Journal of Endovascular Therapy最新文献

{"title":"The CLTI Paradigm Shift: Implications for Clinical Trial Design and Endpoints in Endovascular Management of Infrapopliteal Disease.","authors":"Jihad A Mustapha, Rita Jacob, Larry E Miller, Constantino S Pena, Amjad AlMahameed, Eric J Dippel, Robert E Beasley, Bret N Wiechmann","doi":"10.1177/15266028251363541","DOIUrl":"10.1177/15266028251363541","url":null,"abstract":"<p><p>The evolution from critical limb ischemia to chronic limb-threatening ischemia (CLTI) necessitates a reevaluation of clinical trial endpoints. Traditional measures like hemodynamic indices and lesion patency inadequately reflect CLTI complexity or patient-centered outcomes. This article explores the limitations of conventional endpoints and proposes a modified definition of clinically-driven target lesion (TL) revascularization (CD-TLR) that addresses inflow, TL, and outflow disease. By incorporating a more comprehensive assessment of vascular health and prioritizing patient-relevant outcomes, this modified CD-TLR definition may better reflect modern CLTI management strategies and improve clinical relevance of trial results in this challenging patient population.Clinical ImpactThe evolution from CLI to CLTI requires reassessing how we measure treatment success in clinical trials. This review identifies why traditional endpoints like hemodynamic indices, lesion patency, and CD-TLR may not adequately inform clinical decision-making. The importance of measuring outcomes that directly impact patient quality of life will help clinicians better evaluate and apply clinical trial results. An emphasis on limb salvage, wound healing, and functional outcomes, rather than surrogate endpoints alone, will lead to more informed treatment decisions and improved CLTI management strategies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2325-2331"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977019","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":"Impact of Accessory Renal Arteries on Type II Endoleak-Related Complications After Endovascular Treatment of Complex Aortic Aneurysms.","authors":"Nour Issa, Antti Siika, Joy Roy, Göran Lundberg, Magnus Jonsson","doi":"10.1177/15266028251384223","DOIUrl":"10.1177/15266028251384223","url":null,"abstract":"<p><strong>Objective: </strong>Type II endoleaks (T2EL) are common complications after fenestrated or branched endovascular aortic repair (F/BEVAR) and occur typically through the inferior mesenteric artery (IMA) and lumbar arteries (LA). Accessory renal arteries (aRAs) are found in about one-third of patients. The aim of this study was to investigate whether patients with aRAs are at higher risk of T2EL-related complications than those without aRA.</p><p><strong>Methods: </strong>All patients treated with F/BEVAR at Karolinska University Hospital during 2009-2022 were included in this single-center cohort study with prospectively collected data. Patients with at least one aRA ≥2 mm were compared to those without aRA. Furthermore, patients with aRA were subdivided into groups depending on the location of the origin (neck vs sac). Endpoints included change in maximal aortic diameter, incidence of T2EL, reinterventions, and overall mortality during follow-up. All CT scans were reviewed preoperatively, 30 days postoperatively, and at 1, 3, and 5 years after the procedure.</p><p><strong>Results: </strong>A total of 199 consecutive patients treated with F/BEVAR were included, 76.4% male, mean age 74 years. Fifty-one patients (25.6%) had at least one aRA ≥2 mm, and 148 patients (74.4%) had no aRA ≥2 mm. The median aneurysm diameter at baseline was 61 mm in both groups (with and without aRA, p=0.468). There were no significant differences in comorbidities or demographic details between the groups. At 3 years, patients with aRA had a larger increase in maximal aortic diameter (+4 mm vs -7.5 mm, p=0.004) and a higher incidence of T2ELs (50% vs 17.9%, p=0.019) as compared to patients without aRA. Reinterventions due to T2EL was also higher in the aRA group (29.6% vs 10.9%, p=0.011). Overall mortality did not differ between the groups.</p><p><strong>Conclusions: </strong>The presence of at least one aRA ≥2 mm is associated with an increased risk of persistent T2EL, sac expansion, and need for reinterventions.Clinical ImpactIn this single-centre series of 199 consecutive F/BEVAR procedures, accessory renal arteries ≥2 mm were independently associated with an increased risk of aneurysm sac expansion and subsequent reintervention. In particular, accessory renal arteries originating from the aneurysm sac were correlated with treatment failure and should be considered for preemptive embolization at the time of the index procedure.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2719-2728"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145439905","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":"Safety and Efficacy of Treatment With the Luminor DCB and iVolution Stent in TASC C and D Femoropopliteal Atherosclerotic Disease: 12 and 24-Month Outcome of the T.I.N.T.I.N. Physician-Initiated Trial.","authors":"Koen Deloose, Laura Drudi, Jürgen Verbist, Jorn Robijn, Bram Balduyck, Koen Keirse, Peter Goverde, Stijn Schepers, Marc Dubois, Elien Vernez, Lieven Maene, Joren Callaert","doi":"10.1177/15266028251350025","DOIUrl":"10.1177/15266028251350025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is evidence that the treatment of symptomatic femoropopliteal disease with a drug-coated balloon (DCB) effectively inhibits restenosis. However for longer and more complex lesions, \"bailout\" remains stenting almost inevitable. Although the combination therapy of DCBs and modern bare metal stent (BMS) has not been widely studied, there are indications that this combination therapy is doing better than BMS alone and could be a potential alternative for drug-eluting stent treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study is to evaluate the long-term outcome of the combination therapy with the Luminor DCB and the iVolution stent of iVascular for the treatment of long femoropopliteal lesions Transatlantic InterSociety Consensus (TASC) C and D.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The T.I.N.T.I.N. trial is a physician-initiated, prospective, non-randomized, multicenter trial conducted in Belgium, investigating the safety and efficacy of the treatment with the Luminor DCB and the iVolution self-expanding stent in 100 patients. The primary efficacy endpoint was freedom from clinically-driven target lesion revascularization (CD-TLR) at 12 months. The key secondary endpoints were primary patency at 12 months, CD-TLR at 24 months, and survival at 12 and 24 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants had a mean age of 73.5 ± 9.4 years, with 67.0% being male participants. Sixty-two percent of the patients suffered from severe claudication (Rutherford 3) and 26.0% had limb-threatening ischemia (Rutherford 5). Freedom from CD-TLR at 12 and 24 months was 94.6% (95% CE: 90.0-99.2) and 89.6% (95% CE: 83.2-96.0), respectively. The primary patency rate at 12 months was 90.5% (95% CE: 84.2-96.8). Survival rate at 1 and 2 years was 92.8% (95% CE: 87.8-97.8) and 82.0% (95% CE: 74.2-89.8), respectively. None of the causes of death were procedure or device related.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The combination of a Luminor DCB followed by an iVolution stent implantation resulted in safe and effective outcomes in the treatment of femoropopliteal lesions for up to 24 months. Adding paclitaxel to the bare nitinol stent platform by predilating with a Luminor DCB appears to improve efficacy at 1 and 2 years compared to the use of BMSs only, as observed in the precursor Evolution study.Clinical ImpactThis study proofs that especially in long and complex femoropopliteal lesions (full cohort of 100 patients instead of a subanalysis in a small subgroup with risk of biases), a combination therapy of a Paclitaxel coated balloon and a modern bare metal stent offers high levels of safety and efficacy up to 2 years. For clinicians it means that beside bypass surgery, covered self-expandable stents and drug eluting stents, they have an extra treatment option in the armamentarium for complex vascular disease in this anatomic area. Depending on personal preferences, reimbursement systems and device availabilities they can op","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2536-2544"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668843","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":"Hybrid Coils for Left Subclavian Artery Embolization During Zone 2 Thoracic Endovascular Repair.","authors":"Martina Cambiaghi, Giacomo Isernia, Deborah Ongaro, Gioele Simonte, Gianbattista Parlani, Stefano Bonardelli, Luca Bertoglio","doi":"10.1177/15266028251384929","DOIUrl":"10.1177/15266028251384929","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Prevertebral left subclavian artery (LSA) occlusion was traditionally performed using conventional coil embolization or vascular plugs. The Penumbra Occlusion Device (POD) is a hybrid coil specifically designed for embolizing high-flow vessels. This study aims to report the technical and clinical success of the POD for LSA embolization during Zone 2 Thoracic Endovascular Aortic Repair (TEVAR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials & methods: &lt;/strong&gt;All consecutive patients who underwent LSA embolization using the POD in Zone 2 TEVAR in 2 high-volume aortic centers were retrospectively collected and analyzed. Procedural data and clinical outcomes were collected. The primary endpoint was the technical success rate of LSA embolization using the POD. Secondary endpoints included short-term outcomes and freedom from reintervention. Follow-up was performed with Computed Tomography Angiography (CTA) to confirm successful LSA prevertebral embolization without type Ic endoleak and to assess patency of surgical revascularization of the distal LSA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between January 2020 and April 2024, 37 patients (68% men, median age: 70 years) with degenerative chronic thoracic aortic disease or acute aortic syndromes were included. A single POD was deployed in 49% of cases, primarily via brachial access (81%) using a 4F introducer sheath (68%). In the remaining cases, 1 additional coil was deployed to obtain angiographic occlusion. Technical success of LSA embolization was achieved in 97% of cases, with no evidence of type Ic endoleak on final angiography. At 30-day CTA, 9 patients (24%) had type Ic endoleak: 2 required reintervention with coiling, 4 resolved spontaneously, and 3 were managed conservatively without progression of aortic pathology. Clinical success of LSA embolization at follow-up was 92%, with no reported strokes or transient ischemic attacks. All extra-anatomical bypasses, left vertebral arteries, and distal LSAs remained patent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The POD is an effective tool for LSA embolization during TEVAR. This occlusion system offers a promising alternative to traditional methods by overcoming anatomical limitations, potentially eliminating the need for large introducers in upper extremity access and reducing the number of coils required for permanent occlusion of a high-flow vessel.Clinical ImpactThe Penumbra Occlusion Device (POD) represents a practical alternative to conventional coil or plug embolization for large, high-flow vessels. Its design allows controlled deployment through small-caliber access, potentially simplifying the procedure and reducing the number of devices required. This study demonstrates high technical success and acceptable short-term outcomes, suggesting that the POD can achieve reliable left subclavian artery occlusion during Zone 2 TEVAR. These results may guide procedural planning and support wider adoption of the POD as a feasible option in this sett","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2702-2709"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497515","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":"Technical Notes: Open Ascending Aorta and Valve Repair Following Total Arch Endovascular Repair.","authors":"Florent Porez, Robert Pruna-Guillen, Julien Guihaire, Konstantinos Zannis, Antoine Gaudin, Alessandro Costanzo, Dominique Fabre, Thomas Le Houerou, Alexandros Mallios, Stéphan Haulon","doi":"10.1177/15266028251396292","DOIUrl":"10.1177/15266028251396292","url":null,"abstract":"<p><strong>Introduction: </strong>Arch-branched endovascular repair (B-TEVAR) is an emerging alternative to open arch repair in high-risk patients. As its use grows, complex reoperations involving the ascending aorta (AA) and heart valves will become more frequent. No prior technique for open AA repair after B-TEVAR has been described.</p><p><strong>Technique: </strong>Two patients with prior B-TEVAR underwent open AA and valve surgery. The first patient had AA replacement under circulatory arrest and selective bicarotid perfusion. The second underwent Bentall and mitral valve replacement using femoral-femoral bypass, with a compliant balloon for distal aortic control and selective brachiocephalic trunk (BCT) perfusion.</p><p><strong>Results and discussion: </strong>Both surgeries were successful. The first patient recovered uneventfully. The second had a prolonged ICU stay but recovered fully. Surgical planning must account for endograft position, branch orientation, and clamping strategy. Preoperative CT with 3D reconstruction is essential.</p><p><strong>Conclusion: </strong>AA and valve repair after B-TEVAR is feasible. These cases offer technical insights for managing such complex reoperations as B-TEVAR becomes more common.Clinical ImpactArch-branched endovascular repair (B-TEVAR) is a less invasive alternative to standard open arch repair (OAR). We describe 2 surgical techniques to successfully perform cardiac surgery, including AA and aortic and mitral valve repairs, in patients with a history of B-TEVAR. Tailored approaches to address these challenging cases are mandatory, with a special focus on the endograft branches position and direction.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2397-2402"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710225","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":"Detecting Mitochondrial Oxygen Tension as a Measure of Local Tissue Oxygenation in Patients With Peripheral Arterial Disease Before and After Endovascular Therapy.","authors":"Abdallah H A Zaid Al-Kaylani, Richte C L Schuurmann, Riemer H J A Slart, Reinoud P H Bokkers, Jean-Paul P M de Vries","doi":"10.1177/15266028251344791","DOIUrl":"10.1177/15266028251344791","url":null,"abstract":"<p><strong>Introduction: </strong>Assessment of mitochondrial oxygen tension (mitoPO₂) is a novel technique for measuring skin perfusion. It is based on the oxygen-dependent quenching of delayed fluorescence of 5-aminolevulinic acid (5-ALA), known as the protoporphyrin IX-triple state lifetime technique. This study aimed to determine the tolerability and feasibility of measuring mitoPO₂ in the lower limbs of patients with peripheral arterial disease (PAD) undergoing endovascular therapy. In addition, the study investigated the changes in mitoPO₂ pre- and postoperatively.</p><p><strong>Materials and methods: </strong>This prospective single-center study included patients with Rutherford stage 4 to 6 scheduled for endovascular therapy. Plasters containing 5-ALA were placed over the tibia and at the lower lateral leg 12 hours before the operation. 5-ALA tolerability was assessed by noting the occurrence of related side effects during application, measurements, and in the 48 hours after removal of the plaster. MitoPO₂ was measured immediately before and after the operation over the tibia at the anterior tibialis muscle and the lateral side of the lower leg, and was followed by transcutaneous oxygen pressure and ankle-brachial index measurements.</p><p><strong>Results: </strong>Ten patients were included in this study. No side effects or adverse events related to 5-ALA were observed. One patient reported weak itching within 48 hours after removing the 5-ALA plaster. MitoPO₂ measurements were feasible in all patients at the tibia and lower leg, but were not feasible on the dorsum of the foot. Postoperatively, a significant drop in mitoPO₂ was detected at the tibia. No significant difference was found in mitoPO₂ levels pre- and postoperative at the lower lateral leg. For transcutaneous oxygen pressure, no significant differences were detected postoperatively.</p><p><strong>Conclusions: </strong>5-ALA is tolerable and safe in patients with PAD. MitPO₂ measurements at the tibia and lower lateral leg are feasible and capable of detecting changes in perfusion following endovascular therapy. Further research is needed with larger cohorts and longer follow-up to investigate the relationship between mitoPO₂, oxygen supply, and tissue regeneration.Clinical ImpactThis study demonstrated the feasibility and safety of mitochondrial oxygen tension (mitoPO₂) measurement using 5-aminolevulinic acid (5-ALA) for assessing local skin perfusion in patients with peripheral arterial disease (PAD) undergoing endovascular therapy. Changes in mitoPO₂ post-intervention suggest sensitivity to real-time microvascular and physiological alterations. This technique could potenitally improve overall patient outcomes and wound healing by enhancing patient stratification, treatment planning, perioperative monitoring, and postoperative follow-up.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2497-2506"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318548","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":"Endovascular Aneurysm Repair for a Sac Enlargement Caused by Type IIIb Endoleak Diagnosed Using Four-Dimensional Computed Tomography.","authors":"Satoru Tomita, Kenta Masada, Kazufumi Yoshida, Yojiro Koda, Yosuke Inoue, Yoshimasa Seike, Akiyuki Kotoku, Tetsuya Fukuda, Hitoshi Matsuda","doi":"10.1177/15266028251344806","DOIUrl":"10.1177/15266028251344806","url":null,"abstract":"<p><strong>Purpose: </strong>We describe a case in which 4-dimensional computed tomography (4D-CT) was used to detect a type IIIb endoleak after endovascular aneurysm repair (EVAR).</p><p><strong>Case report: </strong>The patient was a 75-year-old man who underwent EVAR for abdominal aortic aneurysm at our institute 13 years before presentation. The patient had been aortic event-free for 10 years postoperation. However, the sac gradually enlarged after 10 years and reached 55 mm in diameter. Traditional contrast-enhanced CT showed an endoleak but could not be used in type determination (type II or III). Four-dimensional-CT enabled us to make a definitive diagnosis of a type IIIb endoleak; therefore, relining EVAR was performed as a reintervention. Postoperative contrast-enhanced computed tomography confirmed disappearance of the endoleak.</p><p><strong>Conclusion: </strong>Type IIIb endoleaks following EVAR are often difficult to diagnose using traditional modalities. Thus, 4D-CT may be useful in identifying endoleak types.Clinical ImpactThis case report highlights the effectiveness of four-dimensional computed tomography (4D-CT) in diagnosing type IIIb endoleaks after endovascular aneurysm repair (EVAR). Traditional imaging methods often fail to accurately identify this type of endoleak, which can lead to aneurysm rupture if untreated. The use of 4D-CT allowed for a definitive diagnosis and timely reintervention, thus improving patient outcomes. Incorporating 4D-CT into post-EVAR surveillance protocols may enhance the detection and management of type IIIb endoleaks, potentially reducing the risk of complications and improving long-term patient prognosis.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2768-2770"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509213","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":"Total Iodine Contrast-Free Protocol in Complex Endovascular Aneurysm Repair.","authors":"Roberto Falso, Sara Speziali, Rosella Di Domenico, Brigida Biancofiore, Marta Panella, Giulia Landini, Elena Giacomelli, Aaron Thomas Fargion, Walter Dorigo, Raffaele Pulli","doi":"10.1177/15266028251344793","DOIUrl":"10.1177/15266028251344793","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Contrast-induced nephropathy is still a big issue related to using iodine contrast medium in patients with renal impairment undergoing complex endovascular aneurysm repair such as fenestrated or branched endovascular aneurysm repair (F/BEVAR). Although the use of carbon dioxide being well investigated in literature for standard EVAR, there are a few evidence about its use in F/BEVAR. The potential damage to kidneys is not only related to the procedure alone but also to the need to perform computed tomography angiography in the preoperative and postoperative period. With the aim to reduce the damage to renal function in patients with preexisting renal impairment, we report our experience of a total iodine contrast-free protocol in 6 patients with chronic kidney disease (stages from 3 to 5) who require a complex endovascular aneurysm repair due to an aneurysmatic disease of the thoracoabdominal aorta.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Six consecutive patients with chronic kidney disease underwent F/BEVAR at our institution following a total iodine contrast-free protocol, from perioperative period to follow-up. These patients were preoperatively evaluated with duplex ultrasounds and plain-computed tomography scan to perform proper reconstruction with dedicated 3D software. All the procedures were carried on with CO&lt;sub&gt;2&lt;/sub&gt; as contrast medium. During follow-up, every patient underwent plain-computed tomography scan at 1 month and then duplex ultrasound evaluations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Technical success was achieved in all cases. There were no aneurysm or procedure-related complications related to the use of CO&lt;sub&gt;2&lt;/sub&gt; in the perioperative period. At 6 months, in each case, the sac was stable and no endoleak were found. Serum creatinine and estimated glomerular filtration rate values were similar to preoperative ones both in the perioperative period and during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The total iodine contrast-free protocol showed its feasibility and safety to carry on complex endovascular procedures in patients affected by chronic kidney disease from stages 3 to 5 and concomitant aneurysmatic disease of the thoracoabdominal aorta. This protocol could also avoid further deteriorations of renal function that could lead those patients to hemodialysis. A large cohort of patient and an extended follow-up are required in the future to achieve more accurate data.Clinical ImpactThis study aims to evaluate an iodine-contrast-free protocol for patients with chronic kidney disease undergoing complex endovascular aortic repair, such as FEVAR or BEVAR. The use of this protocol may help preserve renal function and prevent further deterioration in patients at high risk for acute kidney injury or hemodialysis. Although the literature describes the role of CO&lt;sub&gt;2&lt;/sub&gt; as a non-nephrotoxic contrast agent, there are no reported experiences involving both preoperative and postoperat","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2481-2490"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192374","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":"Dual- and Triple-Branched Endografts for Zone 0 Aortic Arch Reconstruction: A Narrative Review of Current Devices and Outcomes.","authors":"Zicheng Wan, Nikolaos Tsilimparis, Chang Shu","doi":"10.1177/15266028251388400","DOIUrl":"10.1177/15266028251388400","url":null,"abstract":"<p><p>Dedicated dual- and triple-branched endografts represent a transformative innovation for achieving secure Zone 0 proximal landing in aortic arch reconstruction. Driven by the limitations of traditional open and hybrid approaches, these dedicated devices integrate advanced design features-such as customizable dual-inner branch configurations, mechanical interlock systems, pre-curved ascending aortic stents, and ultra-low-profile delivery systems to enhance fixation, minimize wall stress, and reduce procedural complications. Early clinical experiences have shown promising outcomes with high freedom from aorta-related mortality and low rates of endoleaks and reinterventions, although challenges related to device durability, anatomical variability, and long-term patency remain. As the field shifts from physician-modified prototypes to dedicated commercial platforms, ongoing research is focused on refining device adaptability and integrating advanced imaging and computational modeling to further personalize treatment strategies. These trends underscore an industry-wide move toward minimally invasive, endovascular solutions that aim to improve patient outcomes in the management of complex aortic arch pathologies.Clinical ImpactDedicated dual- and triple-branched endografts enable fully endovascular Zone 0 repair, reducing the need for open or hybrid surgery. For clinicians, they broaden treatment options for high-risk patients and simplify procedural planning. As designs and imaging integration evolve, these devices are expected to improve durability, predictability, and long-term outcomes-marking a major step toward a truly minimally invasive standard for aortic arch reconstruction.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2361-2373"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497474","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":"Physician-Modified Custom Made Endograft Adding an Outer Branch to Correct a Fenestration Offset.","authors":"Lorenzo Torri, Petroula Nana, José I Torrealba, Tilo Kölbel, Giuseppe Panuccio","doi":"10.1177/15266028251384208","DOIUrl":"10.1177/15266028251384208","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the use of a physician-modified endograft (PMEG) through the incorporation of an outer branch within a fenestrated custom-made device (CMD) originally designed for another patient with similar anatomy.</p><p><strong>Technique: </strong>An 80-year-old male, with a symptomatic 80 mm juxtarenal aneurysm, was managed urgently using a readily available fenestrated CMD, designed for a different patient. While 3 of the 4 fenestrations were appropriately aligned with the intended target vessels (TVs), the fourth fenestration, targeting the left renal artery, was incorporated 15 mm lower than the vessel's orifice. To overcome this offset, a 6 mm covered stent (Viabahn, Gore & Associates, Flagstaff, Arizona) was latero-terminal sutured to the fenestration, creating a retrograde outer branch. The procedure was successful, followed by an uneventful postoperative course. Predischarge computed tomography confirmed the patency of the TV and the freedom from endoleak.</p><p><strong>Conclusion: </strong>Urgent setting may demand further modifications of readily available CMD, including the incorporation of branches in fenestrated stent grafts, in order to accommodate in patient's anatomy. Future standardization of the modification techniques may further expand their utilization.Clinical ImpactThis case introduces a physician-modified endograft technique incorporating an outer branch into pre-existing fenestrated custom-made device (CMD) for urgent complex aortic aneurysm repair. Using an available CMD instead of creating a new PMEG reduces preparation time and procedural complexity while maintaining technical success and target vessel patency. This practical, repoducible approach broadens the applicability of fenestrated technology in urgent settings lacking suitable off-the-shelf options.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2380-2386"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446425","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}