EJVES Vascular Forum最新文献

{"title":"Inner Branched Endovascular Repair of a Post-Type B Dissection Aneurysm Previously Treated With a Nellix in Both Lumens: Making the Most of a Complex Situation","authors":"Talje M. Fokkema ,&nbsp;Wajdi Alrawi ,&nbsp;Håkan Åstrand ,&nbsp;Robert C. Lind","doi":"10.1016/j.ejvsvf.2026.01.007","DOIUrl":"10.1016/j.ejvsvf.2026.01.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment of chronic type B aortic dissection associated aneurysms where key vessels originate from both the true and false lumens is technically challenging. Further aneurysm formation may require new interventions after initial treatment. Innovative endovascular techniques can lead to successful treatment.</div></div><div><h3>Report</h3><div>A 74 year old man with a type B dissection was treated with an urgent femorofemoral crossover bypass (in 2001) and surgical graft in the thoracic aorta (in 2003). Due to the combination of a chronic type B dissection and a right sided common iliac artery aneurysm, he was subsequently treated with two separate Nellix endoprotheses (Endologix Inc., Irvine, CA, USA) in the infrarenal aorta. The Nellix endoprotheses were deployed in the true and the false lumens (in 2015). Eight years later, he required another intervention due of progressive enlargement of the thoracic aorta between the surgical graft and Nellix endoprotheses. The chosen treatment was a customised two inner branch thoracic endovascular aortic repair (TEVAR) and four inner branch endovascular aortic repairs, in combination with long Viabahn stent grafts from the TEVAR to the old Nellix endoprothesis in the false lumen (in 2021). All stent grafts were patent at three years of follow up.</div></div><div><h3>Discussion</h3><div>This case report presents a patient in whom former techniques were used as an initial treatment for a chronic type B dissection with aneurysm formation complicating further treatment. This report highlights what can be achieved with careful planning in combination with new available devices, resulting in a good individual outcome.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 114-117"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Clipping of the Inferior Mesenteric Artery for the Treatment of Type II Endoleak Using Intra-operative Indocyanine Green Fluorescence Angiography","authors":"Irene D. Kikkert,&nbsp;Steven J.G. Leeuwerke,&nbsp;Harry G.M. Vaassen","doi":"10.1016/j.ejvsvf.2026.06.005","DOIUrl":"10.1016/j.ejvsvf.2026.06.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Type II endoleaks (T2ELs) are a common finding after endovascular aortic repair (EVAR), often caused by retrograde flow from the inferior mesenteric artery (IMA). Although transarterial embolisation is standard, laparoscopic IMA ligation may provide a definitive alternative in selected cases. Indocyanine green fluorescence angiography (ICG-FA) adds real time vascular visualisation, helping the identification and confirmation of successful ligation. This report illustrates the potential benefit of Indocyanine green guided laparoscopic IMA clipping for managing T2ELs.</div></div><div><h3>Technique</h3><div>The case of a 69 year old man with an abdominal aortic aneurysm who underwent emergency EVAR for a ruptured left iliac artery aneurysm is presented. At two year follow up, computed tomography angiography revealed a persistent T2EL originating from the IMA, resulting in abdominal aortic aneurysm growth. Given the aneurysm’s progression, laparoscopic IMA clipping using ICG-FA was performed. The IMA was identified, and ICG-FA was used to confirm its precise location before applying ligation clips to occlude the vessel. Successful exclusion was further confirmed with repeated ICG-FA. Post-operative recovery was uneventful, and no endoleaks were detected on follow up imaging (computed tomography angiography).</div></div><div><h3>Discussion</h3><div>ICG-FA laparoscopic clipping of the IMA may offer a safe and effective treatment option in selected cases for persistent T2ELs after EVAR. Compared with endovascular options, it allows direct exclusion of the inflow vessel with real time visual confirmation. ICG-FA can provide real time functional imaging of vascular perfusion, enabling intra-operative identification of the IMA and objective confirmation of successful vessel occlusion. Its integration is practical, widely accessible, and may increase the safety and confidence of laparoscopic IMA ligation in selected patients.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 45-48"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13396752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148585295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Renal Outcomes and Procedural Efficacy of Carbon Dioxide Digital Subtraction Angiography in Endovascular Aortic Repair","authors":"Paolo Spath ,&nbsp;Federica Campana ,&nbsp;Enrico Gallitto ,&nbsp;Chiara Mascoli ,&nbsp;Andrea Vacirca ,&nbsp;Rodolfo Pini ,&nbsp;Gianluca Faggioli ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.ejvsvf.2025.12.004","DOIUrl":"10.1016/j.ejvsvf.2025.12.004","url":null,"abstract":"<div><h3>Objective</h3><div>Carbon dioxide (CO₂) has been proposed as a contrast agent during endovascular aortic repair (EVAR) to minimise the risk of worsened post-operative renal function (PO-RFW). However, strong clinical evidence supporting its widespread use remains limited. This systematic review aimed to evaluate current literature on the use of CO₂ digital subtraction angiography (DSA) during EVAR, with particular attention to renal outcomes and procedural efficacy.</div></div><div><h3>Data Sources</h3><div>Systematic searches were conducted in PubMed, Scopus, and the Cochrane Library for studies published up to December 2024 reporting the use of CO₂-DSA during standard EVAR.</div></div><div><h3>Review Methods</h3><div>The review was registered prospectively in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024580889). All papers reporting the use of CO₂-DSA during EVAR were included. The primary outcome was the incidence of PO-RFW, and secondary outcomes included procedural success, arterial image visualisation quality, endoleak detection, and radiation exposure.</div></div><div><h3>Results</h3><div>Of the 108 articles initially identified, 16 studies published between 2007 and 2024 met the inclusion criteria, reporting data on 901 patients (mean age 76 years; 89.1% men) undergoing EVAR with CO₂-DSA. Among these, 622 (69.0% ) were treated exclusively with CO₂-DSA. All studies published since 2018 adopted an automatic injector. Seven studies comparedPO-RFW using different definitions; three of the included studies reported a statistically significantrole for CO₂-DSA in renal protection. Three studies reported a higher dose of radiation during CO₂-EVAR. Renal and hypogastric arteries were effectively visualised during repair in 53–100% and 94–100% of cases, respectively. Data on endoleak detection were heterogeneous, limiting definitive conclusions.</div></div><div><h3>Conclusion</h3><div>The use of CO₂ as contrast medium in EVAR appears to be safe and effective. Evidence suggests potential benefits for renal protection, although inconsistencies are reported regarding study design and outcome definitions. Further research is necessary to standardise CO₂ delivery, imaging assessment criteria, and renal outcome definitions. To standardise clinical practice, a defined protocol is needed to maximise its advantages in everyday practice.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 58-67"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Grasping Thin Polypropylene Sutures Even With Less Traumatic Instruments May Decrease Their Tensile Strength","authors":"Damir Vakhitov ,&nbsp;Olli Tanhuanpää ,&nbsp;Markus Kakkonen ,&nbsp;Pasi Kallio ,&nbsp;Niku Oksala","doi":"10.1016/j.ejvsvf.2026.03.007","DOIUrl":"10.1016/j.ejvsvf.2026.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>Anastomotic false aneurysms can form due to damaged polypropylene sutures (PS). This study aimed to examine whether pinching PS with modern less traumatic vascular instruments affects their tensile strength (TS).</div></div><div><h3>Methods</h3><div>Fifteen pairs each of 3–0 Prolene and 4-0 and 5-0 Optilene, as well as 18 pairs each of 6–0 and 7-0 Surgipro II PS were tested. Half of the sutures were compressed with a Jacobson Micro Needle Holder (NH) and half with DeBakey atraumatic tissue forceps (TF) for two seconds using a standardised pressure force of 40.8 ± 5.0 g. The pressure was based on the mean pinch force produced by a total of six experienced vascular surgical consultants. The same unpaired numbers of these PS served as references. Samples were tested for breakage on a traction device with a tensile force sensor. The TS was calculated for each sample and compared with the reference. Two sets of sutures of each size, containing five NH and TF compressions on each set, were examined for possible surface damages with optical tomography.</div></div><div><h3>Results</h3><div>A statistically significant TS decrease was detected only after NH compression of 6–0 (<em>p</em> = 0.003) and 7-0 (<em>p</em> &lt; 0.001) PS. On optical tomography, the extent of post-compression changes increased with decreasing diameter; the changes were similar throughout the corresponding size and instrument groups. Surfaces compressed with an NH were evenly deformed and rough, with multiple cortex damages. PS pinched with TF were unevenly deformed. The visually detectable surface damage was less extensive compared with what was observed after NH compressions.</div></div><div><h3>Conclusion</h3><div>Pinching of the tested PS led to structural deformations and superficial cortex damage. Compressions of 6–0 and 7-0 PS with an NH led to significant TS reduction.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 181-186"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147749126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Imaging Modalities for Superior Mesenteric Artery Stenosis: A Single Centre Study","authors":"Alexandra A. Brandtzäg ,&nbsp;Jonas P. Eiberg ,&nbsp;Mikkel Taudorf ,&nbsp;Lars B. Lönn ,&nbsp;Timothy A. Resch","doi":"10.1016/j.ejvsvf.2026.03.001","DOIUrl":"10.1016/j.ejvsvf.2026.03.001","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate intra-arterial pressure measurement (IAPM) in relation to pre- and intra-operative diagnostic methods for assessing superior mesenteric artery (SMA) stenosis in patients with a diagnosis of chronic mesenteric ischaemia.</div></div><div><h3>Method</h3><div>This secondary analysis compares computed tomography angiography (CTA), duplex ultrasound (DUS), digital subtraction angiography (DSA), and IAPM, using IAPM as the reference standard. Thirty patients were enrolled in the Copenhagen Mesenteric Stent Study (COMESS), a randomised clinical trial evaluating covered <em>vs.</em> uncovered stents for treating SMA stenosis (COMESS trial, <span><span>ClinicalTrials.org</span><svg><path></path></svg></span> identifier NCT05244629). All included patients were thoroughly examined upon referral to exclude other relevant causes of chronic abdominal pain. All patients had a clinical diagnosis of chronic mesenteric ischaemia and &gt;50% SMA stenosis on CTA. All underwent DUS, DSA, and IAPM. DUS assessed the peak systolic velocity (centimetres per second) across the SMA. During endovascular intervention, DSA was performed in the anteroposterior and lateral projections. A dedicated pressure wire measured the trans-stenotic mean arterial pressure gradient between the SMA and aorta.</div></div><div><h3>Results</h3><div>There was a statistically significant positive correlation between DUS and IAPM (<em>r</em> = 0.698, <em>p</em> = 0.003, 95% confidence interval 253–373), indicating a moderately strong association, with a peak systolic velocity of 372 cm/sec on DUS corresponding to a mean arterial pressure between 15 and 20 mmHg. DSA showed a non-significant correlation with IAPM (<em>r</em> = 0.376, <em>p</em> = 0.11, standard deviation 0.128), with 59% stenosis corresponding to a 10 mmHg gradient. There was no significant correlation between CTA and IAPM (<em>r</em> = 0.143, <em>p</em> = 0.50, 95% confidence interval −43 – 60).</div></div><div><h3>Conclusion</h3><div>DUS shows the best association with IAPM when differentiating a significant SMA stenosis. In contrast, CTA demonstrated no significant correlation with IAPM; however, CTA is of importance for differential diagnosis. Therefore, when SMA stenosis is identified on CTA, further confirmation with DUS is recommended, for moderate to less than pre-occlusive or occlusive SMA stenosis, to determine the need for DSA and potential endovascular treatment.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 162-169"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147713726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Floating Thrombus of the Internal Carotid Artery: A Case Report","authors":"Miguel Castro e Silva,&nbsp;João Alegrio,&nbsp;Manuel Fonseca","doi":"10.1016/j.ejvsvf.2026.05.003","DOIUrl":"10.1016/j.ejvsvf.2026.05.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Carotid free floating thrombus is a rare vascular condition associated with a high risk of early cerebral embolisation. It may occur in the absence of significant carotid stenosis, which complicates therapeutic decision making. Owing to its rarity, optimal management remains controversial, with both medical and surgical strategies described.</div></div><div><h3>Report</h3><div>A 66 year old woman presented with transient right upper limb paraesthesia consistent with a transient ischaemic attack. Computed tomography angiography and duplex ultrasound revealed a mobile free floating thrombus measuring 16–18 mm in the proximal left internal carotid artery, without associated stenosis, plaque ulceration, or dissection. Neurovascular imaging demonstrated a patent circle of Willis and normal intracranial perfusion. Given the thrombus mobility and recent neurological symptoms, urgent surgical thrombectomy was performed under general anaesthesia with cerebral monitoring. The thrombus was removed <em>en bloc</em> without complications. Post-operatively, the patient was treated with anticoagulant and statin therapy. At one year follow up, she remained asymptomatic, with imaging confirming sustained carotid patency and no recurrent thrombus.</div></div><div><h3>Discussion</h3><div>This case highlights that carotid free floating thrombus can present without underlying carotid stenosis and still pose a significant embolic risk. Thrombus morphology, clinical presentation, and cerebrovascular anatomy are key factors guiding management. In selected symptomatic patients with favourable collateral circulation, urgent surgical thrombectomy may represent a safe and effective therapeutic option. Careful post-operative antithrombotic management and imaging surveillance remain important components of overall care.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 17-21"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Outcomes of Zone 2 Thoracic Endovascular Aortic Repair with an Integrated Branch Stent Graft for the Left Subclavian Artery: Evidence from a Western Centre","authors":"Antonio Marzano,&nbsp;Claudia Bittoni,&nbsp;Francesca Miceli,&nbsp;Marta Ascione,&nbsp;Luca di Marzo,&nbsp;Wassim Mansour","doi":"10.1016/j.ejvsvf.2026.06.001","DOIUrl":"10.1016/j.ejvsvf.2026.06.001","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic endovascular aortic repair (TEVAR) is widely used for thoracic aortic diseases, most commonly with a proximal landing in Ishimaru zone 3. When an adequate proximal sealing zone is lacking, extension into zone 2 is required, often necessitating left subclavian artery (LSA) revascularisation. The Castor single branched stent graft provides a fully endovascular solution for zone 2 TEVAR by incorporating an antegrade branch for the LSA. This study reports a single centre Western experience with this device.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on 15 consecutive patients undergoing elective zone 2 TEVAR with the Castor single branched stent graft between July 2023 and December 2025. Indications included thoracic aortic aneurysm, subacute or chronic Stanford type B dissection, and penetrating aortic ulcer. The primary endpoint was technical success, defined as accurate deployment without type I or III endoleak and with preserved LSA patency. Secondary endpoints included clinical success, access related complications, intensive care unit (ICU) and hospital stays, re-intervention, and death. Follow up consisted of serial computed tomography angiography.</div></div><div><h3>Results</h3><div>The mean age was 63.9 ± 11 years, and 87% of patients were men. Technical and clinical success were achieved in 14 patients (93%). One patient required adjunctive covered stenting of the LSA for incomplete branch expansion. There were no access related complications or 30 day deaths. Mean ICU and hospital stays were 1.2 ± 0.6 days and 15.3 ± 9.6 days, respectively. Over a mean follow up of 13.5 ± 8.4 months, all LSA branches remained patent, with no endoleak, device migration, or re-intervention.</div></div><div><h3>Conclusion</h3><div>Zone 2 TEVAR using the Castor single branched stent graft appears feasible, safe, and effective in a Western population. In this small elective series, LSA branch patency was maintained and no device related re-intervention occurred during available follow up. Larger studies with longer follow up are needed to assess durability and longer term outcomes.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 26-32"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148500796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visceral Artery Injuries during Nephrectomy: A Systematic Review of Published Cases","authors":"Marion Cano,&nbsp;Anne Lejay,&nbsp;Hervé Lang,&nbsp;Nabil Chakfé","doi":"10.1016/j.ejvsvf.2026.07.004","DOIUrl":"10.1016/j.ejvsvf.2026.07.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Visceral artery injuries during nephrectomy, such as superior mesenteric artery (SMA) and coeliac artery (CA) injuries, are rare but potentially lethal complications. This systematic review was performed with a focus on visceral artery injuries during nephrectomy in order to describe how to prevent and manage SMA or CA injuries.</div></div><div><h3>Method</h3><div>A systematic literature review was performed in Medline and the Cochrane Library from inception to December 2025 to identify published case reports and case series of SMA or CA injuries during nephrectomy. MeSH terms used were: “mesenteric artery, superior” “coeliac artery”, “intra-operative complications”, and “iatrogenic disease”. Outcomes of interest were initial operative indication, cause and type of injury, anatomic risk factors, timing of diagnosis, type of vascular repair, and patient outcome. Quality of the studies was assessed according to the CARE guidelines.</div></div><div><h3>Results</h3><div>After duplicate removal, screening, and full text eligibility assessment, 16 publications of varying quality reporting 20 cases of SMA and or CA injury during nephrectomy were included. All injuries occurred during left nephrectomy. Injury involved the SMA in 16 cases (80%) and both the SMA and CA in four cases (20%). The dominant mechanism was anatomic misperception: the SMA or CA was mistaken for the left renal artery, facilitated by bulky lymphadenopathy, large tumour size (median 12 cm), and post-inflammatory adhesions. SMA and CA injury was recognised intra-operatively in 16 cases (80%), while delayed diagnosis (ranging 12 – 48 hours) occurred in four cases (20%) and was associated with worse outcomes. Revascularisation was performed in 18 cases (90%), mostly by primary end to end anastomosis of the injured artery. Three patients died (15%).</div></div><div><h3>Conclusion</h3><div>Visceral artery injuries during nephrectomy carry a substantial mortality risk, especially when the diagnosis is delayed. Careful pre-operative computed tomography angiography analysis, prompt injury identification, and immediate vascular surgical support are central elements of prevention and management.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 70-76"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148854097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catching Two Birds with One Stone: A Primary Open Revascularisation First Approach in a Case Report of Chronic Mesenteric Ischaemia","authors":"Nelson Oliveira,&nbsp;Manuel João Silva,&nbsp;Bruno Pereirinha","doi":"10.1016/j.ejvsvf.2026.09.001","DOIUrl":"10.1016/j.ejvsvf.2026.09.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Symptomatic chronic mesenteric artery occlusive disease requires timely revascularisation. Although endovascular management is guideline endorsed as first line treatment, inferior mesenteric artery (IMA) revascularisation lacks evidence based guidance. This report presents a case in which an open repair first approach was selected with the IMA as the primary revascularisation target, aiming to provide long term benefit while enabling concomitant superior mesenteric artery (SMA) revascularisation.</div></div><div><h3>Report</h3><div>A 60 year old woman, who was a smoker (40 pack/year), had a past medical history of hypertension and hypercholesterolemia, and a current body mass index of 17 kg/m², was diagnosed with chronic mesenteric ischaemia (CMI). Anatomically, while both the coeliac and SMA were occluded, severe stenosis of the IMA ostium was also present. An open revascularisation addressing the IMA disease with venous patch and concomitant aorta to SMA bypass was performed through a limited midline transperitoneal approach without adverse events. The patient was discharged two days post-operatively. At one year follow up, an asymptomatic bypass stenosis just after the IMA take off (approximately 2 cm from the proximal anastomosis) was identified on duplex ultrasound (peak systolic velocity 396 cm/second, end diastolic velocity 35 cm/second) and subsequently treated with a paclitaxel eluting balloon (5 x 60 mm) with angiographic resolution. No signs of IMA re-stenosis were detected. At the six month post-angioplasty follow up, no signs of clinical or haemodynamic recurrence were noted in the SMA bypass or IMA ostium.</div></div><div><h3>Conclusion</h3><div>In selected CMI patients, an open first revascularisation strategy may be performed with a low risk of adverse events.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 103-106"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroperitoneal Abdominal Aortic Repair With the da Vinci Single Port System: A Porcine Model Feasibility Study","authors":"Toshio Takayama ,&nbsp;Hubert Stein ,&nbsp;Hideaki Obara ,&nbsp;Toshifumi Kudo ,&nbsp;Mark Preuß ,&nbsp;Rouven Berndt ,&nbsp;Sebastian Eike Debus ,&nbsp;Takayuki Komiya ,&nbsp;Hiroyuki Kaneta ,&nbsp;Fabien Thaveau","doi":"10.1016/j.ejvsvf.2025.11.007","DOIUrl":"10.1016/j.ejvsvf.2025.11.007","url":null,"abstract":"<div><h3>Objective</h3><div>Robotic surgery is rarely used in vascular surgery but has demonstrated significant potential compared with open or laparoscopic techniques in reports of abdominal aortic surgery. Enabling a standardised retroperitoneal approach (RPA) to abdominal aortic repair might reduce the peri-operative mortality and morbidity rates associated with a transabdominal approach. The aim of this experimental study was to establish surgical techniques for robotically assisted infrarenal abdominal aortic repair using a single port RPA.</div></div><div><h3>Methods</h3><div>Retroperitoneal abdominal aortic repair was performed in four live porcine models by a group of experienced and novice robotic surgeons. The procedures were performed using the da Vinci SP (single port) surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Polytetrafluoroethylene grafts (W.L. Gore &amp; Associates, Inc., Newark, DE, USA) were implanted after aortic resection. Operating times for the main procedure steps were recorded.</div></div><div><h3>Results</h3><div>Abdominal aortic repair was feasible in all porcine models applying an RPA through a single incision with the da Vinci SP system. Creating the retroperitoneal access and docking the da Vinci SP was quick, with durations ranging from eight to 20 minutes. Proximal and distal anastomoses were completed in 26 minutes (range 19–33 minutes) and 31.3 minutes (range 23–42 minutes), respectively. In porcine models 2–4, the anastomoses were patent without haemorrhage, with aortic pulsations confirmed on release of the cross clamps. Porcine model 1 was pulseless owing to uncontrolled haemorrhage caused by left external iliac artery penetration at the end of the procedure, and patency could not be tested.</div></div><div><h3>Conclusion</h3><div>Retroperitoneal single port robotic aortic repair was technically feasible with high accuracy in live porcine models. Anastomotic times were reasonable and surgeon comfort level was adequate, which may enable transfer into clinical routine in the future when true clinical benefits will need to be proven in additional studies.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 25-31"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}