EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2026-06-23DOI: 10.1016/j.ejvsvf.2026.06.004
Geoffrey Ying, Niklas Juth, Anders Wanhainen, Rickard Lindblom, Stefan James, Carlota Fernandez Prendes, Kevin Mani
{"title":"Endo-Bentall Repair for Inoperable Aortic Disease: Balancing Innovation and Ethical Responsibility","authors":"Geoffrey Ying, Niklas Juth, Anders Wanhainen, Rickard Lindblom, Stefan James, Carlota Fernandez Prendes, Kevin Mani","doi":"10.1016/j.ejvsvf.2026.06.004","DOIUrl":"10.1016/j.ejvsvf.2026.06.004","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the ethics of introducing the Endo-Bentall (a novel high risk procedure) in the context of compassionate care and to make practical recommendations to support its incorporation into practice.</div></div><div><h3>Methods</h3><div>A seven step ethical framework was systematically applied to three clinical vignettes involving the Endo-Bentall procedure. Ethical issues identified across cases were synthesised and used to develop practical recommendations for clinical practice.</div></div><div><h3>Results</h3><div>Decision making regarding the Endo-Bentall procedure is challenging in the absence of robust outcome data. Patients amenable to treatment represent a highly heterogeneous population, with a high degree of variability in procedural risk, likelihood of technical success, consequences of failure, and uncertainty of long term durability. Despite this, ethical justification may be achievable in carefully selected cases where anticipated benefits proportionately outweigh risks, particularly in the context of otherwise limited therapeutic alternatives.</div></div><div><h3>Conclusion</h3><div>Ethical implementation of the Endo-Bentall procedure is possible in select patients. However, structured safeguards are necessary. These include enhanced informed consent processes with explicit disclosure of the learning curve, limited validation, and unknown long term outcomes; mitigation of potential conflicts of interest through independent or external case review; formal oversight mechanisms despite its classification as compassionate or innovative care; and integration within a learning health system framework with ongoing data reporting and outcome monitoring.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 37-44"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580325","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2026-06-05DOI: 10.1016/j.ejvsvf.2026.05.005
Michal Proczka, Mohammad Zagzoog, Stéphan Haulon
{"title":"A Technique to Avoid Endograft Lumen Narrowing during Endovascular Aortic Arch Repair in Chronic Dissections","authors":"Michal Proczka, Mohammad Zagzoog, Stéphan Haulon","doi":"10.1016/j.ejvsvf.2026.05.005","DOIUrl":"10.1016/j.ejvsvf.2026.05.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of retrograde branches during endovascular aortic arch repair in chronic dissections has been associated with endograft lumen compression in the distal arch true lumen. This results in a functional pseudocoarctation, which carries a risk of cardiac failure.</div></div><div><h3>Technique</h3><div>This exemplar case presents a patient treated with a three-branch arch endograft for an anastomotic false aneurysm and a residual chronic arch dissection extending to the supra-aortic trunks. To overcome device compression, a kissing angioplasty of the endograft and the left common carotid artery branch was performed after achieving wire access to the left subclavian artery. This manoeuvre successfully disrupted the distal arch lamella while securing the left common carotid artery bridging stent and maintaining access to the left subclavian artery.</div></div><div><h3>Discussion</h3><div>This technique is now routinely performed in all patients presenting with chronic aortic dissections. In the authors’ limited recent experience with short-term follow up, no instances of cardiac failure secondary to endograft lumen narrowing have been observed since implementing this manoeuvre. It appears to be a feasible and effective method for overcoming endograft lumen compression and its associated complications.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 33-36"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148500798","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2026-03-04DOI: 10.1016/j.ejvsvf.2026.02.005
Chee Yee Hew Belle , George A. Antoniou
{"title":"Systematic Review, Meta-analysis, and Trial Sequential Analysis of Randomised Controlled Trials Comparing Balloon Expandable with Self Expanding Stents for the Treatment of Iliac Artery Occlusive Disease","authors":"Chee Yee Hew Belle , George A. Antoniou","doi":"10.1016/j.ejvsvf.2026.02.005","DOIUrl":"10.1016/j.ejvsvf.2026.02.005","url":null,"abstract":"<div><h3>Introduction</h3><div>This review aimed to investigate the efficacy and safety of balloon expandable <em>vs</em>. self expanding stents in the treatment of iliac artery occlusive disease.</div></div><div><h3>Method</h3><div>A systematic review of randomised controlled trials (RCTs) comparing balloon expandable with self expanding stents for the treatment of iliac artery occlusive disease was conducted following PRISMA guidelines. MEDLINE and Embase were searched using the Ovid interface. Meta-analysis and trial sequential analysis were performed. Dichotomous data were pooled using fixed effects models (Mantel–Haenszel method). Trial sequential analysis assumed alpha = 5% and power = 80%. The revised Cochrane tool and GRADE framework were used to assess risk of bias (RoB) and certainty of evidence, respectively.</div></div><div><h3>Results</h3><div>Three RCTs reporting 891 patients were included. Meta-analysis found no statistically significant difference in target vessel revascularisation (TVR) (odds ratio [OR] 1.55, 95% confidence interval [CI] 0.43–5.58; <em>p</em> = .50), primary patency (OR 1.24, 95% CI 0.34–4.48; <em>p</em> = .74), amputation (risk difference 0.00, 95% CI –0.02 – 0.02; <em>p</em> = .99), and major adverse vascular events (OR 1.89, 95% CI 0.90–3.97; <em>p</em> = .090) when balloon expandable stents were compared with self expanding stents. For target lesion revascularisation (TLR), the results favoured self expanding stents (OR 2.26, 95% CI 1.00–5.11; <em>p</em> = .050) with borderline statistical significance. Odds of death were lower for self expanding stents (OR 3.25, 95% CI 1.16–9.05; <em>p</em> = .020). Trial sequential analysis confirmed that further trials are required to demonstrate a significant effect. There were “some concerns” in RoB for TLR and TVR, and high RoB in one study for primary patency. Certainty of evidence was low.</div></div><div><h3>Conclusion</h3><div>Meta-analysis of highest level data showed no significant difference in certain clinical outcomes between balloon expandable and self expanding stents in the treatment of iliac artery occlusive disease. Overall, there are insufficient data in the current literature to ascertain the superiority of one stent strategy over another, and trial sequential analysis confirmed that further trials are required.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 152-161"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147713727","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2025-11-15DOI: 10.1016/j.ejvsvf.2025.11.002
Nitin J. Inbaraj , Madhavi Kandagaddala , Shyamkumar N. Keshava , L. Samuel Prabhu Mithra , Jackwin Sam Paul , Santhosh Babu , Jennifer Prabhu , Dheepak Selvaraj
{"title":"Fibroadipose Vascular Anomaly: A Distinct Vascular Malformation","authors":"Nitin J. Inbaraj , Madhavi Kandagaddala , Shyamkumar N. Keshava , L. Samuel Prabhu Mithra , Jackwin Sam Paul , Santhosh Babu , Jennifer Prabhu , Dheepak Selvaraj","doi":"10.1016/j.ejvsvf.2025.11.002","DOIUrl":"10.1016/j.ejvsvf.2025.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Fibroadipose vascular anomaly (FAVA) is a rare and complex vascular malformation. It primarily involves the venous components and is characterised by a matrix of fibrofatty tissue. This study aimed to describe the features of FAVA that differentiate it from venous malformation (VM).</div></div><div><h3>Method</h3><div>A retrospective series of 62 patients diagnosed with FAVA from August 2019 to February 2022 at a tertiary care centre in South India was analysed. The diagnosis was confirmed by histopathology (<em>n</em> = 35) or characteristic magnetic resonance imaging (MRI) findings (<em>n</em> = 27), reviewed by a multidisciplinary team. For the radiological analysis, 21 cases (with proven biopsy, in hospital MRI, and no prior intervention) of FAVA were selected; these were compared with 36 patients with slow flow peripheral VMs confirmed by MRI.</div></div><div><h3>Results</h3><div>FAVA (43.5% males) and VM (55.6% males) presented at a mean age of 26.5 ± 13.1 and 23.7 ± 10.9 years, respectively. While both presented with swelling (93.7% and 94.4%, respectively), pain was significantly more prevalent among FAVA (87.1% <em>vs.</em> 52.8%). FAVA predominantly affected the lower limbs (79%), while VMs had a broader distribution. FAVA was misdiagnosed in 74% of cases, most commonly as VMs. On MRI, FAVAs more frequently demonstrated an intramuscular lesion (90.5% <em>vs.</em> 19.4%; <em>p</em> < .001) with fat proliferation (95.2% <em>vs.</em> 5.5%; <em>p</em> < .001) and fibrosis (90.5% <em>vs.</em> 2.7%; <em>p</em> < .001). FAVAs were also associated with periosteal reaction of bones (28.6% <em>vs.</em> 0%; <em>p</em> < .001) and neural encasement (14.3% <em>vs.</em> 2.7%; <em>p</em> = .26). Both FAVA and VM had vascular spaces (66.7% <em>vs.</em> 80.6%) in which VMs more frequently exhibited phleboliths (52.8% <em>vs.</em> 23.8%; <em>p</em> = .033) and fluid levels (33.9% <em>vs.</em> 0%; <em>p</em> < .001), while FAVA showed the presence of thrombus (61.9% <em>vs.</em> 22.2%; <em>p</em> = .003).</div></div><div><h3>Conclusion</h3><div>FAVA is a clinically and radiologically distinct entity. Recognition of the characteristic MRI features of FAVA, particularly intramuscular fat and fibrosis, may aid in early diagnosis and guide appropriate multidisciplinary management.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 118-122"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612436","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":"Pedicle Screw–Aortic Interaction: A Single Centre Experience and Proposal for a Morphology Based Management Algorithm","authors":"Federica Campana, Stefano Ancetti, Chiara Cini, Paolo Spath, Alessia Pini, Enrico Gallitto, Alessandro Gasbarrini, Mauro Gargiulo","doi":"10.1016/j.ejvsvf.2026.07.007","DOIUrl":"10.1016/j.ejvsvf.2026.07.007","url":null,"abstract":"<div><h3>Objective</h3><div>Pedicle screw (PS) fixation is widely used in thoracolumbar spine surgery. Although major vascular injury is uncommon, PS–aortic interactions may lead to severe complications, and optimal management remains poorly defined. This study proposes a morphology based algorithm to guide multidisciplinary management of PS–aortic interactions and reports a single centre experience.</div></div><div><h3>Methods</h3><div>All consecutive patients referred to a vascular surgery unit between 2020 and 2025 for PS interaction with the descending thoracic aorta were reviewed retrospectively. Pre-operative assessment was performed using contrast enhanced computed tomography angiography (CTA). Screw–aorta interactions were classified as near contact (NC), aortic contact (AC), aortic indentation (AI), or aortic penetration (AP). Management followed a multidisciplinary morphology based algorithm: NC and AC were managed with screw removal under serial intra-operative angiographic control, whereas AI and AP underwent prophylactic thoracic endovascular aortic repair (TEVAR).</div></div><div><h3>Results</h3><div>Eight patients (median age 25 years [interquartile range 18, 38]) were included. Indications for spinal fixation were scoliosis (<em>n</em> = 6) and trauma (<em>n</em> = 2). CTA demonstrated NC in two patients, AC in three, and AI in three; no AP cases were identified. All patients underwent a multidisciplinary vascular–spine procedure with surgical left femoral access in the lateral decubitus position. In NC and AC cases, posterior screw removal was followed by completion angiography confirming the absence of contrast extravasation; therefore, rescue TEVAR was not required. All AI cases underwent prophylactic TEVAR immediately before screw removal. Technical success was achieved in all cases. There were no major adverse aortic events, neurological complications, or 30 day deaths. At a median follow up of 26.9 months (interquartile range 7, 42), all patients were alive and asymptomatic, with no aortic related complications.</div></div><div><h3>Conclusion</h3><div>A morphology based algorithm prioritising aortic wall deformation rather than proximity alone may provide a feasible and potentially safe strategy for managing PS–aortic interactions, supporting standardised multidisciplinary decision making in this rare but high risk condition.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 90-97"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934635","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2026-01-08DOI: 10.1016/j.ejvsvf.2026.01.001
Federico Pascucci , Jennifer Canonge , Marie Corniquet , Frédéric Cochennec , Jean Sénémaud , Joseph Touma , Pascal Desgranges
{"title":"Obturator Foramen Bypass: Long Term Results of a French Case Series","authors":"Federico Pascucci , Jennifer Canonge , Marie Corniquet , Frédéric Cochennec , Jean Sénémaud , Joseph Touma , Pascal Desgranges","doi":"10.1016/j.ejvsvf.2026.01.001","DOIUrl":"10.1016/j.ejvsvf.2026.01.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Obturator foramen bypass (OFB) is an extra-anatomic lower limb revascularisation technique useful in hostile groin cases. Although described during the 1960s, this operation is often considered technically demanding and not widely used nowadays. This study reports the long term outcomes of a series of OFBs.</div></div><div><h3>Method</h3><div>This was a retrospective, observational, single centre study. All consecutive patients who underwent an OFB between 2002 and 2024 at the Henri Mondor University Hospital were included. Pre-operative patient characteristics, as well as intra-operative and post-operative data were analysed. Primary outcomes were survival and primary and secondary patency. Secondary outcomes were wound healing, freedom from re-infection, and limb salvage.</div></div><div><h3>Results</h3><div>Between 2002 and 2024, 26 patients underwent an OFB; 18 were men (69%). The mean age was 64 ± 12 years. In 21 cases (81%) the surgical indication was extensive groin infection with native vessels or prosthetic material involvement. In six cases (23%), the operation was performed under emergency conditions. A cryopreserved arterial allograft was the conduit of choice in 16 cases (62%). Mean follow up was 37 ± 8 months (range, 0–129). The thirty day mortality rate was 15%. Survival rate at 12, 24, and 36–60 months was 73%, 67%, and 60%, respectively. The primary patency rate was 88% at 12 months and 83% at 24–60 months. An early re-intervention was needed in eight patients (31%), mostly for local wound debridement. There were no cases of bypass re-infection requiring removal.</div></div><div><h3>Conclusion</h3><div>Obturator foramen bypass can be a limb and lifesaving procedure in selected cases and experienced centres. Long term patency and wound healing rates are satisfactory. The authors reported a non-negligible early mortality rate, which is associated with the severe initial condition of these patients, often admitted with septic or haemorrhagic shock, and affected by multiple comorbidities. Thorough knowledge of the technique and continuous post-operative follow up are mandatory to eventually prevent and treat complications.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 68-74"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147396489","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2025-12-18DOI: 10.1016/j.ejvsvf.2025.12.003
Louise Koskas , Alexandre Oliny , Stéphan Haulon
{"title":"Looping Stent as a Bailout Manoeuvre Following Carotid Stent Dislocation During Complex Arch Endografting","authors":"Louise Koskas , Alexandre Oliny , Stéphan Haulon","doi":"10.1016/j.ejvsvf.2025.12.003","DOIUrl":"10.1016/j.ejvsvf.2025.12.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular aortic arch repair using branched devices is an emerging alternative to open surgery in selected high risk patients. Although bridging stent complications are well described during follow up of fenestrated or branched repairs, intra-operative events are still rarely reported.</div></div><div><h3>Report</h3><div>A rare case of intra-operative disconnection of a carotid bridging stent during total endovascular aortic arch repair using a custom made three branch endograft is reported. The complication was caused by guidewire entanglement during challenging catheterisation of a dissected left subclavian artery. Prompt recognition and successful endovascular correction avoided major complications.</div></div><div><h3>Discussion</h3><div>This case highlights a potential pitfall during branched endovascular repair. Awareness of such intra-operative risks is essential to prevent technical failure in this challenging and evolving field.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 55-57"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277433","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}
EJVES Vascular ForumPub Date : 2026-01-01Epub Date: 2026-04-25DOI: 10.1016/j.ejvsvf.2026.04.002
Daniel Hinck , Catharina Gäth , Sabine Wipper , Sebastian Debus
{"title":"Comparison of a New Halloysite Based Haemostatic Gauze (SpeedM) With a Kaolin Based Gauze (QuikClot Combat Gauze) in a Standardised Lethal Porcine Model of Uncontrolled Haemorrhage","authors":"Daniel Hinck , Catharina Gäth , Sabine Wipper , Sebastian Debus","doi":"10.1016/j.ejvsvf.2026.04.002","DOIUrl":"10.1016/j.ejvsvf.2026.04.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The study investigates the effectiveness of a newly developed halloysite coated haemostatic gauze (haemostatic gauze (HG), SpeedM) compared with kaolin coated QuikClot Combat Gauze (CG) in a standardised lethal porcine model of arterial haemorrhage. The study aimed to evaluate halloysite's potential as a novel haemostatic agent for traumatic bleeding treatment.</div></div><div><h3>Method</h3><div>Twenty-one anticoagulated pigs underwent a standardised femoral artery injury under anaesthesia. The animals were randomised to treatment with either HG (<em>n</em> = 10) or CG (<em>n</em> = 11). After a five minute compression at 200 mmHg, haemostatic performance was assessed based on primary haemostasis, need for secondary application, haemodynamic stability, and survival over a sixty minute observation period after returning to baseline.</div></div><div><h3>Results</h3><div>Both products achieved primary haemostasis under controlled conditions. Secondary application defined as primary failure was needed in 10% of HG (<em>n</em> = 1) and 18% of CG (<em>n</em> = 2) but without fatality. The mortality rate owing to unstoppable bleeding defined as final failure was lower in the HG group (10%, <em>n</em> = 1) than in the CG group (27%, <em>n</em> = 3). One death occurred in each group before a mean arterial pressure ≥60 mmHg was reached. The other two of the three CG fatalities occurred at a mean arterial pressure >60 mmHg.</div></div><div><h3>Conclusion</h3><div>Although no statistically significant differences were observed between HG and CG regarding mortality (<em>p</em> = .59) or re-application rates (<em>p</em> = 1.0), the unique physicochemical properties of halloysite may warrant further investigation in future adequately powered studies.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 2-8"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148193626","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}