It has been documented that large-artery stiffness is independently associated with increased cardiovascular risk and may potentially lead to heart and kidney failure and cerebrovascular disease. A systematic review of studies investigating changes in arterial stiffness in patients undergoing endovascular repair of aortic disease was conducted. In addition, a review of the available literature was performed, analyzing findings from studies using the cardio-ankle vascular index (CAVI) as a marker of arterial stiffness. Overall, 26 studies were included in the present analysis. Our research revealed a high heterogeneity of included studies regarding the techniques used to assess the aortic stiffness. Aortic stiffness was assessed by pulse wave velocity (PWV), elastic modulus (Ep), and augmentation index (AI). Currently a few studies exist investigating the role of CAVI in patients having an aortic aneurysm or undergoing endovascular aortic repair. The majority of studies showed that the treatment of an abdominal aortic aneurysm (AAA) either with open repair (OR) or endovascular aortic repair (EVAR) reduces aortic compliance significantly. Whether EVAR reconstruction might contribute a higher effect on arterial stiffness compared to OR needs further focused research. An increase of arterial stiffness was uniformly observed in studies investigating patients following thoracic endovascular aortic repair (TEVAR), and the effect was more pronounced in young patients. The effects of increased arterial stiffness after EVAR and TEVAR on the heart and the central hemodynamic, and an eventual effect on cardiac systolic function, need to be further investigated and evaluated in large studies and special groups of patients.

Christos F. Pitros, Fotios O. Efthymiou, Andreas L. Tsimpoukis, Christos P. Dimitroukas, Petros E. Zampakis, Konstantinos G. Moulakakis, George S. Panayiotakis, and Stavros K. Kakkos. Vasc Specialist Int 2023;39:. https://doi.org/10.5758/vsi.230019

Dimitrios Diamantopoulos-Kogkas, Pavlos Georgiou, Christos Pitros, Chrysanthi Papageorgopoulou, Marios Papasotiriou, Nikolaos Karydis, Nikolaos Koutsoyiannis, Athina Mougiou, Konstantinos Katsanos, and Spyros Papadoulas. Vasc Specialist Int 2024;40:. https://doi.org/10.5758/vsi.240022

Stroke is the second most common cause of death and disability worldwide. The correlation between plaque vulnerability and stroke risk needs to be further determined. Shear wave elastography is a promising, non-invasive, low-cost tool for carotid plaques vulnerability assessment. We examined the role of quantification of the carotid plaque's composition using shear wave elastography (SWE) and the subsequent classification of the plaque as symptomatic (in patients who have had stroke/TIA attributed to the plaque) or asymptomatic, and likewise as vulnerable (having features that predispose to stroke, such as lipid-rich necrotic core or hemorrhage) or stable. A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases Medline (PubMed), Scopus, Cochrane Library and ClinicalTrials.gov were searched from inception to July 2024. The primary goal was to evaluate SWE as a diagnostic tool for vulnerable carotid plaques. The search resulted in the identification of 606 studies, of which 24 specifically examined our primary objective. Five comparative studies were included in the symptomatic vs. asymptomatic group of the meta-analysis, while three were included in the vulnerable vs. stable group. For symptomatic vs. asymptomatic plaques analysis the pooled Standardized Mean Difference (SMD) is -0.89 with a 95% confidence interval (CI) of [-1.28, -0.50], while for vulnerable vs. stable plaques analysis the pooled SMD -2.38 with a 95% CI of [-3.68, -1.07]. Symptomatic and vulnerable carotid plaques showcased significantly lower Young's modulus (kPa) values (both, P<0.001). SWE has shown promising results for carotid plaque assessment and stroke risk stratification. Further prospective multicenter clinical studies are needed to determine optimal techniques and parameters for Young's modulus and shear wave velocity indexes, enhancing stroke prevention and treatment.

Acute limb ischemia (ALI) is a time-critical vascular emergency associated with high morbidity and amputation risk if treatment is delayed. Popliteal artery aneurysms (PAAs), though less common, represent an important and often underrecognized cause. We report a 67-year-old man who presented with suddenonset severe leg pain, pallor, sensory loss, and motor deficit, consistent with Rutherford IIb ALI. Computed tomography angiography revealed a nearly thrombosed PAA with absent distal runoff. The patient underwent hybrid revascularization combining open thrombo-embolectomy with prosthetic interposition grafting, intra-and postoperative catheter-directed thrombolysis, and prophylactic four-compartment fasciotomies. Postoperatively, distal perfusion improved significantly, sensation fully recovered, motor function was nearly restored, and independent ambulation was achieved. This case highlights extensive distal embolization with absent tibial runoff , a condition in which isolated embolectomy is often inadequate. It illustrates the effectiveness of a hybrid surgical-endovascular strategy for limb salvage and underscores the importance of rapid imaging, urgent revascularization, adjunctive thrombolysis, and early fasciotomy. These principles are summarized in a practical management algorithm.

Gluteal gangrene rarely complicates interventional procedures such as angiographic embolization in the pelvis or may develop postoperatively after open ligation or endovascular covering or embolization of one or mainly both internal iliac arteries in abdominal aortic surgery if collateral circulation is compromised. On the other hand, gluteal gangrene as a primary manifestation of chronic aortoiliac occlusive disease is very exceptional in literature. We present a patient with atherosclerotic aortoiliac obstruction and a necrotic eschar on her left buttock treated with aortobiiliac bypass after digital subtraction angiography. Internal iliac artery revascularization, even contralaterally, is crucial for the healing of necrotic tissue in these patients.