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The aim of this study is to report single centre outcomes of endovascular arch repair with fenestrated and branched endograft and as well as subgroup analysis considering urgent setting, octogenarian patients, and graft design.

Retrospective, single-center cross-sectional study of complex endovascular arch repair with fenestrated and branched endografts, along with subgroup analyses for urgent settings, octogenarian patients, and graft design. High-risk patients unfit for open surgery were selected based on anatomical criteria and patient preference.
Custom Made Devices (CMDs) were used, including both fenestrated and branched designs. Primary outcomes were technical success, 30-day mortality, and morbidity. During follow-up survival probability, freedom from reintervention, freedom from type I and III endoleak and freedom from target vessels instability were evaluated.

83 patients were treated with fenestrated-branched or chimney repair during the study period. 3 PMEGs, 1 PMEG + ISF and 5 ChEVAR were excluded from further analysis. This final study included 74 patients (median age 71.00 [66.00, 79.00] years, 35.1% female) treated with CMD F/B TEVAR between September 2018 and April 2024. 58 patients were treated with branched and 16 with fenestrated arch repair.
Technical success was achieved in the 93.2% of the patients. 30-day mortality rate in elective setting was 5.4%, and 44.4% in urgent repairs. Cumulative in hospital survival was 85%. Major stroke occurred in the 6.8% of patients (1.8% in elective, 22.2% in urgent), and reinterventions were necessary in the 16.2% of them. Urgent repairs showed higher rates of technical failure (p < 0.01), early mortality (p < 0.001), and major strokes compared to elective repairs (p < 0.01). Octogenarians had significantly higher 30-day mortality but no difference in major adverse events compared to younger patients (p < 0.01). Branched endografts had higher rates of type Ia endoleaks and reinterventions than fenestrated endografts.

Endovascular arch repair with fenestrated and branched endografts is feasible and yields satisfactory outcomes in high-risk populations, particularly in elective settings. Challenges remain for urgent and elderly patients, highlighting the need for improved patient selection criteria.

This study aimed to investigate the effectiveness of percutaneous approach and compare two suture-mediated closure devices, the older generation ProGlide and newer generation ProStyle (Abbott Cardiovascular, Lake County, Chicago, IL) in patients undergoing endovascular aortic repair.

A retrospective, single-center, comparative study on consecutive patients undergoing endovascular aortic procedures from January to November 2022 was undertaken. Arterial calcification was assessed using the peripheral artery calcification scoring system (PACSS). Closure device technical success without the need for open surgical conversion was defined as the primary endpoint. Secondary endpoints were access vessel complications (bleeding, hematoma, vessel occlusion or high-grade stenosis and pseudoaneurysm) and the need for additional closure devices to achieve hemostasis. Logistic regression was used to identify confounders, results are presented as odds ratio (OR) and 95% confidence intervals (CIs).

Between January and November 2022, 147 patients (mean age 71 plus/minus 10 years; 77.6% males) underwent percutaneous endovascular aortic repair. A total of 237 vessels were punctured, 63.3% were treated with ProGlide and 36.7% with ProStyle. Technical success of closure devices was 91.6% (ProGlide 94% vs. ProStyle 87.4%, p = .091). Severe vessel calcification (PACSS 3-4) significantly reduced success rates (81% vs. 95.4%, p = .001). Major complications occurred in 8.4% of cases, with higher rates in severely calcified vessels (p = .006) and larger sheath sizes (p = .008). Multivariate analysis identified the number of closure devices used per vessel as the sole independent predictor of technical failure (OR 0.11, 95% CI 0.03 - 0.36, p = .001). Additional devices were required in 35.9% of cases, influenced by prior surgery and sheath size.

Both the older generation ProGlide and newer generation ProStyle closure devices demonstrated high technical success rates with few access vessel complications. The use of multiple closure devices on a single vessel predicted failure, although the use of additional devices helped maintaining a percutaneous approach in many cases. Severe calcification and large sheath sizes could potentially impact technical success negatively.

Vascular endograft infections (VEIs) are rare but severe complications following endovascular aneurysm repair (EVAR). With increasing adoption of EVAR in aortic aneurysm treatment, the incidence of VEIs is also rising, posing a growing clinical and surgical challenge. The aim of the study was to evaluate challenges, complications and mortality associated with infected endograft explantation (EEx).

This single-center retrospective cohort study analysed all patients undergoing EEx for VEI at our institution between January 2008 and January 2025. VEI diagnosis was established based on the MAGIC criteria. Primary endpoints included 30-day mortality, in-hospital mortality, overall survival, and reinfection rates.

Nine patients were included. Median age was 68 years (IQR: 57-77). Median time to EEx was 4.9 months (IQR: 1.17-7). Direct (in situ) aortic reconstruction was performed in eight patients (88.8%) compromising six reconstructions using autologous veins (AV) (66.6%) and two using bovine pericardium graft (BPG) (22.2%). One patient underwent extraanatomic reconstruction (11.1%). Aortoenteric fistulas were present in five patients (55.5%). Positive microbiological cultures were identified in five patients (55.5%), including two cases of polymicrobial infection (22.2%). 30-day mortality rate was 0 %, while in-hospital mortality rate was 11.1 %. Early postoperative complications and subsequent reinterventions occured in 66.6% of cases. Median follow-up duration was 10.22 months (IQR: 1.46-21.82), with an overall mortality rate of 22.2 %. So far no cases of aortic graft reinfection were observed.

The morbidity and mortality associated with complete infected endograft explantation are within acceptable limits when performed in a specialized, high-volume aortic center. Given the complexity and high-risk nature of these cases, further comparative studies assessing alternative therapeutic strategies are essential to establish the most effective and durable treatment approach for VEI management.

Endovascular aortic aneurysm repair has become the standard for treating abdominal aortic aneurysms (AAA). For complex AAAs, such as juxta-/suprarenal, open surgical repair—entailing suprarenal clamping and, when necessary, reconstruction of the visceral/renal arteries—has historically been considered the gold standard. Nevertheless, newer fenestrated and branched endovascular techniques, provide a valid alternative. Recent ESVS guidelines recommend choosing between open and endovascular repair based on patient fitness, anatomy and preferences.
This study evaluates the results of open surgery for AAA of various complexities, focusing on complications and mortality.

This single-center retrospective study analyzed 185 consecutive patients who underwent open surgery for AAA and aorto-iliac aneurysms between 2017 and 2023. Primary outcomes were 30-days, and overall mortality, while secondary outcomes focused on postoperative complications, especially acute kidney injury (AKI).

Among the 185 patients, 85.95% were male, with a mean age of 70 years. The majority (70.27%) had infrarenal aneurysms, while 27.57% were juxtarenal and 2.16% suprarenal. The mean aneurysm diameter was 59.35 mm, and 73.51% were fusiform. Of the procedures, 83.78% were elective, with 96.22% performed via laparotomy. Clamping was infrarenal in 67.57%, inter-renal in 12.43%, and suprarenal in 20%, with a mean renal ischemia time of 33.5 minutes. The 30-day mortality was 0.54%, while overall mortality, on a mean follow-up of 38 months, was 8.11%.
Postoperative complications included pulmonary insufficiency (16.22%), minor cardiac events (6.49%), acute limb (2.7%), colitis (2.16%), and spinal cord (1.08%) ischemia. AKI rate was 14.05%. 3.78% persist at 30-days, without long-term dialysis. Late complications included symptomatic incisional hernias (9.73%) and prosthesis infection (1.62%). Peri-operative reintervention rate (aortic and non-aortic related) was 8.11%.

Open surgery remains an effective and viable option for treating AAA, especially in complex cases unsuitable for endovascular repair. Managing cardio-pulmonary and renal function preoperatively is crucial for improving outcomes.

The GORE EXCLUDER Iliac Branch Endoprosthesis (GoIBE) provides endovascular treatment of common iliac artery or aortoiliac aneurysms. It includes an iliac branch component and an internal iliac component (IIC) extending into the internal iliac artery (IIA). The latest instructions for use (IFU) were published in February 2022. This study evaluates the utility of the current IFU by comparing outcomes between GoIBD implanted within and outside IFU criteria.

A retrospective review of patients undergoing GoIBE surgery between 2015 and 2023 at our institution was conducted, focusing on intraoperative success, postoperative outcomes, and reinterventions. The IFU criteria were analyzed, including femoral/iliac access, presence of aortoiliac or common iliac artery aneurysm, adequate sealing zones of the internal and external iliac artery, proximal landing zone diameter of the common iliac artery and use of an aortoiliac endoprosthesis.

Among 75 patients with 94 GoIBE implanted, 20 met all IFU criteria, while 74 were implanted outside IFU. In total 22 reinterventions were performed. 18 in the outside-IFU group and 4 in the within-IFU group (p=0.685). Postoperative complications were observed in 4 cases, each belonging to the outside-IFU group (p=0.575). Additionally 5 intraoperative complications occurred, all in the outside-IFU group (p=0.581). Two intraoperative IIA occlusions were recorded, one additional occlusion occurred during follow-up.

There were no significant differences in intraoperative or postoperative complication rates between devices implanted within or outside IFU criteria, suggesting that deviations from the IFU do not inherently compromise procedural outcomes. Follow-up surgery rates were also comparable. Implanting the GoIBE outside IFU appears to be a safe and effective option, allowing for the preservation of the internal iliac artery in most cases.

To evaluate treatment indications, compare therapeutic approaches, and assess outcomes in patients with infrarenal penetrating aortic ulcers (iPAU). Retrospective multicenter observational study of iPAU patients treated between January 2018 and December 2022 in 12 European centers.

Treatment included open surgical repair (OSR) and endovascular techniques: balloon-expandable stent grafts (BESG), covered endovascular reconstruction of the aortic bifurcation (CERAB), and endovascular aortic repair (EVAR) with bifurcated or tube grafts. Primary endpoints were technical success, anatomy-dependent graft selection, and safety outcomes.

Among 260 patients (mean age 74.2 years, 77.7% male), 96.9% (n=252) underwent endovascular repair. PAU size was the primary indication (70.4%). Bifurcated grafts were used in 64.7% (n=163), tube grafts in 35.3% (n=89). Median hospital stay was 4 days. Major adverse events occurred in 3.5%, with 30-day mortality and reintervention rates of 1.5% and 8.1%, respectively. Technical success was high: BESG 97.8%, CERAB 100%, and EVAR 99.3%.
Bifurcated grafts were favored for larger proximal landing zones (21 ± 3 mm vs. 18 ± 5 mm, p = .000), larger bifurcation diameters (20 ± 5 mm vs. 18 ± 4 mm, p = .000), shorter PAU-to-bifurcation distances (30 ± 24 mm vs. 41 ± 33 mm, p = .003), and larger PAU base (22 [16–30] mm vs. 18 [12–25] mm, p = .000). Male gender was the only independent predictor of increased mortality (OR 14.3, p = 0.029).
During a median follow-up of 21.2 months, overall mortality was 19.3% (9.4% aortic-related), with a reintervention rate of 9.9% (9.4% aortic-related).

Endovascular repair, particularly with bifurcated grafts, was the preferred approach, demonstrating low early mortality and morbidity. Bifurcated endografts were used successfully in patients with larger aortic diameters and shorter PAU-to-bifurcation distances. CERAB and BESG also provided excellent outcomes in selected cases.