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The use of drug therapies in patients with chronic venous disease (CVD) remains a topic of debate regarding safety, compliance, and effectiveness. Although the beneficial effects of molecules like diosmin have been established in patients with chronic venous insufficiency (CVI) of C3–C6 classes, the evidence for its use in C0–C1 patients is not well documented. This report aims to describe and analyze the positive impact of a new diosmin-based drug therapy on a population of C0–C1 patients in terms of relief of venous symptoms.

The sapheno-femoral junction (SFJ) and the great saphenous vein (GSV) are recognized as one of the main sources of reflux in chronic venous disease. Moreover, reflux time is considered as the main parameter to characterize GSV disease. Despite this, it is well-known in the clinical practice that not all patients with SFJ/GSV reflux are similar, in terms of disease severity and degree. Some other anatomical findings, such as SFJ and GSV diameters, as well as the absence/incompetence of suprasaphenic femoral valve (SFV) might be of interest to better “quantify” the disease severity. The aim of this paper is to describe, through a duplex scan analysis, the relationship between SFJ incompetence, GSV/SFJ diameter and SFV absence/incompetence, to identify if there are patients with “severe” GSV disease and a potential higher recurrence rate after invasive treatments.

Blunt thoracic aortic injury (BTAI) is a devastating condition that commonly occurs in healthy and young patients. Endovascular treatment is the first choice; however, it has also been demonstrated to alter cardiovascular haemodynamics. The aim of this systematic review was to describe the cardiovascular modifications after thoracic endovascular aortic repair (TEVAR) for BTAI.PubMed (MEDLINE), Scopus, and Web of Science were systematically searched for eligible studies reporting on modifications in aortic stiffness, blood pressure, cardiac mass, and aortic size.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies.A total of 12 studies reporting on 265 patients were included. Severe heterogeneity existed among the included studies with regard to demographics, BTAI grade, endograft specifications, reported outcomes, and the method of evaluation. Regarding aortic stiffness, two studies found a significant increase in pulse wave velocity (PWV) in patients after TEVAR compared with a control group, while one did not find a significant increase in PWV and augmentation index after3 years of follow up. Five studies reported an increase in the incidence of post-TEVAR hypertension up to 55% (range 34.8% - 55.0%) vs. baseline. One study found a statistically significant increase in left ventricular mass and left ventricular mass index during follow up. Nine studies report data regarding aortic dilatation or remodelling after TEVAR. One found a 2.4 fold faster growth rate in ascending aortic diameter vs. controls, while other studies described significant changes in aortic size at different locations along the aorta and endograft after TEVAR.This systematic review highlights adverse cardiac and aortic modifications after TEVAR for BTAI. The results stress the need for lifelong surveillance in these patients and the necessity of developing a more compliant endograft to prevent cardiovascular complications in the long term.

A systematic review and meta-analysis of the peri-operative outcomes of carotid endarterectomy (CEA) on dual antiplatelet therapy (DAPT) vs. aspirin monotherapy was carried out, to determine optimal peri-operative management with these antiplatelet agents.The Web of Science, Pubmed, and Embase databases were searched from inception to July 2021. The corresponding authors of excluded articles were contacted to obtain additional data for possible inclusion.The main outcomes included ischaemic complications (stroke, transient ischaemic attack [TIA], and transcranial Doppler [TCD] measured micro-emboli), haemorrhagic complications (haemorrhagic stroke, neck haematoma, and re-operation for bleeding), and composite outcomes. Pooled estimates using odds ratios (ORs) were combined using a random or fixed effects model based on the results of the chi square test and calculation of IIn total, 47 411 patients were included in 11 studies, with 14 345 (30.2%) receiving DAPT and 33 066 (69.7%) receiving aspirin only. There was no significant difference in the rates of peri-operative stroke (OR 0.87, 95% confidence interval [CI] 0.72 - 1.05) and TIA (OR 0.78, 95% CI 0.52 - 1.17) despite a significant reduction in TCD measured micro-emboli (OR 0.19, 95% CI 0.10 - 0.35) in the DAPT compared with the aspirin monotherapy group. Subgroup analysis did not reveal any significant difference in ischaemic stroke risk between patients with asymptomatic and symptomatic carotid artery stenosis. DAPT was associated with an increased risk of neck haematoma (OR 2.79, 95% CI 1.87 - 4.18) and re-operation for bleeding (OR 1.98, 95% CI 1.77 - 2.23) vs. aspirin. Haemorrhagic stroke was an under reported outcome in the literature.This meta-analysis found that CEA while on DAPT increased the risk of haemorrhagic complications, with similar rates of ischaemic complications, vs. aspirin monotherapy. This suggests that the risks of performing CEA on DAPT outweigh the benefits, even in patients with symptomatic carotid stenosis. The overall quality of studies was low, and improved reporting of CEA outcomes in the literature is necessary.

BackgroundIn many studies on aortic disease women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the AA and arch.MethodsElectrocardiogram-gated cardiac computed tomography scans of 116 patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology.ResultsIn both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7,4% wider compared to female aortas, both in systole and diastole.ConclusionsThe present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated to decreased AA and arch diameters. In men, increased body surface area and age are associated to increased AA and arch diameters, while smoking and diabetes are associated to decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women.

Malignancies involving the inferior vena cava (IVC) have historically been considered not amendable to surgery. More recently, involvement of the IVC by neoplastic processes in the kidney, liver or in the retroperitoneum can be managed successfully.In this systematic review we summarize the current evidence regarding the surgical management of the IVC in cases of involvement in neoplastic processes. Current literature was searched, and studies selected on the base of the PRISMA guidelines. Evidence was synthesized in narrative form due to heterogeneity of studies.Renal cell carcinoma accounts for the greatest proportion of studied patients and can be managed with partial or complete vascular exclusion of the IVC, thrombectomy and direct closure or patch repair with good oncological prognosis. Hepatic malignancies or metastases may involve the IVC, and the joint expertise of hepatobiliary and vascular surgeons has developed various strategies, according to the location of tumor and the need to perform a complete vascular exclusion above the hepatic veins. In retroperitoneal lymph node dissection, the IVC can be excised en-block to guarantee better oncological margins. Also, in retroperitoneal sarcomas not arising from the IVC a vascular substitution may be required to improve the overall survival by clearing all the neoplastic cells in the retroperitoneum. Leiomyoma can have a challenging presentation with involvement of the IVC requiring either thrombectomy, partial or complete substitution, with good oncological outcomes.A multidisciplinary approach with specialist expertise is required when dealing with IVC involvement in surgical oncology. Multiple techniques and strategies are required to deliver the most efficient care and achieve the best possible overall survival. The main aim of these procedures must be the complete clearance of all neoplastic cells and achievement of a safe margin according to the perioperative treatment strategy.

The term “recurrence” in chronic venous disease remains not yet well defined, despite numerous reports describing patterns and causes of the presence of recurrent varicose veins (RVVs). Moreover, saphenous trunk recanalization (STR) has also been documented as one of the major source of RVVs and it is widely used to indicate the “failure” of endovenous ablation. Finally, reappearance of venous symptoms (VSym) should be considered to reach a complete “recurrence” evaluation. RVVs, STR, and VSym rates and mutual co-presence after endovenous treatments are still unclear. The aim of this report is to describe and analyze these three recurrence components after 6 years in patients underwent radiofrequency ablation of the great saphenous vein.

Background Despite the great evolution of endograft devices for thoracic endovascular aortic repair (TEVAR), threatening related complication such as graft migration and endoleaks still occur during follow up. The Drag Forces (DF), that is the displacement forces that play a role in graft migration and endoleaks caused by the blood flow against the thoracic graft, can be studied by means of Computational Fluid Dynamics (CFD). Method A general review of papers found in current literature was performed. CFD studies available on the topic of thoracic aortic diseases and DF were analyzed. All anatomic, hemodynamics or graft related factors which could have an impact on DF were reported. Results Different factors deeply influence DF magnitude in the different site of the Ishimaru's zones classification: angulation, tortuosity and length of the landing zone, graft diameter, length and deployment position, blood pressure, pulse waveform, blood viscosity and patient heart rate have been related to the magnitude of DF. Moreover, also the three-dimensional orientation of DF is emerging as a fundamental issue from CFD studies. DF can be divided in sideways and upward components. The former, even of higher magnitude in zone 0, maintain always an orthogonal orientation and does not change in any type of aortic arch; the latter result strictly related to the anatomic complexity of the aortic arch with values up to four times higher in zone 3. Conclusion Different DF magnitude and orientation could explain how TEVAR have higher rate of migration and endoleaks when we face with more complex aortic anatomies. All these aspects should be foreseen during the planning of TEVAR procedure. In this field, collaboration between physicians and engineers is crucial, as both parts have a primary role in understanding and describing hidden aspects involved in TEVAR procedures.

This study sought to identify the factors associated with the occurrence of in-hospital serious adverse events after elective endovascular aortic repair (EVAR) in older patients within the Global Registry for Endovascular Aortic Treatment.Consecutive patients ages ≥75 years who received GORE EXCLUDER AAA Endoprosthesis (W.L. GoreAssociates, Inc, Flagstaff, AZ) for elective EVAR. Based on the age at index elective EVAR, patients were categorized into 3 groups for subsequent analyses: those ages 75 to 79, 80 to 84, and ≥85 years. The primary end points for this study were the incidence of serious adverse events and all-cause mortality. In-hospital complications were defined according to the International Organization for Standardization 14155 standard (https://www.iso.org/standard/71690.html) and considered serious adverse events if they led to any of the following: (1) a life-threatening illness or injury, (2) a permanent impairment of a body structure or a body function, (3) in-patient or prolonged hospitalization, or (4) medical or surgical intervention to prevent life-threatening illness or injury or permanent impairment to a body structure or a body function.Overall, 1,333 older patients (ages 75-79: n = 601; 80-84: n = 474; and ≥85: n = 258) underwent elective EVAR in the Global Registry for Endovascular Aortic Treatment data set and were included in the present analysis. In total, 12 patients (0.9%) died perioperatively, and 103 patients (7.7%) experienced ≥1 in-hospital serious adverse event, with 18 patients (1.3%) experiencing1 in-hospital complications. No significant differences were seen between the age groups in the rates of in-hospital serious adverse events (7.3% vs 8.2% vs 7.8%; P = .86). In logistic regression analysis, a history of chronic obstructive pulmonary disease (odds ratio = 2.014; 95% confidence interval, 1.215-3.340; P = .006) and prior requirement for dialysis (odds ratio = 4.655; 95% confidence interval, 1.087-19.928; P = .038) resulted as predictors for occurrence of in-hospital serious adverse events. In the whole cohort, the 5-year survival was 63% for patients who did not experience any in-hospital serious adverse events compared with 51% for those who experienced any complications (P = .003). Using multivariable Cox proportional hazards models, it was found that the occurrence of in-hospital serious adverse events (hazard ratio = 6.2; 95% confidence interval, 1.8-21.317; P = .003) and being underweight (hazard ratio = 7.0; 95% confidence interval, 1.371-35.783; P = .019) were the only independent predictors of death in ≤30 days from the initial intervention. Although age did not independently affect the risk for all-cause mortality in ≤180 days after the initial intervention, increasing age was associated with a higher risk for long-term death (ie, ≥181 days from index elective EVAR) in the multivariable analysis (ages 75-79: hazard ratio = 0.379; 95% confidence interval, 0.281-0.512; P.001; and 80-84: hazard ratio = 0.562; 95% confidence interval, 0.419-0.754; P.001).After elective EVAR in older patients (ie, ≥75 years), the occurrence of in-hospital serious adverse events appears to increase the risk of death, particularly in ≤180 days after the initial elective EVAR intervention, and might be related to patient baseline characteristics, including history of pulmonary and renal disease.

Objective: The characteristics and outcomes of patients undergoing vascular surgery hospitalised and managed in Lombardy are described with a comparison of patients tested positive for COVID-19 (CV19-pos) vs. those tested negative (CV19-neg). Methods: This was a multicentre, retrospective, observational cohort study which involved all vascular surgery services in Lombardy, Northern Italy. Data were retrospectively merged into a combined dataset covering the nine weeks of the Italian COVID-19 pandemic phase 1 (8 March 2020 to 3 May 2020). The primary outcome was freedom from in hospital death, secondary outcomes were re-thrombosis rate after peripheral revascularisation, and freedom from post-operative complication. Results: Among 674 patients managed during the outbreak, 659 (97.8%) were included in the final analysis: 121 (18.4%) were CV19-pos. CV19-pos status was associated with a higher rate of complications (OR 4.5; p < .001, 95% CI 2.64 – 7.84), and a higher rate of re-thrombosis after peripheral arterial revascularisation (OR 2.2; p = .004, 95% CI 1.29 – 3.88). In hospital mortality was higher in CV19-pos patients (24.8% vs. 5.6%; OR 5.4, p < .001;95% CI 2.86 – 8.92). Binary logistic regression analysis identified CV19-pos status (OR 7.6; p < .001, 95% CI 3.75 – 15.28) and age > 80 years (OR 3.2; p = .001, 95% CI 1.61 – 6.57) to be predictors of in hospital death. Conclusion: In this experience of the vascular surgery group of Lombardy, COVID-19 infection was a marker of poor outcomes in terms of mortality and post-operative complications for patients undergoing vascular surgery treatments.

Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several ‘unconventional’ approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.

Thoracic endovascular aortic repair (TEVAR) is widespread in clinical practice for treating aortic diseases but it has relevant systemic complications, such as increase of the cardiac workload due to post-TEVAR aortic stiffening, and local issues such as re-entry tears due to the tissue damage caused by endograft interaction. The present study aims to elucidate these aortic biomechanical mechanisms by coupling ex vivo and in silico analysis. By ex vivo tests, the pulse wave velocity before and after TEVAR is measured. Uni-axial tensile tests are performed to measure regional mechanical response of tissue samples, supplied as input data for the in silico analysis. Numerical analysis is finally performed to compute the wall stress induced by the stent-graft deployment and the arterial pressurization. The ex vivo results highlight an increase of baseline PWV by a mean .78 m/s or 12% after TEVAR with a 100 mm stent-graft (p .013). In the in silico analysis, the average von Mises stress in the landing zone increases of about 15% and 20% using, respectively stent-graft with radial oversizing of 10% and 20%. This work shows the effectiveness of integrated framework to analyze the biomechanical post TEVAR mechanisms. Moreover, the obtained results quantify the effect of prosthesis selection on the stiffening of the aorta after TEVAR and on the local increase of the aortic wall stress that is proportional to the stent-graft oversizing.

Aortic graft infection represents one of the most challenging and life-threatening complication of surgical and endovascular treatment of aortic pathologies. The aim of this study was to report the results of a single center with in-situ revascularization for the treatment of aortic graft infections using the neo-aorto-iliac system (NAIS) and to review the literature about this surgical technique.We retrospectively reviewed our aortic graft infection case series and in-situ revascularization using the neo-aorto-iliac system. The study was conducted from January 2009 to June 2020. The primary outcomes analyzed were early mortality (30 days), late mortality (30 days), reinfection rate. Secondary outcomes were the primary patency rate, the secondary patency rate, and the lower limb salvage rate. A literature review of the last twenty years was performed on international medical databases Pubmed (Medline), Scopus and Web of Science.During study period, 12 patients, all male (median age of 69 years [range: 52-87 years]), underwent to infected graft explantation and revascularization by NAIS using femoral-popliteal veins. Six cases were complicated by aorto-enteric fistulas, five were duodenal and one was colon. Patients spent the immediate postoperative period in the Intensive Care Unit for a median time of 4 days (range: 0-9 days). The median length of hospital stay was 27.5 days (range: 1-66 days). The mean follow-up was 21.5 months (range: 0-120). The 30-day mortality rate was 25% (3 patients) due to postoperative complications. No patient dropped out of the follow-up protocol. The primary patency rate was 92% while the secondary patency rate was 100%. No patient underwent lower limb amputation. Persistence of infection occurred in 1 case (8.3%). Overall Kaplan-Meier survival estimates were 75% for 30 days, 50% for 1 year, 48% for 5 years. Literature analysis identified 19 case series.The literature regarding NAIS has low statistical evidence due to retrospective design of the studies. Our results are in agreement with retrospective studies in the literature. When the surgical team is confident with NAIS, this technique should be considered the preferred method, considering an acceptable and comparable mortality rate with other techniques and a better rate of patency, resistance to graft degeneration, recurrent infections and amputation rate.

Background Arterial traumas of the extremities are quite rare in civilian records; nevertheless, patients with trauma of limbs are admitted daily in emergency departments worldwide. The up-to-date information about epidemiology and treatment (open vs. endovascular surgery) comes from war records and it is not always easy getting data on mortality and morbidity in these patients. The aim of this study is to analyze the approach (open or endovascular) and the outcome of patients with vascular trauma of upper limbs (from the subclavian artery) and/or lower limbs (distal to the inguinal ligament), in the greater Milan area. Methods A retrospective analysis was conducted on data recorded by the emergency departments of two hospitals of the greater Milan between 2009 and 2017. We collected all patients with arterial injuries of the limbs in terms of demography, injury patterns, clinical status at admission, therapy (open or endovascular approach), and outcomes in terms of limb salvage and survival. Results We studied 52 patients with vascular trauma of extremities. The main mechanism of trauma was road accident (48.1%), followed by criminal acts (32.7%), self-endangering behavior (13.5%), work (3.8%), and sport accidents (1.9%). Associated lesions (orthopedic, neurological, and/or venous lesions of the limbs) were present in 39 patients (75%). All patients underwent emergency surgery, forty-six patients (88.5%) by open repair (polytetrafluoroethylene or greater saphenous vein bypass grafts, arterial suture or ligation), whereas endovascular approach was used only in 6 patients (11.5%), all treated with embolization. The overall postoperative mortality rate was 5.7% (3 patients). Among survivors, we report 5 major amputations of the lower limbs, 3 of them after bypass graft infection, and 2 after graft failure. The rate of limb salvage was 90.4%. Conclusions Isolated arterial trauma of the extremities are rare, usually they occur in the setting of multiple trauma patients. Despite progresses in surgical techniques, there are still controversies in diagnosis and treatment of these patients. We treated most cases with open surgery (n = 46), choosing endovascular approach (embolization performed mainly by interventional radiologists) in difficult anatomic districts. We believe that, during decision-making of the surgical strategy, it is important to consider the anatomical site of lesions and the general condition of the patients. Moreover, in case of multiple trauma, we suggest a multidisciplinary approach to provide the best medical care to the victims.

Since the outbreak of the 2019 coronavirus (COVID-19), vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term, cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19-negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19-positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19-negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decision-making especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes.Data search was performed on PubMed, Scopus and Web of Science, using as time range "January 1The search retrieved 416 papers; among these, 46 studies were eligible and reviewed in depth. The published literature suggests the existence of a hypercoagulable state in patients with COVID-19 disease occurring via direct and indirect mechanisms. COVID-19 infection seems to promote a prothrombotic status that aggravates vascular disease. Regardless of clinical laboratory or status, active COVID-19 infection is considered a risk factor for poor vascular surgery outcomes. Specifically, it is associated with a fourfold increased risk of death and a threefold increased risk of major adverse events. Prognosis of patients hospitalized with COVID-19 disease is often determined by the extent of pulmonary disease, although vascular complications also greatly affect outcomes. Nevertheless, although COVID‑19 is highly morbid, in high‑risk operations good outcomes can still be achieved even in elderly patients with COVID‑19.In the case of aortic disease during active COVID-19 infection, poor outcomes are associated with COVID-19 vascular and non-vascular complications, while for COVID-19-negative patients not much changed in terms of outcomes, despite the difficulties in management. Endovascular repair, when possible, minimized the impact of treatment, reducing the risk of COVID-related postoperative complications or acquired infection in negative patients.

ObjectivesTo define a consensual approach for the conservative treatment of patients C0s-C3.MethodThe project was structured into two phases. The first one involved a group of Italian specialists in angiology and/or vascular surgery with the aim to compare their therapeutic choices in the management of patients in CEAP C0s-C3. The second phase used a Delphi consensus in order to elaborate practical statements on the conservative management of these patients.ResultsThe first phase involved a group of 166 Italian specialists while the second phase involved a Steering Committee of 6 specialists and a panel of 20 specialists. At the end of the third round, a consensus >80% was reached on seven assertions.ConclusionSeven statements have been drafted by a group of Italian specialists to provide physicians with practical guidance for the conservative treatment of C0s-C3 patients. Outstanding issues on the management of these patients were identified, confirming the urgent need of further research.

OBJECTIVES: Malperfusion syndrome accompanying aortic dissection is an independent predictor of death with in-hospital mortality rates >60%. Asymmetrically decreased renal enhancement on computed tomography angiography is often considered evidence of renal malperfusion. We investigated the associations between renal enhancement, baseline laboratory values and the diagnosis of renal malperfusion, as defined by invasive manometry, among patients with aortic dissection. METHODS: In this retrospective cohort study, we included all patients who were referred to our institution with acute dissection and suspected visceral malperfusion between 2010 and 2020. We determined asymmetric renal enhancement by visual assessment and quantitative density measurements of the renal cortex. We collected invasive renal artery pressures during invasive angiography at the aortic root and in the renal arteries. Logistic regression was performed to evaluate independent predictors of renal malperfusion. RESULTS: Among the 161 patients analysed, the majority of patients were male (78%) and had type A dissection (52%). Invasive angiography confirmed suspected renal malperfusion in 83% of patients. Global asymmetric renal enhancement was seen in 42% of patients who did not have renal malperfusion during invasive angiography. Asymmetrically decreased renal enhancement was 65% sensitive and 58% specific for renal malperfusion. Both global [odds ratio (OR) 4.43; 1.20–16.41, P = 0.03] and focal (OR 11.23; 1.12–112.90, P = 0.04) enhancement defects were independent predictors for renal malperfusion. CONCLUSIONS: In patients with aortic dissection, we found that differential enhancement of the kidney as seen on the computed tomography angiography is predictive, but not prescriptive for renal malperfusion. While detection of renal malperfusion is aided by computed tomography angiography, its diagnosis requires close monitoring and often invasive assessment.

Purpose: To analyze differences in baseline characteristics, overall mortality, device-related mortality, and re-intervention rates in patients who underwent thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (DTAA) with atherosclerotic/degenerative cause or acute aortic syndrome (AAS), using the Global Registry For Endovascular Aortic Treatment (GREAT). Materials and Methods: Patients submitted to TEVAR for AAS or DTAA, included in GREAT, were eligible for this analysis. Primary outcome was 30-day all-cause mortality rate. Secondary outcomes were 30-day aorta-related mortality and re-intervention rate, 1-year and 3-year all-cause mortality, aorta-related mortality and re-intervention rate. Results: Five-hundred and seventy-five patients were analyzed (305 DTAA and 270 AAS). Thirty-day mortality rate was 1.3% and 1.8% for DTAA and AAS, respectively (p=0.741). One-year and 3-year mortality rates were 6.2% versus 9.3 and 17.3% versus 15.9% for DTAA and AAS, respectively (p=0.209 and p=0.655, respectively). Aorta-related mortality rates at 30 days, 1 year and 3 years were 1.3%, 1.3%, and 2.6% for DTAA, 1.8%, 4.2%, and 4.2% for AAS (p=ns). Re-intervention rates at 30 days, 1 year, and 3 years were 1.3%, 4.3%, and 7.5% for DTAA, 3.3%, 8.1%, and 10.7% for AAS (p=ns). Furthermore, a specific analysis with similar outcomes was performed dividing follow-up in 3 periods (1-30 days, 31-365 days, 366-1096 days) and describing mutual differences between 2 groups and temporal trends in each group. Conclusion Patients who underwent TEVAR for DTAA or AAS experienced different mortality and re-intervention rates among years during mid-term follow-up. Although all-cause related deaths within 30 days were TEVAR-related, aorta-related deaths were more common for AAS patients within 1 year. A greater re-intervention rate was described for AAS patients, although only 1 year after TEVAR.

Purpose The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). Materials and methods All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1 week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5 years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. Results During the study period, 1297 patients were treated. Among these, 1265 had at least 1 week of follow-up. Mean follow-up time was 3.0 ± 1.9 years. Recanalization rate at 1 week, 1, 3, and 5 years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6 mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61 years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. Conclusion RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.

INTRODUCTION Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period. EVIDENCE ACQUISITION Articles were obtained through a detailed search of the scientific journal databases (PubMed, Scopus, Web of Science) for those published between January 1, 2011 to December 31, 2020. The term "radiofrequency venous ablation" was combined with "risk factors", "recanalization" and "recurrence", to obtain the first article cluster. EVIDENCE SYNTHESIS Risk factors analysis for saphenous vein recanalization after ablation is not a well-studied problem. Although several studies have analyzed recanalization patterns and anatomical causes of ablation failure, few and disaggregate data are available regarding clinical preoperative risk factors. BMI and saphenous trunk diameter seem to be the only two recognized characteristics that may affect short and long-term recanalization rate, though CVI status, sex, target vein treatment length and others factors may be taken into account. CONCLUSIONS Physicians should consider risk factors for recanalization in patient selection and treatment recommendations, but also recognize that not all "ablation failures" are of clinical relevance.

The acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the COVID-19 disease, a global pandemic. A strong association has been documented between COVID-19 and cardiovascular events, although the exact pathophysiological mechanism is still unclear. Carotid atherothrombosis and ischemic stroke represents one of the possible severe manifestations of COVID-19, as a leading cause of long-term disability and death. Different complex intertwined mechanisms seem to underlie the endothelitis which is the cause of multiple cardiovascular manifestations. To date, few case series describing COVID-19 and acute ischemic stroke caused by cervical carotid thrombosis have been published. All the patients shared common similar radiographic features, comorbidities, and biomarker profiles. The aim of this brief review was to analyze the impact of COVID-19 pandemic in the management of a Vascular Surgery Department, changing the daily vascular practice, as well as to provide practical suggestions for symptomatic carotid stenosis, while reviewing published literature.

The study couples the experimental and the computational approaches in an integrated in silico and ex vivo biomechanical analysis of porcine aorta. The aim of the presented work is to evaluate the mechanical impact of TEVAR on aortic structure.

Introduction The main goal of this systematic review is to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus COVID-19 (Sars-Cov-2). Evidence of acquisition A systematic review on MEDLINE and Embase was conducted up to May 15, 2021. All papers were sorted by abstract and full text by two independent authors. Systematic reviews, commentaries, and studies that did not distinguish status of COVID-19 infection were excluded from review. Patient demographics were recorded along with modality of treatment (endovascular and/or surgical). We analyzed 30-day outcomes, including mortality. Primary outcome was to evaluate clinical characteristic of ALI in patients affected by SARS-CoV-2 in term of location of ischemia, treatment options and 30-day outcomes. Evindence synthesis We selected 36 articles with a total of 194 patients. The majority of patients were male (80%) with a median age of 60 years old. The treatment most used was thromboembolectomy (31% of all surgical interventions). A total of 32 patients (19%) were not submitted to revascularization due to critical status. The rate of technical success was low (68%) and mortality rate was high (35%). Conclusions This review confirms that Sars-Cov-2 is associated with a high risk of ALI. Further studies are needed to investigate the association and elucidate potential mechanisms, which may include a hypercoagulable state and hyperactivation of the immune response. Furthermore, management of ALI is not standardized and depends on patient's condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.

Increased aortic stiffness (AoS) has been recognised as a risk factor in the development of cardiovascular disease. The aim of this systematic review and meta-analysis was to assess the impact of aortic repair on AoS.PubMed, Scopus, and Web of Science were searched systematically for relevant studies evaluating the consequences of endovascular and open aortic repair on AoS.The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement was followed to perform the research process. Papers containing data on AoS before and after both thoracic (TEVAR) and abdominal (EVAR) endovascular repair, as well as open surgical repair (OSR), were included for detailed evaluation. A fixed effects model was used to perform analysis. The Newcastle-Ottawa Scale was calculated for each included study.The first article cluster comprised 367 papers. After removal of duplicates and the adoption of inclusion/exclusion criteria, 14 articles remained, 13 of which were selected for meta-analysis. Ten studies analysed EVAR and three analysed TEVAR. Five of the selected papers were case control studies, with OSR adopted in four of these as the EVAR comparator. Several graft types were used in the endovascular group. AoS increased after TEVAR and EVAR, in terms of pulse wave velocity (PWV), even though several spatial levels and measurement modalities were adopted. No differences were described after OSR, although no pooled data could be analysed.EVAR and TEVAR both demonstrated a significant increase in AoS measurement (PWV). Although the heterogeneity and the low number of available studies limit the strength of the results, this review highlights the potential deleterious endograft role in the cardiovascular system although further studies are needed to achieve robust evidence. Further studies are needed to improve the mutual interaction between aorta and endograft, minimising their impact on the native aortic wall properties.

Objective: The aim of this study is to compare and to test the performance of all available risk scoring systems (RSSs) designed to predict long-term survival rate in asymptomatic candidate patients for carotid endarterectomy (CEA) for significant carotid artery stenosis. Methods: Data on asymptomatic patients who underwent CEA in three high-volume centers were prospectively recorded. Through literature research using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, six RSSs were identified for the intent of the study. Primary endpoints were 3- and 5-year survival rates after CEA. All items used as variables to compose multiple RSSs were applied to every patient in the study population. The 3- and 5-year mortality prediction rates for each score were assessed by sensitivity, specificity, and predictive negative and positive value calculation, as well as univariable Cox proportional hazard models with the Harrell C index. Results: During the study period, 825 CEAs in 825 asymptomatic patients were analyzed. All items used in RSSs were available in the dataset, with some concerns regarding their definition and application among RSSs. The 3- and 5-year survival rates of the study cohort were 94.5% and 90.3%, respectively. Among the six RSSs analyzed, no RSS demonstrated optimal results in terms of mortality rate prediction accuracy, although some scores had good diagnostic and risk of death precision. Conclusion: RSSs, when used alone, fail to optimally detect postoperative life expectancy in asymptomatic CEA patient candidates. Further prospective controlled studies are needed to compose and validate RSSs with better calibration to predict outcomes.

The aim was to report short and midterm outcomes of a cohort of consecutive patients treated by endovascular aortic repair (EVAR) for saccular lesion of the abdominal aorta (sl-AA).This was a multicentre, retrospective, financially unsupported physician initiated, observational cohort study that involved tertiary referral from Italian hospitals. For this study, between January 2010 and December 2020, only those patients treated by EVAR for non-infected sl-AA, namely blister/ulcer like projection and/or penetrating aortic ulcer, were analysed. Primary outcomes of interest were overall survival and freedom from aorta related mortality (ARM).The final cohort included 120 of 3 982 eligible aortic lesions. There were 103 (85.8%) males and 17 (14.2%) females. The median age was 76 years (interquartile range [IQR] 69, 80). Rupture on admission was observed in 10 (8.3%) cases. Early (≤ 30 days) death occurred in two (1.7%) patients. There were five (4.2%) complications requiring surgical re-intervention (iliac limb occlusion n = 4; groin haematoma, n = 1). The median duration of follow up was 20 months (IQR 4, 59.5): the estimated overall survival was 85.5% (standard error [SE] 0.035; 95% confidence interval [CI] 77.3 - 91.1) at 12 months, 78.7% (SE 0.044; 95% CI 69.0 - 86.0) at 36 months, and 74% (SE 0.050; 95% CI 63.2 - 82.5) at 60 months. Only one (0.8%) patient required aortic re-intervention during follow up because of a late endograft infection. The estimated freedom from ARM was 96% (SE 0.050; 95% CI 90.3 - 98.2) at 36 and 60 months. Cox's regression analysis identified that death was associated with age70 years (hazard ratio [HR] 1.10; 95% CI 1.04 - 1.17, p = .001), and coronary artery disease (HR 1.14; 95% CI 1.04 - 1.26, p = .006).EVAR for sl-AA proved to be safe and effective. The mortality rate was low for a group of patients known to be at high risk from open repair, and EVAR remained stable with no ARM during midterm follow up, and an acceptably low 0.8% endograft related re-intervention rate.

Primary avalvular varicose anomaly (PAVA) is a new medical concept defined as primary varicose veins resembling neovascularized tissue on ultrasound examination. PAVAs could be misdiagnosed as recurrence at the saphenofemoral or saphenopopliteal junction, but no studies have yet examined their role before and after venous invasive procedure. In this report, we describe a case of PAVA in a 39-year-old man with symptomatic varicose veins and great saphenous vein truncal incompetence. Six months after radiofrequency ablation of the great saphenous vein, duplex ultrasound revealed complete occlusion of great saphenous vein and partial thrombosis of the still incompetent PAVA.

OBJECTIVE To evaluate trends and differences in Near Infrared Spectroscopy (NIRS) monitoring during carotid endarterectomy (CEA) in patients affected by asymptomatic and symptomatic carotid artery stenosis, to predict postoperative neurological complications (PNCs). METHODS NIRS data of CEAs performed in a University Hospital were retrospectively reviewed. All the interventions were performed under general anesthesia and patients with intraoperative complications were excluded. Mean regional Oxygen Saturation Index (rSO2), pre-clamp values (mean baseline value, MBv and Single Mark Baseline value, SMBv) were collected and compared to the lowest rSO2 values during carotid cross-clamp (LSO2v) calculated within 3 minutes (percentage drop, PD). ROC curve analysis with Youden's Test was performed to determine the best threshold value of PD, in order to identify PNCs in both asymptomatic and symptomatic groups. RESULTS Between 2007 and 2015, a total of 399 CEAs were consecutively performed with NIRS monitoring. Three-hundred-seventy-two CEAs in 355 patients were reviewed. Asymptomatic stenoses were 291 (81.9%), eleven (2.9%) PNC were registered (5 in asymptomatic and 6 in symptomatic group). Asymptomatic and symptomatic diseases had different MBv (69.5±7.5 vs71.8±6.9, respectively; p=.011) and similar rSO2 value during carotid clamping (63.7±8.0vs63.7±6.7, respectively: p=.958). Asymptomatic patients experiencing PNCs had a greater PD than non-PNCs group (20.5±10.2% versus 12.5±7.6%, respectively using MBv as baseline value; p = .002), in contrast, in symptomatic patients, in which a low PD was associated with PNCs, it does not reach statistical significance (using MBv, 12.6±5.4% versus 14.8±6.7%, respectively; p = .476). In order to detect PNCs, ROC analysis revealed an optimal PD cut-off value of -17% in asymptomatic CEAs. (Sensibility (Se) 0.80, Specificity (Sp) 0.76, PPV 0.05, NPV 0.99, Youden's index 0.56; p=.020) In symptomatic a threshold value of -9% was found, without reaching statistical significance. CONCLUSIONS NIRS as cerebral monitoring during CEA can predict PNCs in asymptomatic stenosis. Asymptomatic and symptomatic groups differ in baseline and intraprocedural cut-off values to detect an augmented PNCs risk.

Background: In the current literature, correlations between a contralateral carotid artery occlusion (CCO) withmortality and major adverse cardiac or cerebrovascular events (MACCE) rates after carotid artery stenting(CAS) are often described with controversial conclusions. Moreover, long-term results of mortality, MACCEand restenosis rate are scarcely reported. This study examined the association between a CCO and the short- andlong-term outcomes after CAS. Methods: One hundred and forty-six patients with CCO and without (No-CCO) who underwent between 2010and 2017 to a CAS procedure in a single institution were retrospectively evaluated. The primary aim of the studywas to evaluate mortality and MACCE rates in the short-term (defined as the occurrence during hospitalizationand within 30-day) and after 3-year follow up. The secondary aim of the study was to examine the restenosisrates in the short- and long-term period. Results: The overall success of CAS was 99.3% and the 30-day all-cause mortality rate was 0.7% (one death).About MACCE, there were no major strokes in the CCO groups and 1 (1.4%) in the No-CCO group (P=1.00).The rate of 30-day minor strokes was 1.4% (1 patient) in the CCO group and 2.7% (2 patients) in the No-CCO group (P=1.00). In the 3-year follow up, death occurred in 11 CCO vs. 6 No-CCO patients, respectively(15.1% vs. 8.2%, P=0.30). Regarding MACCE, major stroke occurred in 6 CCO vs. 2 No-CCO patients (8.2%vs. 2.7%, P=0.27), minor stroke in 6 CCO vs. 6 No-CCO (8.2% vs. 8.2%, P=1.0) and myocardial infarction in 6 CCO (8.2%) vs. 3 No-CCO patients (8.2 vs. 4.1%, P=0.49), respectively. Regarding the 30-day restenosisrate, it was observed in one patient (1.4%) in the CCO group while no cases were recorded in the No-CCO group, respectively (P=1.00). In the 3-year follow up, greater than >50% restenosis was observed in 7 patients (9.6%) in the CCO group and in one patient (1.4%) in the No-CCO group (P=0.06), respectively. Kaplan-Meier survival analysis revealed that CCO patients had a lower 3-year freedom from restenosis rate with respect to the No-CCO group (87.6% vs. 98.6%, P=0.024). A Cox regression model on 3-year restenosis highlighted female gender and hypertension to be statistically significant predictors of restenosis. Conclusions: Patients with a preexisting CCO did not show a significative increased risk of procedural adverse events after CAS both in the immediate and long-term follow up, but on the long term they are more likely to experience restenosis. CCO condition should be considered always as a clinical manifestation of a more aggressive carotid atherosclerosis.

INTRODUCTION Thoracic endovascular aortic repair (TEVAR) for treatment of blunt traumatic aortic injuries (BTAIs) is nowadays the gold standard technique in adult patients, replacing gradually the use of open repair (OR). Although randomized controlled trials will never be performed comparing TEVAR to OR for BTAIs management, trauma and vascular societies guidelines today primarily recommend the former for BTAI patients with a suitable anatomy. The aim of this review was to describe past and recent data published in literature regarding pros and cons of TEVAR treatment in BTAI, and to analyze some debated issues and future perspectives. EVIDENCE ACQUISITION Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Scale for the Assessment of Narrative Review Articles (SANRA) were used to obtain and describe selected articles on TEVAR in BTAI. EVIDENCE SYNTHESIS Young (

Background: The aim of this study was to investigate the influence of the aortic arch type on technical and clinical success of carotid artery stenting (CAS) procedure. Methods: Clinical and anatomical data of consecutive patients who underwent CAS from 2010 to 2018 were prospectively collected and retrospectively analyzed. Primary outcome was technical success, define as successful stent delivery and deployment and stroke, myocardial infarction (MI) and transient ischemic attack (TIA) rates at 30 days after CAS. Subgroups analysis with asymptomatic and symptomatic patients were also performed. Results: During the study period, 523 patients were enrolled and analyzed. Among these, 176 (33.6%) had Type I, 227 (43.4%) had Type II and 120 (23.0%) had Type III or bovine aortic arch (BAA) type. Technical success rate was achieved in 96.0% of cases. At 30 days, if compared with Type I or II, patient with Type III or BAA experienced a higher death rate (0 vs. 0 vs. 1.8%, respectively; P=0.056) and combined postoperative stroke/TIA rate (3% vs. 2.8% vs. 9.9%, respectively; P=0.012). No differences for same outcomes between asymptomatic and symptomatic patients were described, although the latter group experienced more postoperative MI. A multivariate analysis revealed Type III or BAA as an independent risk factor for postoperative stroke/TIA (HR 3.23, IC95% 1.40-7.45; P=0.006). Conclusions: In this cohort of patients, death and postoperative neurological complications rates were associated with Type III or BAA, irrespective of symptomatic patients’ status. Extremely attention is required during perioperative period in patients who were candidate to CAS and with challenging aortic arch anatomy.

Atherosclerosis is a systemic disease that leads to accumulation of deposits, known as atherosclerotic plaques, within the walls of the carotids. In particular, three types of plaque can be distinguished: soft, fibrous, and calcific. Most of the computational studies who investigated the interplay between the plaque and the blood flow on patient-specific geometries used nonstandard medical images to directly delineate and segment the plaque and its components. However, these techniques are not so widely available in the clinical practice. In this context, the aim of our work was twofold: (i) to propose a new geometric tool that allowed to reconstruct a plausible plaque in the carotids from standard images and (ii) to perform three-dimensional (3D) fluid–structure interaction (FSI) simulations where we compared some fluid-dynamic and structural quantities among 15 patients characterized by different typologies of plaque. Our results highlighted that both the morphology and the mechanical properties of different plaque components play a crucial role in determining the vulnerability of the plaque.

The present review was conducted to describe current published risk scoring systems to predict late mortality after carotid endarterectomy (CEA). The aim of the study is to identify simple, clinical, and reproducible tools to predict life expectancy in patients with asymptomatic carotid artery stenosis candidates to CEA and therefore which patients may benefit from surgery, reaching the goal of life expectancy >3 to 5 years, recommended by guidelines. Advantages, disadvantages, feasibility, simplicity, and reproducibility of each selected score were analyzed. Rigorous statistical analysis and validation of the score are essential components to produce a calibrated and usable score. Future studies should address the impact of using these tools in CEA candidates for asymptomatic disease.

The aim was to identify pre-operative color Doppler ultrasound (CDUS) variables predictive of post-operative endovenous heat induced thrombosis (EHIT) after radiofrequency ablation (RFA) of the saphenous veins.This was a single centre, observational study with retrospective analysis of consecutive patients treated from December 2010 to February 2017.Pre-operatively, the diameter of the sapheno-femoral junction (dSFJ), distance between superficial epigastric vein and SFJ (dSEV-SFJ) [corrected], maximum great saphenous vein (GSV) diameter (mdGSV), diameter of the saphenous-popliteal junction (dSPJ), and mean small saphenous vein (SSV) diameter (adSSV) were measured. All patients received low molecular weight heparin (LWMH) at a prophylactic dose for a week. Post-operatively, CDUS was performed after 72 h, 1 week, and 3 months.Venous interventions on 512 patients were performed: 449 (87.7%) underwent RFA of the GSV (Group 1), and 63 (12.3%) of the SSV (Group 2). At Day 3 post-operatively, CDUS documented 100% complete closure of the treated saphenous vein segment. Overall, 40 (7.8%) cases of post-operative EHIT were identified: 29 in Group 1, and 11 in Group 2 (6.4% vs. 17.5%, p = .005). Deep venous thrombosis or pulmonary embolism did not occur in either group. At the 1 month follow up, all cases of EHIT regressed. In Group 1, on multivariate analysis, dSEV-SFJ [corrected] (OR, 1.13, p = .036; 95% CI 1.01-1.27) was the only statistically significant predictor for EHIT. A dSEV-SFJ [corrected] distance of 4.5 mm yielded an 84% of sensitivity for EHIT prediction with a 72.4% positive predictive value. In Group 2, univariate analysis did not identify independent risk factors for EHIT occurrence.EHIT was higher than previously reported. The dSEV-SFJ [corrected] was the most significant predictor for EHIT in the GSV group. A greater distance between the tip of the radiofrequency catheter and the SFJ may decrease the risk of developing this complication.

To review published evidence regarding an n-butyl-cyanoacrylate (NBCA) injection device for great (GSV) and small (SSV) saphenous vein incompetence in terms of occlusion rate, postoperative complications and quality of life improvement.International bibliographic databases (PubMed, EMBASE, Scopus) were searched to identify possible target articles. The only inclusion criterion was the use of the VaricloseSeven studies were included in the final data analysis. A total of 918 patients (1000 limbs) underwent an NBCA procedure for GSV (947 cases) or SSV (53 cases) incompetence. The average procedure duration was 11.7 min. The most common postoperative complications were postoperative pain (4.8%) and superficial vein thrombosis (2.1%). No deep vein thrombosis or pulmonary embolism cases were described. The occlusion rates at six, 12 and 30 months were 97.3%, 96.8% and 94.1%, respectively.NBCA injection with the Variclose device seems to be a feasible, effective and safe treatment in GSV incompetence. Long-term follow-up studies and randomized controlled trials are needed to achieve high-quality evidence.

OBJECTIVES: Confident growth assessment during imaging follow-up is often limited by substantial variability of diameter measurements and the fact that growth does not always occur at standard measurement locations. There is a need for imaging-based techniques to more accurately assess growth. In this study, we investigated the feasibility of a three-dimensional aortic growth assessment technique to quantify aortic growth in patients following open aortic repair. METHODS: Three-dimensional aortic growth was measured using vascular deformation mapping (VDM), a technique which quantifies the localized rate of volumetric growth at the aortic wall, expressed in units of Jacobian (J) per year. We included 16 patients and analysed 6 aortic segments per patient (96 total segments). Growth was assessed by 3 metrics: clinically reported diameters, Jacobian determinant and targeted diameter re-measurements. RESULTS: VDM was able to clearly depict the presence or absence of localized aortic growth and allows for an assessment of the distribution of growth and its relation to anatomic landmarks (e.g. anastomoses, branch arteries). Targeted diameter change showed a stronger and significant correlation with J (r = 0.20, P = 0.047) compared to clinical diameter change (r = 0.15, P = 0.141). Among 20/96 (21%) segments with growth identified by VDM, growth was confirmed by clinical measurements in 7 and targeted re-measurements in 11. Agreement of growth assessments between VDM and diameter measurements was slightly higher for targeted re-measurements (kappa = 0.38) compared to clinical measurements (kappa = 0.25). CONCLUSIONS: Aortic growth is often uncertain and underappreciated when assessed via standard diameter measurements. Three-dimensional growth assessment with VDM offers a more comprehensive assessment of growth, allows for targeted diameter measurements and could be an additional tool to determine which post-surgical patients at high and low risk for future complications.