Introduction: The aim of this study was to analyse early and follow-up results of the treatment of popliteal artery aneurysms (PAAs) performed with open surgical repair or with endovascular exclusion with endografts in a multicentric retrospective registry involving seven Italian vascular centres. Materials and methods: We retrospectively collected data concerning 178 open surgical interventions (OR group) and 134 endovascular exclusions (ER group) for PAAs performed between January 2000 and December 2011. Early and follow-up results were analysed in terms of mortality, graft patency, reintervention and limb preservation. Results: OR patients were more frequently symptomatic (64%, 115 cases) than patients in the ER group (34%, 51 cases; p < 0.001), had more frequently acute limb ischaemia (23% and 6.5%, respectively; p < 0.001) and had more frequently a run-off score <2 (39% and 26%, respectively, p = 0.03). In the OR group there were no perioperative deaths; six thromboses (3.3%) and one amputation occurred. In the ER group mortality was 1.5%; 13 thromboses (9.7%) and one amputation (0.5%) occurred. Mean duration of follow-up was 30.6 ± 27.5 months. In the OR group primary and secondary patency, freedom from reintervention and limb preservation rates at 48 months were 63.5% (standard error (SE) 0.05), 76.5% (SE 0.05), 72.5% (SE 0.06) and 89.7% (SE 0.05), respectively. The corresponding figures in the ER group were 73.4% (SE 0.04), 85% (SE 0.04), 75% (SE 0.04) and 97% (SE 0.04), respectively. Conclusions: In this large multicentric retrospective registry, open and endovascular treatment of PAAs are used in different patients with regard to clinical and anatomical characteristics. Both treatments are feasible and safe, providing satisfactory early and long-term results. © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

We report the case of a patient previously treated with an iliac branch endograft for isolated iliac artery aneurysm who developed, more than 2 years later, a type B aortic dissection resulting in the acute expansion of the previously excluded iliac aneurysm. Successful endovascular salvage is described.

The aim of this study was to evaluate outcomes and feasibility of carotid artery stenting versus carotid endarterectomy, both procedures performed in the same patient. Forty-five subjects (33 males, 70 ± 7 years) underwent carotid endarterectomy or carotid artery stenting, the counter procedure on the contralateral carotid performed after a variable period. We evaluated the post-procedural percentage of carotid stenosis at 30, 180 days and one-year follow-up, and the occurrence of acute myocardial infarction, New York Heart Association class progression, stroke, death, cardiovascular death, angina, transient ischemic attack and renal failure. Carotid artery stenting treatment reduced the degree of re-stenosis after 180 days equally to carotid endarterectomy procedure (difference: 0.033%, P = 0.285). No statistically significant differences were observed according to the occurrence of acute myocardial infarction and New York Heart Association class progression, revealing odds ratio (OR) equal to 0.182 (P = 0.361) for acute myocardial infarction and 0.303 (P = 0.434) for New York Heart Association class progression. Carotid endarterectomy confirms its efficacy in carotid revascularization, but carotid artery stenting constitutes a good alternative when the procedures are selected based on patient-specific risk factors

BACKGROUND: Aim of this study was to retrospectively compare perioperative (<30 days) and 2-year results of open and endovascular management of popliteal artery aneurysms (PAAs) in a single-center experience. METHODS: From January 2005 to December 2010, 64 PAAs in 59 consecutive patients were operated on at our institution; in 43 cases, open repair was performed (group 1), whereas the remaining 21 cases had an endovascular procedure (group 2). Data from all the interventions were prospectively collected in a dedicated database, which included main preoperative, intraoperative, and postoperative parameters. Early results in terms of mortality, graft thrombosis, and amputation rates were analyzed and compared by χ(2) text or Fisher exact text. The surveillance program consisted of clinical and ultrasonographic examinations at 1, 6, and 12 months and yearly thereafter. Follow-up results (survival, primary and secondary patency, limb salvage) were analyzed by Kaplan-Meier curves, and differences in the two groups were assessed by log-rank test. RESULTS: There were no differences between the two groups in terms of sex, age, risk factors for atherosclerosis, and comorbidities; PAAs were symptomatic in 48% of cases in group 1 and in 29% in group 2 (P = 0.1). Fifteen patients with mild-to-moderate acute ischemia due to PAA thrombosis underwent preoperative intra-arterial thrombolysis, 13 in group 1 and 2 in group 2. In open surgery group, nine cases were treated with aneurysmectomy and prosthetic graft interposition, and in seven cases, the aneurysm was opened and a prosthetic graft was placed inside the aneurysm. In 27 cases, ligation of the aneurysm with bypass grafting (21 prosthetic grafts and 6 autologous veins) was carried out. In group 2, 20 patients had endoprosthesis placement, whereas in the remaining patient, a multilayer nitinol stent was used. There was one perioperative death in a patient of group 2 who underwent concomitant endovascular aneurysm repair and PAA endografting. Cumulative 30-day death and amputation rate was 4.5% in group 1 and 4.7% in group 2 (P = 0.9). Follow-up was available in 61 interventions (96%) with a mean follow-up period of 22.5 months (range: 1-60). Estimated primary patency rates at 24 months were 78.1% in group 1 and 59.4% in group 2 (P = 0.1). Freedom from reintervention rates at 24 months were 79% in group 1 and 61.5% in group 2 (P = 0.2); estimated 24-month secondary patency rates were 81.6% in group 1 and 78.4% in group 2 (P = 0.9), and freedom from amputation rates were 92.7% and 95%, respectively (P = 0.7). CONCLUSIONS: Endovascular treatment of PAAs provided, in our initial experience, satisfactory perioperative and 1-year results, not significantly different from those obtained with prosthetic open repair in patients with similar clinical and anatomical status. There is, however, a trend toward poorer primary patency rates among patients endovascularly treated, who also seem to require more frequently a reintervention.

BACKGROUND: To retrospectively analyze early and follow-up results of endovascular management of visceral artery aneurysms (VAAs) in a single-center experience. METHODS: From 2007 to June 2013, 26 consecutive elective endovascular interventions for VAAs were performed in 26 patients; preoperative, intraoperative, and postoperative data were prospectively collected in a dedicated database. Early (<30 days) and follow-up results were evaluated. RESULTS: The site of aneurysm was splenic artery in 17 patients, common hepatic artery in 3 patients, renal artery and pancreaticoduodenal artery in 2 cases each, and gastroduodenal artery and celiac trunk in one case each. All the lesions were asymptomatic, and the mean diameter was 22.8 mm. Interventions consisted in coiling in 19 cases; in 4 patients a covered stent was placed, whereas the remaining 3 patients had a multilayer stent. Technical success was 89%. There were no perioperative deaths; 1 patient with splenic artery aneurysm had coils migration with symptomatic splenic infarction and underwent successful redo coils packing. Median duration of follow-up was 18 months. During follow-up, 1 aneurysm-unrelated death occurred. One asymptomatic thrombosis of a treated vessel was recorded, with a 2-year estimated patency rate of 91%. Mean aneurysmal diameter at the latest follow-up was 20.2 mm (P = 0.001 in comparison with preoperative values; 95% confidence interval 1.9-5.2). Complete exclusion of the aneurysm occurred in all but 1 patient, who had a limited increasing in the diameter of its splenic aneurysmal sac after coiling. Another patient developed a more distal aneurysm of the splenic artery after 24 months. No reinterventions were required. Freedom from aneurysm-related complications at 2 years was 72.9% (Standard Error, 0.09). CONCLUSIONS: In our experience, endovascular treatment of VAA, when feasible, provided excellent perioperative results with low rates of complications and reinterventions. Even if the risk of developing aneurysm-related complications during follow-up is substantial, most of them can be watched without the need for repeated interventions.

Aneurysms of the brachiocephalic trunk are rare but their clinical outcomes are potentially devastating; they include rupture, cerebral or arm ischemia secondary to thromboembolism, and compression of the surrounding structures. Although open repair has proven successful, it is associated with significant morbidity and mortality rates. Endovascular treatment, if anatomically feasible, may offer a safer and less invasive approach to these lesions, especially in high-surgical-risk patients. We report the good long-term outcome of endovascular repair of a large innominate artery true aneurysm due to Takayasu's arteritis. A stent graft was safely and successfully deployed to exclude the aneurysm; assessment by vascular imaging at 8-year follow-up demonstrated the efficacy of the procedure.

To report the use of endografts to manage multiple aneurysms due to Cogan syndrome (CS). A 38-year-old woman with descending thoracic aorta and right common carotid artery aneurysms due to CS was treated with endovascular grafts. After 4 years, angio computed tomography scan demonstrated complete exclusion of the aneurysms with no signs of endoleak, whereas echo color Doppler showed patency of the carotid graft, no signs of restenosis, no progression of the disease in the landing zones, and complete aneurysm exclusion. Endovascular repair seems to have favorable long-term outcomes and should be considered a viable alternative to surgery in unfit for open surgery patients, even if they are young, and when the aneurysm size and location would pose a higher risk of perioperative and postoperative complications after an open surgical procedure.

Purpose : To report the use of a endograft to manage a type IB endoleak in a patient with a juxtarenal aortic aneurysm previously treated with a multylayer stent CASE REPORT: Under compassionate use a 68 years old patient with a juxtarenal aortic aneurysm and multiple comorbidities was treated with a multilayer flow modulating stent. Twelve months later a new CT scan identified a type Ib endoleak with an increase of the aortic aneurysm size due to extension of the aneurysmal disease to the aortic carrefour . A new endovascular procedure was then performed , deploying an aorto bisiliac endoprosthesis . After 18 months serial echocolor duplex and CT scans have shown normal visceral arteries patency, no signs of endoleak and sac shrinkage of 5 mm CONCLUSION: In this case, MARS failed to treat the AAA and required a reoperation with conventional covered stentgraft for distal sealing, which may be considered a feasible solution to manage potential endoleaks

OBJECTIVE: The purpose of this study was to retrospectively analyze early and midterm results of endovascular infrainguinal peripheral revascularizations in female patients in our single-center experience, paying particular attention to clinical, anatomic, and technical factors affecting perioperative and follow-up outcomes. MATERIALS AND METHODS: From January 2000 to December 2010, 258 endovascular interventions for femoropopliteal disease were performed. Interventions were retrospectively divided into two groups: interventions performed in women (80 interventions, group 1) and interventions performed in men (178 interventions, group 2). The two groups of patients were compared in terms of demographic data, common risk factors for atherosclerosis, and comorbidities. Early (intraoperative and <30-day) results were analyzed in terms of technical success, conversion to open surgery, primary patency, secondary patency, and, for patients with critical limb ischemia, limb salvage. The follow-up program consisted of clinical and duplex scanning examinations with ankle-brachial index (ABI) measurement within the third postoperative month, at 6 and 12 months, and yearly thereafter. Follow-up results were analyzed in terms of survival, primary and secondary patency, assisted primary patency, and, for patients with critical ischemia, limb salvage. RESULTS: There were no differences between the two groups in terms of risk factors for atherosclerosis, comorbidities, clinical, and anatomic status. Technical success was 96.9% and technical failure rates were 1.2% in group 1 and 3.9% in group 2 (P = .2). Three in-hospital deaths were recorded, all in group 2, whereas in-hospital thromboses occurred in five patients, two in group 1 and three in group 2; with conversion to surgical bypass in all these cases, and in three of the cases, major amputation was necessary (two in group 1 and one in group 2). Cumulative 30-day mortality was 1.1%, with no difference between women (no deaths) and men (three deaths, 1.6%; P = .4). Overall amputation rate at 30 days was 1.2%, again with no differences between the two groups (2.5% and 0.6%, respectively; P = .4); also, the rate of perioperative thrombosis (overall 2.7%) was similar between the two groups (2.5% and 3.3%, respectively; P = .9). Mean duration of follow-up was 17 months (range, 1-85 months). Estimated 36-month survival rates were 95% in group 1 and 84.5% in group 2 (P = .4; log-rank, 0.7). Cumulative primary patency rates at 36 months were 38% in group 1 and 42% in group 2 (P = .4; log-rank, 0.5). Assisted primary patency at 36 months was 45.1% in group 1 and 60.5% in group 2, whereas secondary patency rates were 63.5% and 76%, respectively (P = .8; log-rank, 0.03). CONCLUSION: Endovascular treatment of femoropopliteal occlusive disease provides similar results between men and women at an intermediate follow-up. There is, however, a trend toward poorer results in women requiring further analysis at a longer follow-up period.

We present a rare case of a giant hepatic artery aneurysm in a 61-year-old man that was successfully treated by aneurysmectomy with prosthesis bypass grafting. Because the gastroduodenal artery was occluded, an adequate collateral circulation was not ensured after simple ligation, so a direct arterial flow to the liver was restored to avoid the risk of significant liver or biliary tract ischemia. A computed tomography scan at 1 month showed occlusion of the bypass. The patient remained asymptomatic, despite the supposed lack of adequate collateral circulation. The unpredictable blood supply to the liver is discussed.