In-Hospital Outcomes of Simultaneous and Staged Transcatheter Aortic Valve Replacement and Endovascular Aneurysm Repair.

Introduction: Patients with aortic aneurysms are at elevated risk of rupture, dissection and death during and after transcatheter aortic valve repair (TAVR), often requiring consideration for endovascular aneurysm repair (EVAR) at the time of TAVR. However, data comparing outcomes of simultaneous versus staged TAVR-EVAR are limited.

Methods: Using the National Inpatient Sample between the years 2018 and 2021, we compared in-hospital outcomes of simultaneous and staged TAVR-EVAR.

Single-institution experience with Shape medical polymer sponge embolization as adjunct therapy for rapid aortic remodeling in the multi-modal management of complex persistent large false lumens following aortic dissection.

Persistent false lumen (FL) pressurization after endovascular repair of aortic dissection is associated with increased aortic morbidity and mortality. Shape memory polymer sponge devices (IMPEDE-FX, Shape Medical) have shown promise in promoting sac regression after endovascular aortic repair in abdominal aortic aneurysms in ongoing trials. Here, we report the adjunct use of these devices as part of a multimodal approach to achieve FL occlusion in three patients (average age, 59 years; male = 2, female = 1) with limited options for the management of their persistent large FL following type A (n = 1) and type B (n = 2) aortic dissections between March and December 2024.

Physician Modification of Polytetrafluoroethylene Based Endografts for Aortic Aneurysm Repair.

Objective: Physician-modified endografts (PMEGs) have provided an endovascular approach for repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. While the use of polyethylene terephthalate (Dacron)-based grafts is growing, we aimed to evaluate the use and outcomes of a polytetrafluoroethylene (PTFE)-based system for such cases.

Materials And Methods: In a retrospective, single-center cohort study from November 2021 to June 2024, treatment with physician-modified PTFE endograft for complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms was assessed.

Total Arch With Hybrid Frozen Elephant Trunk Versus Branched Stented Anastomosis Frozen Elephant Trunk Repair.

Objectives: This study aims to evaluate the short-term outcomes of total arch replacement using 2 techniques: the branched stented anastomosis frozen elephant trunk repair (B-SAFER) under moderate hypothermia (25-28 °C), and a simplified total arch and hybrid arch frozen elephant trunk (HA-FET) reconstruction using the Thoraflex stent graft under mild hypothermia (>32 °C).

Methods: Sixty-one patients underwent total arch replacement between June 2020 and March 2024. 25 received HA-FET, and 36 received B-SAFER.

Surgical Management of Symptomatic Carotid Artery Webs.

ObjectiveTo demonstrate the demographic profile and postoperative outcomes among a large single-center series of patients undergoing carotid endarterectomy for carotid web.BackgroundCarotid artery web (CaW) is a shelf-like intraluminal lesion at the carotid bulb that produces stagnant flow and can result in cerebrovascular ischemia among young and otherwise healthy individuals. While there is no consensus on the ideal management strategy for CaW with ipsilateral stroke, emerging evidence favors open surgical intervention.

The association between diabetes and hypertension time course, their cumulative co-exposure, and post-coronary artery bypass graft outcomes.

Background: The association between patient outcomes and cumulative effects of cardiovascular risk factors over time is recognized but poorly quantified. This study quantitively addressed the impact of diabetes and hypertension duration, and their combined effect, on post-coronary artery bypass grafting (CABG) outcomes.

Methods: This single-center cohort study included patients who underwent coronary angiography followed by isolated CABG (n=10803, median follow-up: 111.

Adjunctive endovascular stent graft reinforcement of the common iliac vein for safer anterior lumbar interbody fusion.

Anterior lumbar surgery is associated with risk of vascular complications that lead to termination of surgical goals. We present the case of a 52-year-old male sustaining injury to the left common iliac vein (CIV) during exploration of the retroperitoneum for revision L5-S1 anterior lumbar interbody fusion. One day after initial exploration and CIV repair, a thoracic endovascular stent graft was placed across the left CIV, allowing for completion of revision anterior lumbar interbody fusion.

Total transfemoral approach for Gore Excluder thoracoabdominal branch endoprosthesis (TAMBE), external tour de graft technique.

Total transfemoral endovascular repair of thoracoabdominal aneurysms is feasible with physician-modified endografts. We present our technique for exclusively delivering the Gore Excluder thoracoabdominal branch endoprosthesis (W. L.

Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma.

Background: Thoracic endovascular aortic repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, traumatic penetrating aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI.

Methods: Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011 to 2022.

Endo-Bentall repair: Early results and feasibility of a physician-constructed Endo-Bentall device.

Objective: We present our experience with the endovascular Bentall procedure (Endo-Bentall) using a modular valve conduit in high-risk patients with aortic root pathologies.

Methods: The physician-constructed Endo-Bentall device is composed of a self-expanding transcatheter aortic valve (TAVR), thoracic endovascular aortic stent graft (TEVAR), and 2 wire-reinforced fenestrations for coronary artery stenting. The TAVR valve is sutured into an appropriately sized TEVAR graft.

From zone 1 to zone 3: Feasibility and safety of complex endovascular aortic repairs in type A aortic dissection.

Objective: More than 30% of patients presenting with acute type A aortic dissection are considered high risk or inoperable. This study aims to investigate the early and midterm outcomes of complex endovascular aortic repair of aortic root, ascending aorta, and aortic arch among patients with acute type A aortic dissection.

Methods: From January 2018 to January 2023, 29 patients who were considered high risk for open operation underwent endovascular aortic repair.

Vascular Closure Device vs Open Decannulation for Femoral Venoarterial Extracorporeal Membrane Oxygenation.

Background: Traditional decannulation of femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) involves femoral cutdown. Percutaneous methods have been developed, but data supporting their use are limited. This study sought to compare the MANTA (Teleflex) vascular closure device with open decannulation.

Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology.

Objective: The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2.

Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of Type B aortic dissection.

While much about the fundamental mechanisms behind the initiation and progression of Type B aortic dissection (TBAD) is still unknown, predictive models based on patient-specific fluid-structure interaction (FSI) simulations can help in risk stratification and optimal clinical decision-making. Aiming at the development of personalized treatment, FSI models can be leveraged to investigate the interplay between complex aortic flow patterns and anatomical features, while considering the deformation of the arterial wall and the dissection flap. In this study, the hemodynamics of false lumen thrombosis, a large fenestration, and the orbital orientation of the false lumen is studied through image-based FSI simulations on three TBAD patient-specific geometries.

Decreasing Resident Vascular Case Volumes Have Not Changed National Numbers of Vascular Fellowship Applications in US General Surgery Residents Over the Past Twenty Years.

Objectives: With an aging workforce and high prevalence of vascular disease, the US is expected to face a pronounced shortage of vascular surgeons over the next 2 decades. This has driven initiatives to expand vascular surgery training positions leading to the rise of integrated residency programs (0 + 5) and the expansion of traditional fellowships (VSFs, 5 + 2). Given the increase in dedicated vascular surgery training positions, there has been a growing concern that general surgery residents (GSRs) are experiencing decreased vascular case volumes.

Impact of operative approach and patient frailty on outcomes for aorto-iliac occlusive disease with critical limb threatening ischemia.

ObjectivesMultiple treatment modalities exist for the management of aorto-iliac occlusive disease (AIOD) including endovascular (endo), extra-anatomic bypass (EAB), and anatomic bypass (AB). The goal of this study was to examine the impact of revascularization strategy and patient frailty on outcomes for AIOD in patients with critical limb threatening ischemia (CLTI).MethodsPatients undergoing revascularization for CLTI and AIOD were identified from the NSQIP database over 5 years.

Totally percutaneous endovascular renal allograft salvage for common iliac artery pseudoaneurysm.

Delayed presentation of recipient artery pseudoaneurysms following kidney transplantation is a rare, yet critical, complication. Although the precise etiology remains unclear, factors such as chronic steroid use, iatrogenic injuries (including vascular clamp damage during index surgery), or infections could contribute. Timely surgical intervention is imperative to prevent arterial rupture and life-threatening bleeding.

Investigating the Role of Thrombosis, Fenestration, and False Lumen Orbital Orientation in the Hemodynamics of Type B Aortic Dissection.

While much about the fundamental mechanisms behind the initiation and progression of Type B aortic dissection (TBAD) is still unknown, predictive models based on patient-specific computational fluid dynamics (CFD) can help in risk stratification and optimal clinical decision-making. Aiming at the development of personalized treatment, CFD simulations can be leveraged to investigate the interplay between complex aortic flow patterns and anatomical features. In this study, the hemodynamics of false lumen thrombosis, a large fenestration, and the orbital orientation of the false lumen is studied through image-based CFD simulations on three TBAD patient-specific geometries.

A direct aorta to segmental artery bypass for prevention of spinal cord ischemia after endovascular aortic repair.

Spinal cord ischemia remains a persistent challenge after endovascular aortic aneurysm repair. We present a novel direct aorta to segmental artery bypass before aneurysm repair in a 64-year-old woman presenting with an enlarging aneurysm following dissection. Through an eighth intercostal incision, a polyester graft was sewn into the aorta using pledgeted sutures.

Nasal Intubation is not Associated with "Smoother" Emergence from General Anesthesia for Carotid Endarterectomy: A Case-Cohort Study.

Background: Postoperative hematoma after carotid endarterectomy (CEA) is a devastating complication and may be more likely in patients with uncontrolled hypertension and coughing on emergence from anesthesia. We sought to determine if intubation with a nasal endotracheal tube (ETT)-instead of an oral ETT-is associated with "smoother" (i.e.