Journal of Endovascular Therapy最新文献

{"title":"Mid-Term Results of an Unsupported Body Fenestrated Graft for Treating Thoracoabdominal and Suprarenal Aneurysms.","authors":"Alexandre Oliny, Marine Bordet, Raffaele Pio Ammollo, Matthieu Arsicot, Nellie Della Schiava, Antoine Millon","doi":"10.1177/15266028251388017","DOIUrl":"10.1177/15266028251388017","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of a strategy using the Anaconda Fenestrated endograft for treating thoracoabdominal aortic aneurysms (TAA) and supra-renal aortic aneurysms (SRAAs).</p><p><strong>Methods: </strong>Patients electively treated with the Anaconda Fenestrated endograft for an unruptured TAA or SRAA at our center between 2018 and 2023 were retrospectively analyzed. The treatment strategy included staged procedures prior to fenestrated endovascular aneurysm repair (FEVAR) and implantation of the Anaconda graft into thoracic grafts for TAA and for SRAA with an unfavorable proximal landing zone. Primary outcome was survival. Secondary outcomes included technical and early clinical success, target-vessel patency (TVP), freedom from reintervention, sac evolution, target-vessel instability (TVI), and endoleaks.</p><p><strong>Results: </strong>A total of 57 patients (72% male, median age 70 years) were included, comprising 32 (56.1%) SRAA and 25 (43.9%) TAA. Nineteen patients (33.3%) underwent staged procedures, and technical success was 94.7%. There were 3 (5.3%) early deaths, 1 (1.8%) permanent paraplegia, and 1 (1.8%) type IIIc endoleak, leading to an early clinical success rate of 93.0%. The mean follow-up duration was 31.6 ± 19.7 months for mortality, and 28 ± 17.0 months for other outcomes. A total of 12 (21.1%) deaths were recorded, including 4 aneurysm-related deaths, resulting in 1-year and 4-year overall survival rates of 87.7% and 78.1%, respectively. The primary TVP rate was 95.9% at 1 year and 95.2% at 5 years, while the 1-year and 3-year freedom from TVI was 84.7% and 72.2%, respectively. Seventeen patients (29.8%) required early (n=7) or late (n=14) reinterventions, resulting in 1-year and 3-year freedom from reintervention of 76.1% and 61.1%, respectively. One type 1a (1.8%), 1 type 1b (1.8%), and 5 type 3c (8.8%) endoleaks were identified and treated during follow-up. Aneurysm growth (>5 mm) was observed in 2 patients (3.8%), while sac shrinkage (>5 mm) was achieved in 29 patients (55.8%).</p><p><strong>Conclusion: </strong>This study demonstrates that a strategy using the Anaconda Fenestrated endograft provides acceptable efficacy and safety in the treatment of SRAA and TAA. Despite a high reintervention rate, mid-term survival, and target-vessel patency support the use of this endograft as a valid treatment option for these aneurysms.Clinical ImpactThis study reports the outcomes of 57 patients treated for suprarenal and thoracoabdominal aneurysms using the Anaconda unsupported fenestrated stent graft, combined with thoracic modules when necessary. Mid-term survival and target vessel patency were acceptable, with no indication of inferior performance compared to established platforms. While the reintervention rate warrants caution, these findings support the Anaconda fenestrated system as a potential alternative for complex aneurysms. Larger studies with extended follow-up are needed to bett","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2729-2738"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145460574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of Thoracic Endovascular Aortic Repair and Thrombus Load on Aortic Radial Deformation.","authors":"Alexandra Hauguel, Johan Bondesson, Arshid Azarine, Kianosh Kasani, Abdul I Barakat, Stephan Haulon, Christopher P Cheng","doi":"10.1177/15266028251339347","DOIUrl":"10.1177/15266028251339347","url":null,"abstract":"<p><strong>Purpose: </strong>Aortic stiffness and intraluminal thrombus at baseline have been suggested as potential determinants of the impact of aortic endovascular devices on aortic wall properties. We aim to assess the impact of the endograft and of thrombus load on aortic compliance through the assessment of changes in aortic radial deformation following thoracic endovascular aortic repair (TEVAR).</p><p><strong>Materials and methods: </strong>The 3D geometric models of the aorta at peak systole and end diastole were constructed from both pre- and post-TEVAR 4D flow magnetic resonance imaging (MRI) of aortic aneurysm and dissection patients. Arclength, length-averaged curvature, and true- and whole lumen effective diameters and areas were assessed in different aortic segments (ascending aorta, endografted segment, and all aorta). Aortic radial deformation was defined as percentage change in aortic diameter from diastole to systole. Thrombus load was defined as thrombus volume divided by aortic volume. Spearman's coefficient (R) was calculated to assess linear correlations.</p><p><strong>Results: </strong>The analysis was conducted on 14 patients/TEVAR procedures (n=7 aneurysms, n=7 dissections). Median time between pre- and postoperative MRI was 124.6 ± 81.7 days. Aortic radial deformation significantly decreased in the endografted segment (7.2% ± 3.6% vs 5.0% ± 2.0%, p<0.05), whereas it significantly increased in the ascending aorta (6.2% ± 2.3% vs 14.4% ± 4.0%, p<0.05). No significant impact was observed on axial deformation (length change) and bending pre-to-post-TEVAR in those 2 segments. Regarding changes in geometry, cardiac cycle-averaged ascending aortic diameter was found similar pre-to-post TEVAR (3.7 ± 0.3 cm vs 3.6 ± 0.4, p=0.23). Thrombus load at the level of the diseased thoracic aorta at baseline correlated strongly with the amplification in ascending aorta radial deformation (R=-0.80, R<sup>2</sup>=0.64), and in an even more significant manner when excluding the 2 patients with a history of prosthetic ascending aorta replacement (R=-0.88, R<sup>2</sup>=0.77).</p><p><strong>Conclusion: </strong>Following TEVAR, aortic radial deformation, is reduced in the stented segment and amplified in the ascending aorta. Greater baseline thrombus load results in lower radial deformation amplification post-TEVAR. These findings highlight the benefit of thrombus load assessment pre-TEVAR and the need for increasing the compliance of future grafts to minimize its impact.Clinical ImpactFollowing thoracic endovascular aortic repair (TEVAR), aortic radial deformation, directly related to aortic compliance, is reduced in the stented segment, and amplified upstream in the ascending aorta, likely due to increased stiffness of the endograft, remodeling, and pressure pulse reflection. Thrombus load is found as an effective predictor of aortic radial deformation amplification following TEVAR. This highlights the benefit of thrombus assessment pre-TEVA","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2439-2448"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Management of Aortic Rupture Secondary to Thoracolumbar Spine Fracture From a Domestic Fall: A Case Report and Clinical Challenges.","authors":"David Pakeliani, Liborio Ferrante, Giuseppe Indelicato, Silvana Tumbiolo, Maurizio Finocchiaro","doi":"10.1177/15266028241302683","DOIUrl":"10.1177/15266028241302683","url":null,"abstract":"<p><strong>Purpose: </strong>Instances of aortic lesions combined with thoracolumbar spine fractures have been rarely described, primarily occurring in high-speed motor vehicle collisions and falls from heights.</p><p><strong>Case report: </strong>We present a unique case of a 71-year-old woman with a thoracic aortic rupture caused by a thoracolumbar spine fracture during an accidental domestic fall. She experienced an injury at the level of the celiac trunk on the posterior aspect of the aorta. Hemorrhagic shock and profound hemodynamic instability prompted the swift initiation of a percutaneous endovascular approach, involving the use of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) followed by the parallel graft technique in a sandwich configuration. Subsequently, thoracolumbar spinal fixation was carefully scheduled and performed 20 days after achieving clinical stabilization.</p><p><strong>Conclusions: </strong>This case underscores the importance of a multidisciplinary approach in managing complex aortic and spinal injuries. The combined use of REBOA and the sandwich graft technique can be life-saving in managing acute thoracic aortic injuries, allowing for the staged stabilization and repair of associated spinal fractures.Clinical ImpactThis case highlights a novel approach to managing a rare thoracic aortic rupture caused by an accidental domestic fall. The application of REBOA for immediate hemodynamic stabilization, combined with the use of a sandwich graft configuration, underscores the adaptability of advanced endovascular techniques in complex, life-threatening situations. These interventions demonstrate the importance of tailoring treatment strategies to individual patient needs, especially in cases involving atypical mechanisms of injury. The findings emphasize the value of early multidisciplinary collaboration and dynamic procedural planning, paving the way for improved outcomes and the refinement of clinical protocols in the management of similar trauma cases.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2763-2767"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Thrombocytopenia Indicates Endoleak After Complex Endovascular Aneurysm Repair.","authors":"Annelise Long, Sara L Zettervall, Matthew P Sweet","doi":"10.1177/15266028251351146","DOIUrl":"10.1177/15266028251351146","url":null,"abstract":"<p><strong>Objectives: </strong>High-pressure endoleaks (type I and III) after fenestrated-branched endovascular aneurysm repair (F-BEVAR) pose ongoing rupture risk. Early identification of such endoleaks may facilitate appropriate reintervention. Our objective was to determine if persistent thrombocytopenia after F-BEVAR correlates with high-pressure endoleaks in the early postoperative period.</p><p><strong>Methods: </strong>Patients in a physician-sponsored investigational device exemption study of physician-modified and Cook-manufactured fenestrated/branched endografts were evaluated. Endoleaks identified on computed tomography within the first 6 months of follow-up were classified as high-pressure (type I or III) or low-pressure (type II). Bivariable and multivariable analyses were performed to assess if thrombocytopenia was associated with the presence of endoleaks.</p><p><strong>Results: </strong>Among 185 patients, 26 (14%) developed high-pressure endoleaks and 30 (16%) developed low-pressure endoleaks. Demographics, procedure indications, and preoperative medications were similar across endoleak groups. To maximize sensitivity and clinical utility, we selected a daily average platelet count <100,000/μL as a cut point. The proportion of high-pressure endoleak patients with platelet counts <100,000/μL was significantly greater compared to low-pressure and no endoleak patients on postoperative day 1 (POD#1) through POD#4 (high-pressure 42%, low-pressure 27%, no endoleak 10%; p<0.001). After adjusting for demographics and comorbidities, patients with high-pressure endoleak were over 12 times more likely to have average platelets <100,000/μL on POD#4 compared to patients with no endoleak (OR 12.3, 95% CI 3.5-43.0).</p><p><strong>Conclusions: </strong>F-BEVAR patients who developed high-pressure endoleak had significantly lower platelet counts postoperatively. Aortic imaging should be considered in patients with platelet counts <100,000/μL at POD#4 following F-BEVAR, as 35% of such patients will have a high-pressure endoleak requiring reintervention.Clinical ImpactPersistent thrombocytopenia following F-BEVAR may be an early indication of a high pressure endoleak. Imaging is recommended for patients with platelet count <100,000/μL on POD 4 as 35% of such patients in this study had a high pressure endoleak.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2491-2496"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midterm Outcomes of In Situ and In Vitro Fenestrated Stent-Grafts for Endovascular Repair of Aortic Arch Pathologies.","authors":"Suyu Miao, Liang Gui, Haibin Chen, Hao Ma, Hongyu Yang, Xiwei Zhang, Yuanyong Jiao, Junjie Zou","doi":"10.1177/15266028251384920","DOIUrl":"10.1177/15266028251384920","url":null,"abstract":"<p><strong>Objective: </strong>Thoracic endovascular aortic repair (TEVAR) with fenestration technology for reconstruction of the aortic arch branches has been used in patients with aortic arch pathologies. However, the outcomes of comparisons between the 2 reconstruction methods are rarely reported. This study sought to compare and clarify the midterm outcomes between in situ and in vitro fenestrated stent-grafts for endovascular repair of aortic arch pathologies.</p><p><strong>Methods: </strong>Between July 2016 and December 2023, the patients with aortic arch pathologies, who underwent TEVAR with in situ and in vitro fenestration grafts, were retrospectively evaluated. Endpoints included technical success, 30-day mortality, major adverse events, secondary interventions, target vessel patency, and overall survival.</p><p><strong>Results: </strong>A total of 46 patients (mean age 59 years; 40 males) with aortic arch pathology were included, each group (in situ and in vitro fenestration) with 23 cases. Technical success was 97.8% (45/46), and 1 patient died from severe pulmonary infection within 30 days. Perioperative major adverse events included stroke (n=3; 6.7%), spinal cord ischemia (SCI) (n=1; 2.2%). During a median follow-up of 40.8 months (IQR=57). The estimated all-cause overall survival rate was 97.8% (standard error [SE]=2.2%) and 84.5% (SE=6.7%) at 1 month and 48 months, respectively. The survival rate in the in situ group at 48 months was 95.5% (SE=4.4%) and the in vitro group was 74.2% (SE=11.7%). Log-rank test showed no significant difference (p=0.59). The overall branch arteries' primary patency was 97.8% (SE=2.2%) and 92.2% (SE=4.4%) in 1 month and 48 months. There was no significant difference between the 2 groups at 48 months (87.9% [SE=8.2%] for the in situ group, 95.7% [SE=4.3%] in the in vitro group [p=0.51]). The estimated freedom from secondary intervention was 100%, 90.2% (SE=4.7%), 84.0% (SE=6.1%), and 86.7% (SE=5.6%), at 1 month, 1 year, and 4 years. At 4 years, there was no significant difference in the estimated freedom from reintervention between the 2 groups (77.0% [SE=10.4%] for in situ group and 95.5% [SE=4.4%] in the in vitro group [p=0.33]).</p><p><strong>Conclusion: </strong>For patients with aortic arch pathologies, in situ and in vitro fenestration techniques revealed comparable early and midterm results. Further evaluation of more patients with longer follow-up is needed to substantiate these results.Clinical ImpactOur single-center retrospective cohort study conducted a comparative analysis of in-situ fenestration versus in-vitro fenestration techniques in patients with aortic arch pathologies.Comparative studies between the two approaches are still limited. Our results provide a basis for the selection of in-situ or in-vitro fenestration techniques for endovascular repair of aortic arch lesion.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2657-2669"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145496333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Validity of a Standardized Protocol for Measuring Thoracic Aortic Aneurysm Morphology.","authors":"Olivier L R M van Tongeren, Amber Sharman, Vinamr Rastogi, Rens B Varkevisser, Sanne E Hoeks, Arnoud V Kamman, Hence J M Verhagen, Jorg L de Bruin","doi":"10.1177/15266028251380535","DOIUrl":"10.1177/15266028251380535","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Thoracic endovascular aortic repair (TEVAR) is the predominant treatment for thoracic aortic aneurysms (TAA) due to its superior perioperative outcomes. International guidelines recommend assessing TAA characteristics via computed tomography angiography (CTA). However, the lack of a standardized measurements protocol introduces variability in preoperative planning, and imaging surveillance, and therefore hinders artificial intelligence (AI) integration for fully automated measurements. This study aims to develop and validate a standardized measurement protocol for TAA to improve consistency in measurement and enhance imaging surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was performed at a Dutch tertiary center on patients who underwent TEVAR for a descending TAA from 2010 to 2019. We included degenerative and mycotic TAAs, and exclusions were the lack of a preoperative CTA and/or incomplete postoperative imaging. A standardized measurement protocol was developed based on expert opinion and validated endovascular aortic repair (EVAR) protocols. Imaging analysis utilized dedicated 3D imaging software. The protocol included semi-automated 3D segmentation, center lumen line (CLL) reconstruction, and several measurements, including aortic diameter/volume and sealing lengths. Intraobserver and interobserver agreements were assessed using Bland-Altman analysis and intraclass correlation coefficients (ICCs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We analyzed 133 CTA scans from 31 patients, showing high levels of agreement across measurements, particularly for those repeated by the same observer. Maximum diameter measurements demonstrated excellent consistency, with minimal mean differences for intraobserver and interobserver agreements and excellent correlation (ICC&gt;0.900). Volume measurements were similar consistent, with mean differences of 3.45 (intraobserver) and 2.75 (interobserver) cc. Proximal and distal seal measurements showed good agreement, although interobserver correlation was slightly less consistent. Length of coverage by the endograft exhibited strong consistency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our standardized measurement protocol for descending TAA offers a consistent approach for preoperative planning, imaging surveillance, and research applications, with high agreement in most measurements. This consistency could reduce variability, enhance imaging surveillance. Future research should focus on external validation, integrating AI to further improve measurement consistency, and simplify TEVAR surveillance.Clinical ImpactThis retrospective study of 133 CTA scans from 31 thoracic endovascular aortic repair (TEVAR) for TAA patients demonstrated excellent measurements consistency, including maximum diameter showing strong agreement and minimal differences in volume measurements. In the absence of an existing measurements protocol, our proposed standardized protocol supports improve","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2677-2688"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Development of Multiple Aneurysms in Riolan's Arterial Arch: The Implications of Augmented Blood Flow.","authors":"Die-Fei Shao, Bin Hu, Xu-Xian Qiu, Jia-Yu Zheng, Dong-Lin Li","doi":"10.1177/15266028251384235","DOIUrl":"10.1177/15266028251384235","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2185-2187"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Perioperative Outcomes of Postimplantation Syndrome After Thoracic Endovascular Aortic Repair.","authors":"Nicola Leone, Luigi Alberto Maria Bartolotti, Mattia Migliari, Andrea Ferri, Giovanni Francesco Baresi, Francesco Andreoli, Giuseppe Saitta, Stefano Gennai","doi":"10.1177/15266028251325764","DOIUrl":"10.1177/15266028251325764","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postimplantation syndrome (PIS) is a systemic inflammatory response that occurs following abdominal endovascular aortic repair (EVAR) and thoracic EVAR (TEVAR). The main outcome was to individuate the incidence and risk factors of PIS after TEVAR. Its impact on the length of stay and clinical outcomes were secondary objectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Three hundred sixty-nine consecutive TEVAR procedures performed between February 2010 and November 2022 were included in this retrospective cohort, observational, single-center study. Patients with proximal landing in zones 0 to 5 were enrolled. Data on comorbidities, previous aortic surgery and morphology, thoracic aorta coverage, stent-graft composition, intraoperative variables, and postoperative outcomes were collected. White blood cell (WBC) and C-reactive protein (CRP) serum levels were recorded preoperatively and 48 hours after TEVAR. PIS was defined as the concomitant presence of fever (tympanic temperature ≥38.0°C), CRP serum level &gt;0.7 mg/dl and evidence of pleural effusion on postoperative chest radiograph.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;PIS incidence in our cohort was 26.8%. PIS patients presented with a higher rate of hyperlipidemia (56.6% vs 44.8%, p = 0.045) than non-PIS patients. Stent-graft composition did not play a relevant role in eliciting PIS. PIS was a statistically significant factor in prolonging patients' stay (median 16.0 days vs 8.0 days, p &lt; 0.001, PIS and non-PIS patients). Thoracic aortic coverage &gt;150 mm (Odds Ratio (OR) 4.7, p = 0.004), coronary artery disease (OR 2.1, p = 0.028), and preoperative WBC count (OR 1.1, p = 0.047) were identified as risk factors for PIS, whereas previous aortic surgery (OR 0.5, p = 0.05) was highlighted as a protective factor. Thoracic aortic coverage was a significant risk factor for increased WBC and CRP levels (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;PIS incidence was 26.8% in our cohort. Thoracic aortic coverage, coronary artery disease, and preoperative WBC count were identified as risk factors for PIS after TEVAR, whereas previous aortic surgery was found to be a protective factor. PIS also appeared to have a significant impact on length of stay.Clinical ImpactThis study identified a significant occurrence of post-implantation syndrome (PIS) following TEVAR, affecting over 25% of patients and adversely affecting the duration of hospital stay. Stent graft material did not seem to influence the incidence of PIS. Thoracic aortic coverage, coronary artery disease, and preoperative white blood cell (WBC) count have been identified as risk factors, whereas previous aortic surgery has been found to serve as a protective factor, representing a novel finding in the literature. Further research is warranted to ascertain strategies for mitigating the incidence of PIS, considering the risk factors identified in both current and prior studies. In addition, it is necessary to evaluate ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2421-2428"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging Fusion Guidance for Endovascular Aorto-Iliac Procedures: A Systematic Review and Meta-Analysis.","authors":"Yiren Lai, Li Tang, Xinghua Liu, Qingsheng Lu","doi":"10.1177/15266028251355703","DOIUrl":"10.1177/15266028251355703","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to report the latest and most comprehensive pooled analysis and evidence update, comparing the perioperative outcomes and radiation exposure of endovascular aorto-iliac procedures utilizing imaging fusion (IF) guidance versus conventional imaging techniques.</p><p><strong>Patients and methods: </strong>We performed a systematic literature search using PubMed, Cochrane Library, Embase, and Web of Science up to Oct 2023 for studies that evaluate the effect of IF technology in endovascular treatment on the perioperative outcomes and radiation exposure and published in English. Outcomes measured were procedure time, fluoroscopy time, contrast medium, dose-area product (DAP), radiation doses, length of stay, technical success, the postoperative 30-day mortality, and any major adverse event.</p><p><strong>Results: </strong>A total of 13 eligible articles involving 1498 patients (732 IF vs 766 Control) were included for the evidence synthesis. Baseline characteristics of the 2 groups were similar in all outcomes except that lower previous aortic disease was observed in the control group. Pooled analysis showed shorter procedure time, fluoroscopy time, contrast medium, DAP, and radiation doses in the IF group. No significant differences were observed in the remaining indicators.</p><p><strong>Conclusions: </strong>Given the presence of heterogeneity and potential bias, vascular surgeons should select the imaging strategy based on their experience and patient-specific factors.Clinical ImpactThis study provides compelling evidence supporting the integration of imaging fusion (IF) technology into endovascular aorto-iliac procedures. IF significantly reduces procedure time, contrast medium usage, and radiation exposure-key factors for patient safety, particularly in those with renal impairment. By improving anatomical visualization without increasing adverse outcomes, IF offers clinicians a safer, more efficient alternative to conventional imaging. Its impact is most pronounced in the treatment of dilated aortic lesions, where complex vascular anatomy demands precise navigation. These findings may shift clinical practice toward broader adoption of IF guidance in high-risk or anatomically challenging cases, aligning procedural innovation with improved patient care.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2254-2265"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Balloon-Pushing Technique to Rescue a Covered Hypogastric Artery During Endovascular Aortic Repair.","authors":"Jose I Torrealba, Giuseppe Panuccio, Petroula Nana, Daour Yousef Al Sarhan, Nils Zabel, Tilo Kölbel","doi":"10.1177/15266028251384923","DOIUrl":"10.1177/15266028251384923","url":null,"abstract":"<p><strong>Introduction: </strong>The coverage of a hypogastric artery (HA) may lead to several complications, such as gluteal claudication, erectile dysfunction, and even a higher risk of spinal cord ischemia in complex aortic repair. It has been shown to occur in 1% to 8% of endovascular aortic repair. We present the balloon-pushing technique to rescue an HA after its overstenting by an iliac limb.</p><p><strong>Technique: </strong>After the HA overstenting, a 20 Fr sheath was kept close to the distal edge of the iliac limb. A stiff wire was kept in place and a 12×40 mm balloon was inflated at the overlapping between the iliac limb and the main endograft. Then, the balloon shaft was vigorously pushed, creating a posterior and superior movement of the iliac limb, that ended up freeing the HA origin.</p><p><strong>Conclusion: </strong>The balloon-pushing technique is a simple technique to rescue the HA after its coverage by an iliac limb. Patient anatomy and knowledge of the endografts must be carefully considered.Clinical ImpactThe balloon-pushing technique is a simple technique to rescue the hypogastric artery after its coverage by an iliac limb. Despite its simplicity the technique has not been previously described. We believe it should be used as first manouver to rescue the hypogastric artery if covered by 5-10 mm.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2408-2413"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}