Search Results (124)

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 and Objectives: Proximal aortic neck-related complications severely impact the short- and long-term durability of endovascular aneurysm repair (EVAR). The Heli-FX EndoAnchor system provides proximal sealing zone reinforcement, aiming at both prevention and treatment of endograft migration and type Ia endoleak (EL Ia). The aim of this scoping review was to accumulate data on the prophylactic and therapeutic effect of EndoAnchors on patients undergoing index and revision EVAR for proximal neck complications. Methods and Materials: The PRISMA Extension for Scoping Reviews (PRISMA-ScR) Guidelines were followed. The literature published between 1 January 2009 and 1 September 2025 was searched by two independent reviewers. Studies reporting on morphological and clinical outcomes related to the proximal aortic neck were included. Main outcomes were Heli-FX EndoAnchor system technical success and procedural EVAR success, aortic neck dilation, endograft migration, EL Ia and proximal neck reinterventions. Results: Sixteen studies were included, with a total of 1164 patients. The mean follow-up ranged between 7 and 60 months. Eleven studies provided data on hostile proximal neck characteristics indicating Heli-FX EndoAnchors deployment. Technical success for prophylactic and therapeutic Heli-FX EndoAnchor application ranged between 85 and 100% as well as 86 and 100%, respectively. Procedural success for index and revision EVAR ranged between 85 and 100% as well as 45.4 and 100%, respectively. Residual EL Ia was reported in 103 patients following EndoAnchors deployment during index EVAR and revision cases. Secondary reinterventions related to the proximal sealing zone were reported in 39 patients (17 index EVAR, 19 revision). Mean aortic neck diameter increase between 2.5 and 4.6 mm was reported in four studies, while one study reported a mean >5 mm decrease. Conclusions: The Heli-FX EndoAnchor system was associated with high technical success, while procedural success was acceptable, amendable to neck-related characteristics, especially in revision cases for EL Ia treatment. Long-term data on morphological and clinical outcomes are warranted. Full article

Background: Mock circulatory loops (MCLs) are benchtop experimental platforms that reproduce key features of the human cardiovascular system, providing a safe, controlled, and reproducible environment for haemodynamic investigation. This scoping review aims to systematically map the current landscape of MCLs used for aortic simulation and identify major areas of application. Methods: A systematic search of PubMed, Scopus, and Web of Science identified original studies employing MCLs for aortic simulation. Eligible studies were categorized into predefined themes: (I) (bio)mechanical aortic characterization, (II) hemodynamics, (III) device testing, (IV) diagnostics, and (V) training. Data on MCL configurations, aortic models, and study objectives were synthesized narratively. Results: Eighty-four studies met the inclusion criteria. Twenty-five investigated aortic biomechanics, 23 hemodynamics, 22 device or product testing, 13 validated diagnostic imaging techniques, and one training application. Models included porcine (n = 22), human cadaveric (n = 7), canine (n = 1), ovine (n = 1), bovine (n = 1), and 3D-printed or molded aortic phantoms (n = 55). MCLs were employed to study parameters such as aortic stiffness, flow dynamics, dissection propagation, endoleaks, imaging accuracy, and device performance. Conclusions: This review provides a comprehensive overview of MCL applications in aortic research. MCLs represent a versatile pre-clinical platform for studying aortic pathophysiology and testing endovascular therapies under controlled conditions. Standardized reporting frameworks are now required to improve reproducibility and accelerate translation to patient-specific planning. Full article

Background/Objectives: Blunt traumatic thoracic aortic injury is a rare but often fatal condition, typically resulting from high-energy deceleration mechanisms such as motor vehicle collisions or falls from height. Mortality can reach 80–90% at the scene, with in-hospital mortality up to 46%. Early diagnosis and appropriate management are essential to improve outcomes. Methods: We retrospectively analyzed 45 patients (29 males, 16 females) with varying degrees of aortic isthmus injury treated between January 2007 and December 2024 at two Italian vascular surgery centers. Aortic lesions were graded 0–3, with 40 patients undergoing thoracic endovascular aortic repair. Procedures utilized Gore TAG or Medtronic Valiant endografts. Perioperative management included controlled hypotension and left subclavian artery coverage was performed when necessary. Results: Procedural success was achieved in all patients (100%), with one type II endoleak. No perioperative complications or spinal cord ischemia were observed. Coverage of the left subclavian artery was required in 28.9% of cases. Thirty-day mortality was 9%, with no deaths directly attributable to aortic injury. Postoperative CTA confirmed adequate endograft placement in all patients. Conclusions: Endovascular repair is a safe and effective approach for BTAI, with excellent short-term outcomes. Management should be tailored to injury severity and patient comorbidities, with ongoing vigilance for spinal cord ischemia. Full article

Background and Objectives: Hostile iliofemoral anatomy (HIA) challenges large-bore access in thoracic, branched, or fenestrated endovascular aortic repair (t/b/fEVAR). Retroperitoneal open iliac conduit (ROIC) enables safe delivery, but data in complex t/b/fEVAR are scarce. Materials and Methods: This retrospective single-center cohort study (2017–2025) of 80 t/b/fEVAR patients followed STROBE guidelines. Eight (10%) required elective ROIC for HIA (small iliac diameter < 7 mm or occlusive disease). Outcomes were compared to 23 no-conduit complex endovascular aortic repair cases. Results: ROIC patients [50% female, 87.5% smokers] had higher PAD [62.5% vs. 17.4%, p-value = 0.015]. All ROICs were elective [vs. 69.5% no-conduit, p-value = 0.076]; indications: Type V TAAA [50%], synchronous aneurysms (25%), Type II TAAA [12.5%] and arch aneurysm [12.5%]. Median operative time [365 vs. 200 min, p-value = 0.002], blood loss [1190 vs. 600 cc, p-value < 0.001], and contrast [420 vs. 300 cc, p-value = 0.004] were higher. Technical success was 100% [8/8] vs. 86.9% [20/23] (p-value = 0.28), and clinical success was 87.5% vs. 78.2% (p-value = 0.569). Median ICU stay [3 d vs. 2 d, p-value = 0.817] and hospital stay [12 d vs. 9 d, p-value = 0.404] were prolonged, albeit without statistically significant differences. In-hospital mortality was similar (12.5% vs. 17.4%, p-value = 0.746) between groups. One ROIC patient had intraoperative cardiac arrest [sheath dislodgement]; another required a covered stent for anastomotic rupture. At 12-month follow-up, one Type III endoleak required relining. Conclusions: Planned retroperitoneal open iliac conduits achieved 100% technical success in patients with hostile iliofemoral anatomy, without ischemic complications, despite longer operative times and higher blood loss. ROIC remains a safe and indispensable technique that extends complex endovascular aortic repair to otherwise ineligible patients. Full article

Background/Objectives: Appropriate imaging surveillance, established by the Society of Vascular Surgery (SVS), following endovascular aorta repair (EVAR) is critical for patient monitoring. We hypothesized that adherence to follow-up decreases over time, and therefore, the ability to detect endoleaks after EVAR also decreases. Methods: A retrospective cohort study of patients who underwent EVAR from 2014 to 2022 at our institution was completed. Patients were stratified by adherence to SVS guidelines for up to five years postoperatively. Demographics, detection of an endoleak > 30 days postoperatively, distance from our facility, and Area Deprivation Index (ADI) were collected. Comparisons of baseline comorbidities between groups and multivariate logistic regressions were performed using R studio. Results: 395 patients underwent an index EVAR at our institution from 2014–2022. 174 (44%) of patients adhered to all imaging recommendations, with an average loss to follow-up of 9.7% per year. 61 (15.4%) patients had a detected type II endoleak during the study period. Multivariable analysis identified residence > 50 miles from our institution as an independent risk factor for nonadherence (OR 1.76, p = 0.018) when controlling for age, sex, race, and ADI quartile. Conclusions: Adherence to surveillance guidelines gradually decreases after EVAR, but type II endoleak detection continues to occur years following the operation. While residence greater than 50 miles away was associated with nonadherence, patients’ ADI was not. Our results identify an opportunity for providers who may see patients more frequently to assist in reminding and arranging imaging follow-up for patients following their procedure. Full article

Background/Objectives: Endovascular aneurysm repair (EVAR) is the standard treatment for abdominal aortic aneurysms, but the risk of endoleak compromises its effectiveness. Type IA endoleak, stemming from an inadequate proximal seal, is the most critical complication associated with the highest risk of rupture. Current preoperative planning relies on static anatomical measurements from computed tomography angiography that fail to predict seal failure due to dynamic biomechanical forces. This study aimed to retrospectively validate the predictive accuracy of a novel physics-informed digital twin and artificial intelligence (AI) model for predicting type IA endoleak risk compared to conventional static planning methods. Methods: This was a retrospective, single-center proof-of-concept validation study involving 15 patients who underwent elective EVAR (5 with confirmed type IA endoleak and 10 without type IA endoleak). A patient-specific digital twin was created for each case to simulate stent-graft deployment and capture the dynamic biomechanical interaction with the aortic wall. A logistic regression AI model processed over 16,000 biomechanical measurements to generate a single, objective metric of the endoleak risk index (ERI). The predictive performance of the ERI (using a cutoff of 0.80) was assessed and compared against a 1:3 propensity score-matched conventional control group (n = 45) who received traditional anatomical-based planning. Results: The mean ERI was significantly higher in the endoleak-positive group (0.85 ± 0.10) compared to the endoleak-negative group (0.39 ± 0.11) (p = 0.011). The digital twin/AI model demonstrated superior predictive capability, achieving an overall accuracy of 80% (95% CI: 51.9–95.7) and an area under the curve (AUC) of 0.85 (95% CI: 0.58–0.99). Crucially, the model achieved a sensitivity of 100% and a negative predictive value (NPV) of 100%, correctly identifying all high-risk cases and ruling out endoleak in all low-risk cases. In stark contrast, the matched conventional planning group achieved an overall accuracy of only 51.1% and an AUC of 0.54. Conclusion: This physics-informed digital twin and AI framework successfully validated its capability to accurately and objectively predict the risk of type IA endoleak following EVAR. The derived ERI offers a significant quantitative advantage over traditional static anatomical measurements, establishing it as a highly reliable safety tool (100% NPV) for ruling out endoleak risk. This technology represents a critical advancement toward personalized EVAR planning, enabling surgeons to proactively identify high-risk anatomies and adjust treatment strategies to minimize post-procedural complications. Further large-scale, multicenter prospective trials are necessary to confirm these findings and support clinical adoption. Full article

Background/Objective: Endovascular aneurysm repair (EVAR) using Aorfix (Lombard Medical, Inc., Irvine, CA, USA)^TM has shown excellent outcomes, even in cases of abdominal aortic aneurysm with highly angulated aortic necks (≥60°). However, long-term outcomes for Japanese patients remain unknown. In this study, we aimed to investigate the performance of Aorfix^TM in Japanese patients with highly angulated aortic necks. Methods: Among 114 patients in whom Aorfix^TM was used for EVAR at a single institution from October 2014 to October 2021, 105 patients without rupture or infection were retrospectively reviewed. They were classified into the following two groups: those with proximal neck angulations of ≥60° and <60°. Endpoints included technical success, long-term survival, freedom from aneurysm-related mortality, and freedom from reintervention. Results: Among 105 cases reviewed, 54 and 51 had proximal neck angulations of <60° and ≥60°, respectively. The <60° and ≥60° groups had a mean neck angulation of 30.7° (median 30°, range 10–56°) and 80.3° (median 77°, range 60–110°), respectively. The ≥60° group had significantly increased operation time (p = 0.034), volume of contrast agent used during the operation (p = 0.0301), and duration of fluoroscopy during the operation (p < 0.0001); however, the rates of additional renal artery stenting, cuff placement, and access site complications did not differ between the groups. There were also no differences in the incidence of aneurysm enlargements, secondary intervention, and endoleaks incidence. Conclusions: EVAR with Aorfix^TM achieved satisfactory results in Japanese patients with severe and mild/moderate proximal neck angulation. 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

Introduction: The neutrophil–lymphocyte ratio (NLR) has proven to be an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and endovascular aneurysm repair (EVAR) outcomes. Methods: A multicentric retrospective study of patients undergoing EVAR in elective setting between 2015 and 2023 was performed. Preoperative NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and a cut-off of 5 was used as threshold for the analysis. Primary outcomes (technical success, endograft occlusion, AAA-related reintervention, endoleaks, and mortality rates) were compared between the NLR < 5 and the NLR > 5 group. Kaplan–Meier survival analysis was employed to assess overall survival and the incidence of long-term complications. Results: The study initially considered 1360 patients. Eventually, 823 patients were included in the study, of whom 129 (15.7%) with NLR > 5. The latter group presented a higher AAA diameter (59.1 mm vs. 55, mm; p = 0.004). Technical success was obtained in 98,9% of all enrolled patients. NLR values were significantly associated with ASA class (p = 0.014), involvement of the iliac arteries (p = 0.023), duration of ICU stays (p < 0.001), and overall length of hospitalization (<0.001). At Kaplan–Meier analysis, patient with NLR > 5 showed a significant lower survival rates (p = 0.006), while no significant differences were found in terms of endograft occlusion (p = 0.45), AAA-related reintervention (p = 0.63), and endoleaks (p = 0.49). Conclusions: This study highlights the association between the NLR value and an elevated risk of long-term mortality, highlighting its role as an indicator of the patient’s overall clinical condition rather than immediate surgical outcomes. Focusing on this selected group of patients can improve postoperative care and reduce long-term complications. Full article

Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm², and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA. Full article

Background/Objectives: The aim of this study was to assess the current management strategies of Isolated Left Vertebral Artery (ILVA) arising directly from the aortic arch during total endovascular or hybrid repair of aortic arch pathologies and their safety and efficacy. Methods: A systematic literature review was undertaken to assess the current management strategies for ILVA during total endovascular or hybrid repair of aortic arch pathologies on three databases (PubMed, SCOPUS and Web of Science) from inception to February 2025, according to PICO and PRISMA guidelines (PROSPERO CRD42024562104). The safety (overall and aortic-related mortality; neurological complications) and efficacy (revascularization patency, endoleak and reintervention rate) of both approaches were investigated. Results: Out of 224 articles found, seven retrospective cohort studies (178 patients) were included. Overall, 149 patients (74.2% male, mean age 63 years) underwent ILVA revascularization. Two studies reported open ILVA revascularization through transposition; three studies reported endovascular revascularization strategies, and one study reported both open and endovascular techniques. The overall mortality rate was 1.3% at 30 days and 5.4% at a mean follow-up of 46 months (range 6–120) with a reported rate of aortic mortality of 0.7%. In the transposition group (55 patients), the rate of minor neurological complications was 16.6%, and the rate of major neurological complications was 7.3%; loss of patency rate was 16.3% and reintervention rate was 11.7%. Endovascularly treated patients (94 patients) experienced a rate of minor neurological complications of 2.1% and major neurological complications of 1%; the loss of patency rate was 2.1%, and the reintervention rate was 3.1%. Conclusions: Both surgical and endovascular techniques for ILVA revascularization seem to assure an acceptable rate of mortality and neurological complications during treatment of arch pathologies. However, currently available data are poor, non-standardized and based on single-center experiences. Therefore, until more robust data are available to indicate the superiority of one approach over another, the management strategies for aberrant ILVA should be individualized based on the anatomic characteristics and the center experience. Our findings underscore the need for prospective studies with standardized protocols. Full article

Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and effectiveness of a hybrid approach in high-risk patients with TAA disease and complex renal and hypogastric anatomy. Methods: This was a retrospective single-center study, including all consecutive patients with TAAA and TAAD with complex renal and/or hypogastric artery anatomy treated with a hybrid approach between 2020 and 2024 in a high-volume aortic center. Primary endpoint was technical success. Secondary endpoints were early complications, overall and aortic-related mortality, aortic-related reintervention, the incidence of endoleaks, and the target vessel (TV) patency and TV instability at 30-day and during follow-up. Results: During the study period, a total of 92 patients with TAAA or TAAD were treated at our institution. Five high-risk patients (5.4%) with complex renal/hypogastric artery anatomy underwent open renal debranching and hypogastric revascularization followed by staged endovascular repair with custom-made double fenestrated/branched device. Technical success was achieved in all cases with no intra-operative mortality. No spinal cord ischemia or 30-day mortality occurred. Target vessel patency at 30 days was 90%. At a median follow-up of 38 months (IQR 26–49 months), there were no cases of aortic-related death. Conclusions: Hybrid repair is a feasible and effective option for managing complex TAAA and TAAD in high-risk patients. Larger studies with longer follow-up are needed to better define the clinical role of this approach. Full article

Objectives: New endografts have improved clinical outcomes in patients with abdominal aortic aneurysm (AAA) treated with the endovascular approach (EVAR). The purpose of this study is to evaluate the Endurant endograft for EVAR. Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane for studies including patients treated with EVAR for unruptured AAA. This meta-analysis follows PRISMA guidelines (PROSPERO: CRD42024621517). A Kaplan–Meier-derived individual patient data analysis assessed the survival, the freedom from reintervention, the freedom from type Ia endoleak (ETIa), and the aneurysm-related mortality rates. The analysis reflects aggregated survival data, and the at-risk population decreases over time due to censoring and loss to follow-up. Kaplan–Meier survival curves were digitized to extract survival/mortality values at specific time points, and number-at-risk tables or total events were used to improve time-to-event accuracy. A subgroup analysis compared the outcomes of treatment within versus outside the instructions for use (IFU). Results: Twenty-six studies met our eligibility criteria, incorporating 5901 patients in terms of survival, with survival rates at 1, 5, and 10 years of follow-up at 94.4%, 71.6%, and 42.4%, respectively, while overall aneurysm-related mortality rates were 0.8%, 2.3%, and 7.6%, respectively. Freedom from secondary reintervention was 94.9% at 1 year, 81.9% at 5 years, and 43.7% at 10 years, while freedom from type Ia endoleak was 98.8%, 94.6%, and 85.6%, respectively. Comparing treatment within versus outside the IFU, in terms of survival (HR: 0.94, 95% CI: 0.75–1.16, p = 0.53), freedom from reintervention (HR: 0.85, 95% CI: 0.63–1.15, p = 0.29) and mortality due to aneurysm-related complication (HR: 0.79, 95% CI: 0.34–1.84, p = 0.58) revealed no statistically significant difference. Conclusions: The Endurant endograft provides acceptable rates of survival, freedom from secondary intervention, aneurysm-related mortality rates, and freedom from ETIa; however, continuous long-term follow-up surveillance is necessary. Full article

Background: Advances in stent grafts and endovascular techniques have expanded the indications for thoracic endovascular aortic repair (TEVAR) to include arch lesions. In situ needle fenestration (ISNF) has emerged as a promising technique for revascularizing supra-aortic branches. The aim of this study is to evaluate the safety and efficacy of triple in situ needle fenestration during TEVAR for aortic arch pathologies in a single-center experience. Materials and Methods: A retrospective analysis was conducted on fifteen patients who underwent in situ triple fenestration TEVAR between June 2023 and March 2024. The median age of the patients was 51,33 years (±19.69) and twelve of the patients were male. All procedures were performed under general anesthesia in a hybrid operating room. Ethical approval was obtained from the institutional review board, and informed consent was received from all participants. Results: Primary technical success was achieved in all cases (15/15, 100%). The mean operation time was 197.33 min (range: 126–302). Two patients experienced a minor hematoma at the access site. Mortality was observed in one patient (6.66%) during the 30-day follow-up period. The total hospital stay averaged 7 ± 3.36 days. One patient had a transient ischemic attack, but there were no incidents of stroke or spinal cord ischemia. No procedure-related endoleak was observed during the intervention; however, eight patients required reintervention in the descending aorta. Conclusions: ISNF may be an effective and feasible method for revascularizing arch vessels, with low rates of early mortality and stroke when performed by experienced practitioners. However, larger multicenter studies with longer follow-up are needed to confirm the durability and long-term outcomes of this technique. Full article