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Background Abdominal compartment syndrome (ACS) often complicates ruptured abdominal aortic aneurysm (rAAA) repair. We report results with routine skin-only abdominal wound closure after rAAA surgical repair. Methods This was a single-center retrospective study including consecutive patients undergoing rAAA surgical repair for the duration of 7 years. Skin-only closure was routinely performed, and if possible, secondary abdominal closure was performed during the same admission. Demographic information, preoperative hemodynamic condition, and perioperative information (ACS, mortality, rate of abdominal closure, and postoperative outcomes) were collected. Results During the study period, 93 rAAAs were recorded. Ten patients were too frail to undergo repair or refused treatment. Eighty-three patients underwent immediate surgical repair. The mean age was 72.4 ± 10.5 years, and the vast majority were male (82:1). Preoperative systolic blood pressure Conclusion Routine skin-only closure during rAAA surgical repair results in low rates of ACS at the expense of a high rate of patients being discharged with a planned ventral hernia which, however, seems to be well tolerated by the majority of patients.

Objective: To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant. Data sources: MEDLINE and Embase were searched using the Ovid interface. Review methods: A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients with non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow up. The risk of bias was assessed with the Newcastle–Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm related death. Effect measures were the hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel–Haenszel statistical method and random effects models. Results: Thirteen cohort studies with a total of 22 762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36 – 51). No statistically significant difference was found in the hazard of all cause mortality (HR 1.04, 95% CI 0.61 – 1.77), aneurysm related mortality (HR 1.80, 95% CI 0.85–3.80), or secondary intervention (HR 0.66, 95% CI 0.31 – 1.41) between patients who had incomplete and complete follow up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39 – 1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance vs. those with complete surveillance showed no significant difference in all cause mortality (HR 1.10, 95% CI 0.43 – 2.80). Conclusion: Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. These findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualised or risk adjusted surveillance.

Patients with wide aortic necks undergoing Endovascular Aneurysm Repair (EVAR) have been shown to be at a higher risk for neck-related complications. We aim to examine outcomes of EVAR with an endograft exerting minimal outward pressure (Ovation-Endologix) in patients with a large baseline neck diameter.We performed a retrospective single center study, including consecutive patients undergoing EVAR with the Ovation system from May 2011 to April 2021. Patients were divided in Groups 1 and 2 if the 20, 23, 26, 29 mm or the 34 mm proximal diameter main body was used, respectively. According to the instructions for use of the device, for neck diameters 27-30 mm the 34 mm main body is required. Primary endpoint was rate of neck related complications during follow-up, (type Ia endoleak, migration10 mm and neck-related re-interventions) and rate of aortic neck dilatation (AND). AND was determined based on multiple aortic neck diameters that were recorded and compared between the 1-month computed tomography angiography (CTA) after EVAR and the last available follow-up CTA.Secondary endpoints were peri-procedural and follow-up outcomes such as endoleaks, reinterventions and overall mortality.In total 281 patients were included, 222 in Group 1 and 59 in Group 2. Patients in Group 2 presented significantly shorter neck length, higher neck angulation and more common reversed tapered configuration. Median follow-up was 36 months (Range: 6-106). Early and late type Ia endoleak was observed in 4 and 2 patients in each group, respectively (P = 0.063 and P = 0.195, respectively). Distal migration was observed in 2 patients in Group 2 and AND was recorded in 2 patients in each group (P = 0.195). Freedom from the primary endpoint was estimated at 98%, 94%, 94% at 12-, 36-, 60-months for Group 1 and at 98%, 95%, 86% for Group 2 (P-Value 0.266). Probability of survival was 95%, 86%, 75% at 12-, 36-, 60-months for Group 1 and 83%, 77%, 72% for Group 2 (P-Value 0.226).Multivariate regression analysis identified neither Group 1 versus Group 2 nor absolute value of aortic neck diameter as significant predictors of neck-related adverse events. Neck diameters did not display significant differences over time in any of the levels evaluated.EVAR with the Ovation endograft results in low rates of late neck related complications which is also true for patients with wide baseline aortic necks.

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes-dual-energy index (DEI) and effective Z (Z

To investigate outcomes of endovascular aneurysm repair (EVAR) in high risk patients.Bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) were searched using combinations of thesaurus and free text terms. The review protocol was registered in PROSPERO (CRD42021287207) and reported according to PRISMA 2020. Pooled estimates were calculated using odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) applying the Mantel-Haenszel or inverse variance method. EVAR peri-operative mortality in high risk patients over time was examined with mixed effects meta-regression. The GRADE framework was used to rate the certainty of evidence.The pooled peri-operative mortality in 18 416 high risk patients who underwent EVAR was 3% (95% CI 2.3 - 4%) and has significantly reduced over time (year of publication p = .003; median study point p = .023). The peri-operative mortality was significantly lower in high risk patients treated with EVAR compared with open repair (OR 0.64; 95% CI 0.45 - 0.92), but no significant difference was found in overall (HR 1.06; 95% CI 0.76 - 1.49) or aneurysm related mortality (HR 0.57; 95% CI 0.21 - 1.55). No significant difference was found in overall mortality between high risk patients treated with EVAR vs. no intervention (HR 0.42; 95% CI 0.14 - 1.26), but the aneurysm related mortality was significantly lower in the former (HR 0.30; 95% CI 0.14 - 0.63). The peri-operative mortality was higher in high risk than normal risk patients treated with EVAR (OR 2.33; 95% CI 1.75 - 3.10), as was the overall mortality (HR 3.50; 95% CI 2.55 - 4.80). The certainty of evidence was very low for EVAR vs. open surgery or no intervention and low for high vs. normal risk patients.The EVAR peri-operative mortality in high risk patients has improved over time. Even though the aneurysm related mortality of EVAR is lower compared with no intervention, EVAR may confer no overall survival benefit.

During the vascular surgical reconstruction of aorto-iliac occlusive/aneurysmal disease, bifurcated grafts are used where vascular surgeons intra-operatively select the size and the relative lengths of the parent and daughter portions of the graft. Currently, clinical practice regarding the selection of the most favorable geometric configuration of the graft is an understudied research subject: decisions are solely based on the clinical experience of the operating surgeon. This manuscript aims to evaluate the hemodynamic performance of various diameters, D, of bifurcated aortic grafts and relate those with proximal/distal part length ratios (the angle φ between the limbs is used as a surrogate marker of the main body-to-limb length ratio) in order to provide insights regarding the effects of different geometries on the hemodynamic environment. To this end, a computationally intensive set of simulations is conducted, and the resulting data are analyzed with modern statistical regression tools. A negative curvilinear relationship of TAWSS with both φ and D is recorded. It is shown that the angle between limbs is a more important predictor for the variability of TAWSS, while the graft’s diameter is an important determinant for the variability of OSI. Large percentages of the total graft area with TAWSS < 0.4 Pa, which correspond to thrombogenic stimulating environments, are only observed for large values of φ and D > 20 mm. This variable ranges from 10% (for the smallest values of φ and D) to 55% (for the largest φ and D values). Our findings suggest that grafts with the smallest possible angle between the limbs (i.e., smallest parent-to-daughter length ratio) present the most favorable hemodynamic performance, yielding the smallest percentage of total graft area under thrombogenic simulating environments. Similarly, grafts with the smallest acceptable diameter should be preferred for the same reason. Especially, grafts with diameters greater than 20 mm should be avoided, given the abrupt increase in estimated thrombogenic areas.

Objectives To develop a prediction model that could risk stratify abdominal aortic aneurysms (AAAs) into high and low growth rate groups, using machine learning algorithms based on variables from different pathophysiological fields. Methods A cohort of 40 patients with small AAAs (maximum diameter 32–53 mm) who had at least an initial and a follow-up CT scan (median follow-up 12 months, range 3–36 months) were included. 29 input variables from clinical, biological, morphometric, and biomechanical pathophysiological aspects extracted for predictive modeling. Collected data were used to build two supervised machine learning models. A gradient boosting (XGboost) and a support vector machines (SVM) algorithm were trained with 60% and tested with 40% of the data to predict which AAA would achieve a growth rate higher than the median of our study cohort. Receiver operating characteristics (ROC) curves and areas under the curve (AUC) were used for the evaluation of the developed algorithms. Results XGboost achieved the highest AUC in predicting high compared to low AAA growth rate with an AUC of 81.2% (95% CI from 61.1 to 100%). SVM achieved the second highest performance with an AUC of 68.8% (95% CI from 46.5 to 91%). Based on the best performing algorithm, variable importance was estimated. Diameter–diameter ratio (maximum diameter/neck diameter), Tortuosity from Renal arteries to aortic bifurcation, and maximum thickness of the intraluminal thrombus were found to be the most important factors for model predictions. Other factors were also found to play a significant but less important role. Conclusions A prediction model that can risk stratify AAAs into high and low growth rate groups could be developed by analyzing several factors implicated in the multifactorial pathophysiology of this disease, with the use of machine learning algorithms. Future studies including larger patient cohorts and implementing additional risk markers may aid in the establishment of such methodology during AAA rupture risk estimation.

Objective: To investigate whether the crossed-limb technique confers better or worse clinical outcomes compared to the standard straight limb configuration in standard endovascular aneurysm repair (EVAR). Methods: We conducted a systematic review to identify studies comparing outcomes of EVAR with the crossed versus standard limb configuration. MEDLINE, EMBASE, CINAHL, and CENTRAL were searched in March 2021 using the Healthcare Databases Advanced Search interface developed by the National Institute for Heath and Care Excellence. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Summary estimates were calculated using the odds ratio (OR), risk difference (RD), or mean difference (MD) and 95% confidence interval (CI), applying the Mantel-Haenszel or inverse variance statistical method. Random-effects models were employed. Results: Four observational studies qualified for inclusion, reporting a total of 1132 patients. All presented contemporary experiences. Baseline clinical characteristics were largely similar between patients with and without the crossed-limb configuration, but the anatomy tended to be less favourable in patients treated with the crossed-limb technique. No statistically significant difference was found in the primary outcomes: limb occlusion (OR 1.44, 95% CI 0.65 – 3.19), type Ib endoleak (RD 0.01, 95% CI -0.03 – 0.04), type III endoleak (RD 0.01, 95% CI -0.01 – 0.03); or secondary outcomes: perioperative mortality (RD 0.00, 95% CI -0.03 – 0.03), type Ia endoleak (RD 0.00, 95% CI -0.03 – 0.02), type II endoleak (OR 1.38, 95% CI 0.51 – 3.74), procedure duration (MD 18.07 min, 95% CI -1.14–37.29). Inconsistency across studies was low for all outcomes. The studies were judged to be of high quality on the NOS. The main bias identified using the ROBINS-I tool was due to confounding. Conclusion: The crossed-limb technique was not found to confer inferior clinical outcomes in the medium term compared to the standard limb configuration in patients who undergo standard EVAR.

Objective To investigate whether there is a correlation between institutional or surgeon case volume and outcomes in patients with ruptured abdominal aortic aneurysm (rAAA). Data Sources The Healthcare Database Advanced Search interface developed by the National Institute of Health and Care Excellence was used to search MEDLINE, Embase, CINAHL, and CENTRAL. Review Methods The systematic review complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with the protocol registered in PROSPERO (CRD42020213121). Prognostic studies were considered comparing outcomes of patients with rAAA undergoing repair in high and low volume institutions or by high and low volume surgeons. Pooled estimates for peri-operative mortality were calculated using the odds ratio (OR) and 95% confidence intervals (CI), applying the Mantel-Haenszel method. Analysis of adjusted outcome estimates was performed with the generic inverse variance method. Results Thirteen studies reporting a total of 120 116 patients were included. Patients treated in low volume centres had a statistically significantly higher peri-operative mortality than those treated in high volume centres (OR 1.39; 95% CI 1.22 – 1.59). Subgroup analysis showed a mortality difference in favour of high volume centres for both endovascular aneurysm repair (EVAR; OR 1.61, 95% CI 1.11 – 2.35) and open repair (OR 1.50, 95% CI 1.25 – 1.81). Adjusted analysis showed a benefit of treatment in high volume centres for open repair (OR 1.68, 95% CI 1.21 – 2.33) but not for EVAR (OR 1.42, 95% CI 0.84 – 2.41). Differences in peri-operative mortality between low and high volume surgeons were not statistically significant for either EVAR (OR 1.06, 95% CI 0.59 – 1.89) or open surgical repair (OR 1.18, 95% CI 0.87 – 1.63). Conclusion A high institutional volume may result in a reduction of peri-operative mortality following surgery for rAAA. This peri-operative survival advantage is more pronounced for open surgery than EVAR. Individual surgeon caseload was not found to have a significant impact on outcomes.

To investigate outcomes of pre-emptive embolization of the aneurysm sac or aortic side branches in endovascular aneurysm repair (EVAR).The review was reported as per Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 with a preregistered protocol. Bibliographic sources (MEDLINE, Embase, and CENTRAL) were searched using subject headings and free text terms. Randomized controlled trials comparing EVAR with versus without embolization were included. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI) applying the Mantel-Haenszel method. Continuous outcomes were summarized using mean difference (MD) and 95% CI applying the inverse variance method. The certainty of evidence was appraised with the Grading of Recommendations Assessment, Development, and Evaluation framework. Version 2 of the Cochrane tool was used to assess the risk of bias. Trial sequential analysis assumed alpha = 5% and power = 80%.Four randomized controlled trials were included. No significant difference was found in aneurysm-related mortality (RD 0.00, 95% CI -0.03 to 0.03), overall mortality (OR 1.85, 95% CI 0.42-8.13), aneurysm rupture (RD 0.00, 95% CI -0.03 to 0.03), type II endoleak-related reintervention (RD -0.07, 95% CI -0.21 to 0.06), procedure time (MD 20.12, 95% CI -11.54 to 51.77), or fluoroscopy time (MD 11.17, 95% CI -11.22 to 33.56). Patients with pre-emptive embolization had significantly lower odds of type II endoleak (OR 0.45, 95% CI 0.26-0.78) and sac expansion (OR 0.19, 95% CI 0.07-0.52). The risk of bias was high for all outcomes. The certainty of evidence was very low for all outcomes, except for type II endoleak, for which it was low. Trial sequential analysis showed an inconclusive result for overall mortality and type II endoleak-related reintervention but confirmed the advantage of embolization in reducing type II endoleak and sac expansion.Limited, low certainty data suggest pre-emptive embolization confers no clinical benefits in EVAR.

Background Percutaneous endovascular aneurysm repair (EVAR) and peripheral interventions using the Perclose Proglide suture mediated system has not been adequately studied in patients with synthetic grafts at access sites. Methods We report the use of the Perclose Proglide in 10 patients in whom previously inserted synthetic grafts in the groin were punctured for arterial access (5 for peripheral interventions and 5 undergoing EVAR). In patients undergoing peripheral interventions a single device was used, while in patients undergoing EVAR 2 devices were employed per access site. The preclosing technique was used in every case. Results Hemostasis was achieved in all patients. No complications were observed except for a small laceration and a localized hemodynamically nonsignificant stenosis, without any clinical sequel. Conclusions This small case series indicates the feasibility of percutaneous access with the Perclose Proglide system to perform EVAR and peripheral endovascular interventions in the presence of synthetic grafts in the groin, with promising outcomes.

Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as ultrasound, CT, MRI, digital subtraction angiography and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.

Head and neck cancers represent an aggressive form of neoplastic diseases that warrant surgical resection, in order to achieve optimal outcomes. Moreover, the involvement of the carotid artery is associated with a dismal prognosis and radical tumor resection becomes challenging. The current case report presents a patient with locally metastatic neck carcinoma attached to the right carotid bifurcation, involving both the external and internal carotid arteries up to the distal segment of the internal carotid artery (ICA) at the level of the C1 vertebra. The patient underwent en bloc tumor and vessel resection. The carotid artery was reconstructed using an interposition graft from the common carotid artery to the ICA by means of an autologous saphenous vein graft. A vertical mandibular osteotomy was performed, in order to expose the distal ICA. The postoperative recovery was uneventful. The patient was under follow-up for six months, without any signs of recurrence.

To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant.MEDLINE and Embase were searched using the Ovid interface.A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients versus non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow-up. The risk of bias was assessed with the Newcastle-Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm-related mortality. Effect measures were the hazard ratio (HR) or odd ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random-effects models.Thirteen cohort studies with a total of 22,762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36%-51%). No statistically significant difference was found in the hazard of all-cause mortality (HR 1.04, 95% CI 0.61-1.77), aneurysm-related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31-1.41) between patients who had incomplete and complete follow-up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39-1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance versus those with complete surveillance showed no significant difference in all-cause mortality (HR 1.10, 95% CI 0.43-2.80).Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. The findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualized or risk-adjusted surveillance.

Σκοπός της παρούσας μελέτης είναι να εξετάσει τις διαφοροποιήσεις μεταξύ αξονικών και ορθογωνικών μετρήσεων στον προσδιορισμό της μέγιστης διαμέτρου των ανευρυσμάτων της κοιλιακής αορτής (ΑΚΑ) και τη σημασία των ογκομετρικών παραμέτρων στην καταγραφή της μεταβολής των διαστάσεων στο χρόνο. Επιπλέον να διερευνήσει τον ρόλο γεωμετρικών και εμβιομηχανικών παραμέτρων στον κίνδυνο ρήξης και ενδεχόμενα να αναπτύξει ένα μοντέλο που θα εκτιμάει με ακρίβεια τον κίνδυνο ρήξης ή ταχείας αύξησης εξατομικευμένα πέρα από το καθολικό κριτήριο της μέγιστης διαμέτρου.Όσον αφορά τον προσδιορισμό της μέγιστης διαμέτρου βλέπουμε ότι η αξονικές μετρήσεις υπερεκτιμούν τη διάμετρο και μπορεί να οδηγήσουν σε θεραπευτικές αστοχίες σε περίπου 1/5 ασθενείς. Η ασυμμετρία του ανευρύσματος όπως αυτή προσδιορίζεται από τον ShapeIndex που εισάγουμε και ο οποίος ορίζεται ως το πηλίκο ελάσσονος/μείζονος άξονα της τομής με την μέγιστη διάμετρο, μπορεί να προβλέψει τις περιπτώσεις εκείνες στις οποίες σημαντικές διαφορές θα πρέπει να αναμένονται.Σχετικά με τις ογκομετρικές παραμέτρους, τα ΑΚΑ που ήταν στην ομάδα ταχείας ογκομετρικής αύξησης παρουσίαζαν 10-πλάσιο κίνδυνο να απαιτήσουν χειρουργική αντιμετώπιση σε σχέση με αυτά στην ομάδα βραδείας αύξησης. Ο αντίστοιχος κίνδυνος μεταξύ ταχέως και βραδέως αυξανόμενων ΑΚΑ με βάση την μέγιστη διάμετρο ήταν μόλις 3. Τέλος ο όγκος ήταν περισσότερο ευαίσθητος στην ανίχνευση της αύξησης του μεγέθους στο χρόνο αφού σε 18% των περιπτώσεων όπου παρατηρήθηκε σημαντική ογκομετρική αύξηση, η διάμετρος του ανευρύσματος ήταν σταθερή.Μελετώντας μια περίπτωση ανευρύσματος με εξαιρετικά ταχεία αύξηση καταγράψαμε μια σημαντική ανακατανομή των τάσεων εις βάρος του οπίσθιου τοιχώματος με συγκέντρωση περιοχών υψηλών τοιχωματικών τάσεων στην τελική κατάσταση. Εφόσον το οπίσθιο τοίχωμα είναι η συνηθέστερη θέση της ρήξης τέτοιες παρατηρήσεις πιθανά είναι χρήσιμες στον καθορισμό της φυσικής ιστορίας των ΑΚΑ και τον προσδιορισμό παραγόντων κινδύνου που προβλέπουν αυξημένο κίνδυνο ρήξης.Στη συνέχεια με τη χρήση ΗΚΓ-καθοδηγούμενη CT αγγειογραφία μελετήσαμε τις μηχανικές ιδιότητες του ανευρύσματος και συμπεραίνουμε ότι ανευρυσματικό τοίχωμα παρουσιάζεται περισσότερο ανένδοτο από την φυσιολογική αορτή ενώ ο αυλός παραμορφώνεται σημαντικά στη διάρκεια του καρδιακού κύκλου κάτι που πιθανά υποδεικνύει έναν αποσβεστικό ρόλο του θρόμβου που απορροφά μέρος της συστηματικής πίεσης προστατεύοντας το τοίχωμα.Όσον αφορά την επίδραση της κατανομής του θρόμβου στον κίνδυνο ταχείας αύξησης, φαίνεται ότι η οπίσθια εναπόθεση ενδεχόμενα δρα προστατευτικά μειώνοντας τις τάσεις που ασκούνται στο οπίσθιο τοίχωμα του ανευρύσματος (η συχνότερη θέση της ρήξης) και σχετίζεται με βραδύτερη αύξηση των διαστάσεων του με την πάροδο του χρόνου.Τέλος με τη συνεκτίμηση γεωμετρικών, βιοχημικών και γεωμετρικών παραμέτρων ένα decision tree αναπτύχθηκε που ταξινομεί τα ανευρύσματα σε ομάδες ταχείας και βραδείας αύξησης. Η σημαντικότερη παράμετρος από όλες ήταν κατανομή του θρόμβου εντός του ανευρυσματικού σάκου. Στον αλγόριθμο ακόμα περιλαμβάνονταν ο σχετικός όγκος του θρόμβου και η γωνίωση του αυχένα του ανευρύσματος. 29/34 περιπτώσεις προβλέπονταν με ακρίβεια με βάση το παραπάνω μοντέλο (ακρίβεια 85%).

We describe a patient with contained aortic rupture due to perforation from a protruding lumbar osteophyte, who was treated by open surgery. This case underlines that less common aortic pathologies are possible, which require a high suspicion index to be diagnosed.

Background Persistent type 2 endoleaks (T2EL) require lifelong surveillance to avoid potentially life-threatening complications. Purpose To evaluate the performance of radiomic features (RF) derived from computed tomography angiography (CTA), for differentiating aggressive from benign T2ELs after endovascular aneurysm repair (EVAR). Material and Methods A prospective study was performed on patients who underwent EVAR from January 2018 to January 2020. Analysis was performed in patients who were diagnosed with T2EL based on the CTA of the first postoperative month and were followed at six months and one year. Patients were divided into two groups according to the change of aneurysm sac dimensions. Segmentation of T2ELs was performed and RF were extracted. Feature selection for subsequent machine-learning analysis was evaluated by means of artificial intelligence. Two support vector machines (SVM) classifiers were developed to predict the aneurysm sac dimension changes at one year, utilizing RF from T2EL at one- and six-month CTA scans, respectively. Results Among the 944 initial RF of T2EL, 58 and 51 robust RF from the one- and six-month CTA scans, respectively, were used for the machine-learning model development. The SVM classifier trained on one-month signatures was able to predict sac expansion at one year with an area under curve (AUC) of 89.3%, presenting 78.6% specificity and 100% sensitivity. Similarly, the SVM classifier developed with six-month radiomics data showed an AUC of 95.5%, specificity of 90.9%, and sensitivity of 100%. Conclusion Machine-learning algorithms utilizing CTA-derived RF may predict aggressive T2ELs leading to aneurysm sac expansion after EVAR.