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Purpose: To investigate in an in vitro model if secondary endobag filling can reduce gutter size during chimney endovascular aneurysm sealing (chEVAS).Materials and Methods: Nellix EVAS systems were deployed in 2 silicone juxtarenal aneurysm models with suprarenal aortic diameters of 19 and 24 mm. Four configurations were tested: EVAS with 6-mm balloon-expandable (BE) or self-expanding (SE) chimney grafts (CGs) in the renal branches of both models. Balloons were inflated simultaneously in the CGs and main endografts during primary and secondary endobag filling and polymer curing. Computed tomography (CT) was performed immediately after the primary and secondary fills. Cross-sectional lumen areas were measured on the CT images to calculate gutter volumes and percent change. CG compression was calculated as the reduction in lumen surface area measured perpendicular to the central lumen line. The largest gutter volume and highest compression were presented per CG configuration per model.Results: Secondary endobag filling reduced the largest gutter volumes from 99.4 to 73.1 mm3 (13.2% change) and 84.2 to 72.0 mm3 (27.6% change) in the BECG configurations and from 67.2 to 44.0 mm3 (34.5% change) and 92.7 to 82.3 mm3 (11.2% change) in the SECG configurations in the 19- and 24-mm models, respectively. Secondary endobag filling increased CG compression in 6 of 8 configurations. BECG compression changed by -0.2% and 5.4% and by -1.0% and 0.4% in the 19- and 24-mm models, respectively. SECG compression changed by 10.2% and 16.0% and by 7.2% and 7.3% in the 19- and 24-mm models, respectively.Conclusion: Secondary endobag filling reduced paragraft gutters; however, this technique did not obliterate them. Increased CG compression and prolonged renal ischemia time should be considered if secondary endobag filling is used. [ABSTRACT FROM AUTHOR]

A 52-year-old woman presented with fever and a persisting calf abscess ten years after she had received an aorta-bifemoral bypass. Her infection parameters were increased and she had anaemia. CT of the abdomen revealed air surrounding the proximal anastomosis of the bypass suggesting bypass graft infection. The diagnosis of an aorta-duodenal fistula was confirmed by gastroduodenoscopy showing migration of the bypass through the wall of the duodenum into the intestinal lumen. The bypass was resected and reconstructed using the superficial femoral vein. The patient recovered uneventful.

Objective: Because of their capability of secreting proteinases, macrophages play a central role in the growth and rupture of aneurysms. Noninvasive imaging of macrophages therefore may yield valuable information about the pathogenesis of aneurysm disease. We studied uptake of the macrophage-specific contrast agent ultrasmall paramagnetic iron oxide (USPIO) in the walls of aneurysms and normal-sized aortas., Materials and Methods: Six patients with an aortic and five patients with an iliac aneurysm and 11 age-matched controls were identified in a database of 239 patients who underwent evaluations for the staging of prostate cancer. USPIO-enhanced MRI and contrast-enhanced MDCT were performed for all patients. The presence of USPIO was assessed with an iron-sensitive MRI sequence. Quantification consisted of counting the number of quadrants with USPIO-induced subendothelial signal voids. A chi-square test was used to analyze the significance of the difference between the number of USPIO-positive quadrants in the aneurysm group and that in the control group., Results: The number of USPIO-positive quadrants was significantly higher in the aneurysm than in the control group: 158 quadrants (4.2%) in the aneurysm group and 13 quadrants (0.4%) in the control group (p < 0.001). Two abdominal aortic aneurysms accounted for 90% (154/171) of all USPIO-positive quadrants., Conclusion: USPIO uptake is limited or absent in the wall of normal-sized aortas and most aneurysms. However, individual abdominal aortic aneurysms exhibit high levels of USPIO uptake, indicative of extensive macrophage infiltration in the aneurysm wall. Future research should focus on the predictive value of USPIO uptake for growth and rupture of aneurysms.