Thoracoabdominal aortic aneurysms (TAAAs) are rare but serious conditions characterized by dilation of the aorta characterized by remodeling of the vessel wall, with changes in the elastin and collagen content. Individuals with Marfan syndrome have a genetic predisposition for elastic fiber fragmentation and elastin degradation and are prone to early aneurysm formation and progression. Our objective was to analyze the medial collagen characteristics through histological, polarized light microscopy, and electron microscopy methods across the thoracic and abdominal aorta in twenty-five patients undergoing open surgical repair, including nine with Marfan syndrome. While age at surgery differed significantly between the groups, maximum aortic diameter and aneurysm extent did not. Collagen content increased from thoracic to infrarenal segments in both cohorts, with non-Marfan patients exhibiting higher collagen percentages, notably in the infrarenal aorta (729.3 nm vs. 1068.3 nm, p = 0.02). Both groups predominantly displayed mature collagen fibers, with the suprarenal segment containing the highest proportion of less mature fibers. Electron microscopy revealed comparable collagen fibril diameters across segments irrespective of Marfan status. Our findings underscore non-uniform histological patterns in TAAAs and suggest that ECM remodeling involves mature collagen deposition, albeit with lower collagen content observed in the infrarenal aorta of Marfan patients.

Thoracoabdominal aortic aneurysms (TAAAs) are rare and often remain asymptomatic until rupture, leading to high morbidity and mortality. Elastin degradation, largely mediated by matrix metalloproteinases (MMPs), plays a central role in their pathogenesis. This study aimed to evaluate plasma desmosine (pDES), a specific biomarker of elastin breakdown, as a non-invasive tool for TAAA detection and risk stratification. In a prospective single-centre case–control study, 30 patients with TAAA and 30 age- and sex-matched controls were enrolled. Plasma pDES levels were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Aortic wall samples from 12 patients were analysed for elastic fibre content and MMP expression by histology and western blotting. Statistical analyses included correlation testing, propensity score matching, and receiver operating characteristic (ROC) analysis. TAAA patients exhibited significantly higher pDES levels compared with controls (0.40 ± 0.31 vs. 0.22 ± 0.15 ng/mL; p < 0.001). pDES correlated positively with MMP-2 (ρ = 0.68, p = 0.02), TIMP-1 (ρ = 0.72, p = 0.01), and the proportion of elastic fibres in the aortic media (ρ = 0.61, p = 0.03). ROC analysis showed good diagnostic performance (AUC = 0.82), with a threshold of 0.27 ng/mL yielding 78.6% sensitivity and 76.7% specificity. Elevated pDES levels reflect aortic elastolytic activity and may serve as a promising biomarker for TAAA detection and risk assessment.

Popliteal artery aneurysms represent the most common peripheral arterial aneurysm. The optimal treatment strategy for popliteal artery aneurysms remains controversial. This study aimed to systematically evaluate and compare the clinical outcomes of endovascular versus open surgical repair of popliteal artery aneurysms. MEDLINE, EMBASE REVIEW METHODS: A systematic review and meta-analysis were conducted following the PRISMA guidelines (PROSPERO registration number CRD420251011632). Risk of bias was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool, and evidence certainty was evaluated using the GRADE approach. Primary outcomes included primary and secondary patency rates and freedom from reintervention. Nineteen studies, including 13 473 limbs (2 989 endovascular, 10 484 open), met the eligibility criteria. Open repair was associated with higher primary patency (HR 1.92, 95% CI 1.26 - 2.94, p = .003) and secondary patency (HR 1.60, 95% CI 1.04 - 2.44, p = .030) compared with endovascular repair. Freedom from reintervention also favoured open repair (HR 1.84, 95% CI 1.26 - 2.67, p = .001), whereas overall survival, freedom from amputation, and 30 day/in hospital mortality did not differ significantly between techniques. Endovascular repair resulted in a shorter hospital stay (mean difference -3.25, 95% CI -4.05 - 2.45, p < .001). Subgroup analyses showed that autologous vein bypass had superior primary patency versus endovascular repair (HR 2.37, 95% CI 1.45 - 3.88; p < .001), whereas prosthetic grafts did not differ significantly (HR 1.28, 95% CI 0.76 - 2.15; p = .35). The overall certainty of evidence for the primary outcomes was rated very low. Open surgical repair of popliteal artery aneurysms offers superior primary and secondary patency and should be the preferred treatment option in patients with acceptable operative risk. Endovascular repair may offer an alternative with a shorter hospital stay but carries a higher rate of reintervention.

Background/Objectives: Arterial wall compliance is a key biomechanical property influencing local hemodynamics, vascular remodeling, and surgical performance. Despite its clinical relevance, reference values in lower limb arteries remain insufficiently characterized. This systematic review and meta-analysis aimed to synthesize existing evidence on cross-sectional compliance (CC) of the common femoral artery (CFA), superficial femoral artery (SFA), and popliteal artery (PA) in healthy adults. Methods: A systematic literature search was performed according to PRISMA guidelines to identify studies reporting arterial wall compliance in healthy adults. Study characteristics, measurement techniques, and compliance values were extracted. Risk of bias was assessed using a QUADAS-2/COSMIN-based tool. Pooled estimates were calculated using random effects meta-analysis, PROSPERO CRD420251208399. Results: Thirty-four studies with a total of 3452 participants were included. Reported compliance values varied substantially. The pooled mean CC of the CFA was 0.95 (95%-CI 0.83–1.06, I² = 99.2%). Sex-specific analysis showed a pooled mean CC of 1.07 (95%-CI 0.87–1.28, I² = 99.0%) in males and 0.90 (95%-CI 0.75–1.05, I² = 83.6%) in females. Meta-regression of age, sex, and BMI did not significantly demonstrate association between these moderators and CC or explain observed heterogeneity. Extracted CC values of the SFA ranged from 0.17 to 0.50 mm²/kPa, and mean CC values of the PA ranged from 0.44 to 0.62 mm²/kPa. Conclusions: Available data on CC in lower limb arteries are limited and heterogeneous. Given the substantial between-study heterogeneity, the pooled estimates resulting from the meta-analysis should therefore be considered descriptive and should not be interpreted as definitive physiological reference values.

Mid‐aortic syndrome (MAS) is a rare condition marked by narrowing of the thoraco‐abdominal aorta, often causing severe hypertension. We present a 17‐year‐old male with refractory hypertension due to high‐grade aortic coarctation at the viscero‐renal segment. After failed endovascular interventions, open thoracoabdominal aortic repair was performed. The celiac trunk, superior mesenteric artery (SMA), and right renal artery were initially implanted into the tubegraft as a patch, but limited blood flow required revision including separate bypasses for the visceral arteries and both renal arteries. The patient was discharged with normalized blood pressure. Histopathology revealed adventitial necrosis, smooth muscle disorganization, and severe intimal thickening, suggesting intimal hyperplasia and fibrosis reduced blood flow. Separate bypasses might have been more effective than a patch for long‐term patency. At a 4‐year follow‐up, the patient remains stable, though the right renal bypass is occluded. This case report provides unique insights into the histopathological features of MAS and their potential impact on surgical decision‐making, contributing to our understanding of this rare condition.