGROUND:Preoperative vascular mapping by duplex ultrasound is required in construction of an arteriovenous fistula for hemodialysis (AVF). Due to venous vasospasm in cool temperatures and variability of the dialysis patient's blood volume, the conditions for performing this examination may be less than ideal. However, local regional anesthesia (LRA) resulting in vasodilation of the limb, can allow the use of veins considered to be of insufficient caliber during preoperative ultrasound mapping. The aim of this study was to assess the functionality of AVF when duplex ultrasound is performed by the surgeon following LRA. These results were compared with those from the preceding year, during which preoperative duplex ultrasound had been performed without LRA by vascular specialists, (Clinical Trial registration number: NCT04978155).MATERIALS AND METHODS:This is a prospective study of all the patients having received AVF after systematic immediate preoperative ultrasound (US) under LRA (US-LRA group) in 2020. The initial surgical programming based on the Silva criteria was reported by a vascular medicine specialist. The change of AVF strategy following US-LRA was reported together with AVF usability and patency and compared to the results of the control group, in which AVF had been performed in 2019 without US-LRA.RESULTS:Ninety patients were included in the US-LRA group and 93 in the control group. Modified surgical planning was observed in 38% of cases (35/90) in the US-LRA group including more distal AVF in 28% of patients (26/90) and alternative target vein in 6.6% (6/90). AVF usability at 6 weeks was 80% (72/90) in the US-LRA group and 51.6% (48/93) in the control group (P < 0.001). Median follow-up was 12 months [IQR:9-15] in the US-LRA group and 13 months [IQR:9-18] in the control group. Primary patency at 6, 12, 18 months was significantly better in the US-LRA group (73.6% vs. 57.4%, 54.4% vs. 40.2%, 31.3% vs. 28.2%, respectively, P < 0.001). Assisted patency and secondary patency were comparable in the two groups.CONCLUSIONS:This study showed the benefit of having the surgeon perform US-LRA before starting the procedure, thereby allowing for more distal AVF, better usability and patency.

Objective: The aim of this study was to evaluate the mid and long term patency of elective renal artery reconstructions during open surgical repair of suprarenal aortic aneurysms (SRAA) and type 4 thoracoabdominal aortic aneurysms (T4AAA). Methods: This retrospective, single centre study included all consecutive patients who underwent surgery for SRAA or T4AAA between January 2009 and December 2019 at Toulouse University Hospital. All patients underwent strict pre-operative planning with computed tomography angiography (CTA) and 3D reconstruction of the aortic aneurysm, visceral and renal artery anatomy to choose the most appropriate surgical technique for each case. Primary patency, primary assisted patency, and rates of re-intervention were calculated using the Kaplan-Meier method. Results: In total, 103 patients, having undergone 159 renal artery revascularisation procedures, were enrolled in the study. Fifty-five patients presented with a type T4AAA and 48 patients with a SRAA. In hospital mortality was 2.9%. In association with aortic surgery, 100 direct re-implantation (62.8%), 48 retrograde bypasses (30.1%), and 11 anterograde bypasses (6.9%) of the renal arteries were performed. Median follow up was 45.9 +/- 36 months. Renal artery primary patency rates were 99.4%, 96.4%, and 93.1% at one, three, and five years, respectively. Assisted primary patency rates were 99.4%, 97.7%, and 97.7% at one, three, and five years, respectively, with five cases of renal stenosis > 70% successfully treated by renal stenting. No significant difference in patency was found regarding the type of renal revascularisation. Conclusion: This retrospective study suggests that the mid term patency of elective open renal artery reconstruction during SRAA and type T4AAA surgery preceded by pre-operative planning with 3D-CTA reconstruction, yields excellent outcomes whatever the technique used.

Objective: The chimney technique (ChEVAR) allows for proximal landing zone extension for endovascular repair of complex aortic aneurysms. The aim of the present study was to assess ChEVAR national outcomes in French university hospital centres. Methods: All centres were contacted and entered data into a computerised online database on a voluntary basis. Clinical and radiological data were collected on all consecutive ChEVAR patients operated on in 14 centres between 2008 and 2016. Patients were deemed unfit for open repair. Factors associated with early (30 day or in hospital) mortality and type 1 endoleak (Type I EL) were calculated using multivariable analysis. Results: In total, 201 patients with 343 target vessels were treated. There were 94 juxtarenal (46.8%), 67 pararenal (33.3%), 10 Crawford type IV thoraco-abdominal (5%) aneurysms, and 30 (15.1%) proximal failures of prior repairs. The pre-operative diameter was 66.8 +/- 16.7 mm and 28 (13.9%) ChEVAR were performed as an emergency, including six (2.9%) ruptures. There were 23 (11.7%) unplanned intra-operative procedures, mainly related to access issues. The rate of early deaths was 11.4% (n = 23). The elective mortality rate was 9.8% (n = 17). Nine patients (4.5%) presented with a stroke. The rate of early proximal Type I EL was 11.9%. Survival was 84.6%, 79.4%, 73.9%, 71.1% at 6, 12, 18, and 24 months, respectively. The primary patency of chimney stents was 97.4%, 96.7%, 95.2%, and 93.3% at 6, 12, 18, and 24 months, respectively. Performing unplanned intra-operative procedures (OR 3.7, 95% CI 1.3-10.9) was identified as the only independent predictor of post-operative death. A ChEVAR for juxtarenal aneurysm was independently associated with fewer post-operative Type I ELs (OR 0.17, 95% CI 0.05-0.58). Conclusion: In this large national ChEVAR series, early results were concerning. The reasons may lie in heterogeneous practices between centres and ChEVAR use outside of current recommendations regarding oversizing rates, endograft types, and sealing zones. Future research should focus on improvements in pre-operative planning and intra-operative technical aspects.

The aim of this study was to evaluate the mid and long term patency of the elective reconstructions of the renal arteries during the conventional surgical treatment of suprarenal aortic aneurysms (SRAA) and type 4 thoracoabdominal aneurysms (ATA4), as well as the evolution of the pre- and postoperative renal function.

The endovascular treatment of aorto-iliac aneurysms requires covering of the internal iliac arteries (IIA) with a risk of pelvic ischemia, primarily with buttock claudication. The aim of this study was to analyze the results of EVAR with or without conservation of the internal iliac artery.

Like fenestrated stentgrafts, the chimney technique (CH-EVAR) allows the endovascular treatment of juxta-renal aneurysms (JRA), para-renal aneurysms (PRA) and type IV thoraco-abdominal aneurysms (TAA4). However, few data are available which reflect the results of CH-EVAR in the current practice, out of studies emanating from expert centers. Our objective was thus to report the results of CH-EVAR in our country.

Background: Critical leg ischemia (CLI) represents the ultimate stage of peripheral arterial disease. Despite current surgery advances, patients with CLI have limited therapeutic options. Therapeutic angiogenesis thus appears as a powerful approach, aiming to stimulate vessel formation by angiogenic molecules administration. In this context, combined gene therapy has been proved to be the most efficient. The present study aims to compare, in a preclinical mouse model, the therapeutic benefit of a combination of 2 angiogenic factors fibroblast growth factor 2 (FGF2) and Cyr61 using plasmid and viral vectors, able to generate short- or long-term trans gene expression in the leg, respectively.Methods: Two therapeutic genes, FGF2 and Cyr61, were introduced into internal ribosome entry site based expression vectors (FGFiCyr) allowing co-expression of the 2 transgenes. The proangiogenic plasmid pC-FGFiCyr was assessed by intramuscular administration followed by electrotransfer into ischemic legs. To generate long-term transgene expression, the FGFiCyr bicistronic cassette was introduced into an adenoassociated virus-derived vector (rAAV). The rAAV treatment was performed either before or immediately after surgery. Therapeutic effects were analyzed by laser Doppler imaging, clinical score, and angiography.Results: The plasmid pC-FGFiCyr improved revascularization, reperfusion, and clinical score. Surprisingly, when AAV-FGFiCyr was injected 21 or 28 days before surgery, the proangiogenic rAAV was drastically deleterious on all measured parameters. In contrast, when administrated shortly after surgery, AAV-FGFiCyr generated therapeutic benefits, with a significantly better clinical score than after treatment with the plasmid.Conclusions: Therapeutic effects of the angiogenic combination FGF2-Cyr61 is observed with short-term transgene expression, but the treatment is significantly more efficient when a long-term expression viral vector is used. However, the rAAV-FGFiCyr generated therapeutic benefit only when injected in an ischemic leg, whereas the same dose of rAAV exhibited deleterious effects when administrated to healthy animals. These data may contribute to the understanding of the moderate success of proangiogenic treatments in CLI gene therapy clinical assays.

The objective of this study was to compare the results of the conventional surgical treatment of complex juxtarenal aortic aneurysms (JRAA) and suprarenal and type 4 thoraco-abdominal (SRAA-TAA4) aortic aneurysms in order to determine which type of aneurysm could benefit from endovascular exclusion with a fenestrated stentgraft. We conducted a retrospective monocentric study. Between January 2005 and April 2015, we operated 74 patients for JRAA and 61 patients for SRAA/TAA4. Ruptured or fissured aneurysms were excluded from the analysis. We studied preoperative parameters (characteristic of the population and the aneurysms), peroperative data (type of surgical reconstruction, duration of clamping) and postoperative early and long-term results (morbi-mortality). The median follow-up was 73.3 months (0.7-131.6). The follow-up consisted of a clinical examination at two months, six months then annually associated with duplex examination and/or angio-CT. Intra-hospital mortality was higher in the SRAA-TAA4 group vs. the JRAA group (4.9% vs. 1.4%). Postoperative impaired renal function was significantly more frequent in the SRAA-TAA4 group compared with JRAA (67.5% vs. 31.5%, p=0.0007) just as the need for temporary dialysis (9.5% vs. 1.4%, p=0.004). The duration of total renal clamping was significantly longer in the SRAA-TAA4 group compared with JRAA (45 min vs. 23.5 min, p=0.0001). Respiratory complications (acute pneumonitis, respiratory insufficiency, reintubation) were also more frequent in the SRAA-AAA4 group (33.3% vs. 22.5%; reintubation: 8% vs. 1.4%). No patient had postoperative paraplegia. Two patients (3.4%) in the SRAA-TAA4 group presented an occlusion of a revascularized renal artery. Global survival at two years was 78.4% in the SRAA-TAA4 group vs. 87.2% in the JRAA group. At five years, these rates were 76.4% vs. 79.2%. The conventional surgical treatment of JRAA can be done with an early morbi-mortality equivalent to that of infrarenal aneurysms contrary to SRAA and TAA4. The analysis of the results suggests that SRAA and TAA4 could benefit from an endovascular treatment with fenestrated stentgrafts, especially in high-risk patients.

Despite considerable advances in cardiovascular disease treatment, heart failure remains a public health challenge. In this context, gene therapy appears as an attractive approach, but clinical trials using single therapeutic molecules result in moderate benefit. With the objective of improving ischemic heart failure therapy, we designed a combined treatment, aimed to simultaneously stimulate angiogenesis, prevent cardiac remodeling, and restore contractile function. We have previously validated IRES-based vectors as powerful tools to co-express genes of interest. Mono- and multicistronic lentivectors expressing fibroblast growth factor 2 (angiogenesis), apelin (cardioprotection), and/or SERCA2a (contractile function) were produced and administrated by intramyocardial injection into a mouse model of myocardial infarction. Data reveal that combined treatment simultaneously improves vessel number, heart function parameters, and fibrosis prevention, due to FGF2, SERCA2a, and apelin, respectively. Furthermore, addition of SERCA2a in the combination decreases cardiomyocyte hypertrophy. Large-scale transcriptome analysis reveals that the triple treatment is the most efficient in restoring angiogenic balance as well as expression of genes involved in cardiac function and remodeling. Our study validates the concept of combined treatment of ischemic heart disease with apelin, FGF2, and SERCA2a and shows that such therapeutic benefit is mediated by a more effective recovery of gene network regulation.