Background/Objectives: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by ischemic rest pain or ulcer necrosis. In Europe, spinal cord stimulation (SCS) can be offered to CLTI patients with chronic pain to improve mobility and prolong limb preservation. We evaluated the long-term, real-world outcomes of SCS therapy in patients with CLTI. Methods: In this observational study, medical chart review data from consecutive CLTI patients treated with SCS were analyzed. Results: Fifty-three patients (56.6% Fontaine Stage III, 39.6% Fontaine Stage IV, 3.8% Fontaine Stage IIb) had a single-stage SCS implant procedure between 2013 and 2022. Two years after SCS therapy activation, claudication pain intensity had significantly improved; the overall numerical rating scale pain score decreased from 9.4 ± 0.9 at baseline to 3.7 ± 3.2 (p < 0.0001). In addition, walking distance increased by more than 350 m (from 70 ± 87 to 429 ± 320 m, p < 0.0001), and pre-existing skin lesions stabilized in ten patients (63%). The probability of limb survival in Fontaine’s stage IIb/III and Fontaine’s stage IV patients at 12 months was 90% and 70%, respectively (log-rank p-value = 0.04). Finally, significant associations were found between the occurrence of an amputation after SCS and Fontaine Stage (p = 0.01), active smoking (p = 0.02), hypertension (p = 0.04), and prior minor amputation (p = 0.02). No major complications were reported. Conclusions: Our real-world experience suggests that SCS for CLTI patients provides significant and durable improvements in ischemic pain and functional outcomes. SCS may also help reduce the natural risk of major amputation, especially when implemented at early CLTI stages.

OBJECTIVE:To describe early and midterm outcomes of Viabahn stenting for extensive aortoiliac occlusive disease involving the external iliac artery (EIA). METHODS:In this single-center retrospective study, all consecutive patients in whom a covered self-expanding (SE) Viabahn stent was implanted (W.L. Gore & Associates, Inc, Flagstaff, Arizona) in the EIA for symptomatic Trans-Atlantic Intersociety Consensus (TASC) II C and D lesions between 2012 and 2020 were included. Lesions limited to the iliac artery were treated percutaneously. Iliac lesions extending down to the common femoral artery (CFA) were treated with a hybrid approach. Patency, major adverse limb events (MALEs), target lesion revascularization (TLR), and limb salvage rates were estimated using Kaplan-Meier curves. RESULTS:Of 118 limbs, 48 (41%) were treated for claudication, 33 (28%) for rest pain, and 37 (31%) for tissue loss. Lesions were TASC C (n = 43 limbs, 36%) or TASC D (n = 75 limbs, 64%). Chronic total iliac occlusions were identified in 26 limbs (22%). Concomitant CFA lesions were recorded in 97 limbs (82%). All lesions involved the EIA. Technical success was achieved in 100% of cases. Six (5.7%) perioperative major adverse cardiovascular events occurred, including 4 (3.8%) deaths. Eleven (7.6%) early MALEs were recorded. Two-year primary patency, assisted primary patency, and secondary patency were 85%, 88%, and 95%, respectively. After multivariate analysis, small-diameter stents (<8 mm) were associated with lower primary patency rates (hazard ratio [HR] 3.20, 95% confidence interval [CI]: 1.26-8.13, P = .014) and lower freedom from TLR rates (HR 2.61, 95% CI: 1.02-6.66, P = .045). Adjunctive CFA endarterectomy was significantly associated with higher primary patency rates (HR 0.38, 95% CI: 0.15-0.95, P = .038). CONCLUSION:The use of Viabahn SE covered stents for extensive aortoiliac disease involving the EIA provided acceptable postoperative morbidity and high rates of midterm secondary patency, similar to those usually reported with aortobifemoral bypass. Adjunctive CFA endarterectomy was a major determinant of patency and should be considered an essential component of the treatment strategy. Additional long-term data are necessary to evaluate the role of SE covered stents for the treatment of such lesions.Clinical ImpactThe endovascular management of extensive aortoiliac occlusive disease involving the external iliac artery remains challenging. This study represents one of the largest series dedicated to the treatment of TASC II C and D lesions involving the external iliac artery with self-expanding covered stents. The results suggest mid-term secondary patency rates comparable to those commonly reported after aortobifemoral bypass. Notably, concomitant common femoral bifurcation treatment and the use of ≥8-mm diameter stents were associated with improved patency rates, suggesting that aggressive management of common femoral artery lesions and the use of larger-diameter stents may contribute to optimizing long-term outcomes.

Introduction:Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularisation technique useful in hostile groin cases. Although described during the 1960s, this operation is often considered technically demanding and not widely used nowadays. This study reports the long term outcomes of a series of OFBs. Method:This was a retrospective, observational, single centre study. All consecutive patients who underwent an OFB between 2002 and 2024 at the Henri Mondor University Hospital were included. Pre-operative patient characteristics, as well as intra-operative and post-operative data were analysed. Primary outcomes were survival and primary and secondary patency. Secondary outcomes were wound healing, freedom from re-infection, and limb salvage. Results:Between 2002 and 2024, 26 patients underwent an OFB; 18 were men (69%). The mean age was 64 ± 12 years. In 21 cases (81%) the surgical indication was extensive groin infection with native vessels or prosthetic material involvement. In six cases (23%), the operation was performed under emergency conditions. A cryopreserved arterial allograft was the conduit of choice in 16 cases (62%). Mean follow up was 37 ± 8 months (range, 0-129). The thirty day mortality rate was 15%. Survival rate at 12, 24, and 36-60 months was 73%, 67%, and 60%, respectively. The primary patency rate was 88% at 12 months and 83% at 24-60 months. An early re-intervention was needed in eight patients (31%), mostly for local wound debridement. There were no cases of bypass re-infection requiring removal. Conclusion:Obturator foramen bypass can be a limb and lifesaving procedure in selected cases and experienced centres. Long term patency and wound healing rates are satisfactory. The authors reported a non-negligible early mortality rate, which is associated with the severe initial condition of these patients, often admitted with septic or haemorrhagic shock, and affected by multiple comorbidities. Thorough knowledge of the technique and continuous post-operative follow up are mandatory to eventually prevent and treat complications.

Severe iliac calcifications may preclude standard renal transplantation (RT) because of hostile vascular access. We report a technique of iliac endovascular preparation using Viabahn stent-grafts (W. L. Gore & Associates) as arterial landing zones for RT in five high-risk patients. Endoclamping and arteriotomy and prosthotomy enabled direct anastomosis through the stent and artery. All grafts remained patent with no vascular complications or stenosis. This minimally invasive strategy avoids major bypass surgery and facilitates RT in patients previously considered ineligible. Although early outcomes are encouraging, strict patient selection and experienced surgical teams are essential. Larger studies are needed to validate long-term efficacy and safety.

OBJECTIVE:This retrospective, observational, single centre study aimed to describe midterm results of physician modified stent grafts using antegrade laser fenestrations and image fusion guidance (lEVAR) for the treatment of complex abdominal aortic aneurysms, thoraco-abdominal aortic aneurysms, and type I endoleaks. METHODS:All lEVAR procedures between 1 September 2016 and 1 January 2022 were reviewed. Endpoints included intra-operative adverse events (IOAEs), in hospital death, re-interventions, and target vessel patency. Midterm outcomes were estimated using the Kaplan-Meier time to event method with 95% confidence intervals (95% CI). RESULTS:Sixty patients underwent lEVAR procedures during the study period. All patients were deemed unfit for open repair. The lEVAR cases included 12 symptomatic aneurysms, 33 enlarging aneurysms > 65 mm, 14 anatomical constraints and or presence of previous renal stents, and one rupture. The median aneurysm diameter was 65.5 mm (IQR 13). One hundred and seventy antegrade laser fenestrations were performed (mean 2.8/patient). IOAEs were recorded in 21 cases (35%). Technical success was recorded in 98% of cases. The in hospital mortality rate was 5% (n = 3). The median follow up was 35.7 months. The estimates of overall survival and freedom from re-intervention at three years were 81% (95% CI 68.3 - 89) and 60.2% (95% CI 43.4 - 73.4), respectively. Six target vessels occluded during follow up, giving a three year target vessel patency rate of 90.1% (95% CI 77.5 - 95.8). Two lEVAR explantations were recorded during follow up, either for infection or persistent endoleak. The three year freedom from aortic death estimate was 92% (95% CI 86.9 - 99.7). CONCLUSION:In high risk patients deemed unfit for open repair, lEVAR may provide satisfactory midterm overall survival and target vessel patency rates, although re-intervention rates were high in this study, requiring close and extensive follow up.

Coronary artery disease (CAD) remains one of the leading causes of mortality worldwide, affecting more than 300 million people. Over the past two decades, percutaneous coronary intervention (PCI) has become the cornerstone of CAD treatment, involving the implantation of coronary stents. This review clarifies how coronary stents emerged, evolved, and ultimately reshaped modern interventional cardiology. Beginning with balloon angioplasty and progressing through bare-metal and drug-eluting stents, we show how each advancement solved key clinical shortcomings-dramatically reducing restenosis, thrombosis, and repeat revascularization. We further review the major technological advances driving modern stent development, such as biodegradable alloys and biomimetic coatings. We also highlight the remaining challenges, including long-term stability, manufacturing complexity, and limited translational readiness. Together, these elements support our central thesis: that the historical evolution of coronary stents is fundamental to understanding present PCI practice and to guiding the next phase of device innovation.

(1) Background: Endovascular abdominal aneurysm repair (EVAR) is associated with a reduction in early morbidity and mortality compared with open repair. Procedures performed under hypnosis might represent an alternative to further reduce the risks related to general anesthesia (GA). This study aimed to assess the feasibility and safety of hypnosis and local anesthesia during EVAR. (2) Methods: All consecutive patients who underwent EVAR or fenestrated/branched EVAR (f/bEVAR) under hypnosis and local anesthesia (n = 28) between 2017 and 2019 were retrospectively studied and matched to control patients who underwent the same interventions under GA. (3) Results: There was neither a significant difference in the length of ICU stay (p = 0.06), nor in the occurrence of endoleaks, reintervention, and 30-day mortality rate (p = 1.00, 0.73, and 0.24, respectively). The hypnosis group had lower use of norepinephrine (maximum dose 0.04 ± 0.1 vs. 1.2 ± 4.0 mg·h−1, p < 0.001), shorter procedure duration (181.2 ± 71.4 vs. 214.3 ± 79.6 h, p = 0.04), and shorter length of stay (5.4 ± 3.2 vs. 8.4 ± 5.9 days, p = 0.002). (4) Conclusions: In this pioneering study, hypnosis during EVAR appears feasible and safe. It is associated with lower intraoperative use of norepinephrine, as well as procedure duration and length of in-hospital stay.

Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending thoracic or thoracoabdominal aorta at risk of spinal cord ischemia. Pre-operative non-selective dual-phase CBCT after intra-aortic contrast injection was performed in the aortic segment to be treated. The origin of detected AKA was assessed based on image fusion between CBCT and pre-interventional computed tomography angiography. Then, the CBCT findings were compared with the incidence of postoperative spinal cord ischemia (SCI). Among 21 included patients (median age: 68 years, 20 men), AKA was detected in 67% within the explored field of view, predominantly from T7 to L1 intercostal and lumbar arteries. SCI occurred in 14%, but none when AKA was not detected (p < 0.01). Non-selective CBCT for AKA mapping is deemed safe and feasible, with potential predictive value for post-surgical spinal cord ischemia risk. The study concludes that non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping, providing promising insights into predicting post-surgical SCI risk.

Following laser fenestrated endovascular treatment (LEVAR) of abdominal aortic aneurysms (AAAs), we evaluated the impact of stent indentation in LEVAR, long-term patency of target vessels, and the correlation between laser use and target vessel thrombosis in the long term. A retrospective, monocentric, observational study was conducted on patients diagnosed with complex AAAs treated by LEVAR between 2016 and 2017. The procedure consisted of deploying an Endurant (Medtronic) stent graft and antegrade laser fenestrations under image-fusion guidance. Stenting was performed on target vessels after fenestration. All patients underwent a computed tomography (CT) angiography in the days following the operation, and follow-up scans or duplex ultrasound at 1 month, 6 months, and yearly thereafter. The main objective was the patency of target-vessel stents. Endpoints included mortality, follow-up discontinued by the patient, and conversion to surgery. The study population consisted of 15 patients (13 males) with a mean age of 75 years. Ten (66.6%) patients had degenerative juxta-renal AAAs, 3 (20%) patients had thoracoabdominal aortic aneurysms, and one patient had a type 1a endoleak post-EVAR. Two (13.3%) patients had stenting of one renal artery, 2 (13.3%) had stenting of both, 5 (33.3%) also had superior mesenteric artery (SMA) stenting, 2 (13.3%) had stenting of SMA and celiac trunk only, and 5 (33.3%) had stenting of one renal artery and SMA. Mean hospital stay was 9 days, with 30-day mortality for 1 patient, and 2 (13.3%) intrahospital deaths. The mean follow-up was 52 months. One patient had post-operative thrombosis of the SMA stent, and died at Day 5. Another patient had dissection and thrombosis of the left renal artery during the operation. Twelve (80%) patients had preserved target vessel stent permeability until the end of follow-up, and 1 patient (6.6%) had 60–70% stenosis of the left renal artery at 6-month follow-up. LEVAR procedures require well-equipped vascular centers and endovascular experience, but are associated with high rates of long-term patency of target vessels. A cohort study comparing to custom-made fenestrated EVAR may be considered in our center to provide more accurate results.

Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization. Methods: This retrospective bicentric study included patients who underwent embolization of high-flow PDA aneurysms due to significant celiac trunk stenosis or occlusion. All patients underwent pre-interventional dynamic contrast-enhanced computed tomography. Retrograde embolization was performed using microcoils and/or liquid agents without celiac trunk revascularization. Follow up involved clinical and radiological assessment at one month. Technical and clinical success were evaluated, and complications were categorized as minor or major. Results: Twenty-three patients (mean age 65 ± 14 years; 52% male) were included. Emergency embolization was required in 12 patients (52%). The technical success rate was 100%. Patients were monitored for a median of 16 months. Clinical success was 87%. No hemorrhagic recurrences were observed. Minor complications occurred in two cases. One major complication involved splenic infarction due to glue migration, requiring splenectomy and intensive unit care admission. Conclusions: Retrograde embolization of high-flow PDA aneurysms is effective and safe without needing celiac trunk revascularization.

Le syndrome de l'artère poplitée piégée (SAPP) est une maladie vasculaire rare et souvent mal diagnostiquée qui survient particulièrement chez les jeunes adultes actifs. La claudication intermittente est son principal symptôme et elle est due à la compression externe de l'artère poplitée pendant l'exercice. Évaluer les résultats techniques et cliniques ainsi que la satisfaction des patients après chirurgie du SAPP. Patients et méthodes Il s'agit d'une étude monocentrique et rétrospective prenant en compte tous les patients traités pour SAPP dans le service de chirurgie vasculaire de l'hôpital Henri Mondor/AP–HP entre 2003 et 2022. La chirurgie a consisté en une décompression myotendineuse avec ou sans réparation vasculaire de l'artère poplitée par voie postérieure. Les patients ont été revus dans le cadre d'une consultation postopératoire à 1 mois. Pour le suivi, un questionnaire Google form a été envoyé à chaque patient et éventuellement complété par un appel téléphonique. La population étudiée était composée de 65 patients d'un âge moyen de 27 ans avec une prédominance masculine (67 %). Tous les patients ont été opérés dans le service de chirurgie vasculaire de l'hôpital Henri-Mondor. La durée moyenne de suivi a été de 81 + /-25 mois. Seuls 6 patients (9 %) ont eu besoin d'une réparation vasculaire ; 5 pontages fémoro-poplités et 1 plastie de l'artère poplitée avec patch veineux. Le taux de perméabilité est resté à 100 % durant tout le suivi. Le taux de succès technique postopératoire évalué par écho-doppler a été de 92,5 %. Durant le suivi, 75 % des patients ont pu reprendre une activité au moins équivalente à celle qu'ils avaient avant l'apparition des troubles, 20 % ont dû réduire leur activité et 5 % ont arrêté toute activité sportive. Si le traitement du SAPP offre un bon taux de succès technique immédiat (> 90 %), le taux de satisfaction diminue à 75 % lors du suivi. L'explication de cette diminution est plurifactorielle : récidive du piège, typologie sportive, entraînement non adapté, psychologie trop exigeante de certains patients.

e-Health technology holds great promise for improving the management of patients with vascular diseases and offers a unique opportunity to mitigate the environmental impact of vascular care, which remains an under-investigated field. The innovative potential of e-Health operates in a complex environment with finite resources. As the expansion of digital health will increase demand for devices, contributing to the environmental burden of electronics and energy use, the sustainability of e-Health technology is of crucial importance, especially in the context of increasing prevalence of cardiovascular diseases. This review discusses the environmental impact of care related to vascular surgery and e-Health innovation, the potential of e-Health technology to mitigate greenhouse gas emissions generated by the health care sector, and to provide leads to research promoting e-Heath technology sustainability. A multifaceted approach, including ethical design, validated eco-audits methodology and reporting standards, technological refinement, electronic and medical devices reuse and recycling, and effective policies is required to provide a sustainable and optimal level of care to vascular patients.

Objective: A proximal scallop design allows aortic arch repair without complex endovascular manipulation in the aortic arch. The aim was to assess the safety and efficacy at one year of the Relay proximal scallop stent graft.Methods: A prospective multicentre study evaluated consecutive patients treated with the Relay proximal scallop stent graft in 10 French aortic centres. All consecutive patients eligible for elective thoracic endovascular repair with proximal scallop in the 10 participating centres between January 2015 and July 2018 were included. Primary endpoints were 30 day mortality, stroke, and spinal cord ischaemia (SCI) rates. Outcomes including safety and efficacy, technical and clinical success, all cause death, neurological events, vessel patency, and device specific complications were analysed. Survival and survival without severe complications were estimated using Kaplan -Meier estimates.Results: Ten aortic centres treated 40 patients for thoracic aortic aneurysm (45% ), penetrating atherosclerotic aneurysm ( 30%), and dissection (25%). Half of the procedures (50%) targeted zone 0 of the aortic arch (zone 0 in 17.5% and zones 0/1 in 32.5%), 37.5% targeted zone 2 (35% zone 2 alone; 2.5% zones 1/2), and 15% targeted zone 1 (12.5% zone 1 alone). Median follow up was one year. Thirty day mortality, stroke, and SCI rates were 10%, 5%, and 0% respectively. Primary technical success was 95%. Type Ia, Ib, and III endoleaks rates were 5.4%, 0%, and 0% respectively at one month. The overall mortality rate at one year was 17.5%. Aneurysm expansion was > 5 mm in one case at one year associated with type Ia endoleak ( 3%). There was no supra-aortic trunk thrombosis, one (2%) graft kink, and no migration.Conclusion: One year outcomes showed that the Relay proximal scallop stent graft is an acceptable answer to thoracic aortic disease to deal with short proximal landing zones.