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Abdominal aortic aneurysm (AAA) development is driven by inflammation, in particular myeloid cells, which represent attractive biomarker candidates. Yet to date, the maximum aortic diameter is the only clinically applied predictor of AAA progression and indicator for surgical repair. We postulated that aortic inflammation is reflected in a systemic change of monocyte populations, which we investigated regarding marker potential in AAA diagnosis and prognosis.

We conducted a single-center retrospective cohort study in a diagnostic setting, measuring monocyte subsets by flow cytometry in peripheral blood samples of 47 AAA patients under surveillance, matched with 25 healthy controls and 25 patients with peripheral artery disease (PAD). In a prognostic setting, we acquired longitudinal data of 60 AAA patients including aneurysm growth assessment by computed tomography at 6-month intervals.

Blood levels of total monocytes, CD16+ monocytes and particularly intermediate monocytes were significantly increased in AAA patients versus healthy individuals and were also elevated compared to PAD patients. The combination of intermediate monocyte and D-dimer blood levels outperformed the individual diagnostic marker values. Additionally, the elevated concentrations of total monocytes, intermediate monocytes, and monocyte-platelet aggregates (MPA) were suited to predict rapid AAA progression over short-term periods of six months. Of note, MPA were identified as independent predictor of AAA disease progression in multivariable analysis.

Circulating monocyte subsets are elevated in AAA patients and support diagnosis and prediction of aneurysm progression. Monocyte subsets and D-dimer reflect different hallmarks (inflammation and hemostasis) of AAA pathology and when combined, may serve as improved biomarker.

The aim of this study is to quantitatively evaluate the growth of the proximal landing zone (PLZ), to identify the main predictors influencing the progression of the diameter of the PLZ and to evaluate their influence on the adverse events associated with the proximal landing zone.

Retrospective, single-center cohort study of all consecutive patients who underwent TEVAR in the aortic arch between April 2018 and January 2022.
All patients who were treated with a fenestrated, branched or standard TEVAR and had a proximal landing zone classified as Ishimaru 0-4 were included in the study. PLZ diameter changes over time were assessed using longitudinal mixed-effects models. Risk factors for PLZ growth were evaluated via univariate and multivariate analyses. Associations between PLZ growth and adverse events were examined using Cox-regression.

Seventy-six patients were included, with a mean follow-up of 24.2 ± 20.7 months. The average PLZ growth was 1.7 mm/year (95% CI, 1.1–2.3, p < .001), which was significantly greater than the growth observed in the native aorta, averaging 0.7 mm/year (95% CI 0.46- 0.96, p < .001). In the multivariate analysis time (β = 1.7, 95% CI 1.08–2.33, p < .001), preoperative PLZ diameter (β = 0.92, 95% CI 0.78–1.1, p < .001), oversizing (β = 0.08, 95% CI 0.02–0.14, p = .016) and age (β = -0.06, 95% CI -0.11–-0.01, p = .015), were identified as significant risk factors for growth. Growth was significantly associated with Type Ia endoleak (HR 1.25, 95% CI 1.1–1.4, p < .001) and migration (≥10 mm, HR 1.19, 95% CI 1.07–1.33, p = .001).

The growth of the PLZ after TEVAR exceeds that of the native aorta proximal to the endograft, with progression influenced by both anatomical and procedural factors. Significant PLZ growth is associated with an increased risk of Type Ia endoleaks and migration, emphasizing the importance of regular follow-up and optimized personalized procedural planning.

To report the short outcome, in terms of technical success, post-operative complications, and death for patient who underwent fenestrated physician-modified endovascular grafts (PMEGs) for thoracic aorta’s treatment.

This is a single-center, retrospective observational cohort study of all patients who underwent fenestrated thoracic endovascular repair (fTEVAR) PMEG in a tertiary care center from February 2022 to March 2025. Primary endpoint included technical success. Secondary endpoints were death, neurological complications, endoleak and reintervention, at 30 days and target vessel patency.

28 patients were treated with fTEVAR PMEGs for aortic arch and descending aorta diseases during the studied period. 17 were males (61%), with a mean age of 69 ± 12 years. fTEVAR PMEG was mainly performed intramural hematoma and penetrating aortic ulcer, followed by degenerative aneurysms (21.4%) and dilatation after dissection (21.4%) then acute type B dissection (17.9%). Elective procedures accounted for 60.7% of cases. The majority (89.3%) of the endografts had one fenestration targeting the left subclavian artery. Mean diameter of the target vessel was 9.4 ± 1.15 mm. Valiant endograft was used in all cases. Mean length aorta coverage was 196,5 ± 106.2 mm. Mean operative time was 156 ± 89 minutes. Technical success was 93%, 2 interventions were unsuccessful and required bailout maneuvers. The mean hospitalization duration was 18.7 ± 29.1 days.

At 30 days, 14.5% had neurological complications, 2 (7%) patients required reintervention: 1 because of type Ib endoleak, 1 because of cervical hematoma. One (4%) patient died. Median follow-up was 10,7 ± 10,3 months. All targeted vessels were patent during follow-up.

fTEVAR PMEG offers an effective solution for aortic arch and descending thoracic aorta’s treatment. However, the associated risks of significant complications underscore the importance of careful patient selection, meticulous procedural planning, and comprehensive follow-up.

Aim of this study was to compare the outcomes of the plug-based Manta (Teleflex) vascular closure device (VCD) with the suture-based ProStyle VCD (Abbott Vascular) for large bore percutaneous aortic procedures (PAP).

This is a retrospective, comparative study of all consecutive patients undergoing large bore PAP in a tertiary center between January 2024 and March 2025. Primary endpoint was hemostasis of the puncture site. The rates of occlusion, bleeding, surgical conversion as well as the costs of the VCDs were additionally analyzed.

In overall 60 patients were analyzed. In 44 patients (71 access sites) the Manta VCD was used, while in 16 patients (26 access sites) the Prostyle system was preferred. No difference between the groups was observed regarding the underlying pathology and the baseline characteristics. The median vessel diameter in mm (107 (56-118) vs 109 (82-132) p=0.301), the presence of calcium (73% vs 78%, p=0.38) and the median sheath size (14 (14-26) vs 18 (12-18), p=0.572) were comparable between the two groups. The rates of hemostasis with the Prostyle and the Manta VCDs were 100% and 93% (p=0.167) respectively. No postoperative occlusions of the access sites were observed. No significant difference was noticed regarding bleeding (0% vs 7%, p=0.167), pseudoaneurysm formation (0% vs 3%, p=0.39) and surgical conversion (0% vs 7%, p=0.167) between the two groups. The use of the Manta VCD was associated with significant higher costs (290€ vs 466€, p=0.001).

In this cohort the use of a plug based VCD for large bore PAP showed comparable clinical outcomes with a suture-based approach, while it was associated with significant higher costs.

the loss of proximal seal due to disease progression one of the increasing complications of EVAR.
While some patients with this pathology can be treated with an infrarenal cuffs and endoanchors, others do not have a “neck” suitable for such interventions.
Endografts explantation or extension of the repair above renal arteries has a mortality and morbidity rates (>20%)
This study is an Institutional Review approved retrospective analysis of prospectively collected data of consecutive patients with failed EVAR treated with f/b-EVAR from January 2020 to December 2024

33 patients with prior EVAR were treated for pathology of the proximal neck: type I endoleak (n=20) and for stent migration with aneurysm progression at the level of the visceral segment but no visible endoleak, further 13 Patients.
21 cases have been treated with B-EVAR (T-Brunch) and 12 cases with F-EVAR.

primary technical success rates; the ability to connect all fenestrations/ Branches to their respective aortic branches and the absence of a type I or type III endoleak achieved in 94%. Major Advers Events one Paraplegia, one dialysis and one ischemic colitis. After an average follow-up interval of 18 months, no late occlusions of connecting stents were observed. The late re-intervention rates were 5%, respectively.

Regarding the Increasing complexity of cases ,differences in size between the failed device and the fenestrated device we prefer to use branched Divices as rotation and accurately deploy the fenestrated device inside the patient can be severely compromised by vessel tortuosity and friction between devices. (Jailing of the gate) cannulation of target vessels can be difficult, especially in patients with suprarenal fixation.

Compared with primary B/FEVAR, redo cases are associated with a higher risk of a failure to connect all fenestrations to their respective target vessels.
B/FEVAR is a valuable tool for both primary treatment of AAA with an insufficient proximal landing zone as well as for salvage of a failed EVAR.
BEVAR (T-Branch) Technique shows a broader application with comparable risks of complications.

Mykotische Aortenaneurysmen sind zwar selten, stellen aber eine erhebliche Herausforderung hinsichtlich des operativen und perioperativen Managements dar.
Aufgrund der stetig steigenden Zahl an endovasculären und gleichzeitigem Rückgang offener Aorteneingriffe droht die chirurgische Expertise für komplizierte offene Aorteneingriffe verloren zu gehen. Dennoch scheint die Behandlung mykotischer Aneurysmen auch zukünftig eine Domäne der offenen Aortenchirurgie zu bleiben.

Retrospektive Analyse einer Fallserie (n=4) von Patienten mit einem mykotischen Aneurysma die innerhalb der letzten 5 Jahre in unserer Klinik behandelt wurden.

Innerhalb der letzten 5 Jahre wurden in unserer Klinik 4 Patienten mit einem mykotischen abdominellen Aortenaneurysma behandelt (n=2 EVAR, n=1 EVAR als Bridging und offene frühelektive Konversion, n=1 primär offen). Die Mortalität betrug 25%, ein Patient starb nach Absetzen der Antibiotikatherapie nach EVAR bei Nachweis von Clostridium paraputrificum. Bei den beiden mittels alloplastischer in situ Rekonstruktion und vollständiger Resektion des betroffenen Aortensegments (einmal Salmonellennachweis, einmal ß-hämolysierende Streptokokken im Rahmen einer Spondylodiszitis) wurde die AB Therapie nach 10 Wochen wegen Unverträglichkeit abgesetzt, bei dem zweiten Patient auf Cotrimoxazol deeskaliert. Bei beiden Pat. zeigte die 6 Wochen nach dem Eingriff erfolgte PET CT Untersuchung keine vermehrte Aktivität mehr im operierten Abschnitt.

Die endovaskuläre Behandlung mykotischer Aortenaneurysmen scheint hinsichtlich Langzeitergebnissen einer operativ- offenen Behandlung mit vollständiger Resektion des infizierten Aortensegmentes unterlegen, ist aber als Notfall-Bridgingmaßnahme zu erwägen.
In Fällen, bei denen ein kurativer endovaskulärer Therapieansatz verfolgt wird erscheint eine dauerhafte-lebenslange Antibiotikatherapie erforderlich.
Sofern der Patient für einen offenen operativen Eingriff fit genug erscheint, sollte dies bevorzugt werden und frühelektiv eine autologe Rekonstruktion angestrebt werden. Der Resektion des infizierten Segments kommt unabhängig des verwendeten Materials (homo-auto-xenolog -alloplastisch) erhebliche Bedeutung zu. Insbesondere alloplastische Rekonstruktionen mittels antiinfektiös behandelter Polyesterprothesen bedürfen vermutlich einer dauerhaften AB Therapie.