Thoracic Endovascular Aortic Repair for Penetrating Aortic Trauma.

Background: Thoracic Endovascular Aortic Repair (TEVAR) reduced mortality for blunt aortic injury (BAI) from 30-50% to < 10%; however, penetrating traumatic aortic injury (PAI) remains highly lethal (>40% mortality). This study's goal is to determine outcomes of TEVAR for PAI.

Methods: Patients undergoing TEVAR for traumatic aortic injuries were identified from the Vascular Quality Initiative database from 2011-2022.

Endo-Bentall Repair: Early Results and Feasibility of a Physician-Constructed Endo-Bentall Device.

Objective: We present our experience with endovascular Bentall procedure (Endo-Bentall) using a modular valve conduit (Endo-Bentall) in high-risk patients with aortic root pathologies.

Methods: The physician constructed Endo-Bentall device is composed of a self-expanding transcatheter aortic valve (TAVR), aortic endovascular stent graft (TEVAR), and two wire-reinforced fenestrations for coronary artery stenting. The TAVR valve is sutured into an appropriately sized TEVAR graft.

From Zone -1 to Zone 3: Feasibility and Safety of Complex Endovascular Aortic Repairs in Type A Aortic Dissection.

Objective: Over 30% of patients presenting with acute type A aortic dissection (ATAAD) are considered high - risk or inoperable. This study aims to investigate the early and mid-term outcomes of complex endovascular aortic repair of aortic root, ascending aorta, and aortic arch among patients with ATAAD.

Methods: From January 2018 to January 2023, 29 patients who were considered high risk for open operation underwent endovascular aortic repair.

Vascular Closure Device vs Open Decannulation for Femoral Venoarterial Extracorporeal Membrane Oxygenation.

Background: Traditional decannulation of femoral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) involves femoral cutdown. Percutaneous methods have been developed, but data supporting their use are limited. This study sought to compare the MANTA (Teleflex) vascular closure device with open decannulation.

Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology.

Objective: The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2.

Investigating the role of thrombosis and false lumen orbital orientation in the hemodynamics of Type B aortic dissection.

While much about the fundamental mechanisms behind the initiation and progression of Type B aortic dissection (TBAD) is still unknown, predictive models based on patient-specific fluid-structure interaction (FSI) simulations can help in risk stratification and optimal clinical decision-making. Aiming at the development of personalized treatment, FSI models can be leveraged to investigate the interplay between complex aortic flow patterns and anatomical features, while considering the deformation of the arterial wall and the dissection flap. In this study, the hemodynamics of false lumen thrombosis, a large fenestration, and the orbital orientation of the false lumen is studied through image-based FSI simulations on three TBAD patient-specific geometries.

Decreasing Resident Vascular Case Volumes Have Not Changed National Numbers of Vascular Fellowship Applications in US General Surgery Residents Over the Past Twenty Years.

Objectives: With an aging workforce and high prevalence of vascular disease, the US is expected to face a pronounced shortage of vascular surgeons over the next 2 decades. This has driven initiatives to expand vascular surgery training positions leading to the rise of integrated residency programs (0 + 5) and the expansion of traditional fellowships (VSFs, 5 + 2). Given the increase in dedicated vascular surgery training positions, there has been a growing concern that general surgery residents (GSRs) are experiencing decreased vascular case volumes.

Impact of operative approach and patient frailty on outcomes for aorto-iliac occlusive disease with critical limb threatening ischemia.

Objectives: Multiple treatment modalities exist for the management of aorto-iliac occlusive disease (AIOD) including endovascular (endo), extra-anatomic bypass (EAB), and anatomic bypass (AB). The goal of this study was to examine the impact of revascularization strategy and patient frailty on outcomes for AIOD in patients with critical limb threatening ischemia (CLTI).

Methods: Patients undergoing revascularization for CLTI and AIOD were identified from the NSQIP database over 5 years.

Totally percutaneous endovascular renal allograft salvage for common iliac artery pseudoaneurysm.

Delayed presentation of recipient artery pseudoaneurysms following kidney transplantation is a rare, yet critical, complication. Although the precise etiology remains unclear, factors such as chronic steroid use, iatrogenic injuries (including vascular clamp damage during index surgery), or infections could contribute. Timely surgical intervention is imperative to prevent arterial rupture and life-threatening bleeding.

Investigating the Role of Thrombosis, Fenestration, and False Lumen Orbital Orientation in the Hemodynamics of Type B Aortic Dissection.

While much about the fundamental mechanisms behind the initiation and progression of Type B aortic dissection (TBAD) is still unknown, predictive models based on patient-specific computational fluid dynamics (CFD) can help in risk stratification and optimal clinical decision-making. Aiming at the development of personalized treatment, CFD simulations can be leveraged to investigate the interplay between complex aortic flow patterns and anatomical features. In this study, the hemodynamics of false lumen thrombosis, a large fenestration, and the orbital orientation of the false lumen is studied through image-based CFD simulations on three TBAD patient-specific geometries.

A direct aorta to segmental artery bypass for prevention of spinal cord ischemia after endovascular aortic repair.

Spinal cord ischemia remains a persistent challenge after endovascular aortic aneurysm repair. We present a novel direct aorta to segmental artery bypass before aneurysm repair in a 64-year-old woman presenting with an enlarging aneurysm following dissection. Through an eighth intercostal incision, a polyester graft was sewn into the aorta using pledgeted sutures.

Nasal Intubation is not Associated with "Smoother" Emergence from General Anesthesia for Carotid Endarterectomy: A Case-Cohort Study.

Background: Postoperative hematoma after carotid endarterectomy (CEA) is a devastating complication and may be more likely in patients with uncontrolled hypertension and coughing on emergence from anesthesia. We sought to determine if intubation with a nasal endotracheal tube (ETT)-instead of an oral ETT-is associated with "smoother" (i.e.

Risk factors and treatment interventions associated with incomplete thrombus resolution and pulmonary hypertension after pulmonary embolism.

Background: Residual pulmonary vascular occlusion (RPVO) affects one half of patients after a pulmonary embolism (PE). The relationship between the risk factors and therapeutic interventions for the development of RPVO and chronic thromboembolic pulmonary hypertension is unknown.

Methods: This retrospective review included PE patients within a 26-month period who had baseline and follow-up imaging studies (ie, computed tomography [CT], ventilation/perfusion scans, transthoracic echocardiography) available.

Superior gluteal artery as a reliable back door to embolize mycotic pseudoaneurysm of an isolated Internal Iliac artery.

Background: Antegrade access through the origin of the internal iliac and direct percutaneous access under cross-sectional imaging guidance are commonly used for embolization of internal iliac artery aneurysms, pseudoaneurysms, or endoleaks. Here, we report superior gluteal artery retrograde access to treat internal iliac artery mycotic pseudoaneurysm in a patient with failed direct percutaneous access.

Case Presentation: We present a 65-year-old female with a history of diverticulitis and sigmoidectomy.

Direct aortic access for endovascular thoracoabdominal aneurysm repair using a bifurcated endograft as a branched device.

Aortic aneurysms (AA) are a common complication in patients with large-vessel vasculitis, such as chronic phase Takayasu arteritis, that often require surgical management to prevent a lethal rupture. Historically, mainstay of treatment for AA in the setting of arteritis was traditional open repair. However, in this case study an alternative surgical approach was devised to successfully treat an extent III thoracoabdominal AA in a patient with a diagnosis of Takayasu arteritis and a complex surgical history that made her high risk for an open surgical intervention.

Evaluating the Safety of Transcarotid Artery Revascularization under Local Anesthesia Prior to Coronary Artery Bypass Grafting Surgery.

Background: Controversy exists regarding the timing of intervention for patients with critical coronary artery disease (CAD) awaiting coronary artery bypass and severe carotid artery stenosis (CAS). Transcarotid artery revascularization (TCAR) is a minimally invasive revascularization alternative through direct transcervical carotid access that minimizes the chance of arch manipulation and consequent antegrade embolic stroke rate. While the TCAR procedure can be performed under local anesthesia (monitored anesthesia care [MAC]) versus general anesthesia, the hemodynamic benefits of local anesthesia in patients with severe CAD are significant.

The Caged Knickerbocker: A Novel Modification to Targeted False Lumen Management in Complex Aortic Dissection.

Introduction: Targeted false lumen management has been described for complex presentations of aortic dissection. The "Knickerbocker" technique is often referenced and includes dilating a focal portion of an oversized endograft in the true lumen to purposefully rupture the false lumen septum, but at the expense of increased risk for visceral propagation and malperfusion. This case series describes a novel modification of the Knickerbocker technique by caging the distal end of the endograft prior to focal dilation.