EJVES Vascular Forum最新文献

{"title":"Systematic Review of Femoral Artery Stent Fractures","authors":"Arielle Bellissard ,&nbsp;Salomé Kuntz ,&nbsp;Anne Lejay ,&nbsp;Nabil Chakfé","doi":"10.1016/j.ejvsvf.2024.08.001","DOIUrl":"10.1016/j.ejvsvf.2024.08.001","url":null,"abstract":"<div><h3>Objective</h3><p>Primary stenting for long femoropopliteal (FP) lesions remains controversial because of the high risk of stent fracture (SF). This study aimed to summarise current knowledge on SF from randomised control trials about FP stenting.</p></div><div><h3>Methods</h3><p>A systematic review of the Medline database was performed by a combined strategy of MeSH terms: femoral artery, popliteal artery, stenting, and stent fracture. SF was classified according to a standard classification: 1 = single strut fracture; 2 = ≥ two struts fracture; 3 = type 2 with deformation; 4 = multiple struts fracture with acquired transection; 5, type 4 with gap in the stent body.</p></div><div><h3>Results</h3><p>The literature search identified 25 publications including covered stents (CSs; <em>n</em> = 3), drug eluting stents (DESs; <em>n</em> = 8), bare metal stents (BMS; <em>n</em> = 17), and bioabsorbable stents (<em>n</em> = 1). Data were extracted from 4 047 patients; mean age ± standard deviation was 68.9 ± 3.0 years and 69% were male. The median lesion length was 87.6 mm (interquartile range [IQR] 70.0, 149) with a median chronic total occlusion proportion of 36.8% (IQR 29.0, 56.5). In 208 patients treated with CS, SF rates ranged from none to 2.6% at 36 months with no clinical correlation. In 1 106 patients treated with DES, SF rates were relatively low in large cohorts, ranging from 0% at 12 months to 1.9% at 60 months. In smaller cohorts (under 100 patients per group), they ranged from 12.5% at six months to 46.7% at 12 months, with no clinical repercussion. In 1 610 patients treated with BMS, SF rates ranged from 2% to 32.7% at 12 months and from 2.9% to 48.9% at 24 months, with no clinical repercussion.</p></div><div><h3>Conclusion</h3><p>SF rates in large cohorts were low in CF and DES, and quite common in BMS, although none of them had clinical consequences. However, longer follow up and detailed, accurate reports are needed to assess eventual real clinical outcomes.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 48-56"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24001382/pdfft?md5=32f3b60fece57fb23a506c1d930b4df9&pid=1-s2.0-S2666688X24001382-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142240668","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":"Outcomes Following Vascular and Endovascular Procedures Performed During the First COVID-19 Pandemic Wave","authors":"Panagiota Birmpili ,&nbsp;Ruth A. Benson ,&nbsp;Brenig Gwilym ,&nbsp;Sandip Nandhra ,&nbsp;Nina Al-Saadi ,&nbsp;Graeme K. Ambler ,&nbsp;Robert Blair ,&nbsp;David Bosanquet ,&nbsp;Nikesh Dattani ,&nbsp;Louise Hitchman ,&nbsp;Katherine Hurndall ,&nbsp;Matthew Machin ,&nbsp;Sarah Onida ,&nbsp;Athanasios Saratzis ,&nbsp;Joseph Shalhoub ,&nbsp;Lauren Shelmerdine ,&nbsp;Aminder A. Singh","doi":"10.1016/j.ejvsvf.2024.08.002","DOIUrl":"10.1016/j.ejvsvf.2024.08.002","url":null,"abstract":"<div><h3>Objective</h3><div>The first COVID-19 pandemic wave was a period of reduced surgical activity and redistribution of resources to only those with late stage or critical presentations. This Vascular and Endovascular Research Network COVID-19 Vascular Service (COVER) study aimed to describe the six-month outcomes of patients who underwent open surgery and or endovascular interventions for major vascular conditions during this period.</div></div><div><h3>Methods</h3><div>In this international, multicentre, prospective, observational study, centres recruited consecutive patients undergoing vascular procedures over a 12-week period. The study opened in March 2020 and closed to recruitment in August 2020. Patient demographics, procedure details, and post-operative outcomes were collected on a secure online database. The reported outcomes at 30 days and six months were post-operative complications, re-interventions, and all cause in-hospital mortality rate. Multivariable logistic regression was used to assess factors associated with six-month mortality rate.</div></div><div><h3>Results</h3><div>Data were collected on 3 150 vascular procedures, including 1 380 lower limb revascularisations, 609 amputations, 403 aortic, 289 carotid, and 469 other vascular interventions. The median age was 68 years (interquartile range 59, 76), 73.5% were men, and 1.7% had confirmed COVID-19 disease. The cumulative all cause in-hospital, 30-day, and six-month mortality rates were 9.1%, 10.4%, and 12.8%, respectively. The six-month mortality rate was 32.1% (95% CI 24.2–40.8%) in patients with confirmed COVID-19 compared with 12.0% (95% CI 10.8–13.2%) in those without. After adjustment, confirmed COVID-19 was associated with a three times higher odds of six-month death (adjusted OR 3.25, 95% CI 2.18–4.83). Increasing ASA grade (3–5 <em>vs</em>. 1–2), frailty scores 4–9, diabetes mellitus, and urgent and or immediate procedures were also independently associated with increased odds of death by six months, while statin use had a protective effect.</div></div><div><h3>Conclusion</h3><div>During the first wave of the pandemic, the six-month mortality rate after vascular and endovascular procedures was higher compared with historic pre-pandemic studies and associated with COVID-19 disease.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 64-71"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318695","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":"Integrating Intravascular Lithotripsy to Overcome Severe Aorto-Iliac Atherosclerosis in Standard Endovascular Aortic Repair: A Case Report","authors":"Giuseppe Mastropaolo,&nbsp;Andrea Cumino,&nbsp;Fabiana Zandrino,&nbsp;Sara Pomatto,&nbsp;Vittorio Pasta,&nbsp;Ilaria Ambrogio,&nbsp;Alberto Pecchio","doi":"10.1016/j.ejvsvf.2024.09.005","DOIUrl":"10.1016/j.ejvsvf.2024.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular aneurysm repair (EVAR) is a safe and widespread treatment option for abdominal aortic aneurysm (AAA). Unfavourable anatomy, such as hostile neck and aorto-iliac atherosclerosis, can lead to many complications and compromise the long term reliability of the endograft, resulting in a high rate of EVAR failure. Intravascular lithotripsy (IVL) has emerged as an alternative treatment to address severe iliofemoral atherosclerosis, aiding trackability of devices in EVAR. However, the use of IVL to address severe calcification in hostile necks has not yet been described.</div></div><div><h3>Report</h3><div>A 74 year old man with multiple comorbidities was referred for definitive treatment of an asymptomatic infrarenal AAA with severe aorto-iliac atherosclerosis. Kissing lithotripsy was firstly performed to treat the calcified stenosis of the aortic bifurcation and iliac axes. To prevent infolding and type Ia endoleak (ELIa), IVL was also performed through simultaneous inflation of two IVL balloon catheters and a compliant aortic balloon on a conical shape neck with an eccentric calcified plaque. The procedure was completed with standard EVAR. The three month follow up computed tomography angiography confirmed a successful outcome with shrinkage of the excluded aneurysmal sac, patent iliac axes, and complete disruption of the severe eccentric calcification of the aortic neck with no signs of infolding or endoleak.</div></div><div><h3>Discussion</h3><div>This case report highlights the potential of IVL to improve the proximal sealing zone, prevent infolding and ELIa, enhance trackability of devices, reduce major complications, and extend the application of standard EVAR in patients with challenging anatomy. However, further studies and long term follow up are needed to define the efficacy and safety of integrating IVL in standard EVAR.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 78-82"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526917","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":"Antegrade In Situ Fenestration During Thoracic Endovascular Aortic Repair for Preserving Isolated Left Vertebral Artery","authors":"Xu-xian Qiu ,&nbsp;Qing-long Zeng ,&nbsp;Pei-er Shen ,&nbsp;Dong-lin Li","doi":"10.1016/j.ejvsvf.2024.10.001","DOIUrl":"10.1016/j.ejvsvf.2024.10.001","url":null,"abstract":"<div><h3>Introduction</h3><div>An isolated left vertebral artery (ILVA) on the aortic arch with aortic arch pathologies is common, but how to preserve the ILVA blood flow during endovascular repair remains challenging. Several strategies have been reported but there is still no consensus on the best treatment. This case report presents a novel totally endovascular technique for ILVA revascularisation using antegrade <em>in situ</em> needle assisted fenestration without neck surgical procedures.</div></div><div><h3>Report</h3><div>A 72 year old man with an ILVA and an incomplete circle of Willis underwent endovascular repair of an aortic arch dissection aneurysm. A 30–26 x 160 mm polytetrafluoroethylene aortic stent graft (Ankura; Lifetech, Shenzhen, China) was deployed proximally in zone 2 of the aortic arch covering the primary tear together with the ILVA and left subclavian artery (LSA). A 6F steerable sheath was placed in the LSA through brachial access, and another 6F long sheath with an adjustable puncture needle was introduced through the right femoral access and placed against the ILVA ostium with the guidance of LSA angiography. Antegrade ILVA fenestration was successfully performed using a needle, and a 0.018 inch guidewire was introduced through the puncture hole, followed by balloon dilation and implantation of a 4.5 × 12 mm balloon expandable bare stent (Dynamic; Biotronik, Bulach, Switzerland). The LSA was reconstructed using a retrograde <em>in situ</em> needle fenestration technique through the steerable sheath from left brachial access, and a 9 × 50 mm Viabahn stent graft was deployed. Post-operatively, the patient recovered uneventfully without neurological deficit. One year follow up imaging confirmed patent ILVA and LSA, and favourable aortic remodelling without any leakage.</div></div><div><h3>Conclusion</h3><div>This case suggests that the totally endovascular technique of antegrade <em>in situ</em> fenestration is feasible and effective for preserving an ILVA.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 93-96"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142553949","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":"A Low Cost Emergency Laparotomy Task Trainer for Major Abdominal Bleeding: An Option for Surgical Residents to Learn Lifesaving Basic Surgical Skills","authors":"Tiia Kukkonen ,&nbsp;Eerika Rosqvist ,&nbsp;Marika Ylönen ,&nbsp;Annika Mäkeläinen ,&nbsp;Juha Paloneva ,&nbsp;Teuvo Antikainen","doi":"10.1016/j.ejvsvf.2024.04.002","DOIUrl":"10.1016/j.ejvsvf.2024.04.002","url":null,"abstract":"<div><h3>Objective</h3><p>To instantly stop life threatening abdominal bleeding (e.g., a ruptured abdominal aneurysm), every surgeon should be familiar with the principles of emergency laparotomy (EL) and aortic clamping. Simulation training in a safe environment can be used to rehearse these situations like other medical emergencies. Owing to the lack of a suitable commercial simulator, a homemade task trainer was constructed. This study aimed to evaluate the feasibility of an EL simulation training course among surgical residents using this low cost task trainer.</p></div><div><h3>Methods</h3><p>To enable simulation training for massive abdominal bleeding with subsequent EL and aortic clamping, a multiprofessional team developed an EL task trainer. A structured evaluation of the trainer and its applicability was performed by external consultants, who tested the trainer themselves. Instructions for constructing the trainer were created and costs were calculated. During the EL simulation course targeted for surgical trainees early in their careers, 34 participants familiarised themselves with EL. Their experiences of the feasibility of the course and increase in self assessed clinical competence in managing the situation were studied using a questionnaire. In a subgroup of trainees, the simulation was compared with a real life EL subsequent to the course.</p></div><div><h3>Results</h3><p>Participants found that the trainer was fit for its purpose (mean score, 4.7 out of 5). Their self assessed clinical competence increased in several domains: EL as a procedure (<em>p</em> &lt; 0.01), handling of intra-abdominal tissues and organs during EL (<em>p</em> = 0.008), and emergency procedures in intra-abdominal haemorrhage (<em>p</em> &lt; 0.001). The cost for the body of the trainer was €108 and there was an additional €42 for the disposables for one training scenario.</p></div><div><h3>Conclusion</h3><p>A low cost task trainer with pulsatile flow enabling surgical residents to rehearse EL with aortic clamping can be constructed from commonly available materials. Preliminary experience of its feasibility and effects on learning in a simulation training course have been positive.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 105-111"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000789/pdfft?md5=32aa0ba317f7f30458bce4c5ddd41ca8&pid=1-s2.0-S2666688X24000789-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776225","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":"Thoracic Aneurysm Rupture Due to Thoracic Endovascular Aneurysm Repair Stent Graft Disintegration","authors":"Jeffrey M.A. van der Krogt,&nbsp;Johanna H. Nederhoed","doi":"10.1016/j.ejvsvf.2024.04.001","DOIUrl":"10.1016/j.ejvsvf.2024.04.001","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Page 104"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000777/pdfft?md5=fb602423c2e7c5238195b7d90568776e&pid=1-s2.0-S2666688X24000777-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140776343","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":"Merging Geometrical, Biomechanical, and Clinical Data To Assess the Rupture Risk of Abdominal Aortic Aneurysms","authors":"M. Alloisio ,&nbsp;A. Siika ,&nbsp;J. Roy ,&nbsp;S. Zerwes ,&nbsp;A. Hyhlik-duerr ,&nbsp;T.C. Gasser ∗","doi":"10.1016/j.ejvsvf.2024.07.034","DOIUrl":"10.1016/j.ejvsvf.2024.07.034","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages S21-S22"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697834","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":"Xenopericardial Self Made Tube Grafts in Infectious Vascular Reconstructions: Technical Details","authors":"A. Verrengia ∗ ,&nbsp;A. Mellonia ,&nbsp;P. Baggi ,&nbsp;M. Cambiaghi ,&nbsp;A. Grandi ,&nbsp;P. Dioni ,&nbsp;S. Bonardelli ,&nbsp;L. Bertoglio","doi":"10.1016/j.ejvsvf.2024.07.024","DOIUrl":"10.1016/j.ejvsvf.2024.07.024","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Page S16"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697500","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":"Renal Artery Blood Flow and Surface Parenchymal Perfusion During Renal Artery Endoshunting in a Porcine Model","authors":"Johan Millinger ,&nbsp;Marcus Langenskiöld ,&nbsp;Andreas Nygren ,&nbsp;Klas Österberg ,&nbsp;Joakim Nordanstig","doi":"10.1016/j.ejvsvf.2024.10.003","DOIUrl":"10.1016/j.ejvsvf.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Ischaemia and reperfusion can result in permanent tissue damage. During complex open abdominal aortic surgery, transient clamping of the renovisceral arteries may be required to successfully complete the vascular repair. Endovascular shunting (endoshunting) presents an alternative technique for managing such temporary renovisceral ischaemia. This study aimed to investigate the performance of endoshunting to the renal circulation in a porcine model.</div></div><div><h3>Methods</h3><div>This study of five domestic pigs investigated arterial volume flow rates during endoshunting of a single renal artery and the associated impact on renal perfusion parameters (laser Doppler renal parenchymal perfusion, renal oxygen extraction, and selective urinary output). The study was performed in three steps: baseline registrations (30 minutes), endoshunting (120 minutes), and restoration (60 minutes). The right kidney was used as the experimental side and the left kidney as control.</div></div><div><h3>Results</h3><div>The median arterial flow rate in the left control kidney remained constant throughout the experiment. On the right (endoshunted) side, the baseline median arterial flow rate was 267 (range, 160–404) mL/min. Following activation of the endoshunt, the median arterial volume flow dropped by 59%–110 (range, 45–150) mL/min (<em>p</em> = .018). During endoshunting, the median kidney surface perfusion decreased to 42% of the baseline value. On the control side, a rise in the median parenchymal perfusion was observed after endoshunt activation, which was again normalised following restoration of native right renal artery flow. During endoshunting, the median regional urine production was 0.32 (range, 0.12–0.50) mL/hour but resumed after renal artery flow restoration.</div></div><div><h3>Conclusion</h3><div>On average, the endoshunted kidneys showed a rapid restoration of blood flow, parenchymal perfusion, and urine production after 120 minutes of endoshunting. This suggests that endoshunting to the kidney using an endoshunt system might be a promising strategy to preserve renal function when temporary interruption of native renal artery blood flow is needed during complex vascular surgical repairs involving the renal arteries.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"62 ","pages":"Pages 104-109"},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698607","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":"Infected Thrombosed Popliteal Artery Aneurysm With Cutaneous Fistula","authors":"Leonor Baldaia ,&nbsp;Tiago Oliveira ,&nbsp;Eduardo Silva ,&nbsp;Joana Moreira ,&nbsp;Luís F. Antunes","doi":"10.1016/j.ejvsvf.2024.01.051","DOIUrl":"10.1016/j.ejvsvf.2024.01.051","url":null,"abstract":"<div><h3>Introduction</h3><p>Popliteal artery aneurysms (PAAs) pose some challenges in their surgical management and are often treated by exclusion and bypass procedures. However, post-operative complications, such as endoleaks and sac growth, can occur, potentially leading to serious consequences. Endoleaks, characterised by persistent flow within the aneurysm sac after repair, can cause sac expansion, increasing the risk of adverse outcomes, including the formation of cutaneous fistulae, a rare but potentially severe complication.</p></div><div><h3>Report</h3><p>A 75 year old male with a history of previous bilateral PAA exclusion with a left femoropopliteal bypass using reversed great saphenous vein (GSV) graft in 2012 and a right femoropopliteal bypass using a PTFE prosthesis in 2017, both through medial approach, presented with pain and ulceration in the left popliteal region. Previous angiography had shown residual arterial flow through collateral vessels, requiring thrombin injection. Bilateral bypass thrombosis had also occurred after discontinuing anticoagulation. Computed tomography angiography confirmed a complicated excluded left popliteal aneurysm with superinfection. The patient underwent elective surgery, involving partial aneurysmectomy, endoaneurysmorrhaphy, and fistulectomy through a posterior approach. Post-operatively, the patient experienced resolution of symptoms and inflammatory signs.</p></div><div><h3>Discussion</h3><p>The optimal approach for treating PAAs remains a subject of debate, with some experts advocating the posterior approach to prevent sac growth. However, others support the medial approach, reporting satisfactory results. In this case, the medial approach resulted in incomplete exclusion, leading to sac expansion and a cutaneous fistula. Timely re-intervention through the posterior approach successfully resolved the complication. This report highlights a rare but serious complication of incomplete PAA exclusion. Vigilant post-operative surveillance and intervention are crucial to manage such cases effectively. Further research is warranted to determine the optimal approach for PAA repair and prevent associated complications.</p></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"61 ","pages":"Pages 77-80"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666688X24000522/pdfft?md5=060a06649afe7a00897c3ffb5eb60c72&pid=1-s2.0-S2666688X24000522-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139828424","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}