Robotic single-port femoral artery dissection and anastomosis with the da Vinci system: a cadaveric feasibility study.

Vascular surgical site infections (SSI) are common and associated with graft infection, surgical reintervention, and increased lengths of stay. While antibiotic prophylaxis and negative pressure dressings have improved SSI rates, reported incidence remains as high as 30%. Robotic approaches have decreased surgical site infections in multiple surgical specialties, but remain without a vascular surgery indication.

Long-term outcomes of endovascular aneurysm repair in standard versus narrow aortic bifurcation.

Objective: The purpose of this study is to evaluate the long-term outcomes after endovascular aortic aneurysm repair (EVAR) using a bifurcated device in patients with standard and narrow aortic bifurcation (AOB).

Methods: Data was obtained from 1870 patients who had data prospectively collected in the multi-center Global Registry for Endovascular Aortic Treatment (GREAT). There were 183 (9.

Bare Metal Stenting for Residual Arch Dissections: A Computational Analysis.

Purpose: Type A Thoracic Aortic Dissections are a highly morbid and complex clinical challenge often managed with hemiarch or total arch repair. Hemiarch repair is more commonly performed due to improved neurologic morbidity profile however it leaves behind a residual dissection flap which can lead to aneurysmal degeneration. Bare metal stent placement in conjunction with hemiarch repair is a novel technique which can theoretically avoid leaving a residual dissection flap.

Two-staged aortic repair for acute type A aortic dissection in patients refusing blood transfusion.

Background: It is still challenging to perform high-risk cases, such as acute type A dissection, which frequently require blood transfusions. We created perioperative bloodless protocol, but it includes an optimization to increase the preoperative hemoglobin level enough to tolerate cardiopulmonary bypass. However, it would be impossible to optimize such patients using the strategy in the setting of emergent surgery.

Devices for aortoiliac occlusive disease.

Aortoiliac occlusive disease (AIOD) has traditionally been repaired with open surgery. However, with advancements in endovascular devices and techniques, many have adopted endovascular first approach, even for complex lesions. Stenting is the fundamental technique for endovascular treatment of AIOD, has been proven to be effective and safe.

Transatlantic Delphi Consensus on the Common Iliac Artery Sealing Zone in Endovascular Aorto-Iliac Aneurysm Repair (the DECIDE Study).

Objective: Knowledge of hostile factors and their influence on long-term seal in the iliac landing zone is limited. Currently endorsed clinical practice guidelines lack structural evidence on how the iliac landing zone should be assessed in the pre-, intra-, and postoperative phases. The goal of this study was to obtain an international, expert-based consensus on the definition of a hostile iliac landing zone, on how to size and plan stent-grafts to optimize sustainable distal seal, and on the postprocedural follow-up protocol.

Temporal geometric mapping defines morphoelastic growth model of Type B aortic dissection evolution.

The human aorta undergoes complex morphologic changes that mirror the evolution of disease. Finite element analysis (FEA) enables the prediction of aortic pathologic states, but the absence of a biomechanical understanding hinders the applicability of this computational tool. We incorporate geometric information from computed tomography angiography (CTA) imaging scans into FEA to predict a trajectory of future geometries for four aortic disease patients.

A computational study of artery curvature and endograft oversize influence on seal zone behavior in endovascular aortic repair.

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure involving the placement of an endograft inside the dissection or an aneurysm to direct blood flow and prevent rupture. A significant challenge in endovascular surgery is the geometrical mismatch between the endograft and the artery, which can lead to endoleak formation, a condition where blood leaks between the endograft and the vessel wall. This study uses computational modeling to investigate the effects of artery curvature and endograft oversizing, the selection of an endograft with a larger diameter than the artery, on endoleak creation.

A Patient-Specific Morphoelastic Growth Model of Aortic Dissection Evolution.

The human aorta undergoes complex morphologic changes that indicate the evolution of disease. Finite element analysis enables the prediction of aortic pathologic states, but the absence of a biomechanical understanding hinders the applicability of this computational tool. We incorporate geometric information from computed tomography angiography (CTA) imaging scans into finite element analysis (FEA) to predict a trajectory of future geometries for four aortic disease patients.

Five-year outcomes of endovascular treatment for aortic dissection from the Global Registry for Endovascular Aortic Treatment.

Objective: The Global Registry for Endovascular Aortic Treatment (GREAT) is an International prospective multicenter registry collecting real-world data on performance of Gore aortic endografts. The purpose was to analyze the long-term outcomes and patient survival rates, as well as device performance in patients undergoing thoracic endovascular aortic repair for acute and chronic and complicated or uncomplicated type B aortic dissection (TBAD).

Methods: From August 2010 to October 2016, 5014 patients were enrolled in the GREAT registry.

Social Determinants of Health Factors and Loss-To-Follow-Up in the Field of Vascular Surgery.

Background: It is estimated that 22-57% of vascular patients are lost to follow-up (LTF) which is of concern as the Society of Vascular Surgery recommends annual patient follow-up. The purpose of this report was to identify social determinants of health factors (SDoH) and their relationship to LTF in vascular patients.

Methods: The methods employed were a systematic literature review of 29 empirical articles and a retrospective quality improvement report with 27 endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) patients at the University of Chicago.

Endosutured Aneurysm Repair of Abdominal Aortic Aneurysms with Short Necks Achieves Acceptable Midterm Outcomes-Results from the Peru Registry.

Background: The study aims to describe midterm outcomes following treatment of infrarenal abdominal aortic aneurysms (AAAs) with short necks by endosutured aneurysm repair using the Heli-FX EndoAnchor system.

Methods: This is a retrospective study of prospectively collected data from 9 vascular surgery departments between June 2010 and December 2019, including treated AAAs with neck lengths ≤10 mm. The decision for the use of EndoAnchors was made by the treating surgeon or multidisciplinary aortic committee according to each center's practice.

Intravascular lithotripsy supported endovascular aneurysm repair.

As the use of endovascular aneurysm repair (EVAR) increases, anatomic constraints remain a challenge. In this case report, we describe the use of intravascular lithotripsy to facilitate EVAR in a patient with a severely calcified and stenotic aortic bifurcation. Future applications of intravascular lithotripsy could help expand the use of EVAR to patients with severely stenotic vasculature and optimize outcomes in the treatment of infrarenal abdominal aortic aneurysms.

Five-year outcomes for bell bottom, iliac branch endoprosthesis, and coil and cover approaches from the GREAT registry.

Objective: There are a variety of methods used today to treat common iliac aneurysms with endovascular techniques. Of these approaches, little is known about whether a particular limb strategy influences endoleak, reintervention, or aneurysm regression rates. We present 5-year data comparing endoleak, stent graft migration, fracture, aneurysm sac dynamics, and aortic rupture rates among patients treated with bell bottom limbs (BB), iliac branch endoprosthesis (IBE), and coil and cover (CC) approaches from the Global Registry for Endovascular Aortic Treatment registry.

The geometric evolution of aortic dissections: Predicting surgical success using fluctuations in integrated Gaussian curvature.

Clinical imaging modalities are a mainstay of modern disease management, but the full utilization of imaging-based data remains elusive. Aortic disease is defined by anatomic scalars quantifying aortic size, even though aortic disease progression initiates complex shape changes. We present an imaging-based geometric descriptor, inspired by fundamental ideas from topology and soft-matter physics that captures dynamic shape evolution.

Current Medicare reimbursement for complex endovascular aortic repair is inadequate based on results from a multi-institutional cost analysis.

Objective: Complex endovascular juxta-, para- and suprarenal abdominal aortic aneurysm repair (comEVAR) is frequently accomplished with commercially available fenestrated (FEVAR) devices or off-label use of aortoiliac devices with parallel branch stents (chEVAR). We sought to evaluate the implantable vascular device costs incurred with these procedures as compared with standard Medicare reimbursement to determine the financial viability of comEVAR in the modern era.

Methods: Five geographically distinct institutions with high-volume, complex aortic centers were included.

Novel Approach to Maintaining Patency of an Abdominal Aortic Graft Required for Emergent Cannulation.

A 32-year-old woman with end-stage heart failure and complex anatomy underwent placement of a vascular graft to facilitate arterial cannulation during planned heart transplantation. The procedure involved anastomosis of a prosthetic graft to the abdominal aorta. The vascular graft was plugged with a silicone Foley catheter containing a stopper to maintain patency.

Raised BMI is associated with fewer Type I endoleaks in patients treated with the Gore Excluder device: data from the Global Registry for Endovascular Aortic Treatment (GREAT).

Background: Obesity is increasing in prevalence globally and within the cohort of vascular surgical patients, leading to poorer outcomes. There are few data on endoleak as a complication of AAA surgery in obese patients. The aim of this study was to use large scale registry data from the Global Registry for Endovascular Aortic Treatment (GREAT) to interrogate any relationship between obesity and endoleak following endovascular aneurysm repair (EVAR) using a Gore Excluder device (W.

Race-based outcomes of thoracic aortic aneurysms and dissections in the Global Registry for Endovascular Aortic Treatment.

Objective: This study characterizes racial differences in presentation, as well as short- and long-term outcomes after endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD).

Methods: We queried the Gore Global Registry for Endovascular Aortic Treatment for thoracic endovascular aortic repairs (TEVARs) performed between 2010 and 2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD.