European Journal of Vascular and Endovascular Surgery最新文献

{"title":"Predictors of 30 Day Ischaemic Colitis after Endovascular Repair of Non-ruptured Infrarenal Abdominal Aortic Aneurysm","authors":"Renxi Li , Anton Sidawy , Bao-Ngoc Nguyen","doi":"10.1016/j.ejvs.2024.11.349","DOIUrl":"10.1016/j.ejvs.2024.11.349","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 496-497"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impaired Pre-operative Ambulatory Capacity in Patients Undergoing Elective Endovascular Infrarenal Abdominal Aortic Aneurysm Repair is Associated with Increased Peri-operative Death☆","authors":"Heepeel Chang ,&nbsp;Frank J. Veith ,&nbsp;Jae S. Cho ,&nbsp;Aiden Lui ,&nbsp;Igor A. Laskowski ,&nbsp;Romeo B. Mateo ,&nbsp;Daniel J. Ventarola ,&nbsp;Sateesh Babu ,&nbsp;Thomas S. Maldonado ,&nbsp;Karan Garg","doi":"10.1016/j.ejvs.2024.09.031","DOIUrl":"10.1016/j.ejvs.2024.09.031","url":null,"abstract":"<div><h3>Objective</h3><div>While ambulatory capacity is a readily assessable clinical indicator of functional status, its association with outcomes after endovascular aneurysm repair (EVAR) remains underexplored. This study aimed to investigate the association between pre-operative ambulatory status and outcomes following elective EVAR.</div></div><div><h3>Methods</h3><div>A retrospective review of the multi-institutional Vascular Quality Initiative database was conducted for all patients who underwent elective infrarenal EVAR from 2009 – 2022. Patients were categorised into independent ambulation and impaired ambulation groups. A propensity score matched analysis was performed to produce two well matched cohorts in a 1:1 ratio without replacement. The primary outcome was 30 day death. Secondary outcomes included one year survival and in hospital major complications.</div></div><div><h3>Results</h3><div>Among 11 474 patients, 10 539 (91.8%) were independently ambulatory pre-operatively. Propensity score matching resulted in 885 matched pairs. The impaired ambulation group, although older (mean 77.6 <em>vs</em>. 76.3 years; <em>p</em> = .001), showed comparable baseline characteristics. Post-operatively, the impaired ambulation group had higher cumulative in hospital complications and death as well as 30 day death. Even after adjustment for age, impaired pre-operative ambulation was associated with increased in hospital and 30 day death (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.26 – 3.95; <em>p</em> = .006). Multivariable analysis demonstrated increasing cumulative risk of 30 day death in the setting of impaired pre-operative ambulatory status with age &gt; 75 years requiring post-operative red blood cell transfusion &gt; 2 units (HR 5.75, 95% CI 2.09 – 15.88; <em>p</em> &lt; .001). Beyond 30 days, impaired pre-operative ambulation was not associated with increased one year death (HR 1.09, 95% CI 0.81 – 1.48; <em>p</em> = .57).</div></div><div><h3>Conclusion</h3><div>Among patients who underwent elective infrarenal EVAR in this matched analysis, impaired pre-operative ambulatory capacity was associated with an increased risk of in hospital and 30 day death, further compounded by advanced age and post-operative transfusion. As such, a threshold higher than the traditional size criteria should be considered in shared decision making when determining options for the management of abdominal aortic aneurysm in this high risk cohort.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 432-439"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection and Coil Embolisation of Pelvic Vein Incompetence for Chronic Pain in the Female Pelvis: A Development Phase Economic Analysis","authors":"Rob Hainsworth ,&nbsp;Martin Eden ,&nbsp;Jonathan Ghosh ,&nbsp;Vivak Hansrani ,&nbsp;Steven Rogers ,&nbsp;Charles McCollum ,&nbsp;Gabriel Rogers ,&nbsp;Katherine Payne","doi":"10.1016/j.ejvs.2024.09.041","DOIUrl":"10.1016/j.ejvs.2024.09.041","url":null,"abstract":"<div><h3>Objective</h3><div>Unexplained chronic pain in the female pelvis (CPFP) affects 7% of people of female sex in the UK. Evidence suggests that pelvic vein incompetence (PVI) could explain CPFP and that coil embolisation could provide relief. The aims of this study were to indicate (1) the cost effectiveness of detecting and treating PVI in people experiencing unexplained CPFP, and (2) the maximum value of further research, suggesting suitable areas.</div></div><div><h3>Methods</h3><div>A decision tree compared standard care (regular prescribed analgesia) with an intervention comprising transvaginal duplex ultrasound to screen for PVI, venography to confirm the diagnosis, and coil embolisation treatment. The population included those experiencing unexplained CPFP. A UK National Health Service perspective and 2021 – 22 price year were used. Ten years of health costs and health related quality of life (HRQoL) effects for eligible 40 year olds were simulated. Evidence reviews informed diagnostic accuracy, health service usage, and unit costs. A single centre randomised controlled trial informed all other parameters. Probabilistic analysis incorporated parameter uncertainty in cost effectiveness estimates. Deterministic sensitivity analysis indicated drivers of uncertainty. Value of information methods measured the value of eliminating all relevant uncertainties, given uptake predictions. The main outcome measures were incremental cost and quality adjusted life years (QALYs) for the intervention compared with analgesia, the incremental cost effectiveness ratio (ICER), and expected value of perfect information.</div></div><div><h3>Results</h3><div>The mean ICER for the intervention was £4 558 per QALY gained, and the probability that the ICER was within the UK cost effectiveness threshold (£20 000/QALY gained) was 90%. The expected value of perfect information about all model parameters was £46m. All deterministic sensitivity analysis scenarios met the threshold, except the smallest plausible HRQoL effect of (resolving) CPFP.</div></div><div><h3>Conclusion</h3><div>Detecting and treating PVI causing CPFP appears cost effective, but more primary research would be valuable to reduce decision uncertainty. Uncertainty in the HRQoL estimate for unexplained CPFP appeared to contribute most to decision uncertainty.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 474-482"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Comprehensive Endovascular Aortic Programme and Maintenance of Clinical Excellence during Fenestrated Branched Endovascular Aortic Repair in Two Centres","authors":"Lucas Ruiter Kanamori ,&nbsp;Andrea Vacirca ,&nbsp;Dora Babocs ,&nbsp;Emanuel R. Tenorio ,&nbsp;Guilherme B.B. Lima ,&nbsp;Bernardo C. Mendes ,&nbsp;Ying Huang ,&nbsp;Steven Maximus ,&nbsp;Anthony Estrera ,&nbsp;Gustavo S. Oderich","doi":"10.1016/j.ejvs.2024.11.014","DOIUrl":"10.1016/j.ejvs.2024.11.014","url":null,"abstract":"<div><h3>Objective</h3><div>Comprehensive endovascular aortic programmes need optimal infrastructure and multidisciplinary teams to manage complex aortic aneurysms. This study assessed the implementation of such a programme in two centres and its impact on fenestrated or branched endovascular aortic repair (FB-EVAR) outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of patients treated for complex abdominal and thoraco-abdominal aortic aneurysms (TAAAs) by FB-EVAR between 2013 and 2023 was undertaken. All FB-EVAR patients were analysed, including investigational trials and high risk patients with physician modified endografts. Centre 1 (2013 – 2020) and Centre 2 (2020 – 2023) were compared. Primary endpoints were 30 day and or in hospital mortality and major adverse event (MAE) rates. Secondary endpoints were procedural metrics, spinal cord injuries, freedom from all cause death, failure to rescue, and one year mortality and re-intervention rates.</div></div><div><h3>Results</h3><div>A total of 629 patients were included (475, 75.5% at Centre 1 and 154, 24.5% at Centre 2). The median age was 74 years (interquartile range 68, 79) and 441 (70.1%) were male. Centre 2 had a higher proportion of American Society of Anesthesiology class ≥ 3, genetically triggered aortic diseases (<em>p</em> = .002), chronic post-dissection aneurysms, prior aortic repairs, TAAAs (each <em>p</em> &lt; .001), and symptomatic, larger aneurysms (<em>p</em> &lt; .021). Technical success rates were similar between centres (97.9% <em>vs.</em> 98.1%; <em>p</em> = .91). The early mortality rate was 1.1% (7/629) with no statistically significant difference. No statistically significant differences (<em>p &gt; .</em>050) in new onset permanent dialysis (0.6% <em>vs.</em> 2.0%), major stroke (0.6% <em>vs.</em> 0.6%), and permanent paraplegia (0.8% <em>vs.</em> 2.0%) were observed. Failure to rescue rates were 5.3% in Centre 2 and 3.5% in Centre 1 (<em>p</em> = .74). The one year mortality rate (91% <em>vs.</em> 89%; <em>p</em> = .71) and re-intervention rate (sub-distribution hazard ratio 1.30; <em>p</em> = .21) were similar between centres.</div></div><div><h3>Conclusion</h3><div>FB-EVAR was performed with low mortality and risk of disabling complication rates. No differences in mortality and MAE rates were observed after establishing a comprehensive endovascular programme, despite higher risk and more extensive cases at the new institution.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 407-414"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Analysis of the Outcomes of Patients Following Carotid Intervention in France: Strengths and Challenges of National Claims","authors":"Fabien Lareyre,&nbsp;Laurent Bailly,&nbsp;Juliette Raffort","doi":"10.1016/j.ejvs.2024.11.360","DOIUrl":"10.1016/j.ejvs.2024.11.360","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 505-506"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Team is Only as Strong as Its Weakest Link","authors":"Nuno V. Dias ,&nbsp;Hence J.M. Verhagen","doi":"10.1016/j.ejvs.2024.12.040","DOIUrl":"10.1016/j.ejvs.2024.12.040","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Page 415"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice – Hybrid Stent Graft Technique in Bridging Hostile Renal Arteries in Thoraco-abdominal Branched Endografting☆","authors":"Enrico Gallitto ,&nbsp;Gianluca Faggioli ,&nbsp;Andrea Vacirca ,&nbsp;Emanuel R. Tenorio ,&nbsp;Bernardo C. Mendes ,&nbsp;Marcello Lodato ,&nbsp;Antonio Cappiello ,&nbsp;Jesse Chait ,&nbsp;Gustavo S. Oderich ,&nbsp;Mauro Gargiulo","doi":"10.1016/j.ejvs.2024.10.008","DOIUrl":"10.1016/j.ejvs.2024.10.008","url":null,"abstract":"<div><h3>Objective</h3><div>Target artery patency is crucial for fenestrated and branched endovascular aortic repair (FB-EVAR) in thoraco-abdominal aortic aneurysms (TAAAs). Occlusions more frequently occur in the renal arteries (RAs) than in the coeliac and superior mesenteric arteries, especially in patients with hostile anatomy treated by B-EVAR. This study aimed to report RA outcomes using a hybrid bridging stent graft technique with distal self expandable (SE) combined with proximal balloon expandable (BE) stent graft during B-EVAR with hostile RA anatomies.</div></div><div><h3>Methods</h3><div>Clinical data from consecutive patients treated for TAAA by FB-EVAR in three aortic centres (two in the USA, one in Europe) from 2016 to 2022 were collected prospectively. RA orientation was defined as hostile in case of upward (type B) or downward + upward (type D) orientation. Hostile RAs accommodated by B-EVAR and combination of SE + BE stent grafts were evaluated retrospectively. Intra-operative RA related complications, technical success (TS), and branch occlusions were assessed as early outcomes. Primary and secondary RA patency, freedom from RA related re-interventions, and freedom from RA instability were assessed during follow up.</div></div><div><h3>Results</h3><div>Of 584 TAAAs managed by FB-EVAR, 83 patients (14.2%) had 125 hostile RAs (type B, 45.6%; type D, 54.4%) managed by B-EVAR with hybrid SE + BE stent grafts. Intra-operative complications occurred in three RAs (2.4%), including two dissections and one disconnection, all successfully managed with additional stents. TS was achieved in all cases, with no RA occlusions at 30 days. The median follow up was 21 (interquartile range 4, 38) months. Estimated three year RA primary patency was 97 ± 2%. Re-interventions were performed in five RAs (4.0%), including two RA branch embolisations for bleeding, two catheter thrombectomies with stent relining (bilateral occlusion in one patient), and one revision of type Ic endoleak. Freedom from RA related re-interventions and RA instability was 95 ± 2% and 91 ± 3% at three years, respectively. RA secondary patency was 99 ± 1% at three years.</div></div><div><h3>Conclusion</h3><div>In hostile RA anatomies, a combination of distal SE and proximal BE stent grafts as bridging stenting in B-EVAR is safe and effective, with low rates of occlusion, re-interventions, and branch instability at midterm follow up.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 422-431"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising Abdominal Aortic Aneurysm Screening of 65 Year Old Men by Exploring Risk Factor Based Targeted Screening Strategies in the Light of Declining Prevalence of the Disease","authors":"Patrik Söderberg ,&nbsp;Anders Wanhainen ,&nbsp;Sverker Svensjö","doi":"10.1016/j.ejvs.2024.10.005","DOIUrl":"10.1016/j.ejvs.2024.10.005","url":null,"abstract":"<div><h3>Objective</h3><div>A decline in abdominal aortic aneurysm (AAA) prevalence calls into question the credibility of general population screening of 65 year old men. Selectively targeting high risk individuals among this group could be more effective in preventing death from AAA rupture. This cross sectional study analysed risk factor data in a cohort of 65 year old men screened in the Swedish general population based AAA screening programme, with the aim of exploring the effectiveness of hypothetical targeted screening strategies.</div></div><div><h3>Methods</h3><div>All men attending AAA screening in four neighbouring counties in Sweden between 2006 and 2010 completed a health questionnaire on smoking habits and medical history. Abdominal aortic aneurysm was defined as measuring ≥ 30 mm. The sensitivity and specificity of different targeted screening strategies, with targeted subpopulations defined by duration of smoking with and without additional risk factors, were explored using receiver operating characteristic (ROC) curves.</div></div><div><h3>Results</h3><div>A total of 16 232 men were screened, with 236 (1.5%) screen detected AAAs. A strategy combining smoking, presence of coronary artery disease (CAD), or both was associated with the mathematically optimal balance between sensitivity and specificity (optimal threshold) in the ROC analysis. The optimal threshold corresponded to targeting men having smoked for thirty years or more, a history of CAD, or both, where 74.0% of all AAAs could be detected by screening 33.0% of the population, compared with general screening. Targeting men that have smoked for ten years or more indicated that 84.0% of all AAAs could be detected by screening 55.0% of the population. A simplified strategy of targeting ever smokers resulted in detecting 85.0% of all AAAs by screening 61.0% of the population.</div></div><div><h3>Conclusion</h3><div>Targeted screening of men at high risk of AAA, focusing on smoking history for inclusion, may be a safe and effective alternative to general population screening.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 416-421"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Tear of Inferior Vena Cava in Motor Vehicle Collision","authors":"Gregor Siegl,&nbsp;Kurt Tiesenhausen","doi":"10.1016/j.ejvs.2024.10.042","DOIUrl":"10.1016/j.ejvs.2024.10.042","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Page 402"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Choice – Feasibility and Safety of Using Carbon Dioxide Exclusively in Regular Endovascular Aortic Aneurysm Repair: Results of a Multicentre, Prospective, Zero Iodine Contrast Endovascular Aneurysm Repair Study☆","authors":"Emiliano Chisci ,&nbsp;Emanuele Ferrero ,&nbsp;Michele Antonello ,&nbsp;Luca Mezzetto ,&nbsp;Raffaele Pulli ,&nbsp;Giacomo Isernia ,&nbsp;Mauro Gargiulo ,&nbsp;Giovanni Pratesi ,&nbsp;Luca Bertoglio ,&nbsp;Stefano Michelagnoli","doi":"10.1016/j.ejvs.2024.11.011","DOIUrl":"10.1016/j.ejvs.2024.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>Carbon dioxide (CO₂) angiography has emerged as a viable alternative to regular iodinated contrast medium (ICM) for guiding endovascular aneurysm repair (EVAR) procedures. This study aimed to evaluate the feasibility and safety of a standardised EVAR procedure using only CO₂ angiography.</div></div><div><h3>Methods</h3><div>A prospective, multicentre, national study enrolled consecutive patients between January 2023 and January 2024 with asymptomatic abdominal aortic aneurysms measuring ≥ 55 mm and for whom a standard endovascular graft (instructions for use) was anatomically feasible. The study involved the use of an automatic CO₂ injector to standardise intra-operative imaging. A strategy comprising five standardised steps was devised to visualise a target vessel (TV) that could not be seen during the first CO₂ angiogram. The five steps were: (A) place the introducer closer to the TV; (B) tilt the table by 5 – 10° in the direction opposite to the TV; (C) selectively cannulate the TV; (D) cannulate the contralateral gate (only for repositionable devices); CO₂ angiography was repeated in steps 1 – 2; and (E) use ICM.</div></div><div><h3>Results</h3><div>Two hundred and ninety-three patients were enrolled (10 centres), with a median age of 78 (interquartile range [IQR] 72, 83) years; 256 (87.4%) were male. The overall procedure time, fluoroscopy time, and injected CO₂ volume were 90 (IQR 65, 125) minutes, 15 (IQR 10, 22) minutes, and 600 (IQR 400, 800) mL, respectively. The 30 day mortality, complication, and re-intervention rates were 0.3% (<em>n</em> = 1), 6.8% (<em>n</em> = 20), and 2.4% (<em>n</em> = 7), respectively. CO₂ related adverse events were rare (1%; <em>n</em> = 3) and minor. A zero iodine contrast EVAR procedure was feasible in 240 (patients 81.9%). The five standardised steps were used extensively: step A, 170 procedures (58.0%); step B, 109 procedures (37.2%); step C, 21 procedures (7.2%); step D, 14 procedures (4.8%); and step E, 53 procedures (18.1%), with a median volume of 20 (IQR 10, 35) mL. Significant predictors for ICM use were aneurysm diameter &gt; 70 mm and a lowermost renal artery positioned between 3 and 9 o’clock.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the standardised zero iodine contrast EVAR protocol reported here is both safe and feasible and is applicable in 82% of consecutive non-selected patients. Limitations primarily arose from anatomical factors, and adjunctive standardised manoeuvres can effectively address these challenges in most cases.</div></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":"69 3","pages":"Pages 392-402"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}