Wire wrap involving the celiac and superior mesenteric artery portals of the GORE EXCLUDER thoracoabdominal branch endoprosthesis: A multi-center case series.

The GORE EXCLUDER thoracoabdominal branch endoprosthesis is the only commercially available, off-the-shelf stent graft for endovascular repair of thoracoabdominal aortic aneurysms in the United States. The design features preloaded guidewires, eliminating the need to separately catheterize each branch portal. However, wire wrapping of the target vessel cannulation wires can cause technical difficulties during catheterization and presents challenges to bridge stent delivery and deployment, leading to bridge stent wrapping.

Fiber Optic RealShape (FORS) and three-dimensional overlay technology in preemptive segmental artery embolization to reduce the risk of spinal cord ischemia prior to fenestrated endovascular aortic aneurysm repair.

Branched/fenestrated endovascular aortic aneurysm repair (B/FEVAR) carries a risk of spinal cord ischemia (SCI), which increases along with increasing length of aortic luminal coverage of the repair. Pre-emptive coverage with first-stage thoracic endovascular aortic aneurysm repair or embolization of intercostal/lumbar vessels as a staging procedure to reduce the risk of SCI after repair has become commonplace. Intercostal/lumbar embolization can be a technically challenging procedure due to the number of vessels and multiple projections required for cannulation, leading to long procedure times and high radiation/contrast dosing, sometimes requiring multiple sessions to complete.

Aneurysm sac regression after fenestrated or branched endovascular aortic repair is associated with superior long-term survival.

Objective: Aneurysm sac behavior after fenestrated or branched endovascular repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAAs) remains a key knowledge gap. The purpose of this study was to identify independent predictors of sac behavior after FB-EVAR and assess the relationship between sac behavior and long-term survival.

Methods: Patients undergoing FB-EVAR between 2005 and 2023, in 10 physician-sponsored investigational device exemption studies in the United States, were analyzed.

Benefits of an Enhanced Recovery Pathway for Lower Extremity Amputation Patients.

Background: Enhanced recovery programs (ERPs) may improve lower extremity amputation (LEA) care through interdisciplinary collaboration, patient education, multimodal pain control, and early mobilization. We sought to determine the ERP impact on outcomes for patients undergoing major LEA.

Methods: Patients receiving ERP care (02/01/2022-07/31/2023) were compared to a historic pre-ERP cohort (01/01/2020-01/31/2022).

Outcomes of High Risk and Complicated Type B Aortic Dissections Treated with Thoracic Endovascular Aortic Repair.

Objective: The Society for Vascular Surgery (SVS) and the Society for Thoracic Surgery published reporting standards defining complicated and uncomplicated type B aortic dissections (TBADs) and included previously undefined high risk features. This retrospective review of multi-institution SVS Vascular Quality Initiative (VQI) post-approval study (VQI PAS) data aimed to evaluate the outcomes of patients with high risk TBAD (hrTBAD) and complicated TBAD (cTBAD) treated with thoracic endovascular aortic repair (TEVAR).

Methods: The data of 641 patients collected from 2013 to 2023 were included.

Predictors of failure to rescue after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms.

Objective: Failure to rescue (FTR), defined as mortality due to failure in responding to in-hospital complications, is an important quality indicator. This study aimed to assess incidence and predictors for FTR among centers performing fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAA).

Methods: Consecutive patients treated by FB-EVAR for TAAAs between 2005 and 2022 in 27 centers of the International Multicenter Aortic Research Group were analyzed.

Sex Differences in Textbook Outcomes among Adults Undergoing Elective Abdominal Aortic Aneurysm Repair.

Background: Female patients with abdominal aortic aneurysms (AAAs) undergoing repair have worse outcomes than men. Textbook outcomes (TOs) have been described as a metric to direct quality improvement efforts and assess institutional performance. We investigated sex differences among patients achieving a TO after open (OAR) and endovascular aortic aneurysm repair (EVAR).

Testing ChatGPT's Ability to Provide Patient and Physician Information on Aortic Aneurysm.

Introduction: Our objective was to test the ability of ChatGPT 4.0 to provide accurate information for patients and physicians about abdominal aortic aneurysms (AAA) and to assess its alignment with Society for Vascular Surgery (SVS) clinical practice guidelines (CPG) for AAA care.

Material And Methods: Fifteen patient-level questions, 37 questions selected to reflect 28 SVS CPGs and 4 questions regarding AAA rupture risk were posed to ChatGPT 4.

Multicenter Prospective Evaluation of Patient Radiation Exposure During Fenestrated-Branched Endovascular Aortic Repair: A Ten-year Experience.

Objective: To assess patient radiation exposure as reflected by cumulative air kerma (CAK) and dose area product (DAP) during fenestrated-branched endovascular aortic repair (FB-EVAR).

Summary Background Data: Patient radiation exposure during FB-EVAR has been reported inconsistently.

Methods: Data from 2,111 patients enrolled in 10 physician-sponsored investigational device exemption studies (2012-2022) were analyzed from the United States Aortic Research Consortium database.

Textbook outcomes as a novel patient-centric metric to inform carotid revascularization.

Objective: The recent National Coverage Determination surrounding carotid stenting and shared decision-making has ushered in an era of patient-centric carotid care. However, historical carotid intervention endpoints have lacked patient-centered nuances to inform clinical decisions. Accordingly, we aimed to create a comprehensive novel, patient-centric textbook outcome (TO) to inform treatment paradigms.

Evolving practices of spinal drain use for branch/fenestrated endovascular aortic repair patients in the United States Aortic Research Consortium.

Objective: The use of cerebrospinal fluid drains (CSFDs) for the prevention or mitigation of spinal cord ischemia (SCI) is a subject of debate for patients undergoing branch/fenestrated endovascular aortic repair. We sought to evaluate the practices surrounding CSFD use concurrently with rates of SCI occurrence, recovery, and CSFD complications in the US Aortic Research Consortium.

Methods: We conducted a retrospective analysis of the US Aortic Research Consortium registry consisting of patients undergoing branch/fenestrated endovascular aortic repair under individual physician-sponsored investigational device exemptions from January 2011 to April 2024.

Trends and outcomes over time with fenestrated and branched endovascular aortic repair in the United States Aortic Research Consortium.

Objective: To characterize trends and outcomes with fenestrated and branched endovascular aortic repair (F/B-EVAR) performed at centers participating in the US Aortic Research Consortium.

Methods: F/B-EVARs performed in 10 prospective, nonrandomized, physician-sponsored investigative device exemption studies from 2015 to 2023 were studied retrospectively. Outcomes included 30-day major adverse event (MAE) and 1-year secondary reintervention.

Standards for Abdominal Aortic Aneurysm Repair Quality Improvement Registries: A Delphi Consensus Report From VASCUNET and the International Consortium of Vascular Registries.

Objective: Outcome registries in vascular surgery are used increasingly to drive quality improvement by vascular societies. The VASCUNET collaboration, within the European Society for Vascular Surgery (ESVS), and the International Consortium of Vascular Registries (ICVR) developed a set of variables for quality improvement registries on abdominal aortic aneurysm (AAA) repair as a registry standard.

Methods: Representatives from international vascular registries within VASCUNET, ICVR, and other nations with established registries were invited to provide the variables.

Operative times and outcomes of complex endovascular repairs of thoracoabdominal aneurysms.

Background: Owing to the significant morbidity and mortality of open thoracoabdominal aortic aneurysm surgery, complex endovascular repairs have become increasingly common, but still carry substantial risk. These repairs require large-bore access, with resultant pelvic and lower extremity ischemia. We, therefore, hypothesized that operative timing would be associated with outcomes, because efficient surgery would limit the ischemic time as well as anesthesia time.

A prevention protocol reduces spinal cord ischemia in patients undergoing branched/fenestrated endovascular aortic repair.

Objective: Spinal cord ischemia (SCI) is a devastating complication that is associated with thoracoabdominal aortic repair, with higher risk associated with increased aortic coverage length, making patients undergoing branched/fenestrated endovascular repair (B/FEVAR) particularly vulnerable. A bundled SCI prevention protocol was previously reported to reduce SCI rates when compared to a historic cohort in a single-center study. Therefore, this analysis aims to further validate and update outcomes associated with the protocol given the routine implementation of this strategy at two institutions (University of Florida and the University of Alabama at Birmingham) since inception.

Appropriate Use Criteria Committees: The professional society role in the development and implementation of Appropriate Use Criteria.

Vascular surgeons have the ability to manage and intervene on numerous vascular diseases of both the arterial and venous systems. With the growing number of interventions available as endovascular technology evolves, it is important to determine when a procedure is safely indicated for a vascular surgery patient. Appropriate Use Criteria (AUC) offer synthesized clinical information and practice standards that can aid clinicians in making these management decisions.

Outcomes using inverted iliac limb bifurcate components in fenestrated/branched endografting.

Background: The use of standard bifurcate pieces in fenestrated/branched endovascular aortic repair (F/BEVAR) requires adequate length from the lowest branch or fenestration to the aortic bifurcation. In patients with prior aortic surgery, the aortic bifurcation is often artificially established in a more proximal position, compromising the infrarenal length, which hinders the placement of a standard bifurcate component below the fenestrated/branched component. Short bifurcate bodies using an inverted contralateral limb have been purpose-built to address this challenge.