To meet the clinical need for small-diameter vascular grafts, we propose a new generation of Tissue-Engineered Vascular Grafts (TEVGs) based on the textile assembly of the Cell-Assembled extracellular Matrix (CAM): a non-cross-linked, entirely biological, and human biomaterial produced by cells in culture. Previously, we demonstrated the feasibility of producing woven CAM tubes with mechanical properties suitable for use as vascular grafts. In this study, we demonstrate, for the first time, the long-term use of these woven TEVGs in vivo. Miniaturized human TEVGs were produced, thanks to the versatility of the weaving process, and successfully implanted in the abdominal aorta of immunosuppressed rats. After one year, ultrasound images revealed flow through the TEVGs (overall patency: 86%). A neo-media was observed on the luminal surface as early as 1 month and was composed of differentiated muscular cells and elastin, covered by a monolayer of confluent and aligned endothelial cells. The immune response to TEVGs, mainly driven by M2-type macrophages, was mild and decreased over time. Unexpectedly, CAM calcification was observed in areas of high biomaterial compaction, a phenomenon never observed in previous in vivo CAM studies. This work showed that CAM-based textiles persist for at least one year in a vascular graft position. In conclusion, the woven assembly of the CAM produced a highly promising vascular graft, given its excellent in vivo stability and integration.

OBJECTIVE:The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular graft or endograft infection (VGEI), in succession to the 2020 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. By summarising and evaluating the best available evidence, recommendations for the evaluation and management of patients with VGEI 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:Eighty-one recommendations have been issued across the following main topics: definitions, diagnosis, multidisciplinary team management, antimicrobial therapy, management of intracavity or extracavity VGEI, and follow up. A chapter addresses the concept of shared decision making, with supporting information for patients. A final chapter addresses unresolved issues. CONCLUSION:These ESVS clinical practice guidelines provide comprehensive, up to date advice to clinicians and patients on the management of VGEI.

Background: Type IV carotid artery aneurysms are uncommon; mycotic variants are rarer and challenging. We report a distal internal carotid aneurysm managed with a two-stage hybrid approach. Case: A 28-year-old man had an enlarging left cervical mass with transient dysphagia and dysphonia. CT showed a distal internal carotid aneurysm measuring 71 × 49 mm, extending to the pre-foraminal segment. FDG-PET/CT demonstrated avid uptake (SUV 8.9). Work-up excluded endocarditis; Quantiferon was positive. Multidisciplinary review deemed endografting unsuitable and bypass unsafe given absent distal control. Intervention: Under local anesthesia, a 50-minute balloon occlusion test of the petrous internal carotid artery was followed by coil embolization and proximal vascular plug, completing arterial sacrifice. Post-procedure transient monocular visual loss corresponded to a small watershed infarct; hemodynamic augmentation achieved full recovery within 24 hours. Six days later, aneurysmectomy was performed with ligation of the common and external carotid arteries. Cultures grew Cutibacterium acnes; clindamycin then six weeks of amoxicillin were given. The patient was discharged day seven. At day 22 the wound had healed, dysphonia improved, and inflammatory markers fell without new neurologic events. Conclusion: When anatomy precludes reconstruction, staged sacrifice after a successful balloon occlusion test can enable definitive aneurysmectomy while preserving cerebral perfusion.

OBJECTIVE:Infective native aneurysms of the femoropopliteal arteries (INA-FPs) are rare and mostly reported in patients with a history of intravenous drug use (IVDUs). This study aimed to summarize all cases of INA-FPs presented in the literature, to describe patient characteristics, microbiology, treatments and outcomes, and compare IVDU with non-IVDU patients. METHODS:A systematic search of PubMed, ScienceDirect, Embase, and the Cochrane Library was done for studies published between 1990 and July 2024. The study followed the PRISMA guidelines and articles were scrutinized regarding patient characteristics, anatomical segment, etiology, microbiology, treatment modalities, and outcomes. RESULTS:Eighty-two studies comprising 368 patients with 382 INA-FPs were included. INA-FPs were located in the common femoral artery (CFA) in 305 cases (79.8%), the deep femoral artery in 4 (1.0%), the superficial femoral artery in 45 (11.8%), and the popliteal artery in 28 (7.3%). These INA-FPs developed in 299 IVDU (81.3%) and in 69 non-IVDU patients (18.7%). IVDU patients were younger (mean age 39 years vs 65 years; P < .001), more frequently had common femoral artery involvement (93.2% vs 23.3%; P < .001), and had lower 1-year mortality rates (2.9% vs 17.3%; P < .001). The most common pathogen was Staphylococcus aureus (39%). Details on multidisciplinary team management and antimicrobial therapy were missing. Ligation was the most performed treatment in IVDU patients (89.3%), whereas bypass was the most used in non-IVDUs (69.6%). In the entire cohort, bypass was associated with a five-fold increase in rebleeding risk compared with ligation (P < .001), and 50% were fatal. Ligation demonstrated a four-fold increased risk of claudication compared with bypass (24% vs 6%), but amputation rates were equal. CONCLUSIONS:INA-FPs are rarely reported, with significant differences in patient characteristics, surgical management, and outcomes between IVDU and non-IVDU patients. These findings underscore the need for tailored multidisciplinary team management that carefully balances the benefits of revascularization against the risks of fatal bleeding.

Introduction: Iliac artery aneurysms (IAAs) which may coexist with abdominal aortic aneurysms (AAAs) or appear as isolated lesions, represent around 2 % of intra-abdominal aneurysms. Endovascular repair using iliac branch devices (IBDs) helps preserve internal iliac artery (IIA) perfusion, reducing complications like buttock claudication. However, device displacement and type III endoleaks are significant challenges, especially in tortuous anatomy. Report: We report two cases of type III endoleak due to displacement of Gore Iliac Branch Endoprosthesis (IBE). In the first case, a 60-year-old male with a left IAA experienced immediate postoperative IBE migration and type III endoleak, necessitating urgent reintervention with bridging stents. In the second, a 74-year-old male treated for a right IAA had recurrent IBE displacements over four years, with repeated type III endoleaks, managed by repeated stenting. Severe iliac tortuosity contributed to both cases. Discussion: These cases highlight the complexities of IAA endovascular repair with IBDs, particularly the risk of device migration and endoleaks, with severe iliac tortuosity, device properties (e.g. conformability, low friction coefficient), and response to cardiac pulsatility increasing migration risk. Future studies should address these challenges, focusing on device design improvements and predictive imaging techniques, including artificial intelligence, to enhance long-term outcomes in IAA repair.

Importance:Although pharmacovigilance signals and a strong pathophysiological rationale have suggested a potential risk of arterial dissections or aneurysms associated with angiogenesis inhibitors, this association deserves to be further investigated through clinical practice evidence studies. Objective:To evaluate the association between exposure to angiogenesis inhibitors and the occurrence of arterial dissections or aneurysms in patients treated for metastatic colorectal cancer (mCRC). Design, Setting, and Participants:A nested case-control study was conducted within a cohort of adults initiating targeted therapy (angiogenesis or epidermal growth factor receptor inhibitors) for mCRC between January 1, 2012, and December 31, 2017. Data were analyzed from April 2021 through August 2023. Data were drawn from the French nationwide Système National des Données de Santé database, which combines health insurance and hospital discharge records. Cases of arterial dissection or aneurysm were identified through 2019 and matched with up to 10 controls by age, sex, and time since cohort entry. Exposures:The angiogenesis inhibitors indicated for mCRC in France (ie, bevacizumab, aflibercept, ramucirumab, and regorafenib) were considered. Exposure was defined using 3 criteria: exposure at any point (exposed vs unexposed), recency (current, past, or unexposed), and cumulative duration of exposure (quartiles). Exposure periods were estimated using recommended administration schedules or drug elimination times. Main Outcomes and Measures:The primary outcome was incident hospitalization for arterial dissection or aneurysm, identified through hospital discharge diagnoses. Conditional logistic regression models were applied to estimate the association between exposure to angiogenesis inhibitors and the occurrence of arterial dissections or aneurysms, expressed as odds ratios (ORs) with 95% CIs. Results:Of the 34 733 patients included in the cohort, 195 incident cases (0.6%) were matched with 1950 controls. The study population (2145 patients) included 1562 male patients (72.8%); the median (IQR) age was 69 (63-73) years for cases and 68 (62-73) years for controls. Considering exposure at any point, 141 cases (72.3%) and 1381 controls (70.8%) were exposed to angiogenesis inhibitors; after adjustment for cardiovascular risk level, no association was observed between exposure and the occurrence of arterial events (OR, 1.07; 95% CI, 0.75-1.52). No associations were found with either recency or cumulative duration of exposure, regardless of the exposure estimation method. Conclusions and Relevance:In this case-control study of arterial dissections or aneurysms in patients receiving targeted therapy for mCRC, the lack of association with angiogenesis inhibitor exposure was reassuring, given the established benefits of these drugs, particularly bevacizumab, for this indication.

OBJECTIVE:Computed tomography angiography (CTA) imaging is essential to evaluate and analyse complex abdominal and thoraco-abdominal aortic aneurysms. However, CTA analyses are labour intensive, time consuming, and prone to interphysician variability. Fully automatic volume segmentation (FAVS) using artificial intelligence with deep learning has been validated for infrarenal aorta imaging but requires further testing for thoracic and visceral aorta segmentation. This study assessed FAVS accuracy against physician controlled manual segmentation (PCMS) in the descending thoracic aorta, visceral abdominal aorta, and visceral vasculature. METHODS:This was a retrospective, multicentre, observational cohort study. Fifty pre-operative CTAs of patients with abdominal aortic aneurysm were randomly selected. Comparisons between FAVS and PCMS and assessment of inter- and intra-observer reliability of PCMS were performed. Volumetric segmentation performance was evaluated using sensitivity, specificity, Dice similarity coefficient (DSC), and Jaccard index (JI). Visceral vessel identification was compared by analysing branchpoint coordinates. Bland-Altman limits of agreement (BA-LoA) were calculated for proximal visceral diameters (excluding duplicate renals). RESULTS:FAVS demonstrated performance comparable with PCMS for volumetric segmentation, with a median DSC of 0.93 (interquartile range [IQR] 0.91, 0.94), JI of 0.87 (IQR 0.84, 0.89), sensitivity of 0.99 (IQR 0.98, 0.99), and specificity of 1.00 (IQR 1.00, 1.00). These metrics are similar to interphysician comparisons: median DSC 0.93 (IQR 0.86, 0.93), JI 0.87 (IQR 0.76, 0.88), sensitivity 0.90 (IQR 0.86, 0.94), and specificity 1.00 (IQR 1.00, 1.00). FAVS correctly identified 99.5% (183/184) of visceral vessels. Branchpoint coordinates for FAVS and PCMS were within the limits of CTA spatial resolution (Δx -0.33 [IQR -1.70, 1.12], Δy 0.61 [IQR -1.25, 3.60], Δz 2.10 [IQR 0.37, 5.06] mm). BA-LoA for proximal visceral diameter measurements showed reasonable agreement: FAVS vs. PCMS mean difference -0.11 ± 5.23 mm compared with interphysician variability of 0.03 ± 5.27 mm. CONCLUSION:FAVS provides accurate, efficient segmentation of the thoracic and visceral aorta, delivering performance comparable to manual segmentation by expert physicians. This technology may enhance clinical workflows for monitoring and planning treatments for complex abdominal and thoraco-abdominal aortic aneurysms.

Spontaneous recanalization (SR) of an internal carotid artery (ICA) is a rare phenomenon. Cases reported in literature described the evolution of dissection or atherothrombotic / cardioembolic acute occlusions. No case of post-endarterectomy ICA occlusion resolved by SR has never been reported. Herein, we describe the case of a 64-year old male patient who presented an ipsilateral ischemic stroke due to the ICA occlusion in the second post-operative day of a carotid endarterectomy (CEA) and SR 6 months later, without anticoagulant therapy administration. The aim of this report was to increase awareness of this unusual entity and to highlight the usefulness of duplex ultrasound (DUS) surveillance of ICA eventual postoperative occlusions in order to detect accidental recanalization and to propose an adjunctive treatment whenever needed.

OBJECTIVE:There is a lack of consensus on certain terminology and definitions related to vascular graft and endograft infections (VGEIs) and secondary aorto-enteric erosion and or fistula and their treatment, outcome reporting, follow up, and reporting standards. The objective of this study was to complete a Delphi consensus study on these VGEI related issues. METHODS:The Delphi methodology was used with a panel of 43 international experts (specialists in vascular or cardiovascular surgery, infectious diseases, nuclear medicine, and radiology). Four Delphi rounds were planned using an online questionnaire initially with 31 statements. Panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements were revised, added, or deleted, and the results were presented in iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach's α > 0.80. Reporting was performed according to the ACcurate COnsensus Reporting Document (ACCORD) guideline. RESULTS:All 43 panellists fulfilled all four rounds, resulting in 100% participation. Cronbach's α increased through the rounds: round 1, 0.88; round 2, 0.89; round 3, 0.90; and round 4, 0.90. A final fifth round was performed among all surgeons (n = 27) defining secondary aorto-enteric erosion and or fistula, with 100% participation. Agreement was reached for 29 final statements: two on need for consensus, two on definition of multidisciplinary team, three on microbiology diagnosis, six on treatment, three on secondary graft-enteric partial erosion, secondary graft-enteric fistula, and secondary aorto-enteric fistula, three on treatment outcomes, nine on follow up, and one on reporting standards including 11 items. CONCLUSION:Consensus was achieved for 29 statements, which were developed to establish a common perception of VGEI and secondary aorto-enteric erosion and or fistula, with the potential to improve research in this field and ultimately patient care.

Introduction:Primary venous leiomyosarcoma is an unusual and aggressive tumour; its presentation on the renal vein is rare. This case study presents a 50 year old man with severe obesity who was incidentally diagnosed with a left renal vein leiomyosarcoma during pre-operative evaluations for a cholecystectomy. Following a multidisciplinary discussion with oncology and vascular surgeons, the patient underwent complete resection of the left renal vein along with the mass. Technique:This article proposes an innovative surgical technique for the reconstruction of the left renal vein in case of a left renal vein leiomyosarcoma. Reconstruction was achieved using a physician made biological stent graft, employing a nitinol bare stent wrapped in a pericardial patch. The video provides a step by step explanation of the procedure. Isolation and the surgical technique for the reconstruction of the left renal vein following en bloc resection of the leiomyosarcoma are shown, followed by reconstruction of the vein using a nitinol stent covered with bovine pericardium. Several precautions were adopted to minimise the risk of intestinal fistula, including heterotopic graft re-implantation and omentoplasty. Discussion:Complete surgical excision remains the cornerstone of vein sarcoma treatment and offers the best chance for disease control. The literature has only reported en bloc resection of renal vein sarcomas with nephrectomy. This case report presents an innovative surgical technique for left renal vein replacement, showing a potential alternative in the management of this rare condition in order to preserve the vein.

BACKGROUND:This study aimed to evaluate the outcomes of a multidisciplinary team approach managing infections of complex aortic endografts, focusing on conservative treatment as an alternative to surgical explantation in selected cases. This was a retrospective, monocentric study conducted at Bordeaux University Hospital. METHODS:From January 2018 to July 2024, we reviewed cases of complex aortic endografts (chimney endovascular aortic repair [ChEVAR], fenestrated endovascular aortic repair [BEVAR], and fenestrated endovascular aortic repair [FEVAR]) infections, managed by our multidisciplinary vascular infection team (MDVIT). The primary end points were in-hospital mortality and overall survival. Secondary end points included complications during hospitalization and follow-up. RESULTS:All 11 cases of complex endografts infections managed by our MDVIT were scrutinized, infected FEVARS n = 10 and infected ChEVAR n = 1. The mean age was 72 years. The patients were divided into 2 groups: group A (7 patients) managed with conservative treatment with antimicrobial therapy ± percutaneous drainage, and group B (4 patients) undergoing surgical treatment due to complications. Group A demonstrated infection remission in 6/7 patients (86%) with antimicrobial therapy. One patient from group A required emergent surgery due to sepsis and was reassigned to group B. All patients in group B presented with complications such as aorto-duodenal fistulas n = 3 and pseudoaneurysms n = 1; 3 underwent graft explantations, and one underwent sacotomy and duodenal fistula repair without graft removal. The overall in-hospital mortality was 9%, and the mean follow-up was 15 months (range 3-37). The overall survival was 82% at 1 year. Long-term vascular complications were limited, and suppressive antimicrobial therapy was effective with high rate of remission of infection. CONCLUSIONS:Multidisciplinary team management enables a tailored approach to complex aortic endograft infections. Conservative treatment was first-line treatment, but for cases complicated by fistula or pseudoaneurysm surgical explantation was performed. Antimicrobial grafts and visceral debranching played a pivotal role in the surgical cases. This study highlights the importance of multidisciplinary decision-making and follow-up to optimize patient outcomes and inform future multicenter research.

Vascular graft and endograft infections (VGEIs) are severe, and microbiological diagnosis is of vital importance to select the best anti-infection therapy to improve patient outcomes. Despite advances in microbiological techniques, the rate of VGEIs without microbiological documentation remains high (14 – 24.3%). 1 Sixt T. Aho S. Chavanet P. Moretto F. Denes E. Mahy S. et al. Long-term prognosis following vascular graft infection: a 10-year cohort study. Open Forum Infect Dis. 2022; 9: ofac054 Crossref PubMed Scopus (10) Google Scholar This might be explained by the frequent use of anti-infection therapy before graft removal and the presence of biofilm associated microorganisms, which are slower to grow on microbiological media. 2 Puges M. Pereyre S. Bérard X. Accoceberry I. Le Roy C. Stecken L. et al. Comparison of genus specific PCR and culture with or without sonication for microbiological diagnosis of vascular graft infection. Eur J Vasc Endovasc Surg. 2018; 56: 562-571 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar

Conradsen et al.1 Conradsen Skov R.A. Lawaetz M. Eldrup N. Resch T.A. Sörelius K. et al. Danish Academic Research Consortium for INAAsDanish nationwide study on surgical treatment of infective native abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2024; ([epub ahead of print] [in this issue]) Google Scholar offered valuable insights into infected native abdominal aortic aneurysm, with a particular emphasis on comparing short and long term outcomes between open surgical repair (OSR) and endovascular aneurysm repair (EVAR). The primary endpoint of this study was the treatment modality trend, while the secondary endpoints encompassed all cause mortality and infection related complications. The data presented by the authors are captivating and have stirred up debate. While the study does have inherent limitations, notably its retrospective design that could introduce biases, the authors have successfully mitigated these shortcomings through rigorous statistical analysis. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery AneurysmsEuropean Journal of Vascular and Endovascular SurgeryVol. 67Issue 2PreviewThe European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. Full-Text PDF Open AccessDanish Nationwide Study on Surgical Treatment of Infective Native Abdominal Aortic AneurysmsEuropean Journal of Vascular and Endovascular SurgeryPreviewThis study aimed to describe surgical trends, survival, and infection related complications (IRC) in a Danish cohort of patients with infective native aortic aneurysms (INAAs). Full-Text PDF Open Access

IntroductionIn critically ill surgical patients treated with open abdomen and negative pressure therapy (OA/NPT), the association between nutritional support and clinical outcome is still controversial. The main objective of this study was to assess the effect of enteral nutritional support during the acute phase (i.e., the first 7 days) on clinical outcome (abdominal wall closure rate or fistula formation) in critically ill surgical patients treated by OA/NPT.MethodsOver a 5-year period, every critically ill patient who underwent nutritional support while treated by OA/NPT was retrospectively included. The main study outcome was a composite criterion, defined as delayed abdominal closure ≥8 days and/or secondary abdominal complications (secondary anastomotic leak, intra-abdominal abscess and fascial dehiscence). Inverse probability of treatment weight (IPTW) was derived from a propensity score model. Multivariable logistic regression was used to test the association between clinical outcome and different modalities of nutritional support (enteral nutrition vs. nil per os during the first week after OA/NPT, early vs. late enteral nutrition, normal vs. low caloric/protein intake).ResultsOver the study period, 171 patients were included and 50% underwent delayed abdominal closure and/or secondary abdominal complications. The rate of delayed abdominal closure or secondary abdominal complications was significantly lower in patients who received enteral nutrition versus those who remained nil per os (40% vs. 61%, p = 0.007), with an IPTW-adjusted OR of poor clinical outcome of 0.49 [95%CI: 0.25–0.98]. There was no other statistical association between modalities of nutritional support and the study outcome.ConclusionIn critically ill patients with OA/NPT, the use of enteral feeding within 7 days after surgery was associated with better clinical outcome. Further studies are mandatory to better define the adequate timing for enteral feeding, the energy needs and the protein requirements during the acute phase after OA/NPT.

Introduction Le mécanisme d'action des antiangiogéniques, qui fournit un rationnel physiopathologique compatible avec une atteinte artérielle, et des séries de cas et études de pharmacovigilance ont fait naitre des interrogations concernant la sécurité de ces médicaments. L'objectif de cette étude était d’étudier l'association entre l'utilisation d'antiangiogéniques et la survenue de dissection ou d'anévrisme artériel chez les patients traités pour cancer colorectal métastatique (CCRm). Méthodes Une étude cas-témoins nichée dans une cohorte d'adultes ayant débuté une thérapie ciblée indiquée dans le CCRm (antiangiogéniques, anti-EGFR) entre 2012 et 2017, et sans antécédent de dissection et anévrisme artériel a été menée dans le SNDS. Les patients hospitalisés pour dissection ou anévrisme artériel entre 2012 et 2019 constituaient les cas, appariés jusqu’à 10 témoins sur l’âge, le sexe, et la durée depuis l'inclusion. L'analyse principale a considéré l'exposition aux antiangiogéniques globalement (exposition, non exposition). Les analyses secondaires ont considéré l'ancienneté (en cours, passée, non exposition) et la durée cumulée d'exposition, les périodes d'exposition étant calculées selon deux méthodes (schéma d'administration, demi-vie d’élimination). L'association a été estimée à l'aide de modèles de régression logistique conditionnelle ajustés sur le niveau de risque cardiovasculaire défini par la présence de comorbidités cardiovasculaires. Résultats Parmi les 34 733 patients de la cohorte, 195 cas (0,6 %) ont été identifiés et appariés à 1950 témoins. La population était majoritairement masculine (73 %) avec un âge médian de 69 ans (IIQ : 63-73) pour les cas et 68 ans (62-73) pour les témoins. Dans l'analyse principale, 141 (72,3 %) cas et 1381 (70,8 %) témoins étaient exposés aux antiangiogéniques et aucune association avec la survenue de dissection ou anévrisme artériel n'a été retrouvée (RC [IC95%]=1,09 [0,76;1,54], RCa [IC95%]=1,07 [0,75;1,52]). L'absence d'association a été retrouvée dans les analyses secondaires quelles que soient la méthode de calcul des périodes d'exposition et la définition d'exposition utilisées. Conclusion L'incidence très faible de dissection ou anévrisme artériel et l'absence d'association avec l'exposition aux antiangiogéniques dans cette étude apportent des éléments rassurants compte tenu de leur bénéfice attendu dans le CCRm.