BACKGROUND:The chimney technique may offer an alternative approach for managing juxta- and pararenal abdominal aortic aneurysms (AAA). This analysis presents the outcomes of the chimney technique and compares elective chimney and fenestrated endovascular aortic repair (FEVAR) findings in complex AAA. METHODS:The STROBE statement was followed to conduct a single-center retrospective analysis of patients who underwent chimney for complex AAA from January 1, 2016, to December 31, 2024. A comparison between elective chimney and FEVAR cases was also performed. Primary outcomes included technical success, mortality and survival. RESULTS:Seventy-two patients underwent chimney (94.4% males); 60 elective cases. Regarding the total chimney cohort, technical success was 98.6% and 30-day mortality 11.1%. Gutter endoleaks were detected in 6.9%; all resolved at 30 days. The mean follow-up was 36.8±5.8 months. Survival was 48.2% (standard error [SE] 9.5%) and freedom from reintervention was 87.3% (SE 6.5%) at 60 months. Forty-one elective FEVARs were compared to 60 elective chimney cases. Elective chimney patients had significantly larger aortic diameters (63 [Q1:56, Q3:78] mm vs. 56 [Q1:54, Q3:66] mm, P=0.02). Technical success (P=0.79) and 30-day mortality (P=0.30) were similar. The mean follow-up in elective chimney was longer compared to FEVAR (40.0±6.3 vs. 27.5±6.3 months; P=0.03). The estimated survival was consistently significantly lower in elective chimney cases (log rank; P=0.003) while freedom from reintervention was similar (P=0.88). CONCLUSIONS:The chimney technique demonstrated acceptable 30-day outcomes. Compared to elective chimney, 30-day FEVAR outcomes were similar, but FEVAR survival was significantly higher. The need for reintervention was equal.

PURPOSE:Iliac branch devices (IBDs) are indicated for the preservation of internal iliac artery (IIA) perfusion. Data on bridging stent choice in IBD are limited. The aim of this meta-analysis was to assess Advanta V12/iCast outcomes when used as bridging stent during IBD procedures. METHODS:The English medical literature was systematically searched through PubMed, Scopus, and Cochrane Library (last search: 03.01.2025). The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed, and a predefined protocol was registered to PROSPERO. Randomized controlled trials and observational studies (2000--2025) reporting on the Advanta V12/iCast-related outcomes were eligible. The ROBINS-I tool and Grading of Recommendations Assessment, Development and Evaluations (GRADE) were used to assess the risk of bias and quality of evidence. Primary outcomes were technical success, stenosis/occlusion, endoleak Ic/IIIc, and reintervention rates during follow-up. Data on the outcomes of interest were synthesized using proportional meta-analysis. RESULTS:From 2698 study reports, 10 observational studies (510 targeted IIAs, 467 IIAs bridged with Advanta V12/iCast) were included. According to ROBINS-I, eight studies were of low and two were of moderate quality. Technical success was 98% (95% confidence interval (CI) = 93%-100%; I2 = 0%; certainty: very low). Regarding the 30-day outcomes, the occlusion/stenosis rate was 2% (95% CI = 0%-9%; I2 = 0%), the endoleak Ic/IIIc rate was 0.3% (95% CI = 0%-3%; I2 = 0%) and the reintervention rate was 1% (95% CI = 0%-3%; I2 = 0%). The mean follow-up among studies was 23.4 months (95% CI = 14.2-32.7). During follow-up, the occlusion/stenosis rate was 4% (95% CI = 1%-11%; I2 = 19%; certainty: very low), the endoleak Ic/IIIc overall rate was 5% (95% CI = 3%-8%; I2 = 0%; certainty: very low), and the reintervention rate was 5% (95% CI = 3%-9%; I2 = 0%; certainty: very low). CONCLUSIONS:The Advanta V12/iCast balloon-expandable covered stent showed low occlusion/stenosis, endoleak, and reintervention rates at 30 days and follow-up and appeared to be a reliable bridging stent choice in IBDs.Clinical ImpactThe available literature on iliac branch devices does not provide adequate evidence supporting bridging stent selection. This systematic review and meta-analysis on the use of Advanta V12/iCast as bridging stent showed a high technical success rate of 98%, along with low occlusion/stenosis, endoleak Ic/IIIc and reintervention rates at 30 days, which were maintained below 5% during the total follow-up. These results reflect on the reliability of Advanta V12/iCast when used as bridging stent in iliac branch devices. However, the low quality of evidence should be considered upon result interpretation.

Background and Objectives: Amyloidosis is a systemic disorder characterized by extracellular deposition of misfolded protein fibrils, most commonly light-chain (AL) or transthyretin-derived (ATTR) ones. Cardiac involvement is well recognized, but large-vessel complications, including thoracic aortic aneurysms (TAA) and dissections, are rare and under-reported. The aim of this review article is to provide insights into pathophysiology, clinical diagnosis and the therapeutic opportunities in amyloidosis-related thoracic aortic diseases. Methods and Materials: The PRISMA Extension for Scoping Reviews (PRISMA-ScR) Guidelines were followed. An extensive search of the available literature in the English language, published between 1 January 2000, and 31 December 2025, in three large-scale scientific databases was undertaken by two independent reviewers. The terms "amyloidosis", "thoracic aorta", "thoracic aortic aneurysm", "aortic dissection", and "aortopathy" were used both as specific items, as well as in MeSH Terms. Studies reporting on the pathophysiology, diagnosis, clinical manifestations, treatment options and prognosis of amyloid deposition on the thoracic aorta were included in the review. Because of the nature of the existing literature, only a narrative review was possible. Results: Twenty-nine studies were included. Owing to the rarity of reporting, data was derived mainly from case reports and series, as well as autopsy studies. Amyloid infiltration of the aortic wall has been associated with medial architectural disruption, degeneration of elastic fibers, impairment of vasa vasorum perfusion, and arterial stiffness, all of which could contribute to aneurysmal dilation and aortic lesions. Amyloidosis management combines targeted anti-plasma cell therapy with supportive care. In AL amyloidosis, melphalan-dexamethasone (MDex) was historically standard, but regimens such as cyclophosphamide, bortezomib, and dexamethasone (CyBorD) and bortezomib, melphalan, and dexamethasone (BMDex) achieve higher complete response rates. Immunotherapy with Daratumumab has shown high overall and complete response rates. Fibril-directed approaches, including doxycycline and epigallocatechin gallate, and monoclonal antibodies, are under evaluation. Acute management of large-vessel manifestations follows conventional protocols, but prognosis is often dominated by underlying cardiac and systemic involvement. Conclusions: Management of thoracic aortic involvement follows standard imaging surveillance and surgical criteria, though operative risk is increased. Multidisciplinary care, early recognition, and individualized risk stratification are essential to improve outcomes, particularly given frequent cardiac involvement.

INTRODUCTION:The aim of this study is to present the 30-day and mid-term outcomes of the off the shelf Covered Endovascular Reconstruction of Iliac Bifurcation (CERIB) technique in patients managed with endovascular repair for aortoiliac aneurysms. METHODS:A single-centre retrospective analysis was conducted including patients with aorto-iliac aneurysms that received the CERIB technique from December 2022 to December 2025. Proximal repair of the aorta was performed either with standard EVAR (endovascular aneurysm repair) or complex EVAR. Mortality, patency, presence of endoleak and reinterventions were analysed at 30-days and during mid-term period. RESULTS:Fifty-nine patients (mean age: 71.6±6, 100% males) were included, receiving 78 CERIB procedures (19 bilaterally). Nineteen patients had previous endovascular aortic repair and half of them (49%; 29/59) received primarily EVAR. The technical success was 100%. Two deaths (3,3%) were recorded in two F/BEVAR patients during 30-day post-op period. The mean follow up was 12±7 months with one cancer related death (1,7%; 1/57). Patency rate was estimated at 98% [standard error; (SE) 2%] at 12 months and remained the same with no further event during follow-up. The freedom from gutter endoleak Ib rate was 96.8% (SE 2.2%) at 6 months and remained the same with no further event. The freedom from re-intervention rate was 93.8% (SE 3%) at 6 months and remained the same with no further event. CONCLUSION:The CERIB technique represents an endovascular procedure for managing complex aorto-iliac pathology, with excellent technical success, favourable patency rates, low early complication and reintervention rates, and durable mid-term outcomes.

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive technique for the treatment of thoracic aortic aneurysms (TAA). We hypothesized that alteration of blood hemodynamics in the thoracic aorta caused by stent implantation can possibly lead to hypertension and reduced coronary flow leading to the induction of heart failure (HF). The search in PubMed, Web of Science, Scopus, and the Cochrane library for studies containing data about the occurrence of HF after TEVAR resulted in 1231 articles of which 11 fulfilled the inclusion criteria. A meta-analysis was undertaken with the raw incidence of HF post-implantation as the primary endpoint. This occurred, in the first 30 days, to 684 out of 30,680 total patients (2.23%), and the raw incidence rate of HF was 0.03 [0.02-0.04], p<0.001. The random effects model was used because the examined studies had significant heterogeneity (I2=99.999%, τ2=3.905×10-4, p<0.001. In addition, significant publication bias was observed (Egger's test z=2.156, p=0.031). HF may develop in 30 days post-TEVAR possibly because of the increased aortic stiffness and the subsequent heamodynamic alterations which reduce the coronary blood supply. Thus, it may be necessary to initiate early pharmacological intervention while further research with randomized controlled trials with longer follow-up is warranted for the evaluation of the incidence of HF in the long term after TEVAR.Clinical ImpactOur meta-analysis shows that heart failure (HF) can occur in approximately 3% of patients within 30 days after TEVAR, indicating that HF is a clinically relevant but often under-recognized complication. Increased aortic stiffness and subsequent heamodynamic alterations which reduce the coronary blood supply may contribute to the development of HF. Our findings highlight the need for careful peri- and post-operative cardiac monitoring, particularly in patients with pre-existing cardiovascular risk and the need for hemodynamic optimization after stent-graft implantation.

Abdominal aortic aneurysm refers to the irreversible abnormal dilation of the aorta at the abdominal level, and it is acknowledged as one of the leading causes of mortality on a global scale. Most abdominal aortic aneurysms are asymptomatic until they approach the point of rupture; thus, it is essential to establish an efficient workflow for the accurate detection of this condition to enhance clinical outcomes. The incorporation of artificial intelligence learning algorithms into healthcare workflows holds the prospect of significantly improving the accuracy of decision-making related to patient mortality risk. Since the potential surgical repair of an aortic aneurysm depends upon the maximum external diameter of the aneurysm, this study aims to develop an end-to-end algorithmic method for classifying low-risk and high-risk cases based on abdominal aortic aneurysm data. To perform the predictive analysis, we adopt neuro-fuzzy systems, ensembles of neuro-fuzzy systems, and hybrid evolutionary-based fuzzy classifiers. The models are trained using features extracted from the radiomics framework and exhibit high generalisation performance, as measured by the adopted metrics, and estimated on a K-fold cross-validation basis. Numerical studies further reveal that the hybrid evolutionary-based fuzzy system exhibits exceptional accuracy in distinguishing between the two identified classes.

BACKGROUND:The Alto endograft received CE Mark approval in August 2020 for endovascular repair of abdominal aortic aneurysms (AAAs), requiring a proximal aortic landing zone of only 7 mm below the inferior renal artery for sealing. This study presents early and 1-year outcomes from the Hellenic Alto Registry in patients treated for intact AAAs, either electively or urgently for symptomatic aneurysms. METHODS:The Hellenic Registry is a multicenter prospective database including patients who underwent endovascular aneurysm repair with the Alto Abdominal Stent Graft System between 2021 and 2023. Preoperative and postoperative aneurysm characteristics were recorded. Outcomes included early (technical success, 30-day survival) and 1-year results (survival, reintervention, sac remodeling, and endoleak presence). RESULTS:A total of 124 patients (96% male, mean age 72.1 ± 6, mean AAA diameter 59.8 ± 10 mm) were included; 94% were asymptomatic. Mean proximal neck diameter at 7 mm was 23 ± 3 mm, length 18 ± 9 mm, and angulation 28 ± 14°. Nineteen patients (15%) had neck length <10 mm, and 14 (11%) had an aortic bifurcation <20 mm. Fifty-eight (45%) had at least 1 external iliac artery <7 mm. Technical success was 98%; 2 patients required intraoperative conversion to an aorto-uni-iliac endograft with femorofemoral bypass. Six patients underwent limb relining. Mean procedure time was 129 ± 60 min, mean contrast volume was 130 ± 50 mL, and median radiation 27 ± 18 min. Mean hospital stay was 2.5 ± 1.5 days. No intraoperative high flow endoleaks were detected. No death of reintervention was reported at 30 days. The mean aneurysm sac diameter was 58 ± 11 mm and 53.6±8 mm at 30 days and 1 postoperative year (58% stable, 34% decreased), respectively. At 1-year follow-up, the survival rate was 99,2% [standard error (SE) 0,8%], 98,4% (SE 1,1%) and 98,4% (SE 1,1%) at 80, 120 and 365 days respectively; The freedom from reintervention rate was rate was 99,2% (SE 0,8%), 98,4% (SE 1,1%), 96,7% (SE 1,6%) and 95,9% (SE 1,8%) at 30, 60, 180 and 365 days respectively. Freedom from type I endoleak rate was 99,2% (0,8%), 98,4% (SE 1,1%) and 97,5% (SE 1,4%) at 30, 180 and 365 days respectively. CONCLUSION:In real-world practice, the Alto stent graft demonstrated excellent technical and clinical success with low reintervention rates at 1 year, including a part of patients with challenging proximal and distal anatomy.

Background/Objectives: The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). Methods: The STROBE statement was followed in order to conduct a single-center retrospective analysis of patients with nNPAL vs. NPAL managed, from 1 September 2011 to 30 June 2022, with f/bTEVAR. The primary outcomes were technical success, 30-day mortality and stroke. Results: A total of 83 patients with nNPAL vs. 126 patients with NPAL were included. Among the nNPAL group, 34 (39.7%) underwent previous aortic arch replacement and the remaining underwent an ascending aortic replacement. The nNPAL patients were more commonly treated for chronic dissections (nNPAL: 70.6% vs. NPAL: 21.6%, p < 0.001), presented a more proximal disease (zone 0: nNPAL: 27.7% vs. NPAL: 7.1%, p < 0.001; zone 1: nNPAL: 50.6% vs. NPAL: 10.2%, p < 0.001) and received more triple-branch devices (nNPAL: 16.9% vs. NPAL: 3.2%, p < 0.001), with a higher rate of Ishimaru zone 0 landing (nNPAL: 86.8% vs. NPAL: 51.6%, p < 0.001). Technical success (nNPAL: 98.8% vs. NPAL: 94.4%, p = 0.07) and 30-day mortality (nNPAL: 6.0%, vs. NPAL: 11.9%, p = 0.16) were similar. Stroke was lower among nNPAL patients (nNPAL: 4.8% vs. NPAL: 13.5%, p = 0.04). A multivariate regression analysis confirmed nNPAL as an independent protector for stroke (p = 0.002). Survival (log rank: p = 0.02) was higher within the nNPAL group at 24 months. Conclusions: f/bTEVAR in patients with nNPAL zone showed encouraging outcomes. Despite more proximal landing in zone 0, stroke was significantly lower when compared to NPAL patients.

OBJECTIVE:Sarcopenia has been identified as an independent risk factor for mortality in thoracoabdominal aortic aneurysm (TAAA) patients treated with fenestrated and branched endovascular aortic repair (f/bEVAR). The aim of this study was to investigate the impact of f/bEVAR with extensive aortic coverage on the development of sarcopenia. METHODS:A single-center retrospective study was conducted including patients treated with f/bEVAR between 2016 and 2022. Preoperative computed tomography angiography and 1-year follow-up scans were used to measure lean psoas muscle area (LPMA, cm2 × Hounsfield units [HU]) and lean erector spinae muscle area (cm2 × HU) at the L3 vertebra level. A previously established cut-off value of preoperative LPMA was used to divide the patients into two groups: the sarcopenia group (SG; LPMA <350 cm2 × HU) and the no SG (NSG; LPMA ≥350 cm2 × HU). The primary outcome of this study was the development of sarcopenia after f/bEVAR. RESULTS:A total of 103 patients with types I, II, III, and V TAAAs were included (SG, n = 72; NSG, n = 31). SCI was more common in SG (24% vs 10%; P = .039). Three-year survival was 94 ± 3% with all four deaths occurring in the SG (P = .210). At 1 year after f/bEVAR, psoas muscle loss (LPMA loss, -24% vs -0.3%; P = .047) was more pronounced in the NSG, with 45% of the cases falling below the value of 350 cm3 × HU during the 12-month follow-up. Staged endovascular repair and chronic aortic dissection with fewer patent intercostal and lumbar arteries before f/bEVAR decreased LPMA loss during follow-up. For lean erector spinae muscle area, muscle loss was similar between groups (-27% vs -24%; P = .769). CONCLUSIONS:During the first year after f/bEVAR for TAAA, a significant loss of psoas and erector spinae muscle was detected after extensive aortic coverage. Individualized treatment planning with staged procedures and continued evaluation of sarcopenia status, including focused prevention and treatment of sarcopenia, could help to optimize outcomes. Further studies are needed to define the role of sarcopenia as a reliable stratification tool for mortality and major adverse events after f/bEVAR.

BACKGROUND:This study investigated the outcomes of fenestrated/branched aortic arch repair (f/bTEVAR) in patients with chronic penetrating aortic ulcers (PAU) or pseudoaneurysms. METHODS:A single-center retrospective analysis of patients managed with f/bTEVAR for PAU or pseudoaneurysms involving the aortic arch between September 1st, 2011, and December 31st, 2023, was conducted. Any outpouching-like lesion leading to an aortic diameter ≥50% of the normal one was considered pseudoaneurysm, while similar lesions leading to a diameter increase <50% were considered PAUs. Primary outcomes were technical success, mortality and stroke at 30 days. RESULTS:Twenty-three patients had PAU and 28 pseudoaneurysm [age: 72 (Q1:67, Q3:76) years, 78.4% males]. Peripheral arterial disease was more common among PAU patients (PAU: 43.5% vs. pseudoaneurysm: 10.7%, P = 0.007). Only patients with pseudoaneurysm underwent urgent repair (PAU: 0% vs. pseudoaneurysms: 25%, P = 0.03). No differences in device configuration were detected. Technical success was 100% in PAUs and 92.8% in pseudoaneurysms (P = 0.67). Thirty-day mortality was 4.3% in PAUs versus 10.7% in pseudoaneurysms (P = 0.40). Four (7.8%) major strokes were recorded; 4.3% in PAUs versus 10.7% in pseudoaneurysms (P = 0.40). The median follow-up was 12 months (Q1: 1, Q3: 24). The survival was 80.6% (SE 8.8%) in PAUs versus 79.6% (SE 8.2%) in pseudoaneurysms (log-rank, P = 0.45). CONCLUSIONS:In this small cohort of f/bTEVAR for PAUs versus pseudoaneurysms, technical success and mortality were similar. The major stroke rate exceeded 10.0% in pseudoaneurysm patients, alarming on the safety of the procedure in this subgroup. Larger studies are needed to verify the need for differentiation of these pathologies.

Background Vascular surgery practice presents a variety of ethical dilemmas for vascular surgeons and nurses. Aim The present study aimed to explore the ethical dilemmas that healthcare professionals are facing in vascular surgery practice. Methods Qualitative study design was employed in this study. Two focus group were conducted using a semi-structured focus group guide, in which ten healthcare professionals participated. Recordings were transcribed, and then analyzed using an inductive content analysis approach. Results Analysis identified two primary themes: (1) Balancing patient care and minimizing harm, which included subthemes on patient autonomy and concordance, age and surgical intervention, and end-of-life care with invasive procedures; and (2) Aligning treatment with patient values, which encompassed subthemes on understanding patient preferences and values, and addressing patient concordance, lifestyle modification, and challenges of non- concordant patients. One of the most challenging issues they face daily in clinical practice is balancing patient care with minimal complications. Conclusions Vascular healthcare professionals express various concerns during daily vascular surgery practice. The challenges of balancing patient care with minimizing harm along with the patient’s values remain a major issue.

OBJECTIVE:Half of re-interventions after fenestrated and branched endovascular aortic repair (FB-EVAR) are target vessel related. Regarding bridging stent choice, existing data are controversial. This meta-analysis aimed to evaluate the performance of Advanta V12/iCAST as the bridging stent in FB-EVAR. DATA SOURCES:The English medical literature was searched through MEDLINE, Embase (via Ovid), and Cochrane databases (end date 15 April 2024). REVIEW METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PICO (Patient, Intervention, Comparison, Outcome) model were followed. A predefined protocol was registered to PROSPERO (CRD42024556603). Randomised controlled trials and observational studies (2010 - 2024) reporting on Advanta V12/iCAST related target vessel outcomes were eligible. Risk of bias was assessed using ROBINS-I, and evidence quality was assessed via Grading of Recommendations Assessment, Development and Evaluations (GRADE). Primary outcomes were freedom from instability, stenosis and or occlusion, types Ic and IIIc endoleak, and re-intervention of target vessels bridged with the Advanta V12/iCAST. Prevalence and regression meta-analysis were performed. RESULTS:From 1 439 articles, ten retrospective studies (7 525 target vessels; 3 890 target vessels bridged with Advanta V12/iCAST) were included. According to ROBINS-I, no study was of high quality. Mean follow up was 24.3 (95% confidence interval [CI] 23.9 - 24.7) months. Freedom from instability, stenosis and or occlusion, and types Ic and IIIc endoleak were 94% (95% CI 91 - 96%; p < .010; I2 = 91%; GRADE certainty, very low), 97% (95% CI 96 - 98%; p =  .070, I2 = 44%; GRADE certainty, low), and 97% (95% CI 94 - 98%; p < .010; I2 = 81%; GRADE certainty, very low), respectively. Freedom from target vessel re-intervention was 95% (95% CI 92 - 97%; p < .010; I2 = 85%; GRADE certainty, very low). Four studies provided extractable data on Advanta V12/iCAST in fenestrations and four in branches. No difference was detected in freedom from instability (p = .47), stenosis and or occlusion (p = .36), and types Ic and IIIc endoleak (p = .90). Freedom from re-intervention was 93% (95% CI 87 - 96%; p < .010; I2 = 90%) in fenestrations and 95% (95% CI 91 - 97%; p = .060, I2 = 64%) in branches. CONCLUSION:The Advanta V12/iCAST bridging stent showed high freedom from target vessel instability, stenosis and or occlusion, and endoleak. Freedom from re-intervention was 95%, being similarly high in fenestrations and branches.

Background: Arteriovenous grafts (AVG) can be the only bailout solution for patients who require kidney replacement therapy but are unsuitable for arteriovenous fistula (AVF) creation. Currently, high-level evidence on the effectiveness and safety of antithrombotic therapy in AVG patients is scarce. Materials and methods: Following the PICO (patient; intervention; comparator; outcome) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a data search of the English literature in PubMed, SCOPUS, Central Cochrane was conducted, until March 1st, 2023 (PROSPERO Protocol Number: CRD42023401785). Studies on humans with an AVG receiving any kind of antithrombotic medication, reporting on primary and secondary patency rates, and bleeding complications were included. Due to data heterogeneity, a descriptive report of the outcomes was undertaken. Results: Twelve studies, including 22,436 patients with end-stage renal disease (ESRD) and AVG were included, with patient recruitment spanning over a 41-year time-period (1982-2023). Antithrombotic factors included acetylsalicylic acid (ASA), clopidogrel, dipyridamole, warfarin, unfractioned heparin (UFH), and direct oral anticoagulants (DOACs). Ten studies reported on primary patency rates, and two on secondary patency rates. Primary and secondary patency rates (PPR, SPR) were reported better in four studies, similar in three and worse in one study, regarding patients receiving any kind of antiplatelet therapy. Anticoagulation therapy was not associated with increased PPR or SPR, except for one study on apixaban. Patients receiving single or combined antiplatelets versus patients receiving no treatment presented higher bleeding risk in two studies and similar bleeding risk in three studies. Anticoagulation therapy, excluding apixaban, was associated with higher bleeding risk in three studies, when compared to no anticoagulation. Conclusions: Data derived from the current literature were equivocal regarding the use of antiplatelet treatment in patients with AVG. Studies on anticoagulation therapy are confined. Randomized trials with confounder stratification remain crucial for robust long-term data.

Objectives: New endografts have improved clinical outcomes in patients with abdominal aortic aneurysm (AAA) treated with the endovascular approach (EVAR). The purpose of this study is to evaluate the Endurant endograft for EVAR. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane for studies including patients treated with EVAR for unruptured AAA. This meta-analysis follows PRISMA guidelines (PROSPERO: CRD42024621517). A Kaplan–Meier-derived individual patient data analysis assessed the survival, the freedom from reintervention, the freedom from type Ia endoleak (ETIa), and the aneurysm-related mortality rates. The analysis reflects aggregated survival data, and the at-risk population decreases over time due to censoring and loss to follow-up. Kaplan–Meier survival curves were digitized to extract survival/mortality values at specific time points, and number-at-risk tables or total events were used to improve time-to-event accuracy. A subgroup analysis compared the outcomes of treatment within versus outside the instructions for use (IFU). Results: Twenty-six studies met our eligibility criteria, incorporating 5901 patients in terms of survival, with survival rates at 1, 5, and 10 years of follow-up at 94.4%, 71.6%, and 42.4%, respectively, while overall aneurysm-related mortality rates were 0.8%, 2.3%, and 7.6%, respectively. Freedom from secondary reintervention was 94.9% at 1 year, 81.9% at 5 years, and 43.7% at 10 years, while freedom from type Ia endoleak was 98.8%, 94.6%, and 85.6%, respectively. Comparing treatment within versus outside the IFU, in terms of survival (HR: 0.94, 95% CI: 0.75–1.16, p = 0.53), freedom from reintervention (HR: 0.85, 95% CI: 0.63–1.15, p = 0.29) and mortality due to aneurysm-related complication (HR: 0.79, 95% CI: 0.34–1.84, p = 0.58) revealed no statistically significant difference. Conclusions: The Endurant endograft provides acceptable rates of survival, freedom from secondary intervention, aneurysm-related mortality rates, and freedom from ETIa; however, continuous long-term follow-up surveillance is necessary.

Background and Objectives: Accurate evaluation of vulnerable carotid atherosclerotic plaques remains essential for preventing ischemic stroke. Conventional imaging modalities such as ultrasound and computed tomography angiography (CTA) have limited capacity to identify histopathological features of plaque instability, including fibrous cap rupture, lipid-rich necrotic core, and intraplaque hemorrhage. Artificial intelligence (AI) techniques—particularly deep learning (DL) and radiomics—have recently emerged as valuable adjuncts to standard imaging, achieving AUC values of 0.83–0.99 across modalities in identifying vulnerable plaques. This scoping review summarizes the available evidence on the application of AI in the detection and assessment of vulnerable carotid plaques. Methods: A systematic search of the English-language literature was conducted in MEDLINE, SCOPUS, and CENTRAL from 2000 to 30 June 2025, following the PRISMA-ScR framework. Eligible studies applied AI-based approaches (machine learning, deep learning, or radiomics) to evaluate carotid plaque vulnerability using ultrasound, CTA, or MRI. Extracted outcomes included diagnostic performance, correlation with histopathology or neurological events, and predictive modeling for stroke risk. Results: Of 201 records screened, 12 studies met inclusion criteria (ultrasound = 6; CTA = 4; high-resolution MRI = 2; publication years 2021–2025). All reported receiver operating characteristic area-under-the-curve (ROC-AUC) values for endpoints related to plaque vulnerability (symptomatic versus asymptomatic status, presence of intraplaque hemorrhage or lipid-rich necrotic core, fibrous-cap surrogates, and, less frequently, short-term cerebrovascular events). For ultrasound, contrast-enhanced videomics achieved an AUC of 0.87 (10 centers; n = 205), B-mode texture/radiomics reached 0.87 (n = 150), and segmentation-assisted models 0.827 (n = 202); other ultrasound models reported AUCs of 0.88–0.91. For CTA, a symptomatic-plaque machine-learning model yielded AUC 0.89 ( n = 106); a perivascular-adipose-tissue (PVAT) radiomics nomogram achieved AUC 0.836 on external validation; a histology-referenced pilot attained AUC 0.987; and one mild-stenosis TIA model reported ROC performance. For high-resolution MRI (HR-MRI), radiomics-based models showed AUC 0.835–0.864 in single-modality cohorts and up to 0.984 with multi-contrast inputs. Across modalities, AUC ranges were: ultrasound 0.827–0.91, CTA 0.836–0.987 (external 0.836), and HR-MRI 0.835–0.984. Only two out of twelve studies performed external validation; calibration and decision-curve analyses were rarely provided, and most cohorts were single-center, limiting generalizability. Conclusions: AI demonstrates strong potential as a complementary tool for evaluating carotid plaque vulnerability, with high diagnostic performance across imaging modalities. Reported AUCs ranged from 0.83 to 0.99 based primarily on internal or hold-out validation, representing the upper bound of theoretical rather than real-world performance. Nonetheless, large prospective multicenter studies with standardized protocols, histopathological correlation, and external validation are required before clinical integration into stroke prevention pathways.

OBJECTIVE:The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with descending thoracic and thoraco-abdominal aortic pathologies, in succession to the 2017 version, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS:The guidelines are based on scientific evidence complemented with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to the ESVS grading system, where the strength (class) of each recommendation is graded from I to III and the level of evidence from A to C. RESULTS:One hundred and twenty-nine recommendations have been issued across the following main topics: (1) acute thoracic aortic syndrome; (2) chronic type B aortic dissection; (3) descending thoracic and thoraco-abdominal aortic aneurysms; (4) ruptured descending thoracic and thoraco-abdominal aortic aneurysms; and (5) blunt thoracic aortic injury. Additional topics include genetic aortopathy, floating thrombus and shaggy aorta, inflammatory aortitis, mycotic aortic aneurysms, coarctation of the aorta, aberrant subclavian artery, and service standards such as surgical volume, imaging, risk assessment, and optimisation. Special considerations include pregnancy, left subclavian artery revascularisation, spinal cord ischaemia, stroke prevention, vascular access, and the patient's perspective. A final chapter addresses unresolved issues. CONCLUSION:These clinical practice guidelines provide comprehensive, up to date advice to clinicians and patients on the management of descending thoracic and thoraco-abdominal aortic pathologies.

Background/Objectives: Endovascular aneurysm repair (EVAR) of the aorta may trigger an inflammatory response that affects coagulation. In the EVAR of para-renal and thoraco-abdominal aortic aneurysms, the implants are more complex and the duration of surgery is longer. However, the exact pathophysiological mechanisms of coagulation activation are not yet well understood. The primary aim of this study is to investigate the effects of complex EVAR of para-renal and thoraco-abdominal aortic aneurysms on the coagulation status of patients. Methods: This prospective observational study (STROBE), approved and registered by the Ethics Committee of the University Hospital of Larissa (UHL) (NCT06432387), will enroll consecutive patients undergoing elective EVAR of para-renal and thoraco-abdominal aortic aneurysms. Exclusion criteria: Refusal to participate, previous surgery within 3 months, American Society of Anesthesiologists physical status (ASA PS) > 3, known history of thrombophilia or functional platelet dysfunction. Perioperative laboratory tests will be performed according to institutional guidelines. These include a complete blood count, conventional coagulation tests, and kidney and liver function tests. In addition, the following parameters will be determined: von Willebrand factor, factors VIII and XI, D-dimers, fibrinogen, Adamts-13, anti-Xa, platelet activation (multiplate), and high-sensitivity troponin. Blood samples will be taken pre-operatively before induction of anesthesia (01), on postoperative day 1 (02), and on postoperative day 3-4 (03). During hospitalization, myocardial injury after non-cardiac surgery (MINS), major adverse cardiovascular events after non-cardiac surgery (MACE), acute kidney injury (AKI), post-implantation syndrome (PIS), and death from any cause will be recorded. In addition, our patients will be reviewed at 30 days, 3, 6, and 12 months for MACE, implant failure, or death from any cause. All enrolled patients will be treated by the same medical team at UHL according to the indications. According to our power analysis, for a cohort of patients with three consecutive measurements, 58 patients should be included in the study. To compensate for possible dropouts, the sample size was increased to 65 patients. Conclusions: The results of the present study could help physicians to better understand the effects of complex EVAR of para-renal and thoraco-abdominal aortic aneurysms on blood coagulation and platelet activation.

Background and Objectives: Proximal aortic neck-related complications severely impact the short- and long-term durability of endovascular aneurysm repair (EVAR). The Heli-FX EndoAnchor system provides proximal sealing zone reinforcement, aiming at both prevention and treatment of endograft migration and type Ia endoleak (EL Ia). The aim of this scoping review was to accumulate data on the prophylactic and therapeutic effect of EndoAnchors on patients undergoing index and revision EVAR for proximal neck complications. Methods and Materials: The PRISMA Extension for Scoping Reviews (PRISMA-ScR) Guidelines were followed. The literature published between 1 January 2009 and 1 September 2025 was searched by two independent reviewers. Studies reporting on morphological and clinical outcomes related to the proximal aortic neck were included. Main outcomes were Heli-FX EndoAnchor system technical success and procedural EVAR success, aortic neck dilation, endograft migration, EL Ia and proximal neck reinterventions. Results: Sixteen studies were included, with a total of 1164 patients. The mean follow-up ranged between 7 and 60 months. Eleven studies provided data on hostile proximal neck characteristics indicating Heli-FX EndoAnchors deployment. Technical success for prophylactic and therapeutic Heli-FX EndoAnchor application ranged between 85 and 100% as well as 86 and 100%, respectively. Procedural success for index and revision EVAR ranged between 85 and 100% as well as 45.4 and 100%, respectively. Residual EL Ia was reported in 103 patients following EndoAnchors deployment during index EVAR and revision cases. Secondary reinterventions related to the proximal sealing zone were reported in 39 patients (17 index EVAR, 19 revision). Mean aortic neck diameter increase between 2.5 and 4.6 mm was reported in four studies, while one study reported a mean >5 mm decrease. Conclusions: The Heli-FX EndoAnchor system was associated with high technical success, while procedural success was acceptable, amendable to neck-related characteristics, especially in revision cases for EL Ia treatment. Long-term data on morphological and clinical outcomes are warranted.