OBJECTIVE:This study aimed to assess the effect of bridging stent graft (BSG) selection on the outcomes of endovascular aneurysm repair using an iliac branch device (IBD) and to compare the performance of the Advanta V12 and BeGraft Plus stent grafts for this purpose. METHODS:This was a retrospective, single centre cohort study including all patients undergoing elective implantation of a Cook Zenith IBD between January 2010 and May 2024. Primary endpoints were technical success, primary BSG patency, and IBD related endoleaks, re-interventions, and target vessel instability (TVI). Secondary endpoints were aneurysm related death and procedure related complications. RESULTS:During the study period, 212 IBDs were implanted in 156 patients (148 men [94.9%]; mean age 68 ± 8 years). Fifty-six patients (35.9%) received bilateral IBDs. The BSGs implanted were Advanta V12 in 114 IBDs (53.8%), BeGraft Plus in 88 IBDs (41.5%), and other BSG types in ten IBDs (4.7%). Primary technical success was achieved in 211 of 212 implanted devices (99.5%), with no early deaths. During a median follow up of 31 months (interquartile range 12, 66), 18 (8.5%) internal iliac artery (IIA) branches occluded in 14 patients. Estimated IIA branch patency at 1, 2, and 4 years was 99.5 ± 0.5%, 91 ± 2.6%, and 84 ± 3.6%, respectively, with no statistically significant differences regarding the BSG used (log rank p = .55). There were 17 (8.0%) IBD related endoleaks during follow up, and 25 patients (16.0%) required a late re-intervention, most of them due to endoleaks or in stent stenosis. Estimated freedom from TVI at 1, 2, and 4 years was 94 ± 1.9%, 84 ± 3.3%, and 76 ± 4%, respectively, with no statistically significant differences regarding the BSG used (log rank p = .35). CONCLUSION:Advanta V12 and BeGraft Plus performed well as BSGs in combination with the Cook Zenith IBD for endovascular aorto-iliac aneurysm repair and they both showed similar outcomes in terms of primary patency and freedom from IBD related endoleaks, re-interventions, and TVI.

BACKGROUND:Previous studies have demonstrated significant changes in arterial stiffness and secondary cardiac effects following endovascular repair of infrarenal or thoracic aortic aneurysms. However, data remain scarce regarding the impact of more extended complex fenestrated and branched endovascular aortic repair (F/BEVAR) for pararenal and thoracoabdominal aortic aneurysms. This study aimed to investigate alterations in arterial stiffness and cardiac function following F/BEVAR. METHODS:A total of 41 patients undergoing F/BEVAR for pararenal or thoracoabdominal aortic aneurysms were prospectively enrolled. Arterial stiffness was evaluated by measuring the carotid-femoral pulse wave velocity (cfPWV). Cardiac function was assessed by left ventricular global longitudinal strain, left atrial volume index, peak atrial longitudinal strain, left ventricular end-diastolic volume, and N-terminal pro-B-type natriuretic peptide. Measurements were obtained preoperatively and at 1 and 6 months postoperatively. RESULTS:Arterial stiffness increased significantly postoperatively. CfPWV increased from 10.85 ± 2.27 preoperatively to 15.30 ± 3.70 m/s at 1 month (P < 0.001) and remained elevated at 14.54 ± 3.90 m/s (P = 0.22), at 6 months. Ventriculoarterial coupling increased (cfPWV/global longitudinal strain ratio - 0.60 ± 0.23 to - 0.79 ± 0.29 m/s%; P < 0.001). Left atrial volume index increased (30.4 ± 13.7 to 33.1 ± 13.6 ml/m2; P < 0.001), left ventricular end-diastolic volume increased (74.3 ± 21 to 77.1 ± 20.1 mL; P < 0.001), and peak atrial longitudinal strain decreased (30.1 ± 9.7 to 27 ± 8.8%; P = 0.06) at 1 month. N-terminal pro-B-type natriuretic peptide levels increased transiently (341 ± 204 to 1,266 ± 786 pg/mL; P < 0.01) at 1 month follow-up, but seemed to be improved at the second examination. All cardiac markers were elevated at 1-month follow-up and most of them continued to deteriorate at 6 months. A high percentage of aortic coverage seemed to deteriorate the cfPWV measurements. CONCLUSION:Endovascular repair of complex aortic aneurysms with F/BEVAR is associated with a significant increase in arterial stiffness and measurable changes in cardiac function. Further research is necessary to better understand the potential implications of these extensive endovascular procedures for the cardiac function in the long-term. In view of these findings, long-term cardiovascular monitoring should be considered for patients undergoing extensive endovascular aortic repair.

BACKGROUND:This study aims to report the results of target vessels (TVs) bridged with more than one bridging stent-graft (BSG) in branched endovascular aneurysm repair (BEVAR) and assess the impact of hybrid configuration, BSG selection and relining on the outcomes. METHODS:Retrospective bicentric study including patients undergoing BEVAR for TAAA between January 2010-November 2025. Primary endpoints included primary patency and BSG-related endoleaks, reinterventions and target vessel instability (TVI). Endpoints were compared between TVs with one or more BSG, with or without hybrid configuration (balloon expandable stent-graft [BESG] + self-expandable stent-graft [SESG]), and with or without relining. A subanalysis in the subset of renal arteries (RAs) was also performed. RESULTS:Four hundred fifteen patients with 1081 vessels targeted with branches were included. 922 (85%) TVs were stented with one BSG and 159 (15%) with more than one device. Of those 159 TVs, 34 (21%) had a hybrid BESG+SESG configuration. Relining was performed in 250 (23%) TVs. Median follow-up was 20 months (IQR 8-45). In RAs, TVs with hybrid configuration presented better primary patency (Breslow P=0.004) and better freedom from TVI (Breslow P=0.019). Cox regression confirmed the type of BSG as an independent risk factor for primary patency and TVI with hybrid configuration performing better than BESG and SESG alone. CONCLUSIONS:Hybrid BESG+SESG configuration presented better primary patency and TVI in RAs targeted with branches in our series. The use of relining or combinations of more than one BSG without hybrid configuration did not show any significant improvement in TV related outcomes.

Objective The aim of the present study was to report outcomes of inner branches of the Cook Platform in endovascular repair of complex abdominal (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs). Methods All consecutive patients treated at two institutions with F/BEVAR for cAAA or TAAA using stent grafts with inner branches between April 2015 and December 2024 were included. Analysed endpoints included technical success, peri-operative mortality, target vessel patency, freedom from endoleak, target vessel related re-intervention, and target vessel instability (TVI) for vessels addressed with inner branches. Results A total of 108 patients (79 male, mean age 71 ± 8.9 years) with 181 inner branches were analysed. Nineteen (17.6%) patients had a cAAA and 89 (82.4%) patients a TAAA. A stent graft with fenestrations and inner branches was used in 92 (85.2%) patients. Thirty day mortality was 3.7% (4/108). Technical success per inner branch was 98.9% (179/181). Estimated patencies at 1 and 2 years were 95.0% ± 1.7%, and 90.5% ± 2.6%, respectively. Estimated patency at 2 years was lower for the renal arteries compared with the splanchnic arteries (80.4% ± 5.3% vs. 98.9% ± 1.1% respectively, p = .002). Estimated freedom from TVI for vessels treated with inner branches at 1 and 2 years was 93.3% ± 1.5% and 87.6% ± 2.2%, respectively. Estimated freedom from TVI at 2 years was higher for grafts with a combination of fenestrations and inner branches compared with grafts with inner branches only (91.4% ± 3.0% vs. 79.5% ± 6.5%, p = .022). Conclusion Inner branches were associated with excellent technical success rates. Renal arteries were associated with higher occlusion rates at 2 years compared with splanchnic arteries. Grafts with a combination of inner branches and fenestrations might be preferable over grafts with inner branches only, presenting higher patency and lower TVI rates.

BACKGROUND Given its associations with high morbidity and mortality, type A aortic dissection requires urgent surgical intervention. Patients with Marfan syndrome present additional complexity due to underlying connective tissue abnormalities that warrant multiple thoracic aortic operations. The "arch-first" technique was developed to allow single-stage open extensive replacement of the thoracic aorta while maintaining continuous antegrade cerebral perfusion, thereby minimizing brain ischemia. In the current endovascular era, the frozen elephant trunk - a hybrid technique combining a conventional surgical graft for arch reconstruction with an integrated distal stent-graft - has gained popularity in management of these cases, displacing extensive open approaches. However, for specific patient populations, the arch-first technique remains a suitable approach. CASE REPORT This report describes 6 patients (5 men, 1 woman; aged 24-73 years) who were treated between June 2022 and June 2025 through application of the arch-first technique in complex clinical scenarios, highlighting its benefit in providing effective single-stage management of extensive thoracic aortic pathology. Although no patient experienced neurological deficits, 50% (3/6) required prolonged mechanical ventilation due to the invasiveness of the procedure. CONCLUSIONS The arch-first technique represents an effective surgical strategy for single-stage extensive thoracic aortic replacement, offering reliable cerebral protection and reduced neurological risk in complex aortic disease cases, particularly those involving patients with Marfan syndrome and in reoperation settings. Despite its invasive nature and potential for pulmonary morbidity, the arch-first technique remains a valuable option for selected patients. Further multicenter studies are needed to compare its outcomes with frozen elephant trunk and hybrid approaches.

OBJECTIVES:This study analyses the results of endovascular treatment of juxtarenal and suprarenal aortic aneurysms (J/SAAAs) using fenestrated stent-grafts with 4 fenestrations (4×FEVAR) in which the celiac artery (CA) was left unstented. METHODS:Retrospective multicentre study of all consecutive patients treated between May 2018 and January 2024 at 4 European aortic centres. Patients undergoing 4×FEVAR for a J/SAAA in which the fenestration for the CA was left unstented were included. The primary outcomes were primary patency of the CA and CA-related endoleaks, reinterventions and target vessel instability. RESULTS:68 patients (64 males; mean age 73±7 years) were included. Sixty-two (91%) patients were preoperatively planned to leave the CA unstented. In the remaining six (9%) there was a failure to catheterize the vessel or advance the introducer. There was no CA-related endoleak or occlusion in any patient in the completion angiography. During a median follow-up of 27 months (interquartile range 17-54), a CA-related endoleak was detected in one (1.5%) patient that required reintervention and stenting 2 years after the index procedure. Three (4%) patients presented with an asymptomatic occlusion at 6, 12 and 13 months after surgery, which were treated conservatively. Estimated CA-primary patency at 1, 2 and 3 years was 98.4±1.6%, 94.8±2.9% and 94.8±2.9%, respectively. Two (3%) patients underwent a reintervention involving the CA: the patient with the CA-related endoleak and one patient with thoracic stent-graft extension and stenting of the CA due to proximal progression of disease. Estimated freedom from target vessel instability at 1, 2 and 3 years was 98.4±1.6%, 92.2±3.8% and 92.2±3.8%, respectively. CONCLUSIONS:Endovascular repair with 4×FEVAR without stenting of the CA appears to be a safe and effective strategy to treat J/SAAA in selected patients with adequate sealing in the visceral aorta.Clinical ImpactThis study analyses the outcomes of endovascular treatment of juxtarenal/suprarenal aneurysms (J/SAAA) using fenestrated stent-grafts with 4 fenestrations (4xFEVAR) in which the fenestration for the celiac artery (CA) was left unstented. This approach can decrease the complexity and duration of 4xFEVAR procedures virtually converting them to simpler 3xFEVAR procedures, while adding proximal sealing length and potentially facilitating a proximal extension of the endovascular repair. The outcomes of this multicentre study suggest that this strategy can be a safe and effective option to treat J/SAAA with adequate sealing in the visceral aorta.

Subclavian artery pseudoaneurysms are rare and may present decades after blunt trauma. We report the case of a 38-year-old man presenting 22 years after clavicular fracture with a giant intrathoracic pseudoaneurysm of the proximal left subclavian artery, with the vertebral artery arising immediately distal to the lesion. Due to the limited proximal landing zone and short carotid-subclavian distance, a one-stage hybrid repair was performed, consisting of carotid-carotid-subclavian bypass and zone 1 thoracic endovascular aortic repair. The procedure achieved complete exclusion with preserved cerebral and upper limb perfusion. At 5 years, the patient remains asymptomatic without endoleak or graft-related complications.

OBJECTIVE:We aimed to perform a systematic review and meta-analysis comparing the outcomes of single-stage vs multistaged fenestrated-branched endovascular aortic repair (FB-EVAR) for extensive thoracoabdominal aortic aneurysms (TAAAs). METHODS:MEDLINE, Embase, and Cochrane databases were searched from inception to March 2024. This study was registered in PROSPERO (CRD42024567099) and followed the PRISMA guidelines. Inclusion was restricted to original studies comparing single-stage vs multistaged FB-EVAR for reported patients evaluated as extensive TAAAs (Crawford/Safi extent I-III and V). A multistaged approach consisted of aneurysm exclusion besides FB-EVAR using one or more staging strategies, including temporary aneurysm sac perfusion, first stage thoracic endovascular aortic repair, unintentional open surgical or endovascular proximal thoracic aortic repair, and minimally invasive staged segmental artery coil embolization. Endpoints evaluated included permanent and any spinal cord injury (SCI), 30-day or in-hospital mortality, acute kidney injury, cardiac, cerebrovascular, and bowel complications. A random effects meta-analysis was performed using pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:Four cohort studies involving 1949 patients treated by elective FB-EVAR were included, including 1097 patients (56.28%) treated by the multistaged approach. The most frequently used staging strategy was thoracic endovascular aortic repair in 404 patients (37%). Multistaged repairs significantly reduced permanent SCI events (OR, 0.37; 95% CI, 0.23-0.58; P < .0001), any SCI events (OR, 0.51; 95% CI, 0.29-0.93; P = .03), and 30-day or in-hospital mortality (OR, 0.57; 95% CI, 0.38-0.85; P = .006). Additionally, the multistaged approach was associated with lower risk of acute kidney injury (OR, 0.67; 95% CI, 0.51-0.89; P = .005), although there were no significant differences observed for cardiac, cerebrovascular, or bowel complications. CONCLUSIONS:Multistaged FB-EVAR for elective extensive TAAA repair significantly reduces the risks of permanent and any SCI events, 30-day or in-hospital mortality, and acute kidney injury.

OBJECTIVE:This systematic review aimed to assess the clinical outcomes of branched endovascular aneurysm repair (BEVAR) with inner branches (iBEVAR) and inner/outer branches (oBEVAR). DATA SOURCES:A systematic literature review was performed using the electronic bibliographic databases MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library up to May 2024. REVIEW METHODS:The review was designed and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies reported death, technical failure, primary target vessel (TV) patency, TV related complications, branch related re-interventions, and spinal cord ischaemia (SCI). Risk of bias was evaluated with the ROBINS-I tool. RESULTS:Twenty seven observational studies reporting a total of 1 780 patients treated with BEVAR and 6 633 TVs were included. Three hundred and eightysix patients (84.3%) were treated electively with iBEVAR and 72 (15.6%) urgently vs. 845 (63.2%) and 491 (36.7%) with oBEVAR, respectively. The pooled estimate of 30 day death was 4.9% (95% confidence interval [CI] 2.9 - 8.2%) for iBEVAR and 7.6% (95% CI 4.9 - 11.7%) for oBEVAR. Overall mortality rates were 13.8% (95% CI 9.7 - 19.1%) for iBEVAR vs. 15.4% (95% CI 10.6 - 21.9%) for oBEVAR. The rate of SCI was 6.5% (95% CI 4.2 - 10.0%) in iBEVAR compared with 12.9% (95% CI 9.6 - 17.1%) in oBEVAR. Primary TV patency was similar between iBEVAR (97.3%, 95% CI 94.8 - 98.6%) and oBEVAR (97.6%, 95% CI 95.3 - 98.7%). TV related complication rates were 2.9% (95% CI 2.0 - 4.1%) for iBEVAR vs. 3.9% (95% CI 2.7 - 5.6%) for oBEVAR. Technical failure rates were 4.1% (95% CI 2.4 - 6.9%) for iBEVAR vs. 5.7% (95% CI 3.5 - 9.1%) for oBEVAR. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty was low or very low for all outcomes. CONCLUSION:BEVAR with inner and inner/outer branches has been used in elective and urgent cases, as well as across a variety of anatomies, with both designs demonstrating satisfactory clinical outcomes.

Background/Objective: Bridging stent optimal choice in fenestrated and branched endovascular aortic repair (f/bEVAR) is under investigation. This systematic review and meta-analysis studied the outcomes of the BeGraft peripheral and peripheral PLUS as bridging stents in f/bEVAR. Methods: The methodology was pre-registered to the PROSPERO (CRD420251007695). Following the PRISMA guidelines and PICO model, the PubMed, Cochrane and Embase databases were searched for observational studies and randomized control trials, in English, from 2015 to 2025, reporting on f/bEVAR patients using the second-generation BeGraft peripheral or the BeGraft peripheral PLUS balloon expandable covered stent (BECS; Bentley InnoMed, Hechingen, Germany) for bridging. The ROBINS-I assessed the risk of bias and GRADE the quality of evidence. Target vessel technical success, occlusion/stenosis, endoleak Ic/IIIc, reintervention and instability during follow-up were primary outcomes, assessed using proportional meta-analysis. Results: Among 1266 studies, eight were included (1986 target vessels; 1791 bridged via BeGraft); all retrospective, except one. The ROBINS-I showed that seven were at serious risk of bias. According to GRADE, the quality of evidence was “very low” for primary outcomes. Target vessel technical success was 99% (95% CI 98–100%; I2 = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2–5%; I2 = 44%), occlusion/stenosis was 1% (95% CI 1–4%; I2 = 8%) and endoleak Ic/IIIc was 1% (95% CI 0–3%; I2 = 0%). The estimated target-vessel reintervention was 2% (95% CI 2–4%; I2 = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0–16%; I2 = 0%;), 1% (95% CI 0–5%; I2 = 14%) and 4% (95% CI 2–7%; I2 = 40%), respectively. Conclusions: The BeGraft peripheral and peripheral PLUS BECS performed with high technical success and low instability when used for bridging in f/bEVAR. Cautious interpretation is required due to the very low quality of evidence.

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:Although endovascular aortic repair (EVAR) has been increasingly used for the treatment of abdominal aortic aneurysm (AAA), rupture is still a life-threatening event in 1-5% of those treated patients. We aimed to compare the characteristics, hemodynamic status at presentation, and outcomes between patients with previous EVAR (ruptured EVAR [rEVAR]) and those with no previous aortic intervention (rWPT group) who presented with AAA rupture. METHODS:Between January 2019 and November 2023, all consecutive patients who experienced a ruptured infrarenal/juxtarenal AAA, received endovascular or open intervention and prospectively recorded in the Hellenic Vascular Registry (Greek) were analyzed. The two groups of patients (rEVAR and rWPT) were compared. RESULTS:A total of 203 patients with AAA rupture were studied. Among them, 40 patients (19.7%) had previous EVAR for AAA (rEVAR group), while the remaining (163; 80.3%) were included in the rWPT group. Patients with rEVAR were on average 5.8 years significantly older (P < 0.001). There was no significant difference regarding the hemodynamic status at presentation between rEVAR and rWPT groups. The overall mortality was 40.4% (82/203). Mortality for patients with rEVAR was 37.5% compared to 41.1% for the group of rWPT (P = 0.7). Among all patients, age (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.04-1.12; P < 0.001), hemodynamic shock at initial presentation (OR: 6.57, 95% CI: 2.52-17.12; P < 0.001), and open repair (OR: 5.31, 95% CI: (2.33-12.08; P < 0.001) were significant prognostic factors of mortality. CONCLUSION:Our study provides evidence that patients with post-EVAR rupture are equally hemodynamically unstable at presentation compared to patients with de novo ruptures. The mortality associated with post-EVAR rupture is high and not inferior compared to that observed for de novo ruptures. Significant risk factors for a dismal outcome in the whole cohort of patients who presented with AAA rupture were age, hemodynamic shock at initial presentation, and open repair.

OBJECTIVE:This study aimed to report the ten year data for patients treated with the Gore Excluder AAA Endoprosthesis featuring the C3 Delivery System for infrarenal aortic disease, as recorded in the European C3 module of the Gore Global Registry for Endovascular Aortic Treatment. METHODS:The European C3 module included patients from 13 centres who underwent endovascular aortic aneurysm repair between August 2010 and December 2012. Outcomes were assessed using descriptive statistics and Kaplan-Meier survival analysis with 95% confidence intervals (CIs). RESULTS:At module closure, 396 patients (87.1% men; mean age ± standard deviation 73.9 ± 7.8 years) were available for analysis, with a mean follow up duration ± standard deviation of 6.4 ± 3.2 years. Of these, 94.4% underwent elective endovascular aortic aneurysm repair for infrarenal aortic aneurysm, and 16.9% (67 of 396) were treated outside the instructions for use. At ten years, the all cause mortality rate was 46.0% with 182 deaths: five aortic related, 120 non-aortic related, and 57 of unknown cause. Freedom from aortic related death was 98.6% (95% CI 96.7 - 99.4%). Freedom from any re-intervention and device related re-intervention was 77.3% (95% CI 71.8 - 81.8%) and 80.6% (95% CI 75.3 - 84.9%), respectively. Freedom from type 1 endoleak was 95.4% (95% CI 92.3 - 97.5%), with type 2 endoleaks accounting for 82% (41 of 50) of all endoleaks. Structural complications were rare: two cases of migration (0.5%), one case of compression (0.3%), and no cases of device fractures. Nine patients (2.3%) required conversion, and secondary rupture occurred in three cases (0.8%). CONCLUSION:The Gore C3 Excluder shows long term safety and durability for infrarenal aortic disease, with low rates of aortic related death and major aortic events. These findings support its effectiveness in a real world setting. However, surveillance adherence remains challenging in daily practice.

The objective was to report outcomes of urgent juxta/pararenal aneurysms (J/P-AAAs) managed using off-the-shelf multibranched thoracoabdominal endografts (OTS m-BEVARs). In this observational, multicenter, retrospective study, patients with J/P-AAAs who underwent urgent endovascular repair using OTS m-BEVARs (Cook, T-branch) in 23 European aortic centers from 2013 to 2023 were analyzed. J/P-AAA rupture, symptoms, and aneurysm diameter >70 mm were considered as indications for urgent repair. Technical success (TS), spinal cord ischemia (SCI), and 30-day/hospital mortality were assessed as early outcomes. Survival, freedom from (FF) reinterventions, and target artery instability (TAI) were evaluated during follow-up. Definitions and results were reported according to the current Society for Vascular Surgery reporting standard for aneurysms involving renal-mesenteric arteries. Overall, 197 cases (J-AAAs: 64 [33%], P-AAAs: 95 [48%], previous failed-EVAR: 38 [19%]) were analyzed. The mean age and aneurysm diameter were 75 ± 8 years and 76 ± 4 mm, respectively. The ASA score was 3 and 4 in 118 (60%) and 79 (40%) patients, respectively. Rupture, symptoms, and diameter >70 mm were present in 51 (26%), 110 (56%), and 131 (66%) patients, respectively. An adjunctive proximal thoracic endograft was used in 28 (14%) cases. The mean aortic coverage between the upper portion of the endograft and the lowest renal artery was 154 ± 49 mm. Single-stage repair and cerebral-spinal-fluid drainage were reported in 144 (73%) and 53 (27%) cases, respectively. TS was achieved in 182 (92%) cases (rupture: 84% vs no rupture: 95%; P = .02). Failures consist of target artery loss (11: renal artery: 9 and celiac trunk: 2), type I-III endoleak (2), and 24-hour mortality (2). Rupture was a risk factor for technical failure (P = .02; odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.1-12.1). Overall, 15 (8%) patients had persistent SCI (rupture: 14% vs no rupture: 5%) with 11 (6%) cases of paraplegia (rupture: 10% vs no rupture: 5%; P = .001). Rupture (P = .04; OR: 3.1; 95% CI: 1.1-8.9) and adjunctive proximal thoracic endograft (P = .01; OR: 4.1; 95% CI: 1.3-12.9) were risk factors for SCI. Twenty-two (11%) patients died within 30 days or during a prolonged hospitalization. Previous failed-EVAR (P = .04; OR: 3.6; 95% CI: 1.1-12.3), paraplegia (P < .001; OR: 9.9; 95% CI: 1.6-62.2), postoperative mesenteric events (P = .03; OR: 10.4; 95% CI: 1.2-93.3), and cardiac (P = .03; OR: 8.2; 95% CI: 2.0-33.0) and respiratory (P < .001; OR: 10.1; 95% CI: 2.9-35.2) morbidities were associated with 30-day/hospital mortality. The mean follow-up was 19 ± 5 months. Estimated 3-year survival and FF reinterventions were 58% and 77%, respectively. TAI occurred in 27 (14%) patients (within 30 days: 3%-2%, after 30 days: 24%-12%; occlusion: 15, endoleak: 14) with an estimated 3-year FF-TAI of 72%. Urgent repair of J/P-AAAs using OTS m-BEVAR is feasible and effective with satisfactory TS and 30-day/hospital mortality in high-risk patients. However, extensive aortic coverage is necessary, leading to a non-negligible SCI rate, especially in aortic rupture or when adjunctive thoracic endografts are necessary. Predictors of TS, SCI, and mortality were identified, and they should be considered for surgical indication and outcomes' optimization.

OBJECTIVE:The aim of this study was to report outcomes of the BeGraft and BeGraft Plus as bridging covered stents in fenestrated and branched endovascular aneurysm repair (FB-EVAR). METHODS:Patients treated and followed in two institutions receiving at least one BeGraft or BeGraft Plus as bridging covered stent between January 2018 and July 2023 were included. RESULTS:A total of 765 target vessels (TVs) in 281 patients were aimed to be bridged with the BeGraft or BeGraft Plus. Target vessel technical success was 99.5% (761/765). Estimated TV patency at one and two years was 98.5 ± 0.5% and 96.7 ± 0.9%, respectively, with no difference between fenestrations and branches. Estimated freedom from TV related endoleak at one and two years was 98.5 ± 0.5% and 97.9 ± 0.6%, respectively. Estimated freedom from endoleak at two years was lower for TVs targeted with branches compared with TVs targeted with fenestrations (94.2 ± 1.9% vs. 99.7 ± 0.3%, respectively; p < .001). Estimated freedom from TV related re-intervention at one and two years was 97.7 ± 0.6% and 97.1 ± 0.7%, respectively. Estimated freedom from TV related re-intervention at two years was lower for TVs targeted with branches compared with TVs targeted with fenestrations (93.1 ± 2.0% vs. 99.0 ± 0.5%, respectively; p < .001). Estimated freedom from TV instability at one and two years was 96.8 ± 0.7% and 94.5 ± 1.1%, respectively. Estimated freedom from TV instability at two years was 96.0 ± 1.3% for fenestrations and 91.2 ± 2.2% for branches (p = .003). CONCLUSION:The BeGraft and BeGraft Plus covered stents showed good midterm outcomes as bridging covered stents in FΒ-EVAR. Branches showed higher instability rates compared with fenestrations. Branches showed similar patency rates to fenestrations.

Background Studies over the last years have revealed the possible impact of endovascular repair of abdominal or thoracic aortic aneurysms on the arterial stiffness and secondary on the cardiac function and the central hemodynamics. Methods A literature search was conducted to collect data on current methods of arterial stiffness assessment and the induced changes in arterial stiffness after endovascular or open surgical repair of abdominal or thoracic aortic aneurysms. Results Seventeen studies were analyzed. In most of these studies, arterial stiffness, either assessed by pulse wave velocity or augmentation index, was found to be increased after aortic aneurysm repair. Factors that increase arterial stiffness seem to be endovascular repair of the aneurysm and the proximity of the stent graft to the heart. The clinical implications of increased arterial stiffness are left ventricular hypertrophy, coronary arteries malperfusion and potential end-organ damage. Conclusions Both endovascular and open aortic aneurysm repair can alter arterial stiffness, with endovascular repair having a greater effect. Future research is essential, particularly in exploring the impact of aortic aneurysm repair methods on vital organs and cardiac function. Extended follow-up studies are proposed to gain a better understanding of the long-term cardiovascular consequences of both endovascular and open surgical repair outcomes.

EDITORIAL article Front. Surg., 15 January 2024Sec. Vascular Surgery Volume 11 - 2024 | https://doi.org/10.3389/fsurg.2024.1362571