EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ.

Clinical practice guidelines summarize and assess all relevant evidence on a specific topic at the time of their creation, with the goal of assisting physicians in selecting the best management strategies for individual patients with a given condition. These guidelines take into consideration the impact on patient outcomes as well as the risk–benefit ratio of different diagnostic or therapeutic methods. Although these guidelines do not replace textbooks, they complement them and cover topics pertinent to contemporary clinical practice. 

EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ.

Background: To report technical success as well as perioperative outcomes of patients who underwent endovascular aortic repair (EVAR) of penetrating abdominal aortic ulcers ≤35 mm in diameter (PAU). Patients and methods: The abdominal aortic aneurysm (AAA) quality registry of the German institute for vascular research (DIGG) was used to identify patients with standard EVAR for infrarenal PAU ≤35 mm between 1/1/2019 and 12/31/2021. Infectious, traumatic, inflammatory PAUs, PAUs associated with connective tissue disease, PAUs following aortic dissection as well as true aneurysms were excluded. Demographics, cardiovascular comorbidity, technical success as well as perioperative morbidity and mortality were determined. Results: Amongst 11 537 patients who underwent EVAR during the study period, 405 with PAU ≤35 mm were eligible from 95 participating hospitals across Germany (22% women, 20.5% octogenarians). The median aortic diameter was 30 mm (Interquartile range 27-33). Cardiovascular comorbidities were frequent with coronary artery disease (34.8%), chronic heart failure (30.9%), history of myocardial infarction (19.8%), hypertension (76.8%), diabetes (21.7%), smoking (20.8%), history of stroke (9.4%), symptomatic lower extremity peripheral arterial disease (20%), chronic kidney disease (10.4%) and chronic obstructive pulmonary disease (9.6%). Most patients were asymptomatic (89.9%). Among the symptomatic patients, 13 presented with distal embolization (3.2%) and 3 with contained ruptures (0.7%). Technical success of endovascular repair was 98.3%. Both, percutaneous (37.1%) or femoral cut-down access approaches (58.5%) were registered. Endoleaks of any type were present with type 1 (0.5%), type 2 (6.4%) and type 3 (0.3%) endoleaks. Overall mortality was 0.5%. Perioperative complications occurred in 12 patients (3.0%). Conclusions: According to this registry data, endovascular repair of PAU is technically feasible with acceptable perioperative outcomes, but further studies investigating mid- and long-term data are needed before invasive treatment of PAU disease in an elderly and comorbid patient population should be recommended.

Outcomes of endovascular repair of infrarenal penetrating aortic ulcers.

BACKGROUND
This study compared outcomes of endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) in patients with infective native abdominal aortic aneurysms (INAAA), evaluating perioperative and in-hospital mortality, antibiotic treatment duration, complications, overall survival rates, and reintervention-free times at 10 years.


METHODS
A retrospective cohort study of 125 INAAA patients (80 EVAR, 45 OAR) diagnosed between January 2004 and December 2019 was conducted. Patients were categorized as fit or unfit for open surgery based on cardiac, respiratory, and renal status, following the guidelines established in the EVAR-1 and EVAR-2 trials. Primary outcomes included 30-day and in-hospital mortality. Secondary outcomes encompassed early and late complications requiring reintervention, antibiotic treatment duration, 10-year overall survival, 10-year reintervention-free survival, and factors influencing 30-day mortality. Statistical analysis used chi-square, t-tests, and Mann-Whitney U tests. Logistic regression assessed mortality. Kaplan-Meier estimation evaluated survival. Analyses used SPSS version 18.0 (p < 0.05 considered significant) RESULTS: Males predominated in both OAR (37/45, 82.2%) and EVAR (62/80, 77.5%) groups (P = 0.693). Mean age was 64.8 ± 9.8 years for OAR and 69.0 ± 12.6 years for EVAR (P = 0.063). The abdominal aorta was the most common aneurysm location, accounting for 91/125 (72.8%) cases. Salmonella spp. accounted for 19/45 (42.2%) of positive culture cases, and 34/125 (27.2%) patients had ruptured aneurysms. The EVAR group had a higher proportion of unfit patients (41/80, 51.2%) compared to OAR (10/45,22.2%; P=0.003). 30-day mortality rates were 6/80 (7.5%) for EVAR and 2/45 (4.4%) for OAR; OR = 1.75 (95% CI: 0.34 - 9.06), P = 0.508, while in-hospital mortality rates were 7/80 (8.8%) and 5/45 (11.1%); OR = 0.77 (95% CI: 0.23 - 2.58), P = 0.668. No significant differences were found in antibiotic treatment duration (median 11 vs 6 months, P=0.594), 10-year overall survival rates (62.8% vs 64.8%, P=0.90), or reintervention-free time (83.8% vs 82.2%, P=0.922), and aneurysm-related death (84.7% vs 92.9%, P=0.159), Unfit patient status was an independent predictor of 30-day mortality (adjusted OR, 10.654; 95% CI, 1.041-109.030; P=0.046).


CONCLUSIONS
Our study demonstrates that EVAR and OAR provide comparable outcomes in INAAA management, despite EVAR being performed more frequently in unfit patients. The similar early mortality rates, antibiotic treatment durations, and long-term survival between the two approaches support EVAR as a viable alternative to OAR. Importantly, our finding that unfit patient status independently predicts perioperative mortality emphasizes the critical role of patient selection in treatment decisions. These results collectively suggest that EVAR may be particularly beneficial for high-risk INAAA patients unsuitable for OAR, potentially expanding treatment options for this challenging condition.

A 10-year Retrospective Comparison of Endovascular and Open Aneurysm Repair for Infective Native Abdominal Aortic Aneurysm.

Early and Midterm Results after Endovascular Repair of Non-infected Saccular Lesions of the Infrarenal Aorta.

FLASH Mechanisms Track MECHANISMS OF FLASH RADIOTHERAPY SPARING OF NORMAL TISSUE AS INFORMED BY RNA-SEQ TRANSCRIPTOME ANALYSES

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Early and Midterm Results after Endovascular Repair of Non-infected Saccular Lesions of the Infrarenal Aorta.

FLASH Mechanisms Track MECHANISMS OF FLASH RADIOTHERAPY SPARING OF NORMAL TISSUE AS INFORMED BY RNA-SEQ TRANSCRIPTOME ANALYSES