Lifelong aortic risk in Turner syndrome: Unexpected aortic events in asymptomatic patients.

Individuals with Turner syndrome (TS) face a high relative risk of acute aortic dissection compared with the general population. Dissection risk is greatest in those who have congenital heart disease, thoracic aortic aneurysms, or hypertension. This case report features two adult patients with TS who presented with asymptomatic thoracic aortic pathologies that were identified on routine surveillance imaging.

Outcomes of fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms in patients with heritable thoracic aortic diseases.

Objective: Open surgical repair is the first-line treatment for patients with complex aortic aneurysms and heritable thoracic aortic diseases (HTADs). Fenestrated-branched endovascular aortic repair (FB-EVAR) has been used selectively in higher-risk patients. This study assessed early- and midterm outcomes of FB-EVAR for complex aortic aneurysms in patients with HTADs.

Early outcomes of endovascular repair of aortic arch lesions in zone 0/1 with a thoracic branched endoprosthesis.

Objective: The pivotal trial 30-day outcomes of the GORE TAG Thoracic Branch Endoprosthesis in patients with endovascular repair of the aortic arch or descending thoracic aorta using a zone 0 or 1 landing zone were evaluated.

Methods: In this nonrandomized, multicenter, prospective study, the primary, clinically driven outcome was a composite of the following through 1 month: technical success (successful device deployment with maintenance of side-branch patency and the absence of aortic rupture), lesion-related mortality, disabling stroke, permanent paraplegia or paraparesis, new onset renal failure requiring permanent dialysis, and protocol-defined unanticipated reintervention.

Results: The 77 study patients enrolled had aneurysm (n = 50), dissection (n = 24), or other isolated lesion types (n = 3); 90.

Outcomes of routine surveillance of grade 1 blunt traumatic aortic injury.

Background: Blunt traumatic aortic injury (BTAI) can present with a wide range of severity from mild intimal injuries (grade 1) to rupture (grade 4). Although there is consensus that patients with grade 3 and 4 injuries should undergo immediate thoracic endovascular aortic repair (TEVAR), the optimal treatment strategy for milder injuries is less clear owing to the lack of data regarding the natural history of these injuries. Grade 1 injuries are typically treated with anti-impulse therapy and surveillance imaging.

Treatment Trends and Outcomes of Endovascular versus Open Thoracoabdominal Aortic Aneurysm Repair - A Single-center Comparative Cohort Study.

Objective: To evaluate treatment trends and compare outcomes following fenestrated-branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAA).

Background: FB-EVAR has been increasingly utilized as a less invasive alternative to OSR for treatment of TAAAs.

Methods: We studied patients who underwent elective FB-EVAR or OSR of TAAAs (2008-2020), since the initiation of an Advanced Endovascular Aortic Program.

Treatment and outcomes of type IIIb endoleaks affecting the main fenestrated-branched aortic stent graft component among patients treated for complex abdominal and thoracoabdominal aortic aneurysms.

Objective: Type IIIb endoleak (T3bE) owing to fabric tears or integrity issues is infrequent, but has been poorly described among patients undergoing fenestrated-branched endovascular aortic repair (FB-EVAR). This study aimed to describe the incidence, management, and outcomes of T3bE after FB-EVAR for the treatment of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs).

Methods: Clinical data, imaging, and outcomes of consecutive patients enrolled in prospective, nonrandomized physician-sponsored investigational device exemption studies evaluating company-manufactured devices for FB-EVAR at three centers were reviewed from 2013 to 2024.

Pitfalls in sizing and planning for fenestrated and branched stent-grafts in patients with chronic post-dissection thoracoabdominal aortic aneurysms.

Fenestrated-branched endovascular aneurysm repair is increasingly utilized in managing chronic post-dissection thoracoabdominal aortic aneurysms (TAAAs), with multicenter data indicating outcomes comparable to those in degenerative TAAAs. However, the anatomical and technical considerations in chronic dissection are distinct, often involving collapse of the true lumen, separate origins of target vessels from the true versus false lumen, and persistent dissection flaps extending into the renovisceral segment. Transcatheter electrosurgical septotomy is an emerging adjunct technique that aids in expanding the true lumen and optimizing proximal and distal sealing zones and branch vessel alignment during subacute and chronic post-dissection TAAA repair.

Explant of an infected four-vessel fenestrated and bilateral iliac branch stent graft in a patient of Jehovah's Witness faith.

Infection of fenestrated-branched stent graft is an uncommon but potentially catastrophic complication. The technical challenge of total stent graft explant and reconstruction of the renal-mesenteric arteries is associated with high mortality and morbidity. Among patients of Jehovah Witness faith, refusal to accept blood transfusion adds to the risk given the invasiveness of these operations.

One-year outcomes from the pivotal trial of a four-branch off-the-shelf solution to treat pararenal and extent IV thoracoabdominal aortic aneurysms.

Objective: To report 1-year primary-arm outcomes of the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis pivotal trial.

Methods: The multicenter, nonrandomized, prospective study included patients with extent IV thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs). All-cause and adjudicated lesion-related mortality were assessed at 12 months.

Long-term comparison of physician-modified endografts with and without low-profile fabric designs for repair of complex abdominal and thoracoabdominal aortic aneurysms.

Objective: After commercial approval, our institution began using the Cook Zenith Alpha low-profile stent graft (LPSG) for physician-modified endograft (PMEG) repair of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAA) owing to its smaller sheath size and wider apex-to-apex stent distances, allowing for better accommodation of modifications. We aimed to compare outcomes of PMEGs using LPSGs and the standard-profile stent graft (SPSG), Zenith TX2.

Methods: We reviewed clinical data and outcomes of patients treated using PMEGs for CAAAs (short-neck infrarenal, juxtarenal, and pararenal AAAs) and TAAAs between 2007 and 2024.

Five-year pivotal trial outcomes of the Gore Excluder conformable endoprosthesis implanted in abdominal aortic aneurysms with short non-angulated infrarenal seal zones.

Objective: The GORE EXCLUDER Conformable Abdominal Aortic Aneurysm Endoprosthesis with Active Control System (EXCC) is approved in the United States (U.S.) for treatment of AAAs and highly angulated (≤90°) and short (≥10 mm) infrarenal aortic proximal seal zones (necks).

Endovascular repairs of complex chronic post-dissection thoracoabdominal aortic aneurysm using modular patient-specific fenestrated-branched stent-graft components.

Chronic post-dissection thoracoabdominal aortic aneurysms (pD-TAAAs) pose unique challenges for endovascular repair due to true lumen compression, vessel origin from separate lumens, and extension of dissection into side branches. We report two cases of pD-TAAA with persistent false lumen perfusion and progressive aortic dilatation. In both cases, the celiac axis was perfused from an isolated false lumen due to occlusion of the reentrance tear, with the remaining patent target vessels originating from the true lumen.

Increasing clinical experience and changes in practice protocols improved outcomes of fenestrated branched endovascular repair of complex aortic aneurysms.

Objective: To evaluate the impact of increased clinical experience and changes in practice protocols on the incidence of early major adverse events (MAEs) during fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs).

Methods: Clinical outcomes of 847 consecutive patients (72% males; median age, 74 years; interquartile range, 69-79 years) treated by the same operator in two centers were reviewed (2007-2024). Of these, 590 patients were treated under a prospective investigational device exemption study.

Direct absorbed and equivalent dose of radiation to the eyes in patients and operators during fenestrated and branched endovascular aortic repair.

Objective: Fenestrated and branched endovascular aneurysm repairs (FB-EVAR) stand out as interventions with the highest radiation exposure to patients, operators, and staff, raising concerns for accumulating radiation doses to the eye lens. Therefore, this study aimed to describe the absorbed dose of radiation to the eyes of the patient and primary operator and relate this to indirect metrics of radiation exposure.

Methods: All consecutive patients undergoing FB-EVAR between March 2022 and September 2024 as part of a prospective, nonrandomized cohort for investigational devices, were included in this cross-sectional study.

Wound-healing and onboard care during long-duration human deep space exploration from a surgical perspective through the lens of a scoping review.

Objective: The aim of this study was to develop a bridge between the fields of aerospace medicine and vascular surgery, and to emphasize the need for leading experts in vascular medicine, interventional radiology, and surgery to address the critical human spaceflight research gaps highlighted by the National Aeronautics and Space Administration (NASA).

Methods: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on literature published between 2000 and 2024. A well-defined search strategy was employed for keyword searches across multiple databases, including PubMed, Scopus, Cochrane, Embase, the NASA Life Science Data Archive, NASA technical reports, and Google Scholar.

Spinal Cord Ischemia Prevention and Management in Thoracoabdominal Branched Endovascular Aortic Repair.

Spinal cord ischemia (SCI) is the most feared complication of complex aortic surgery owing to significant morbidity, decreased patient quality of life, and increased risk of overall short- and long-term mortality. As endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) has evolved to become a first-line therapy owing to decreased perioperative complications and mortality when compared to open surgical repair, a focus on prevention and rescue of SCI has become a primary concern. This review describes the background, incidence, risk factors, prevention, and treatment of SCI following branched endovascular aortic repair of TAAAs.

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.

A systematic review and meta-analysis comparing single-stage versus multistaged approaches for endovascular repair of extensive thoracoabdominal aortic aneurysms.

Objective: We aimed to perform a systematic review and meta-analysis comparing the outcomes of single-stage vs multistaged fenestrated-branched endovascular aortic repair (FB-EVAR) for extensive thoracoabdominal aortic aneurysms (TAAAs).

Methods: MEDLINE, Embase, and Cochrane databases were searched from inception to March 2024. This study was registered in PROSPERO (CRD42024567099) and followed the PRISMA guidelines.

Technical strategies and pitfalls for total transfemoral implantation of off-the-shelf four vessel thoracoabdominal multibranch endoprosthesis with or without utilization of preloaded wires.

The thoracoabdominal multibranch endoprosthesis is a commercially available off-the-shelf four-vessel inner branched endograft for complex abdominal and thoracoabdominal aortic aneurysms. Although the device is intended to be used with upper extremity access per its instructions for use, total transfemoral approach may be needed in patients with unfavorable arch anatomy and may decrease the risk of cerebrovascular events. This article describes technical strategies and pitfalls of total transfemoral thoracoabdominal multibranch endoprosthesis implantation techniques with conventional co-axial steerable sheath, as well as variations of techniques utilizing preloaded wires in "up-and-over" configuration.

Double preloaded internal up-and-over technique for total transfemoral four vessel thoracoabdominal multibranch endoprosthesis with temporary aortic balloon occlusion for ruptured complex abdominal aortic aneurysm.

The thoracoabdominal multibranch endoprosthesis (TAMBE) is the first off-the-shelf, four-vessel branched endograft to obtain US Food and Drug Administration commercial approval for the treatment of complex abdominal and thoracoabdominal aortic aneurysms. Total transfemoral TAMBE approaches, previously described, may benefit patients with challenging aortic arch anatomy. This report presents a further refinement of the internal up-and-over total transfemoral TAMBE technique with temporary aortic balloon occlusion, applied in the setting of a ruptured pararenal abdominal aortic aneurysm.

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.

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.