Search Results (352)

Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW^® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology’s safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW^® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW^®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications—including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)—occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW^® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency. Full article

Background: Lateral extra-articular tenodesis (LET) is a surgical procedure that is additionally implemented in concurrent anterior cruciate ligament reconstruction (ACLR). Although numerous articles have addressed the use of LET in conjunction with ACLR, few definitive contraindications were identified. Given the scarcity of literature evaluating contraindications for LET modality, this study aimed to systematically review the reported contraindications of this procedure in the context of concurrent ACLR. Methods: The searched key terms: (extra-articular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament), with no publication date restrictions in PubMed, ScienceDirect, Cochrane Central, Web of Science, and Embase databases. We included clinical human studies, with levels of evidence I–III and in the English language. Results: The analysis evaluated fourteen articles published between 2012 and 2024. Level III evidence was found in the majority of studies (n = 9) and Level I evidence was found in the rest (n = 5). The majority of the included articles were retrospective (n = 8) and there were also prospective studies (n = 6). The articles reviewed showed that articular cartilage damage and concomitant injuries to other knee ligaments, alongside ACL injury, are the most frequently mentioned. Conclusions: This is the first study that systematized the contraindications for the LET procedure in ACLR. The contraindications remain unclear; however, the following may be highlighted: articular cartilage damage and injury to another ligament in the knee, in addition to ACL injury. Full article

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion. Methods: In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed. Results: The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed. Conclusions: A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings. Full article

Background: The Lapidus procedure has become a cornerstone in the surgical management of hallux valgus, especially in cases with associated tarsometatarsal instability. This study investigated and compared the radiographic outcomes of three distinct Lapidus constructs, aiming to provide valuable insights into the optimal fusion configurations for achieving long-term stability improvement and maintaining the intermetatarsal angle (IMA) postoperatively. Methods: In this retrospective study, the objective was to assess and compare the outcomes of three different fusion constructs used in the Lapidus procedure: group 1, transverse screw fixation; group 2, metatarsal cuneiform screw fixation; and group 3, combined transverse and metatarsal cuneiform screw fixation. The study encompassed 32 feet: 11 in group 1, 8 in group 2, and 13 in group 3. The primary focus was to evaluate postoperative stability through radiographic imaging complemented by clinical assessments and an examination of complications. Statistical analyses were used to compare outcomes across the three fixation groups immediately, 3 months, 6 months, and 1 year postoperatively. Results: Radiographic assessments demonstrated successful fusion, and patients reported improvements in pain and function and overall satisfaction with the procedure. Complication rates were within an acceptable range. The IMA in all three groups exhibited a significant reduction postoperatively compared with preoperative measurements. Group 3 demonstrated a notably stronger initial reduction in the IMA compared with groups 1 and 2, and they maintained a statistically significantly more stable IMA value and exhibited a lower recurrence rate compared with the other two groups 1 year postoperatively. Conclusions: These findings endorse the use of Lapidus fusion with these three constructs, particularly with combined transverse and metatarsal cuneiform screw fixation, as a dependable and efficacious surgical approach in addressing hallux valgus with concomitant tarsometatarsal instability. Full article

Transoral endoscopic therapies in gastro-esophageal reflux disease (GERD) are increasingly performed in patients who do not respond to medical therapy or are not suitable for or willing to undergo long-term PPI therapy or surgery. Currently available effective techniques include reconstruction of the gastro-esophageal valve by transoral incisionless fundoplication (TIF) and tightening of the gastro-esophageal junction through scarring, obtained by mucosal resection or ablation. TIF may be accomplished by an EsophyX 2.0/Z, MUSE, or GERD-X device. An iatrogenic stricture of the cardia may be obtained using a procedure called anti-reflux mucosectomy (ARMS), which includes several technical variants, or through mucosal ablation (ARMA). TIF using EsophyX 2.0 has strong evidence of efficacy in patients with small hiatal hernias, irrespective of hernia reducibility, who experience high-volume reflux episodes and troublesome regurgitation despite PPI therapy. MUSE can be performed only in the presence of a spontaneously reducing hiatal hernia and is probably more effective than EsophyX in maintaining the reduced hernia over time. However, MUSE is no longer available in Western countries. GERD-X shows promising results but needs further confirmation of its efficacy over the long term. ARMS and ARMA are not indicated in the presence of hiatal hernias but have shown promising results in the short term and are less expensive than TIF. Appropriate patient selection and the possibility of proposing a tailored approach to different types of patients and clinical/anatomical conditions result in favorable outcomes in most GERD patients, especially considering their quality of life and independence from PPIs. In the last several years, transoral endoscopic therapies have been proposed, along with concomitant laparoscopic repair for large hiatal hernias (cTIF), for GERD occurring after esophageal peroral endoscopic myotomy (E-POEM), in obese patients before or after bariatric surgery, and in patients with Barrett’s esophagus. Full article

Background: Bowel surgery is a key component of advanced deep endometriosis management, with anastomotic leakage representing the most serious postoperative complication. This study aimed to identify risk factors for dehiscence after lower colorectal anastomosis and to determine effective preventive measures. Methods: This retrospective/prospective study included 425 consecutive patients aged 37.7 ± 6.0 years with laparoscopical bowel resection due to multiorgan complex deep endometriosis. All bowel surgeries were performed with use of indocyanine green (ICG). Many technical aspects of surgery and preventive procedures were analyzed which could impact leakage risk of surgery. Results: Endometriotic nodules were resected with segmental bowel resection (n = 294; 69.8%), discoid bowel resection (n = 84; 20.0%), and shaving procedure (n = 43; 10.2%). A total of 12 dehiscence events occurred (2.8%), including intraperitoneal leakage (n = 1; 0.2%), rectovaginal fistula (RVF) (n = 10; 2.3%), and rectoureteral fistula (n = 1; 0.2%); no rectovesical fistulas were observed. RVF developed only following segmental resections. Protective measures used during lower bowel procedures included fibrin glue (n = 375; 88.2%), omental flaps (n = 86; 20.2%), reinforcing sutures (n = 33; 7.8%), protective stomas (n = 25; 5.9%), and ghost stomas (n = 14; 3.3%). Among patients who developed RVFs, 90% had no protective stoma, and these cases were predominantly associated with low (from 6 to <8 cm; n = 4/77; 5.2%) and very low (from 5 to <6 cm; n = 4/10; 40%) anastomoses. In very low anastomoses (n = 4), 1 RVF occurred despite a protective stoma but there existed other strong risk factors, such as levator ani infiltration and vagina opening, whereas 3 others RVF developed in patients without a protective stoma. Notably, in ultra-low anastomoses (<5 cm), protective stomas prevented the anastomosis in 100%, and no fistula was observed (n = 3). The following factors were associated with the increased rate of RVF: segmental resection (p = 0.0355), low and very low anastomosis (p = 0.0010), lateral infiltration of the levator (p < 0.0001), concomitant hysterectomy or vaginal opening (p = 0.051), and prolonged operative time (p = 0.0010), Clostridioides difficile infection (p = 0.0001). Conclusions: RVFs occurred mainly after segmental resection (no other type of bowel resection), with very low anastomosis (5–6 cm from anal verge), in patients with levator ani infiltration and concomitant vaginal or uterine surgery; in such situations, discoid resection is the safer option. Despite the complexity of procedures, preventive strategies maintained a low overall RVF rate; no RVFs occurred in ultra low anastomoses (<5), indicating effective prevention with protective stomas. Full article

Background and Objectives: Laparoscopic procedures have become a routine approach in colorectal surgery. We aimed to evaluate intraoperative, postoperative and pathological outcomes of laparoscopic right hemicolectomy in comparison with open right hemicolectomy. Materials and Methods: We reviewed our database for colorectal surgery and collected data regarding right hemicolectomies performed over a period of 10 years regarding patient characteristics, operative outcomes and postoperative outcomes. We compared laparoscopic with open right hemicolectomies. All the anastomoses in the laparoscopic group were performed intracorporeally. Results: We included 384 cases, 74 (19.3%) laparoscopic and 310 (80.7%) open right hemicolectomies. Baseline characteristics were comparable between the two groups. Conversion rate was low (2.7%). A drain was placed more often in the open colectomies (p < 0.001). Laparoscopic colectomies lasted longer by 25 min on average in the entire cohort (p = 0.002) and by 30 min in cancer-only cases without concomitant procedures (p < 0.001). Laparoscopic procedures yielded more lymph nodes (p = 0.007), as well as longer distal resection margins (p < 0.001) and total specimen (p < 0.001). There was no difference between the two approaches concerning intraoperative complications (p = 0.36) or need for transfusion (p = 0.708). There was also no difference regarding overall (p = 0.361) or major complications (p = 1), as well as anastomotic leak (p = 0.475), surgical site infections (p = 0.275) or readmission rates (p = 1). Hospitalisation duration was shorter by 3 days after laparoscopic surgery in the entire cohort (p < 0.001), as well as when cancer-only cases without concomitant procedures were considered (p < 0.001). Conclusions: Laparoscopic right hemicolectomy with intracorporeal anastomosis provides perioperative safety and pathology outcomes comparable to open surgery, while significantly reducing hospital stay. Full article

Background and Clinical Significance: Subvalvular aortic stenosis (SAS) is the second most common form of aortic stenosis after valvular disease and predominantly affects male patients. It is frequently associated with other congenital cardiac anomalies, such as ventricular septal defect, and is rarely diagnosed during infancy. Instead, SAS typically manifests during childhood or adulthood as a progressive left ventricular outflow tract obstruction, leading to left ventricular hypertrophy and, in many cases, aortic regurgitation. Case Presentation: The first patient was a 61-year-old man presenting with progressive dyspnea, in whom echocardiography revealed severe subaortic stenosis and computed tomography demonstrated aneurysmal dilatation of the ascending aorta. Intraoperatively, the aortic valve was found to be dystrophic with mixed stenotic and regurgitant disease; therefore, subaortic membrane resection, mechanical aortic valve replacement, and ascending aortic replacement with a synthetic graft were performed. The second patient was a 31-year-old man with exertional dyspnea and a discrete subaortic membrane associated with mild ascending aortic dilatation. Surgical treatment consisted of complete membrane resection and aortic valve repair, while the ascending aorta was preserved. Both patients had an uneventful postoperative course and were discharged on the fourth postoperative day. At 3-month follow-up, both were asymptomatic, in normal sinus rhythm, and demonstrated satisfactory echocardiographic findings without residual left ventricular outflow tract obstruction. Conclusions: Surgical intervention remains the definitive treatment for subvalvular aortic stenosis when clinically indicated. Concomitant cardiac or aortic pathology should be addressed during the same procedure to optimize outcomes. When performed with meticulous technique and appropriate patient selection, surgical correction is associated with excellent early recovery and favorable mid-term results, although long-term follow-up remains essential due to the risk of recurrence. Full article

Background: Although the concomitant Maze procedure successfully restores sinus rhythm in patients with valvular atrial fibrillation, it remains unclear whether electrical restoration translates into uniform functional recovery across different valvular etiologies. To address this issue, we compared the long-term left atrial (LA) mechanical recovery between patients with mitral stenosis (MS) and mitral regurgitation (MR) after the Maze procedure. Methods: This retrospective study included 211 patients who underwent the Maze procedure concomitant with valvular surgery and maintained sinus rhythm after 1 year. Patients were stratified into three groups, namely MS (n = 51), MR (n = 98), and non-mitral (n = 62) serving as a reference. LA function was evaluated using speckle-tracking echocardiography at baseline, immediately postoperatively, and at 1 year. Primary outcomes were changes in LA reservoir (LASr), LA conduit (LAScd), and LA contractile (LASct) strains. Results: At 1-year follow-up, the non-mitral reference group exhibited the best LA function, followed by the MR group, whereas the MS group showed the most impaired values (p < 0.001). Analysis of functional recovery revealed a mechanistic divergence, i.e., although the improvement in passive stiffness (LAScd) was comparable between the MS and MR groups (p = 0.42), the recovery of active contractile strain (LASct) was significantly superior in the MR group compared to the MS group (p < 0.05). The MS group failed to regain effective atrial contraction despite successful rhythm control. Conclusions: Although the Maze procedure successfully restored sinus rhythm, functional recovery varied significantly by etiology. The superior recovery in patients with MR was driven by the restoration of active atrial contraction, whereas patients with MS exhibited persistent mechanical dysfunction attributed to irreversible myocardial structural remodeling, despite similar improvements in compliance. Therefore, electrical success does not guarantee functional success, particularly in patients with MS. Full article

Background: Anterior saphenous vein (ASV) incompetence represents the third most common form of truncal varicose veins, and evidence for endovenous laser ablation (EVLA) in this setting remains limited. Methods: We evaluated outcomes of EVLA in cases with dominant ASV insufficiency. All EVLA procedures performed by a single surgeon between April 2019 and December 2023 for primary ASV reflux (ASV-R) were compared with a cohort containing all EVLA treatments for great saphenous vein (GSV) insufficiency without ASV reflux from April to December 2019 (GSV-R). We used a 1470-nm diode laser with radially emitting fibers for the interventions. Results: We included 378 patients (mean age 49.5 years): 208 and 256 treated limbs in the ASV-R and GSV-R cohorts, respectively. Female patients were more frequent in the ASV-R cohort than in the GSV-R cohort (80.5% vs. 62.9%, p < 0.001). ASV-R cases exhibited concomitant GSV insufficiency in 54.3% of cases. Redo procedures due to initial treatment failure were more frequent in ASV-R (1.9% vs. 0%, p = 0.04). Over a mean follow-up period of 332 days, 16 recurrences occurred in the ASV-R cohort compared with 4 in the GSV-R cohort, corresponding to a significantly increased hazard of recurrence in ASV-R (HR 8.41, 95% CI 2.78–25.4). Rates of subsequent foam sclerotherapy (16.8% vs. 10.5%) and minor complications (5.3% vs. 4.3%) did not differ significantly between ASV-R and GSV-R, respectively. ASV-R cases without concomitant GSV reflux demonstrated a higher need for secondary sclerotherapy, compared to ASV-R cases with additional GSV insufficiency. Conclusions: Our findings suggest that EVLA for ASV insufficiency is technically more challenging and yields inferior outcomes than EVLA for GSV incompetence. These considerations should be taken into account during preoperative planning and patient counseling. Further prospective and comparative analyses are needed to better define the effectiveness of thermal ablation strategies in ASV insufficiency and to support patient-centered, individualized treatment decisions. Full article

Background: Ipsilateral concomitant ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstruction is an uncommon but clinically important pediatric condition. Because standard imaging often detects only one level of obstruction, the coexistence of both lesions is frequently overlooked. Delayed diagnosis may result in persistent hydronephrosis, recurrent urinary tract infections, and progressive renal injury. This systematic review synthesizes current evidence regarding diagnostic challenges, management strategies, and outcomes in children with dual UPJ–UVJ obstruction. Methods: A systematic review following PRISMA 2020 guidelines was conducted and prospectively registered in PROSPERO. Major databases were searched for studies describing pediatric patients with confirmed ipsilateral UPJ + UVJ obstruction. Extracted data included clinical presentation, diagnostic pathways, imaging modalities, timing of diagnosis, surgical sequencing, and postoperative outcomes. Results: Across the 8 included studies, preoperative recognition of dual obstruction was uncommon. Most cases were diagnosed intraoperatively when retrograde stent passage failed or postoperatively when hydronephrosis persisted after an apparently adequate first procedure. Retrograde or antegrade pyelography consistently outperformed ultrasonography and diuretic renography in identifying distal pathology. Staged repair—typically beginning with pyeloplasty—emerged as the most reliable approach, as correction of the proximal obstruction alone frequently improved distal drainage. UVJ-first strategies were less effective and often required secondary pyeloplasty. Endoscopic and minimally invasive techniques showed promise in selected patients but were reported in limited numbers with short follow-up. Functional renal outcomes generally stabilized or improved following complete correction, particularly when intervention occurred early in life. Conclusions: Dual UPJ–UVJ obstruction remains a diagnostic challenge in pediatric urology. Complementing standard imaging with contrast pyelography and maintaining vigilance during intraoperative stent placement can improve detection. Available reports suggest that a staged proximal-first surgical strategy can optimize drainage and reduce the risk of unnecessary distal reconstruction. Early intervention appears beneficial for renal recovery, though long-term outcomes remain insufficiently studied. Ongoing follow-up is essential, particularly in children with recurrent urinary tract infections or persistent hydronephrosis. Full article

Cardiac contractility modulation (CCM) is a bioelectronic therapy that delivers precisely timed electrical signals during ventricular refractoriness to modulate myocardial contractility without triggering depolarization. Unlike pacing-based therapies, CCM does not initiate a new depolarization but instead modulates intracellular signaling pathways to enhance myocardial contractility without increasing myocardial oxygen consumption. CCM therefore represents a myocardial conditioning strategy distinct from cardiac resynchronization therapy, conduction system pacing, or neuromodulation. Experimental and translational studies demonstrate that repeated CCM delivery induces sustained myocardial adaptations, including improvements in excitation–contraction coupling, molecular signaling pathways, and structural remodeling that extend beyond transient hemodynamic effects. Across clinical investigations, CCM has been associated with meaningful improvements in exercise tolerance, health-related quality of life, and functional status in carefully selected populations. Observational data further suggest a potential reduction in heart failure-related hospitalizations when therapy is applied within evidence-aligned indications. Recent technological developments—including simplified ventricular lead configurations, rechargeable compact generators, and integrated CCM–defibrillator platforms—have reduced procedural complexity and may broaden clinical applicability, particularly in patients with concomitant implantable cardioverter–defibrillator indications. This review synthesizes mechanistic insights, clinical evidence, patient selection principles, and practical considerations to define the evolving role of CCM within contemporary heart failure care pathways. Full article

Background and Objectives: Acetabular fractures in elderly patients are increasing in incidence and are frequently associated with osteoporotic bone, fracture comminution, marginal impaction, and pre-existing joint degeneration. Open reduction and internal fixation (ORIF) alone in this population is associated with high rates of fixation failure, post-traumatic osteoarthritis, and secondary conversion to total hip arthroplasty (THA). Acute THA, with or without concomitant internal fixation, has emerged as an alternative strategy aimed at enabling early mobilization and reducing reoperation rates. Materials and Methods: We retrospectively reviewed a series of elderly patients who sustained an acetabular fracture and were treated with acute THA, either as a standalone procedure or combined with internal fixation. Demographic data, fracture patterns, surgical technique, implant choice, complications, and short-term clinical and radiographic outcomes were analyzed. Results: Acute THA allowed immediate or early weight bearing in all patients. Implant stability was achieved using a highly porous, multi-hole acetabular component with supplemental screw fixation and selective use of internal fixation to restore columnar stability when required. Complications were comparable to those reported in the contemporary literature for acute THA in acetabular fractures. Conclusions: In carefully selected elderly patients with acetabular fractures at high risk of failure after ORIF, acute THA with or without internal fixation represents a viable definitive treatment strategy, enabling early mobilization and avoiding the morbidity associated with delayed salvage arthroplasty. Full article

Background: The direction of deviation in strabismus may influence the predictability of the surgical procedure, but this factor remains insufficiently investigated. The aim of this study was to compare postoperative changes in ocular deviation, measured by video oculography, following surgical treatment in patients with concomitant exotropia and esotropia. Methods: A prospective longitudinal study included 49 patients with horizontal strabismus. All patients underwent an eye examination before and after surgery, with ocular deviation measured in nine gaze positions using video oculography. Preoperative and postoperative results were analyzed separately for esotropias and exotropias to assess surgical efficacy in both conditions. Results: Ocular deviation significantly improved after strabismus surgery in both esotropia and exotropia across all nine gaze positions (p < 0.05). The greatest improvement was observed in the primary position, with an efficacy rate of 75% in exotropia (mean reduction of 14.93 prism diopters) and 78% in esotropia (mean reduction of 17.50 prism diopters). Residual postoperative deviation was similar between the two types of strabismus (p > 0.05). In non-primary gaze positions, surgical efficacy was lower—particularly during complex eye movements—in both groups. Conclusions: Strabismus surgery resulted in a significant reduction in ocular deviation across all gaze positions in patients with concomitant horizontal strabismus, as objectively assessed by video oculography. Postoperative improvements were comparable between exotropia and esotropia, with the highest surgical efficacy observed in the primary gaze position. These findings support the use of objective multigaze evaluation to more comprehensively characterize postoperative alignment and to inform future assessments of surgical outcomes. 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