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Background: Type 2 endoleaks (T2ELs) have been considered a benign condition and intervention is recommended when they are associated to sac expansion. The aim of this study was to report on T2EL embolization midterm outcomes, using neurointerventional material., Methods: A single-center retrospective analysis of consecutive patients treated with transarterial embolization, using neurointerventional material, for T2EL after standard endovascular aortic aneurysm repair (EVAR) between January 01, 2017 and July 30, 2022, was undertaken. Primary outcome was technical success and secondary outcome was T2EL recurrence during follow-up., Results: Twenty six patients [92.3% males, mean age 73.9 ± 7.7 years] were included. The median time between EVAR and T2EL diagnosis was 12 months (range: 1-84 months). In 38.5% of patients, T2EL was detected at first month after EVAR. The time to embolization was 18 months (range: 1-96 months). In 42.3% of cases, a patent inferior mesenteric artery was suspected to relate to T2EL formation while in 42.3% of cases, a lumbar artery. Twelve procedures (38.4%) were performed using coils and Onyx and 13 (50%), using only Onyx. Technical success was 84.6%. The mean follow-up was 24 months (range: 1-60 months), including 20 patients. In 30% of cases, an T2EL recurrence was detected. Three patients (11.5%) underwent secondary embolization., Conclusions: Transarterial embolization for T2EL, using neurointerventional material, provided acceptable technical success and T2EL recurrence rates at 2 years of follow-up. Longer follow-up data would further estimate the durability of the technique., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Infection of peripheral bypass is a very severe complication associated to a high rate of morbimortality. The aim of this study was to prospectively evaluate cryopreserved arterial allografts (CAAs) performances in the treatment of this complication. Between April 1996 and June 2008, we prospectively collected data from patients presenting with major infections of peripheral bypasses who benefited from a CAA reconstruction in association with the excision of the infected bypass. CAA were taken from multi-organ donors and frozen at -80 °C. CAA mean conservation time was 115 days (±132). Over this 12-year study, 36 patients (31 men, five women, mean age = 68) benefited from CAA reconstruction for major infections of peripheral bypasses. Eighteen patients (50%) had a septic syndrome, five patients (14%) had an acute ischemia at the reconstruction time, and 12 patients (33%) had an anastomotic rupture. Emergency CAA reconstruction was performed on seven patients (19%). There were no perioperative deaths and no early amputations. Patient follow-up was complete, with a mean 42 -month duration (range, 3-116). There were no persisting or recurring infections. During the follow-up, 10 patients benefited from revision, excision, or replacement of the CAA and fifteen patients died from causes nonrelated to the initial infection. The cumulative rate of limb salvage was 87% at 3 years. Primary and secondary cumulative patency rates were 57% and 78% at 3 years, respectively. CAA reconstruction in association with infected bypass excision is an effective treatment for peripheral bypass major infections. Our results prompt us to go on with CAA reconstructions for this type of indication., (Copyright © 2010. Published by Elsevier Inc.)

Background: We report a hybrid treatment for a ruptured penetrating aortic ulcer (PAU) of the aortic arch in emergency conditions., Methods: A 74-year-old man with severe comorbidity was diagnosed with a symptomatic rupture of a PAU of the aortic arch. As he was considered unfit for conventional open repair and it was an emergency condition, an acute endovascular repair with cervical debranching of the supra-aortic trunks could be proposed. The left common carotid artery and left subclavian artery were first debranched and revascularized through cervical access, and the endovascular stent graft was then deployed via femoral access in the aortic arch. At >or=2 years the patient is safe with no sign of progression of the disease., Conclusion: Acute debranching and stent grafting is feasible in emergency conditions to treat ruptured PAU of the aortic arch, with satisfying short- and mid-term outcomes, and can be proposed to patients considered unfit for conventional open repair.

The aim of this work was to evaluate, in terms of activity and immediate postoperative results, the modifications of our elective surgical treatment of infrarenal abdominal aortic aneurysms (AAAs) resulting from the use of stent grafts to treat AAAs, following the recommendations issued by the French Health Products Safety Agency (AFSSAPS) in December 2003. This monocentric and retrospective study used the clinical data of patients operated on for asymptomatic AAA between January 2001 and December 2006. Endovascular treatment of AAAs with aortic stent grafts was introduced in our current practice in January 2004, following the recommendations of the AFSSAPS (high-risk patients for open surgery presenting with an AAA > or =50 mm). Group I was composed of patients operated on between January 2001 and December 2003 according to the standard open technique. Group II was composed of patients operated on between January 2004 and December 2006 with either standard open surgery or endovascular surgery. The main criteria of evaluation were the number of operated patients, their American Society of Anesthesiology (ASA) score of surgical risk, and the intrahospital morbidity and mortality. The number of treated patients significantly increased between these two periods (group I n = 49, group II n = 88, with 38 endovascular treatments; p < 0.001), without any changes in average age (70 vs. 72 years), percentage of men (93.7% vs. 95.5%), and mean AAA size (57.8 vs. 56 mm) between the two groups. ASA scores were significantly higher in group II (ASA III and IV, group I = 20.4% vs. group II = 55.7%; p < 0.0001), whereas the intrahospital mortality rate (4.1% vs. 3.4%) and the rate of major postoperative complications (16.3% vs. 11%) have remained stable. In group II, the median duration of hospitalization was significantly reduced (12 vs. 9 days, p < 0.001). In conclusion, in our center, following the AFSSAPS recommendations, the introduction of endovascular treatment has enabled us to electively treat a greater number of AAA patients with higher surgical risk, without aggravating the immediate postoperative results.

Purpose: To report endovascular treatment of 2 patients with aneurysmal deterioration of peripheral arterial allografts., Case Report: Two men (65 and 64 years old) who had undergone an arterial allograft reconstruction for infection of prosthetic infrapopliteal bypass grafts 5 and 7 years ago, respectively, were diagnosed with asymptomatic aneurysmal deterioration of the allografts. Stent-graft repair was successful in both cases, completely excluding the aneurysms. At >or=1 year, continued aneurysm exclusion was confirmed by duplex scan, with no evidence of endoleak, migration, or stenosis., Conclusion: Endovascular treatment may be a useful therapeutic option when treating patients with late peripheral allograft deterioration.