Introduction: A type 2 endoleak (EL2) remains the most prevalent complication of endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA). Methods: We conducted a retrospective, single-center analysis, including patients who underwent embolization for an isolated EL2 after EVAR. The study population was stratified into two groups: Group A, consisting of patients whose EL2 resolved after the first embolization procedure, and Group B, consisting of those with refractory EL2 (rEL2). The indication for EL2 treatment was aneurysmal sac growth amounting to >10 mm from the index EVAR. The indications for endograft explantation were the absence of high comorbidities and persisting aneurysmal sac expansion. Those with high comorbidities were subjected to another endovascular procedure or a conservative approach, the latter being preferred. The primary endpoint was EL2 resolution. The secondary endpoints were mid-term outcomes in terms of aneurysmal sac shrinkage, stability and expansion rates, and aneurysm-related complications. Results: Among 57 patients, 19 patients (33.3%) showed signs of EL2 after the first embolization, whereas 38 (66.6%) presented rEL2. Of these, 14 (36.8%) presented significant aneurysmal sac expansion: 8 patients underwent a secondary embolization, while an open conversion was performed in the remaining 6 patients (42.8%), 4 of whom, in an elective setting, showed a complete resolution of EL2, while 2 patients treated in an urgent setting died from a ruptured aneurysm. Among the patients treated with a secondary embolization, only 2 patients presented EL2 resolution, while the other 6 patients (75%) showed rEL2. Out of the 38 patients with rEL2, 24 patients did not undergo further interventions; of these, 11 (45.8%) presented sac expansion, and 16% developed type IA EL. Conclusions: A strict follow-up and possibly a more aggressive treatment should be considered in an elective setting for patients with rEL2.

Introduction: Popliteal artery entrapment syndrome (PAES) is a rare disease of the lower limbs, mainly affecting young patients, due to extrinsic compression of the neurovascular bundle at the popliteal fossa. The aim of this study was to describe our experience during a median 15-year period. Methods: Patients treated for PAES in our institution from 1979 to 2024 were included. Preoperative, intraoperative, and postoperative data were analyzed. Results: A total of 47 patients with a total of 78 limbs were treated. Duplex ultrasound with active maneuvers was performed in all limbs (100%). Angiography was performed in almost all patients (97.4%), computed tomography angiography in 56 (71.8%), and magnetic resonance angiography in 22 (28.2%). Concerning surgical treatment, musculotendinous section was performed in 60 limbs (76.9%), and autologous venous bypass was achieved in 18 limbs (23.1%). The rates for freedom from target lesion revascularization—meaning that no significant stenosis or occlusion during follow-up required revascularization—and 15-year primary patency were 92.4% and 98%, respectively. Conclusion: Long-term results of surgical treatment for PAES seem to be very satisfying. Myotomy with or without arterial reconstruction using venous bypass can lead to good patency at 15 years of follow-up.

Zone 2 thoracic endovascular aortic repair (TEVAR) frequently requires left subclavian artery (LSA) preservation to maintain vertebrobasilar and upper-extremity perfusion while obtaining a durable proximal seal. Dedicated single-branch endografts were developed to standardize this step and to facilitate a reproducible fully endovascular strategy. Two main device concepts currently shape this field: integrated unibody branch platforms, represented by Castor and the second-generation Cratos, and modular retrograde-branch systems, represented by the Gore TAG Thoracic Branch Endoprosthesis (TBE). The Castor/Cratos evidence base is broader and older, and is mainly centered on type B aortic dissection, with prospective multicenter and real-world data showing favorable branch patency and aortic remodeling. By contrast, TBE evidence is expanding rapidly and is supported by prospective midterm data in arch aneurysms as well as by increasingly large post-commercial series and comparative analyses across zones 0–2. Beyond outcomes, the two platforms differ substantially in branch directionality, potential contribution to proximal fixation, modularity, branch diameter range, proximal landing requirements, access profile, and regulatory/off-the-shelf availability, all of which have direct consequences for anatomical suitability in dissection, aneurysm disease, and trauma. This narrative review synthesizes current evidence and proposes an anatomy-first, pathology-aware framework for selecting between Castor/Cratos and TBE in totally endovascular zone 2 TEVAR with LSA revascularization.

We present a novel, fully endovascular technique for subacute complicated type B aortic dissection, combining the Castor single-branched endograft with the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair method to achieve zone 2 sealing, left subclavian artery preservation, and complete aortic remodeling. This standardized, anatomically tailored strategy avoids hybrid procedures and enhances procedural reproducibility. We applied this approach in three patients with complex anatomies, all treated successfully without complications or reinterventions. Our experience supports the safety and effectiveness of this technique, offering a promising alternative for the management of complicated type B aortic dissection during the subacute phase.

To report peri-operative and midterm outcomes following open surgical, endovascular, and hybrid revascularisation for acute lower limb ischaemia (ALLI) using contemporary techniques and to provide adjusted comparative analyses accounting for key baseline differences. This was a multicentre, retrospective study including patients treated for ALLI (January 2016 - November 2024) across 20 international vascular centres. Patients underwent open surgery (56%), endovascular treatment (20%), or hybrid procedures (24%). Primary outcome was major amputation and or death at the latest follow up. Secondary outcomes included peri-operative mortality, amputation, acute kidney injury, and re-intervention. Multivariable Cox regression analyses adjusted for age, sex, Rutherford stage, and chronic kidney disease were performed. A Fine-Gray competing risk model accounted for death as a competing event for major amputation. A total of 1 259 patients (51% men; mean age 72 ± 14 years; no popliteal aneurysms) from 19 European centres and one centre in New Zealand were included. At 30 days, peri-operative mortality was 11% (open 12%, endovascular 3%, hybrid 7%; p = .04), and major amputation occurred in 9% (open 10%, endovascular 8%, hybrid 7%; p = .41). Median follow up was 36 months (range 8 - 49 months). At 3 years, estimated mortality was 22.9% (standard error [SE] 1.5%) after open, 11.5% (SE 1.9%) after endovascular, and 19.6% (SE 2.2%) after hybrid procedures. Adjusted analyses demonstrated that endovascular treatment was associated with a lower risk of the composite outcome of major amputation and or death compared with open surgery (hazard ratio 0.69, 95% confidence interval [CI] 0.53 - 0.89; p = .005). For major amputation, the Fine-Gray competing risk analysis showed a reduced subdistribution hazard with endovascular treatment (subdistribution hazard ratio 0.71, 95% CI 0.33 - 0.99; p = .006). Endovascular ALLI intervention was associated with lower long term amputation risk compared with open surgery, with comparable survival. These findings support endovascular treatment as a safe alternative in patients with ALLI.

Background: Endovascular treatment of popliteal aneurysms (PA) has increased in the last few years, quickly becoming the main treatment performed in many vascular centers, based on the acceptable and promising outcomes reported in the literature. However, endograft infections after endovascular popliteal aneurysm repair (EPAR) are the most dangerous complications to occur as they involve serious local compromise and usually require open surgical conversion and device explantation to preserve the affected extremity. Case report: We report two patients who were admitted to the emergency room of our hospital for pain and edema in the lower leg. Both patients had undergone exclusion of a ruptured PA a few years before by endovascular graft. CTA testing showed a significant volume of fluid-corpuscular collection related to perianeurysmal abscess collection in both cases. Blood cultures and drained material cultures were positive for Staphylococcus capitis in the first case and S. aureus in the second. Prophylactic antibiotics were administered for 10 days, then patients underwent an open surgical conversion with the complete explantation of endovascular material and a femoro-popliteal bypass using an autologous vein in the first case and a biological bovine pericardium prosthesis in the second case. The infective department of our hospital had defined a discharged specific antibiotic therapy for each patient, based on intraoperative microbiological samples. Furthermore, we have examined the literature and found six more cases described in case report articles that refer to popliteal graft infections by different microorganisms, mostly presenting acute limb ischemia as the first symptom and suggesting endograft explantation with open conversion and autologous vein bypass as the commonest therapeutic choice. Conclusions: The open surgical conversion of popliteal endograft infection is the best strategy to manage peripheral infection after an endovascular popliteal aneurysm repair procedure.