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Purpose: The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs)., Materials and Methods: A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment., Results: Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention., Conclusion: Retrograde cannulation can also be successfully performed in the case of inner branches., Clinical Impact: In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment., 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.

Purpose: To evaluate bridging stent geometry in patients who underwent branched endovascular aortic repair (B-EVAR) and to correlate the outcomes with intrinsic bridging stent characteristics aiming to identify the stent(s) that guarantees the best performance., Methods: Pre-operative and post-operative computed tomography images of all patients undergoing B-EVAR between September 2016 and April 2019 were retrospectively analyzed. Following geometrical features were measured: target vessel take-off angle (TOA); longitudinal stent shortening; shape index (SI), intended as ratio between minimum and maximum diameter of the lumen cross sections, averaged on three segments: zone 1 (proximal stented zone), zone 2 (intermediate), and zone 3 (distal)., Results: Thirty-eight branches (8 right (RRA) and 8 left renal arteries (LRA), 11 superior mesenteric arteries (SMA), 11 celiac trunks (CTR)) were treated. Fluency (Bard Peripheral Vascular), COVERA (Bard Peripheral Vascular), and VBX (WLGore&Assoc) stent-grafts were implanted in 10, 12, and 16 branches, respectively. Pre-operative TOA was more acute in RRA and LRA when compared to CTR and SMA, and straightened in post-operative configuration (109.86 ± 28.65° to 150.27 ± 21.0°; P < 0.001). Comparable values of SI among the stent types were found in zone 1 (P = 0.08), whereas higher SI in VBX group was detected in zones 2 (P < 0.001) and 3 (P < 0.001). The VBX group was also the most affected by stent shortening (11.12 ± 5.65%; P = 0.001)., Conclusion: Our early experience showed that the VBX stent offers greater stent circularity than the other devices even if a greater shortening has been observed drawing attention with regards to the decision of the nominal stent length.

Background: Aim of our study is the analysis of clinical results and aneurysmal sac evolution after multilayer flow modulator (MFM) placement, in patients with thoracoabdominal aortic aneurysms (TAAs)., Methods: All patients with asymptomatic TAA treated at our institution between 2012 and 2014 with MFM were retrospectively analyzed. Thirty-day evaluated outcomes were mortality and complications. Follow-up evaluated outcomes were mortality, aneurysm collateral branches patency, and reintervention. A geometrical analysis of 2-year follow-up computed tomography scans was carried out to evaluate the total aneurysm volume, the percentage of aneurysm growth, and the evolution of maximum aneurysm diameter., Results: Seven patients (mean age: 71.8 years, range: 63-85 years) were considered in the study. Mean preoperative aneurysm diameter was 6.8 cm (range 6-8.3 cm). No 30-day mortality or complications were observed. Mean follow-up was 29.4 months. During follow-up, 3 deaths (42.8%) were observed, not related to MFM complications. Reintervention rate was 42.8%, occurred in all cases after 2-year follow-up; in 2 cases, the reintervention was necessary due to an excessive increase of the aneurysmal sac. During the follow-up, a mean growth rate of 6 mm/year (4 patients) for the diameter of the aneurysm external wall and a total aneurysm volume increase from 2.45 × 10 5  mm 3 to 3.50 × 10 5  mm 3 (4 patients) was evaluated., Conclusions: Our results have shown no mortality related to aneurysm rupture during the follow-up and high rate of reinterventions after MFM placement. Further geometrical analyses, based on the proposed approach, regarding a larger group of patients with long-term follow-up are required to draw indications about the MFM use., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Endovascular treatment of thoracic aortic disease currently allows to treat high-risk patients with better results than open repair. It represents the first option for treatment according to the most recent guidelines. The aim of the study is to evaluate the early results of the low-profile Zenith Alpha Thoracic Endoprosthesis (ZATE)., Methods: Between October 2012 and July 2015, 14 asymptomatic patients were treated with ZATE. 10 patients were male, mean age was 71, 7 years (range 58-85 years). 8 patients presented with atherosclerotic aortic aneurysm (7 thoracic aneurysm and 1 type I thoracoabdominal aneurysm), 2 chronic type B aortic dissection, 1 type IV endoleak 5 years after TEVAR, 3 aortic arch penetrating ulcers complicated by pseudoaneurysm. Hybrid staged procedures in 11 patients included 7 total aortic arch debranching (1 single [innominate] chimney stent-graft + carotid-carotid-subclavian), 2 carotid-carotid-subclavian artery bypass, 2 carotid-subclavian artery bypass., Results: No 30-day mortality or major complications were observed. The mean length of stay was 7.3 days (range 4-14 days). Mean procedure time, X ray time and Contrast load were 115 minutes (range 90-150 minutes), 20 minutes (range 10-30) and 79 mL (range 40-120 mL) respectively. 25 stent-grafts were implanted. The mean follow-up was 21 months (range 14-32 months). No mortality and no major complications were observed during the follow-up. In case of arch debranching with landing 0 and 1 zone the mean distance between the beginning of the endoprosthesis and the debranching inflow vessel was 5.5±2.4 mm., Conclusions: The use of ZATE could be a viable alternative for treating patients with aortic arch proximal landing zone to facilitate the precise deployment. Larger case studies and longer follow-up are needed.

Background: The aim of this paper was to compare in a retrospective study the outcome of aortoaortic graft (straight graft) versus aortoiliac graft (bifurcated graft) with regards to periprocedural and 30-day after surgery complications., Methods: From January 2004 to December 2009 377 patients underwent elective open surgery for infrarenal abdominal aortic aneurysm. Data were collected in a dedicated database. Group A includes patients treated with straight graft (N.=186) whereas group B, patients treated with bifurcated graft (N.=191). Outcome data include duration of surgical procedure, blood loss, peri- and postprocedural complications, hospital stay, 30-day mortality and complications. Following some authors, we set our cut-off for choosing a bifurcated graft when one or both Iliac Arteries were wider than 18 mm in diameter and the patient had a reasonable life expectancy., Results: Duration of surgical procedure was 183 minutes in the group A vs. 216 minutes in the group B (P<0.01). Blood loss was 554 mL and 720 mL, in the groups A and B respectively (P<0.01). The difference between other results evaluated was not statistically significant., Conclusions: In statistics terms, this retrospective study showed no relevant differences between straight graft and bifurcated graft with regard to mortality and major complications during the peri- and postoperatory period. Hence, as a conclusion, we could assert that if the iliac artery diameter is 18 mm a bifurcated graft could be used, without any increase in morbidity and mortality rates.

Background: The aim of this study was to analyze our series of endovascular treatments using a multilayer flow modulator (MFM) and to show the midterm results., Methods: At our institution, 8 patients were treated with an MFM. Four patients presented with an aortic aneurysm (2 type II thoracoabdominal aortic aneurysms [TAAAs], 1 type IV TAAA, and 1 juxtarenal abdominal aortic aneurysm) and 4 with an aneurysm involving the common iliac artery. Mortality, rupture and secondary intervention, major complications, patency of collateral vessels, and volume analysis were evaluated. Treated patients were followed up with computed tomography angiography at 1, 3, 6, and 12 months., Results: Results showed no 30-day mortality or major complications; technical success was achieved in 87.5% of patients, patency of collateral vessels was reached in all cases at intraoperative completion angiography. Mean follow-up was 22.1 months (range, 18-30), survival rate was 87.5%, and one case of death unrelated to MFM treatment was reported. During follow-up, MFM and collateral vessel patency were observed in all cases. Secondary endovascular or open surgical procedures were not needed during follow-up. Volume analysis showed a slight increase in patients with aortic aneurysm, and an overall trend to increase in thrombosis was observed in all cases., Conclusions: Endovascular treatment of aneurysms with MFM seems to have encouraging midterm results. Should our results be confirmed by larger series and longer follow-up studies, MFM may become a viable alternative to other endovascular approaches., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients.

Aim: This is a retrospective study of a single center experience in the endovascular treatment of penetrating aortic ulcer (PAU)., Methods: Sixteen consecutive patients aged 69.1±9.6 years presenting PAU (in the aortic arch in 2, the descending thoracic aorta in 11, and in the abdominal aorta in 3) undergone therapy. Nine patients presented symptomatic, while 7 were asymptomatic. All patients underwent computer tomography angiography (CTA) of the thoracic and the abdominal aorta. Endovascular therapy alone was carried out in 12 patients, while 4 received hybrid therapy., Results: One patient died of multiorgan failure after hybrid procedure. Complications consisted of type II endoleak from lumbar arteries in 1 case of endovascular procedure, and acute respiratory insufficiency in 1 patient treated by endovascular technique on the emergency basis for aortic rupture., Conclusion: PAU involves more frequently the descending thoracic aorta. Endovascular treatment (alone or in hybrid therapy) can give good results in patients with severe concomitant diseases. Prognosis of these patients is not favourable in most cases (48-month survival rate 47.9%) due to severe concomitant diseases.