Search Results (31)

Background/Objectives: Ultra-low-profile (ULP) endografts have expanded the applicability of endovascular aneurysm repair (EVAR) in patients with challenging aortoiliac anatomy and narrow access vessels. However, direct long-term comparisons between different ULP devices remain limited. This study aimed to compare mid- to long-term outcomes of the INCRAFT and Ovation endografts in a single-center experience. Methods: This retrospective single-center study included 102 patients (45 Ovation, 57 INCRAFT) with a median follow-up exceeding 60 months. We retrospectively analyzed 102 consecutive patients undergoing elective EVAR with ULP devices between January 2011 and December 2019. Forty-five patients were treated with Ovation and 57 with INCRAFT. The primary endpoint was technical success. Secondary endpoints included survival, reintervention, endoleak, and device-related complications. Statistical comparisons were performed using Student’s t-test and Fisher’s exact test. Results: Primary technical success was achieved in all cases. The Ovation group exhibited more complex proximal neck anatomy, including greater thrombus involvement (47.4% vs. 12.7%, p < 0.001). Post-implantation syndrome occurred more frequently with INCRAFT (14% vs. 0%, p = 0.009). No significant differences were observed in endoleak, major adverse events, or total reintervention. Long-term mortality was higher in the Ovation group (37.8% vs. 15.8%, p = 0.01), although deaths were not aneurysm-related. Median follow-up exceeded 60 months in both groups. Conclusions: Both ULP endografts demonstrated favorable long-term outcomes within the limitations of a non-randomized, anatomically heterogeneous cohort. Full article

Background: Intentional occlusion of the internal iliac artery (IIA) during endovascular repair of aorto-iliac aneurysms may predispose patients to pelvic ischemic complications such as gluteal claudication, erectile dysfunction, and bowel ischemia. Iliac branch devices (IBDs) have been developed to preserve hypogastric perfusion. E-Liac (Artivion/Jotec) is one of the latest modular IBDs yet reports on mid-term performance are limited to small single-center cohorts with short follow-up. The CAMpania PugliA bRanch IliaC (CAMPARI) study is a multicenter investigation of E-Liac outcomes. Methods: A retrospective observational cohort study was conducted across five Italian vascular centers. All consecutive patients undergoing E-Liac implantation for aorto-iliac or isolated iliac aneurysms between January 2015 and December 2024 were identified from prospectively maintained registries. Inclusion criteria comprised elective or urgent endovascular repair of aorto-iliac aneurysms in which an adequate distal sealing zone was not available without covering the IIA and suitability for the E-Liac device according to its instructions for use (IFU). Patients with a life expectancy < 1 year or hostile anatomy incompatible with the IFU were excluded. The primary end point was freedom from branch instability (occlusion/stenosis, kinking, or detachment of the bridging stent). Secondary end points included freedom from any endoleak, freedom from device-related reintervention, freedom from gluteal claudication, aneurysm-related and all-cause mortality, acute renal failure, and sac regression > 5 mm. Results: A total of 69 consecutive patients (68 male, 1 female, median age 72.0 years) received 74 E-Liac devices, including 5 bilateral implantations. The mean infrarenal aortic diameter was 45 mm and the mean CIA diameter 34 mm; 14 patients (20.0%) had a concomitant IIA aneurysm (>20 mm). Concomitant fenestrated or branched aortic repair was performed in 23% of procedures. Two patients received a standalone IBD without implantation of a proximal aortic endograft. Technical success was achieved in 71/74 cases (96.0%); three failures occurred due to inability to catheterize the IIA. Distal landing was in the main IIA trunk in 58 cases and in the posterior branch in 13 cases. Over a median follow-up of 18 (6; 36) months, there were four branch instability events (5.4%): three occlusions and one bridging stent detachment. Seven patients (9.5%) developed endoleaks (one type Ib, two type II, two type IIIa, and two type IIIc). Five patients (6.8%) required reintervention, and five (6.8%) reported gluteal claudication. There were seven all-cause deaths (10%), none within 30 days or related to aneurysm rupture; causes included COVID-19 pneumonia, acute coronary syndrome, melanoma, gastric cancer, and stroke. No acute renal or respiratory failure occurred. Kaplan–Meier analysis showed 92% (95% CI 77–100) freedom from branch instability in the main-trunk group and 89% (60–100) in the posterior-branch group (log-rank p = 0.69). Freedom from any endoleak at 48 months was 87% (95% CI 75–95), and freedom from reintervention was 93% (95% CI 83–98). Conclusions: In this multicenter cohort, the E-Liac branched endograft demonstrated high technical success and favorable early–mid-term outcomes. Preservation of hypogastric perfusion using E-Liac was associated with low rates of branch instability, endoleak, and reintervention, with no 30-day mortality or aneurysm-related deaths. These findings support the safety and efficacy of E-Liac for aorto-iliac aneurysm management, although larger prospective studies with longer follow-up are needed. Full article

Background: This study examines the use of the E-liac stent-graft system for the endovascular treatment of aortoiliac or isolated common iliac aneurysms. Methods: Consecutive patients between January 2014 and December 2024 were included. Data on patient characteristics, clinical presentation, lesion features, procedural aspects, and follow-up outcomes were collected and examined. Complications during the perioperative period and subsequent reinterventions were also documented. Results: A total of 81 patients met the inclusion criteria (65 men, 80.2%, median age 71.2 ± 11.43 (range 61–86 years). Technical success was achieved in all cases. A total of 97 internal iliac arteries were revascularized; in 54 cases (66.7%), the endovascular technique was EVAR + unilateral iliac branch device (IBD), in 16 cases (19.8%), it was EVAR + bilateral IBDs, and unilateral isolated IBD was conducted in 11 (13.6%) patients. The median patient follow-up time was 64.7 months (range 1–120). During follow-up, the mortality rate was 22.2%, with an iliac branch patency of 90.1%. Buttock claudication was observed in five (6.2%) patients and nerve ischemia in one (1.2%). One type I endoleak (1.2%) occurred following endovascular treatment of an isolated common iliac artery aneurysm, and three type II endoleaks (3.7%) were observed; none of them were associated with aneurysm sac enlargement. Three type III endoleaks (3.7%) occurred due to disconnection of the iliac branch from the extension of the concomitant EVAR. Conclusions: This long-term study, with 11 years of follow-up, reports outcomes with the E-liac stent-graft for the treatment of aorto-iliac or iliac aneurysms and demonstrates that it can be safely applied with low mortality and reintervention rates, and high patency rates. Full article

Background: Common femoral artery aneurysms are rare and are usually associated with aneurysms at other sites, mainly the aorta, iliac, popliteal, superficial femoral, and profunda femoral artery. This combination poses the challenge of synchronous repair for clinically relevant aneurysms. Although endovascular abdominal aortic aneurysm repair is the main type of treatment for abdominal aortic aneurysms nowadays, this is not true for common femoral aneurysms, where open repair remains the gold standard. These two distinct operations could be combined in a one-stage procedure when aortoiliac and common femoral aneurysms present simultaneously. This approach potentially saves time and costs, without increasing complications. Methods: A retrospective search was conducted in the Vascular Surgery Department database of a tertiary referral center for vascular surgery, covering procedures from January 2005 to May 2025. Patients were included if they had undergone simultaneous endovascular abdominal aortic aneurysm repair and open repair of a common femoral artery aneurysm. Clinical records, operative details, imaging studies, and follow-up data were reviewed. We additionally provide a literature review regarding this approach. This review additionally incorporates the current knowledge regarding the treatment of common femoral artery aneurysms. Results: Out of 668 endovascular abdominal aortic aneurysm repair procedures, three patients (0.45%) were identified. These three patients were among five patients who were treated for true common femoral artery aneurysm by open repair in the same time interval. All of the patients are currently in good condition without late complications. One patient, who had not performed any follow-up imaging, was diagnosed with large aneurysms at other sites, 10 years later. Conclusions: The combined one-stage endovascular abdominal aortic repair and open repair of a common femoral artery aneurysm by interposition grafting is technically a simple approach that led to satisfactory outcomes. Full article

Vascular surgery has evolved from durable yet invasive open reconstructions to less traumatic endovascular techniques. While endovascular repair reduces perioperative morbidity, it introduces durability challenges and the need for lifelong surveillance. Laparoscopic surgery bridged some gaps but was hindered by steep learning curves and technical limitations. Robotic-assisted surgery represents a “third revolution”, combining the durability of open repair with the recovery and ergonomic benefits of minimally invasive approaches through enhanced 3D visualization, wristed instrumentation, and tremor filtration. This review synthesizes current evidence on robotic applications in vascular surgery, including aortic, visceral, venous, and endovascular interventions. Feasibility of robotic vascular surgery has been demonstrated in over 1500 patients across aortic, visceral, venous, and decompression procedures. Reported outcomes include pooled conversion rates of ~5%, 30-day mortality of 1–3%, and long-term patency rates exceeding 90% in aortoiliac occlusive disease. Similarly favorable outcomes have been observed in AAA repair, visceral artery aneurysm repair, IVC reconstructions, renal vein transpositions, and minimally invasive decompression procedures such as median arcuate ligament and thoracic outlet syndromes. Endovascular robotics enhances catheter navigation precision and reduces operator radiation exposure by 85–95%, with multiple series demonstrating consistent benefit compared to manual techniques. Despite these advantages, adoption is limited by high costs, lack of dedicated vascular instruments, absent haptic feedback on most platforms, and the need for standardized training. Most available evidence is observational and from high-volume centers, highlighting the need for multicenter randomized trials. Future directions include AI-enabled planning and augmented-reality navigation, which are the most feasible near-term technologies since they rely largely on software integration with existing systems. Other advances such as microsurgical robotics, soft-robotic platforms, and telesurgery remain longer-term developments requiring new hardware and regulatory pathways. Overcoming barriers through collaborative innovation, structured training, and robust evidence generation is essential for robotics to become a new standard in vascular care. Full article

Objectives: This study investigated the impact of aortoiliac geometry on thrombotic complication following aortic endovascular aneurysm repair (EVAR). Methods: Data from 54 patients who received abdominal EVAR between January 2015 and December 2023, in which 18 developed unilateral iliac limb in-stent thrombus, were retrospectively reviewed. Clinical data, including cardiovascular risk factors, laboratory findings, and geometrical factors, including iliac diameter, sectional area, limb angles, and tortuosity, were collected. Aortoiliac geometry analyses were performed on the 3D model reconstructed from abdominal aortic computed tomography angiography (CTA) using semi-automated software (MIMICS version 25.0). Results: Compared to non-thrombotic limbs, thrombotic iliac limbs showed larger maximum diameters (17.48 ± 0.95 mm vs. 14.14 ± 0.62 mm, p = 0.006), lower graft limb angles (117.52° ± 5.61° vs. 148.54° ± 4.31°, p < 0.001), lower aortoiliac angles (123.48° ± 4.66° vs. 141.96° ± 4.76°, p = 0.009), and higher iliac tortuosities (0.2 ± 0.03 vs. 0.12 ± 0.02, p = 0.02). Paired comparisons between normal and diseased limbs in 18 patients with thrombotic events also showed statistical differences in terms of iliac limb maximum diameter, graft limb angle, aortoiliac angle, and iliac tortuosity. Conclusions: Thrombosis formation following EVAR in iliac limbs was associated with limb diameter, graft limb angle, aortoiliac angle, and tortuosity. Full article

Background/Objectives: The aim of our study was to document and analyze the long-term geometric alterations that occur in the infrarenal aorta and iliac arteries over time after a successful elective standard endovascular abdominal aneurysm repair (EVAR) as well as to investigate the potential relationship of aortoiliac remodeling with the long-term complications of EVAR. Methods: The prospectively collected clinical and computed tomography angiography (CTA) data from 168 patients treated with elective standard EVAR between 2013 and 2018 were retrospectively analyzed. Follow-up assessments were performed at 1, 24, and 60 months postoperatively. Primary anatomical variables included 11 measurements: total right and left aortoiliac lengths, infrarenal aortic length, right and left aortoiliac angles on the frontal CTA plane, right and left intra-iliac angles, inter-iliac angle, infrarenal aortic body angle on the sagittal CTA plane, and right and left aortoiliac angles on the sagittal CTA plane. Secondary variables were the mean percentage changes in anatomical measurements between the follow-up time intervals. The primary clinical endpoint was the occurrence of any complication related (ARC) to the index EVAR or reinterventions. Secondary endpoints included any graft migration (AM) observed in proximal aortic or distal iliac sealing zones, and failure of aneurysm sac regression (FSR) or an increase in sac diameter by >5 mm. Six different bifurcated endografts were used. For subgroup analysis, the primary differentiating feature among grafts was the presence or absence of suprarenal fixation with hooks. Results: Median follow-up was 77 months, with an interquartile range (IQR) of 24.0 months. Observed EVAR-related mortality was 2.4%. Twenty-seven (16.1%) ARC events occurred, and migration was detected in 21 (12.5%) patients, combined with endoleak in 20 of them. The incidence of FSR was 43.5%, and approximately a third of ARCs and AMs occurred after the 60th month of follow-up. Across all measured lengths and the inter-iliac angle on the frontal CTA plane, a significant increase was observed, while all other angles demonstrated a significant decrease over time. The pattern of aortoiliac remodeling followed a linear progression for the first 24 months, transitioning to either a quadratic or cubic trend by the 60-month mark. Linear regression analysis revealed that an excessive increase in length variables was significantly associated with lower AAA sac regression rates. Furthermore, multivariate analysis identified that suprarenal fixation with hooks was the only factor associated with a reduced likelihood of AMs and a five-fold decrease in FSRs. Conclusions: Despite a fully successful EVAR, significant aortoiliac geometrical remodeling is evident over time. Extensive remodeling of aortoiliac lengths appears to be associated with lower rates of AAA sac regression. Suprarenal proximal aortic fixation with hooks may serve as a protective mechanism, reducing the likelihood of long-term complications. Life-long follow-up remains an essential measure for early detection of long-term EVAR failures. Full article

Background: Accurate prognoses are challenging in high-risk vascular conditions, such as abdominal aortic aneurysms, and limited diagnostic standards, decision-making criteria, and data semantics often hinder clinical reliability and impede diagnostics’ digital transition. This study aims to evaluate the performance, robustness, and usability of an automatic, replicable pipeline for aortic lumen surface reconstruction for pathological vessels. The goal is to provide a solid tool for geometric reconstruction to a more complex enhanced diagnostic framework. Methods: A U-Net convolutional neural network is trained using preoperative CTA scans, with 101 for model training and 14 for model testing, covering a wide anatomical and aortoiliac pathology spectrum. Validation included segmentation metric, robustness, reliability, and usability assessments. Performances are investigated by means of the test set’s prediction metrics for several instances of the model’s input. Clinical reliability is evaluated based on manual measurements performed by a vascular surgeon on the obtained 3D aortic lumen surfaces. Results: The test set is selected to cover a wide portion of aortoiliac pathologies. The algorithm demonstrated robustness with an average F1-score of 0.850 ± 0.120 and an intersection over union score of 0.760 ± 0.150 in the test set. Clinical reliability is assessed using the mean absolute errors for diameter and length measurements, respectively, of 1.73 mm and 2.27 mm. The 3D surface reconstruction demonstrated reliability, low processing times, and clinically valid reconstructions. Conclusions: The proposed algorithm can correctly reconstruct pathological vessels. Secondary aortoiliac pathologies are detected properly for challenging anatomies. To conclude, the proposed 3D reconstruction application to a digital, patient-specific diagnostic tool is, therefore, possible. Automatic replicable pipelines ensured the usability of the model’s outputs. Full article

We present an 81-year-old male with an extensive past medical history and an enlarging abdominal aortic aneurysm (AAA). Axial imaging showed dense aortoiliac calcification with a complete occlusion of the right common iliac and high-grade stenosis of the left common iliac artery (CIA). Shockwave Intravascular Lithotripsy and the pave-and-crack technique utilizing an endoconduit were used to dilate the left external iliac artery and the CIA to facilitate placement of an aortic stent graft and exclude the patient’s AAA. This method gives surgeons the ability to treat patients with AAAs endovascularly, despite a heavily diseased and/or diminutive iliac anatomy. We also present a contemporary literature review of the utilization of the pave-and-crack technique as well as tips and tricks of how we do it. Full article

Objectives: The ALTURA™ stent graft system is designed for the treatment of abdominal aortic and/or aorto-iliac aneurysms. This study evaluates the performance of the ALTURA™ stent graft, focusing on AAA diameter, landing zones, stent graft length, and migration following endovascular aortic repair (EVAR). Methods: This is a retrospective analysis of computed tomography (CT) images focuses on patients with infrarenal abdominal aortic aneurysm (AAA) treated with the ALTURA™ stent graft system (Lombard, Ltd., Didcot, UK) at Pauls Stradins Clinical University Hospital in Riga, Latvia, and University Hospital Düsseldorf in Düsseldorf, Germany. The study population consisted of patients with asymptomatic AAAs who underwent elective treatment between January 2014 and June 2017. Follow-up CT scans were performed at one month, six months, one, two, and three years after implantation. Changes in stent graft length, aneurysm sac diameter, and the proximal and distal sealing zones were evaluated. Results: A retrospective analysis was conducted on computed tomography (CT) images from 40 patients (mean age 70.4 ± 8.5 years, 34 males, 6 females) who were treated with the ALTURA™ stent graft system for infrarenal abdominal aortic aneurysms (mean aneurysm diameter 5.6 ± 1.0 cm). The mean follow-up duration was 24.2 ± 10.6 months, with CT scans completed for all patients at one month and for 80% at one year. The mean total shortening of the stent graft one year after EVAR was 4 ± 3 mm (p < 0.001), 7 ± 5 mm after two years (p < 0.001), and 9 ± 6 mm after three years (p < 0.001). The iliac extensions shortened by 4 ± 3 mm after one year (p < 0.001), 6 ± 4 mm after two years (p < 0.001), and 8 ± 4 mm after three years (p < 0.001). Significant shortening was observed in the iliac extension, while changes in the aortic stent graft were not statistically significant. The reduction in the distal sealing zone and upward migration of the stent graft were 3 ± 3 mm after one year (p < 0.001), 5 ± 5 mm after two years (p < 0.001), and 7 ± 7 mm after three years (p < 0.001). Over the follow-up period, significant stent graft shortening and loss of the distal sealing zone were observed. However, these changes remained within a clinically acceptable range and did not lead to type I endoleak. Aneurysm sac shrinkage greater than 10 mm one year after treatment was observed in 25% of patients (p < 0.001). No aneurysm ruptures or AAA-related deaths were reported. Conclusions: Significant shortening of ALTURA™ stent graft, migration, and sealing zone reduction were observed without clinical impact after three years. However, in patients with short distal sealing zones, these changes could increase the risk of type Ib endoleak. Longer follow-up is needed to assess long-term durability. Full article

Purpose: to investigate the effects of vessel geometry on steno-occlusive and dilatative common iliac artery (CIA) pathologies. Methods: this single-center, retrospective study included 100 participants, namely 60 participants with a unilateral, isolated CIA pathology who were divided into three pathology-based groups (a stenosis group, n = 20, an occlusion group, n = 20, and an aneurysm group, n = 20) and 40 participants without a CIA pathology (control group). All participants underwent abdominal and pelvic computed tomography angiography. The aortoiliac region of the participants was reconstructed into three-dimensional models. Elongation parameters (tortuosity index (TI) and absolute average curvature (AAC)) and bifurcation parameters (iliac take-off angle, iliac planarity angle, and bifurcation angle) were determined using an in-house-written piece of software. Demographic data, anthropometric data, cardiovascular risk factor data, and medical history data were obtained from participants’ electronic health records. The following statistical methods were used: one-way ANOVA, chi-square test, t-tests, Wilcoxon test, Kruskal–Wallis test, and multivariate linear regression. Results: in the occlusion group, both TI and AAC values were significantly higher on the contralateral side than on the ipsilateral side (both p < 0.001), whereas in the aneurysm group the AAC values were significantly higher on the ipsilateral side than on the contralateral side (p = 0.001). The ipsilateral and contralateral TI and AAC values of the iliac arteries were significantly higher in the aneurysm group than in the other three groups (all p < 0.001). Age significantly affected all of the elongation parameters except for the TI of the infrarenal aorta (all p < 0.010 except the TI of the infrarenal aorta). In addition, the AAC values for the iliac arteries were significantly associated with obesity (ipsilateral iliac artery, p = 0.045; contralateral iliac artery, p = 0.047). Aortic bifurcation parameters did not differ significantly either within each group (ipsilateral versus contralateral side) or between the individual groups. Conclusions: occlusions tend to develop in relatively straight iliac arteries, whereas unilateral, isolated CIA aneurysms are more likely to occur in elongated aortoiliac systems. Full article

Background/Objectives: Atherosclerosis is a leading cause of death, especially in the developed world, and is marked by chronic arterial inflammation and lipid accumulation. As key players in its progression, monocytes contribute to plaque formation, inflammation, and tissue repair. Understanding monocyte involvement is crucial for developing better therapeutic approaches. The objective of this study is to assess the prognostic value of monocytes for limb-related outcomes following revascularization for complex aortoiliac lesions, thereby emphasizing the central role of monocytes in atherosclerosis. Methods: This prospective cohort study-enrolled patients who had undergone elective aortoiliac revascularization at two hospitals between January 2013 and December 2023. Patients with TASC II type D lesions were included, excluding those with aneurysmal disease. Demographic, clinical, and procedural data were gathered, and patients were monitored for limb-related outcomes. Preoperative complete blood counts were analyzed, and statistical analyses, including multivariable Cox regression, were conducted to identify predictors of major adverse limb events (MALE). Results: The study included 135 patients with a mean age of 62.4 ± 9.20 years and predominantly male (93%). Patients were followed for a median of 61 IQR [55.4–66.6] months. Smoking history (91%) was the most prevalent cardiovascular risk factor. Preoperative monocyte count >0.720 × 10⁹/L was associated with worse 30-day limb-related outcomes (MALE: OR 7.138 95% CI: 1.509–33.764, p = 0.013) and long-term outcomes, including secondary patency (p = 0.03), major amputation (p = 0.04), and MALE (p = 0.039). Cox regression analysis confirmed an elevated monocyte count as an independent predictor of MALE (adjusted hazard ratio 2.149, 95% CI: 1.115–4.144, p = 0.022). Conclusions: This study demonstrated that patients with a higher absolute monocyte count may be more exposed to the risk of MALE in patients with aortoiliac TASC II type D lesions undergoing revascularization, with predictive accuracy in both the short and long term. Additionally, it was an independent predictor of major amputation. This new marker has the potential to serve as a cost-effective and easily available tool for risk stratification, helping identify patients at higher risk of MALE. Full article

Background/Objectives: In recent years, manufacturers have developed new low-profile stent grafts to allow endovascular treatment of abdominal aortic aneurysms (AAA) in patients with small access vessels. We evaluated the early and mid-term outcomes of the Incraft (Cordis Corp, Bridgewater, NJ, USA) ultra-low profile endograft implantation in a high-volume single center. Methods: Between 2014 and 2023, 133 consecutive endovascular aneurysm repair (EVAR) procedures performed using the Incraft endograft were recorded in a prospective database. Indications included infrarenal aortic aneurysms, common iliac aneurysms, and infrarenal penetrating aortic ulcers. Mid-term results were analyzed using the Kaplan–Meier method. Results: During the study period, 133 patients were treated with the Cordis Incraft endograft, in both elective and urgent settings. The Incraft graft was the first choice for patients with hostile iliac accesses, a feature characterizing at least one side in 90.2% of the patients in the study cohort. The immediate technical success rate was 78.2%. The intraoperative endoleak rate was 51.9% (20.3% type 1 A, 0.8% type 1 B, and 30.8% type 2 endoleak). Within 30 days, technical and clinical success rates were both 99.3%; all type 1A and 1B endoleaks were resolved at the 30-day follow-up CT-angiogram. After a mean follow-up of 35.4 months, the actuarial freedom from the re-intervention rate was 96.0%, 91.1%, and 84.0% at 1, 3, and 5 years, respectively. The iliac leg patency rate was 97.1%, 94.1%, and 93.1% at 1, 3, and 5 years, respectively. No statistically significant differences were observed between hostile and non-hostile access groups, nor between the groups with grade 1, grade 2, and grade 3 access hostility. Conclusions: The ultra-low profile Cordis Incraft endograft represents a valid option for the endovascular treatment of AAA in patients with hostile iliac accesses. The procedure can be performed with high rates of technical and clinical success at 30 days and the rates of iliac branch occlusion observed during the follow-up period appear acceptable in patients with poor aorto-iliac outflow. Full article