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Objective The outcomes for patients after endovascular treatment of abdominal aortic aneurysm (AAA) are determined primarily by the endpoints of death and endoleaks, the latter representing continued risk of rupture. The data of a multicentre registry were analysed with regard to the early outcome of stent-graft procedures for AAA and the complications associated with this treatment. In addition, the results during follow-up were analysed by determining mortality and endoleak development as separate endpoints and as a combined endpoint defined as endoleak-free survival. Setting 38 European institutions of Vascular Surgery collaborating in a multicentre registry project. Patients and methods 899 patients with AAA underwent between May 1994 and March 1998 elective endovascular repair (818 men and 81 women; mean age 69 years). 80 (8.9%) of the patients had medical conditions that excluded them from open repair. 818 (91%) of patients had a bifurcated device, 63 (7%) had a straight tube graft, and only 18 (2%) had an aorto-uni-iliac device. Clinical examination and contrast-enhanced computed tomography was performed at fixed follow-up intervals to assess increase or decrease of the maximum transverse diameter (MTD). Endoleaks observed at follow-up were discriminated into persistent endoleak and temporary endoleak. The latter is defined as single time observed endoleaks or with two or more negative imaging studies between observed endoleaks. Life-table analyses were used to calculate the rates of freedom-from-endoleak (no endoleak at any time), freedom-from-persistent endoleak (no persistent endoleak), patient survival, and persistent-endoleak-free-survival. Results The median follow-up of this patient series was 6.2 months. The ratio between observed and expected follow-up data was 82% for the overall follow-up period. However, at 18 months of follow-up this rate was only 45%. The number of patients followed during this period was sufficient to allow statistically meaningful assessment. The MTD in patients with temporary endoleaks demonstrated a significant decrease at 6 to 12 months compared to preoperative values (mean 57 and 53 respectively, p = 0.004). In patients with persistent endoleaks there was no change between the preoperative and 6-month MTD (mean 57 and 60 mm respectively). At 6 and 18 months freedom-from-endoleak was 83% and 74% and freedom-from-persistent endoleak was 93% and 90%, respectively. The 18-month cumulative patient survival was 88% and the main outcome measure, the persistent endoleak-free-survival was 79%. Conclusions The MTD decreases in patients with temporary endoleak, but not in patients with persistent endoleak. Therefore, the use of the rate of freedom-from-persistent endoleak, reflecting absence of persisting endoleaks to estimate the prognosis with regard to the AAA, is justified. Determining persistent endoleak-free survival appears a rational approach to provide a realistic outlook for patients with stent-grafted AAA. The observed 18-month endoleak-free survival reflects a satisfactory mid-term result.

Objectives: To assess the early experience with the transfemorally placed modular endovascular MinTec graft (TPEG) for abdominal aortic aneurysm (AAA). Design: One single centre prospective evaluation of the endograft procedure as well as early postoperative results. Setting: An academic teaching hospital. Patients: 30 consecutive patients treated during a period of 15 months. Results: Peri- and postoperative morbidity and mortality were evaluated according to the recommendations of the Ad Hoc Committee on Reporting Standards. The endograft procedure was successful in 28 patients (93.4%); two patients (6.6%) needed conversion into open conventional y-graft replacement; one patient died 36 days following intervention from multiple organ failure. Another patient died from pancreatitis unrelated to the implantation. Endoleaks were treated by “overstenting” or distal extension of the endografts, but conversions were unnecessary. Five severe adverse events were noted in four patients. Conclusions: TPEG is a feasible but technically demanding procedure, requiring both surgical techniques and catheter skills. The potential for less operative morbidity and simpler aneurysm management compared to conventional open surgery may be present. Close follow-up of patients is necessary to understand the development and treatment of endoleaks.

ObjectiveTo identify predictors of failure in percutaneous endovascular aneurysm repair (P-EVAR) using the Prostar XL Percutaneous Vascular Surgery Device (Abbot Vascular, Santa Clara, CA, USA) and the need for conversion to conventional femoral cutdown (O-EVAR).MethodsConsecutive patients who underwent P-EVAR with the Prostar XL device between January 2009 and April 2012 were included in this series. Patients with a circular calcified common femoral artery (CFA) on computed tomography angiography were operated using O-EVAR and were therefore excluded. To identify predictors of success of closure in P-EVAR, artery characteristics, sheath size used, and comorbidities were analyzed in a univariate logistic regression model.ResultsPercutaneous access was achieved in 154 femoral access sites with conversion to O-EVAR was needed in 10 (6.5%). Significant predictors of conversion included sheath size (continuous, relative risk [RR] 1.50, p 0.75 (RR 8.93, p 0.75 would favor a primary open groin approach.

Objective/Background The objectives were to report the management and outcomes of a 96-year-old man who presented with an acutely swollen right leg due to a ruptured popliteal aneurysm, and to review the relevant literature. Methods A ruptured popliteal artery aneurysm is a rare diagnosis and is one that is often missed at time of presentation. Previous case reports have documented successful outcomes following surgical repair, and a smaller number following endovascular repair. This is a case report of a 96-year-old man who eventually underwent endovascular repair of a ruptured popliteal artery aneurysm after a delay in diagnosis. A literature review was performed to analyse published data in this field. Results The patient underwent an uncomplicated endovascular repair with a GORE® VIABAHN® stent. A 15-week follow-up ultrasound demonstrated biphasic flow in a patent stent-graft with an unchanged aneurysm sac size and no evidence of an endoleak. A review of the literature demonstrated nine cases of ruptured non-mycotic popliteal artery aneurysms treated endovascularly. Seven cases survived the postoperative period, three had no follow-up recorded, and four cases had patent stent-grafts at time of follow-up. Conclusion Safe and effective endovascular repair of a ruptured popliteal artery aneurysm with endograft patency seen at the 15-week follow-up is reported. Review of the literature suggests that open repair remains the first-line management choice; however, endovascular repair is a valuable alternative. There is a further need for longer-term monitoring of endograft patency following endovascular repair., Highlights • Ruptured popliteal aneurysm is rare. • Diagnosis is easily missed unless specifically considered. • Endovascular repair appears to be safe and effective.

Endovascular aneurysm repair (EVAR) has become the primary treatment option for elective abdominal aortic aneurysms. However, a significant number of patients require secondary interventions to maintain adequate aneurysm exclusion and ultimately prevent death from abdominal aortic aneurysm (AAA) rupture. To maintain success and offer timely secondary intervention, intensive image surveillance has been recommended. These rigorous surveillance regimens are costly and may have deleterious effects from radiation and contrast exposure. Improvements in patient selection, operative technique and devices have caused a decline in complications after EVAR. Therefore, there is a need to reduce surveillance after EVAR for patients at lower risk of complications and install individualized follow-up protocols. This review describes the current strategies for surveillance and clarification of risk factors and predictors for late complications and discusses proposed risk-adapted strategies for postoperative surveillance after EVAR.

Background During the last decade endovascular treatment has emerged as an important alternative to open surgical repair because of its reduced invasiveness. Results of both modalities are evaluated in this study. Methods A retrospective review of 26 patients (18 males and 8 females; mean age: 62±9 years) who underwent surgical open repair of hepatic artery aneurysm (HAA) between 1998 and 2015 was performed. Indications to open or endovascular procedure was based on aneurysm size, anatomical features and operative risk. Results Aneurysm size ranged between 2 and 17 cm (mean value: 3.3 cm). Endovascular treatment was performed in 9 patients (34.6%) while open repair in 17 (65.4%). Endovascular procedures included 5 (55.5%) coils embolization and 4 (44.5%) endograft exclusion. Open repair included 9 (53%) aneurysmectomies with end-to-end anastomosis, 7 (41.1%) aneurysmectomies and bypass grafting and 1 (5.9%) simple ligation. In the surgical group, one case of respiratory insufficiency and one myocardial infarction were observed. A 7 cm pseudoaneurysm was found during follow-up for a hepatic artery aneurysm treated 8 years before: the patient underwent re-laparotomy and artery ligation. In the endovascular group, a stent-graft thrombosis occurred and one case of aneurysm reperfusion after coils embolization was found at 48 months follow-up: both patients were treated by means of surgical conversion with aorto-hepatic bypass. Conclusions Endovascular and open repair are both effective in the treatment of HAA. Type of treatment selection is individualized based on patients' clinical status, aneurysm location and the presence of hepatic collateral circulation.

Aim: The aim if this study was to present our experience in the operative management of diseased thoracic aorta in patients with Marfan Syndrome (MFS). In the period 1993-2015 86 patients with MFS and diseased thoracic aorta were treated in our center. Methods: An open surgical treatment was performed in 63 cases and an endovascular exclusion was performed in 23 cases (including hybrid treatments). The larger part of those interventions were elective, and 21 cases were in urgent fashion. Result:. The perioperative mortality was 4.8%. At 30 postoperative day paraplegia was observed in 8.1 % of patients, renal and respiratory failure in 5.8% and 8.1%, respectively. After a mean follow-up of 13.2+3.6 years long-term survival rate was 79.1%. In the group of patients treated with open surgery we observed three cases of Carrell's patch aneurysm, which required open reintervention. In the endovascular cases we observed four cases of graft migration, two cases of aortic antegrade dissection and five cases of endoleak with significative sac growth. Conclusion: Perioperative mortality and morbidity after open and endovascular repair were acceptable in this series in patients with MFS. Because of the high risk of complications and reinterventions after TEVAR, however, we currently limited aortic stent grafting in selected patient in whom an aortic open repair is contraindicated or as bridge technique in urgent fashion.