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Introduction: Endovascular treatment of type B aortic dissections (TBAD) has currently acquired a primary therapeutic role when anatomically feasible. The main issue with thoracic endovascular aortic repair (TEVAR) for aortic dissection is the actual nature of the aortic wall, which is structurally compromised and more fragile. Indeed, a wealth of data have shown that TEVAR for TBAD will lead, in a substantial proportion of cases, to a device-related adverse event named distal stent-graft induced new entry (dSINE)., Areas Covered: Currently available aortic stent-grafts have not been specifically devised for the treatment of aortic dissection. A novel dissection specific stent-graft (DSSG) was developed, which is a custom-made device based on the Zenith Alpha Thoracic platform (Cook Medical). The DSSG has several unique properties that, in principle, make its use optimal in TBAD patients., Expert Opinion: TEVAR in the setting of aortic dissections remains technically challenging. The occurrence of dSINE represents a unique complication in this scenario and may lead to high rates of aortic-related adverse events and need for secondary interventions. The use of a novel custom-made DSSG in the setting of chronic TBAD has been proven to be safe, feasible and effective. However, even this approach may fail to completely prevent dSINE formation.

Objective: The aim of this multicentric registry was to assess the outcomes of "anteRior versus posteRior divisional bRanches Of the hYpogastric artery as distAl landing zone for iLiac branch devices (R3OYAL).", Methods: The main exposure of interest for the purpose of this study was the internal iliac artery (IIA) divisional branch (anterior vs posterior) that was used as distal landing zone. Early endpoints included technical success and adverse events. Late endpoints included survival, primary/secondary IIA patency, and IIA branch instability., Results: A total of 171 patients were included in the study, of which 50 received bilateral implantation of iliac branch devices (IBDs). This resulted in a total of 221 incorporated IIAs included in the final analysis, of which 40 were anterior divisional branches and 181 were posterior divisional branches. Technical success was high in both groups (anterior division: 98% vs posterior division: 100%, P = .18). Occurrence of any adverse event was noted in 14% of patients in both groups ( P = 1.0). The overall rate of freedom from the composite IBD branch instability did not show significant differences between patients receiving distal landing in the anterior or posterior division of the IIA at 3 years (79% vs 87%, log-rank test = .215). The 3-year estimates of IBD patency were significantly lower in patients who received distal landing in the anterior divisional branch than those who received distal landing in the posterior divisional branch (primary patency: 81% vs 96%, log-rank test = .009; secondary patency: 81% vs 97%, log-rank test < .001)., Conclusions: The use of the anterior or posterior divisional branches of the IIA as distal landing zone for IBD implantation shows comparable profiles in terms of immediate technical success, perioperative safety, and side-branch instability up to 3 years. However, IBD patency at 3 years was higher when the distal landing zone was achieved within the posterior divisional branch of the IIA., Clinical Impact: The results from this large multicentric registry confirm that use of the anterior or posterior divisional branches of the internal iliac artery (IIA) as distal landing zone for implantation of iliac branch devices (IBD) shows comparable profiles of safety and feasibility, thereby allowing to extend the indications for endovascular repair of aorto-iliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Although mid-term rates of device durability and branch instability seem to be similar, the rates of primary and secondary IBD patency at three years was favored when the distal landing zone was achieved in the posterior divisional branch of the IIA., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Female sex is a risk factor of post-operative mortality and morbidity after abdominal aortic aneurysm (AAA) repair. The aim of this systematic review is to assess the sex-specific early mortality following both elective and urgent AAA repair., Evidence Acquisition: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Observational studies (2000-2022), of the English medical literature, focusing on early mortality after AAA repair in females under elective or urgent setting were eligible. A systematic search of MEDLINE, EMBASE and CENTRAL databases, was conducted (November 30 th , 2022). The risk of bias was assessed using the Newcastle-Ottawa Scale. Primary outcome was 30-day mortality in relevant strata. A proportional metanalysis was used to assess the estimates., Evidence Synthesis: Seventeen retrospective studies and 83,738 females were included. Thereof 68.7% underwent elective repair while the remaining were managed urgently. Endovascular repair (EVAR) was applied in 37.3% of patients (15.4% urgent) vs. 62.7% with OSR (23.5% urgent). In the total cohort, the perioperative mortality was estimated at 11% (OR, 95% CI: 5-17%, P<0.01, I 2 99.92%) while 3% (OR, 95% CI: 0.02-0.03, P<0.01, I 2 93.42%) deceased after elective repair (2% OR, 95% CI 0.01-0.02, P<0.01, I 2 83.08%, after EVAR and 5% (OR, 95% CI: 0.05-0.06, P<0.01, I 2 77.36%, after OSR) and 36% (OR, 95% CI: 0.28-0.44, P<0.01, I 2 99.51%) after urgent repair (25% OR, 95% CI: 0.16-0.34, P<0.01, I 2 98.45%, after EVAR and 40% (OR, 95% CI: 0.34-0.46, P<0.01, I 2 95.96%, after OSR)., Conclusions: AAA repair in females appears to be associated with considerable postoperative mortality. Despite the rapid development of innovative techniques and intensive care of severely ill patients, perioperative mortality after ruptured AAA remains devastatingly high.

Objective: To describe outcomes after elective and non-elective fenestrated-branched endovascular aortic repair (FB-EVAR) for thoracoabdominal aortic aneurysms (TAAAs)., Background: FB-EVAR has been increasingly utilized to treat TAAAs; however, outcomes after non-elective versus elective repair are not well described., Methods: Clinical data of consecutive patients undergoing FB-EVAR for TAAAs at 24 centers (2006-2021) were reviewed. Endpoints including early mortality and major adverse events (MAEs), all-cause mortality, and aortic-related mortality (ARM), were analyzed and compared in patients who had non-elective versus elective repair., Results: A total of 2603 patients (69% males; mean age 72±10 year old) underwent FB-EVAR for TAAAs. Elective repair was performed in 2187 patients (84%) and non-elective repair in 416 patients [16%; 268 (64%) symptomatic, 148 (36%) ruptured]. Non-elective FB-EVAR was associated with higher early mortality (17% vs 5%, P <0.001) and rates of MAEs (34% vs 20%, P <0.001). Median follow-up was 15 months (interquartile range, 7-37 months). Survival and cumulative incidence of ARM at 3 years were both lower for non-elective versus elective patients (50±4% vs 70±1% and 21±3% vs 7±1%, P <0.001). On multivariable analysis, non-elective repair was associated with increased risk of all-cause mortality (hazard ratio, 1.92; 95% CI] 1.50-2.44; P <0.001) and ARM (hazard ratio, 2.43; 95% CI, 1.63-3.62; P <0.001)., Conclusions: Non-elective FB-EVAR of symptomatic or ruptured TAAAs is feasible, but carries higher incidence of early MAEs and increased all-cause mortality and ARM than elective repair. Long-term follow-up is warranted to justify the treatment., Competing Interests: Consulting, research grants and/or advisory boards: T.J. (Medical University of Warsaw)—Artivion, Cook Medical; B.C.M. (Mayo Clinic)—Cook Medical, WL Gore, Medtronic; T.K. (University of Hamburg)—Cook Medical; J.S.—(University of Lille)—Cookmedical, WLGore, GE Healthcare; L.B. (Hospital San Raffaelle)—Cook Medical; B.M. (Maastricht UMC)—Cook Medical, WL Gore, Phillips, Bentley; M.G. (University of Bologna-DIMEC)—Cook Medical, WL Gore; N.D. (Lund University)—Cook Medical; A.S. (University of Massachusetts)—Cook Medical, Philips, Artivion; A.B. (University of Alabama)—Artivion, Cook Medical, Medtronic, WL Gore, Terumo; K.M. (Uppsala university)—Cook Medical; M.F. (University of North Carolina)—Cook Medical, WL Gore, ViTaaa, Centerline, Getinge; C.T. (University of Texas Southwestern)—Cook Medical, WL Gore; D.B.S. (University of Pennsylvania)—Cook Medical, WL Gore, Endologix, Medtronic; N.T. (Ludwig-Maximilians-University Hospital)—Cook Medical; S.H. (Université Paris Saclay)—Cook Medical, Bentley, and GE healthcare; M.P.S. (University of Washington)—Artivion; E.F. (Universidade NOVA de Lisboa)—Cook Medical, Medtronic; M.E. (Harvard Medical School)—Cook Medical; K.K.Y. (Amsterdam UMC)—Medtronic, W.L. Gore&Associates, Terumo Aortic; G.P. (University of Hamburg)—Cook Medical, Philips; A.K. (Vita-Salute University)—Alvimedica/CID, Boston Scientific, Cordis, Getinge, Medtronic, and Terumo; G.W.S. (Maastricht UMC)—Cook Medical, Philips; S.L.Z. (University of Washington)—WL Gore; G.S.O. (University of Texas Health Science Center)—Cook Medical, WL Gore, GE healthcare, Centerline. The remaining authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)