Background: There is a paucity of reporting outcomes of complex aortic aneurysm treatment such as juxtarenal abdominal aortic aneurysms, where additional techniques to preserve renal artery perfusion are required. Methods: Retrospective analysis of consecutive patients who underwent emergent and elective aortic repair with fenestrated PMEGs between March 2019 and January 2023. Endpoints were technical success, reinterventions, secondary reinterventions and target vessel patency. Results: Forty-seven target vessels in 37 patients (23 male, median age 75 years) were targeted, of which 44 were renal arteries (RAs) with a mean diameter of 5.4 ± 1.0 mm. Thirteen were accessory RAs and six had a diameter ≤ 4 mm. Technical success rate was 87% overall; 97% for main and 62% for accessory RAs respectively. Target vessel patency and freedom from secondary reintervention was 100% and 97% at 30 days and 96% and 91% at one year, respectively. There was no 30-day mortality. Conclusion: Fenestrated physician-modified endografts are safe and effective for the treatment of patients with juxtarenal abdominal aortic aneurysms when incorporating main renal arteries. Limited technical success may be expected when targeting accessory renal arteries, especially when small in diameter. Long-term follow-up is needed to confirm durability of PMEGs for renal artery preservation.

The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people’s physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of “ofeleein i mi vlaptin”, that is, to help or not to harm.

The INCRAFT stent graft system is an ultra-low-profile endograft for the exclusion of infrarenal aortic aneurysms. In the market approval studies, an increased rate of device-related complications was observed and the endograft was approved with mandated postmarketing investigations. Our aim was to analyze mid-term outcomes of a real-world patient cohort treated with the INCRAFT endograft. Consecutive patients treated with the INCRAFT endograft between February 2015 and December 2022 at a single institution were included. In accordance with the Society for Vascular Surgery reporting standards, safety endpoints were reported and outcome endpoints included reinterventions, technical success, aortic-related and overall-mortality, endoleak, stent fracture, and endograft migration >5 mm. Eighty patients (85% male) with a mean age of 76 ± 7 years were included. Fifty-two patients (65%) were treated within the endograft's instruction for use. Mean aortic diameter was 59 ± 10 mm and 91% of the procedures were performed percutaneously. Mean follow-up (FU) was 37 ± 25 months and there was no aortic- or procedure-related mortality. Reinterventions occurred in 25 patients (31%) with a freedom from reintervention at 1, 3, and 5 years of 84%, 66%, and 55%. The most frequent reinterventions were limb graft stenting (23%) and type II endoleak embolization (14%). Limb occlusion rate was 9% and in 3 patients (4%) distal endograft migrations >5 mm occurred. Persisting type II endoleaks were observed in 29% and aneurysm diameter was stable in 41% and had shrunk in 38%. Three type III endoleaks (4%) developed during FU and 4 open conversions (5%) were necessary. No known risk factors, including treatment outside instruction for use, were predictive for reinterventions. Treatment of infrarenal aortic aneurysms with the INCRAFT stent graft system was safe and successful. Nevertheless, a substantial rate of reinterventions was necessary during FU to maintain endograft patency and prevent aneurysm growth.

Purpose: Description of physician-modified endograft technique and its advantages using the TREO stent graft system. Technique: After partial back-table deployment of the TREO endograft, fenestrations are created using a scalpel and reinforced with a double snare loop and running suture. The distance between the Z-shaped stents of the TREO main body of almost 20 mm allows for more flexible placement of multiple fenestrations and easier and faster re-sheathing. The technique is illustrated with physician modification of a TREO aortic cuff and bifurcated endograft in three patients with juxtarenal aortic aneurysms or type Ia endoleak after previous endovascular aortic aneurysm repair. Conclusion: Physician modification of the TREO stent graft system can be safely performed, making it an excellent additional option to treat juxtarenal aneurysms. Clinical Impact: The TREO stent graft system offers various sizing options including different main body lengths and diameters, thus increasing applicability. Larger distance between the main body’s stents facilitates placement of multiple physician-modified fenestrations. Re-sheathing is easier and faster due to the low number of main body stents which have to be re-sheathed. Therefore, the TREO stent graft system is an excellent platform for the physician-modified technique.

Background: Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population.Methods: Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models.Results: Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03–1.16; and PR 2.03, 95%CI 1.22–3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03–1.08; PR 1.24, 95%CI 1.16–1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001).Conclusion: Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.

Low-profile endografts have reported increased rates of limb graft occlusions. The INCRAFT stent graft system is an ultra-low-profile endograft for the exclusion of infrarenal abdominal aortic aneurysms. Our aim was to report thromboembolic events (TEs) in patients treated with the INCRAFT device and its association with risk factors. A retrospective study was performed of 80 patients treated with the INCRAFT endograft between February 2015 and December 2022 at a single institution. All available imaging studies were reviewed by two reviewers independently. TEs included intraprosthetic thrombus (IPT), limb graft occlusion (LGO), and distal embolization. A regression analysis was performed to evaluate possible risk factors associated with the development of TEs. These included tortuous access vessels, IPT, access vessel diameter, and the ratio between the cross-sectional area of the main body to the bilateral limb grafts. Limb occlusions occurred in seven patients (9%) and 12 limbs (7.5%), resulting in a primary and secondary patency at 1, 3, and 5 years of 96% and 99%, 94% and 97%, and 89% and 93%, respectively. IPT was found in 36% of patients and affected endograft limbs in 93%. Ten distal occlusions in eight patients (10.0%) were considered to originate from IPT, which led to symptomatic occlusions of below-the-knee vessels in all patients. Freedom from IPT at 1, 3, and 4 years was 80%, 61%, and 43%, respectively. Age ≤70 years and access vessel diameter ≥10 mm were associated with IPT development. IPT was significantly associated with LGO (odds ratio, 77.10; P = .003). Thromboembolic events are frequent after treatment with the INCRAFT endograft with a LGO rate of 9% per patient and IPT found in 36% of patients. IPT was more common in patients ≤70 years and was a significant risk factor for LGO.