Deep vein thrombosis (DVT) is a frequent burden and a post-thrombotic syndrome (PTS) can be a serious long-term consequence. Iliofemoral DVT should be associated with severe forms of PTS. Therefore an early thrombus removal has been recommended in specific conditions. The aim of this study was to find out both, the long-term results after surgical thrombectomy of iliofemoral DVT in respect of the development of PTS as well as the venous hemodynamics after surgery concerning venous reflux and venous obstruction. Sixty-seven patients who underwent surgical thrombectomy between the years 2000 and 2014 were included in this study; iliofemoral DVT was present in 52 of these patients. 35 patients could be reinvestigated after a mean follow-up of 8.5 years. CEAP (Clinical-Etiological-Anatomical-Pathophysiological) and Villalta scores were recorded in order to describe and assess PTS. Follow-up examinations included a detailed duplex mapping. Venous hemodynamics were measured by digital photoplethysmography and venous occlusion plethysmography. The primary patency rate of the iliofemoral segment was 88% after 8.5 years. 48% of all patients showed reflux in deep vein segments. Mild or moderate PTS occurred in 57% of all patients. Notably, there was no patient with an active ulcer or severe PTS. The mean venous outflow volume of all patients in the treated legs was 66.1 ml/100ml/min and significantly less than in the controlled contralateral non-treated legs (p<0.05). The mean venous refilling time was 16.3 seconds, while the mean value of the non-treated contralateral legs was 25.6 seconds and therefore significantly higher (p<0.05). Even though venous hemodynamics are significantly inferior in the treated legs, this study demonstrates excellent patency rates and good clinical outcome after surgical thrombectomy of iliofemoral veins.

Background/Objectives: Retrograde false lumen perfusion after thoracic endovascular aortic repair (TEVAR) can compromise positive remodeling and clinical outcomes. The aim of this study is to describe the feasibility and outcomes of a false lumen thrombosis technique. Methods: A single-center, retrospective analysis of patients between January 2017 and January 2022 who underwent TEVAR in conjunction with false lumen embolization. Results: Twelve patients (83% type A, 17% type B; 33% with frank rupture; mean age 65 years; eleven men) underwent 13 false lumen embolization procedures with a 92% technical success rate and a 100% clinical success rate. Positive aortic remodeling was observed in all the patients. The maximum thoracic aortic diameter remained stable (p = 0.526) but the true lumen increased from 22 to 33 mm (p = 0.009) and the false lumen decreased from 41 to 20 mm (p = 0.076) after a median follow-up of 31 months. Conclusions: False lumen embolization using the candy-plug is safe and promotes positive aortic remodeling.

Malignant tumours of the aorta are a rare disease and often misdiagnosed as they masquerade as wall adjacent thrombus or inflammatory disease. Due to the often delayed diagnosis and the rapidly progressing illness, the outcome is very poor. A 50 year old female patient who had received coeliac and mesenteric artery stenting followed by an aortomesenteric bypass after stent occlusion two years earlier was treated. After an episode of hypertensive crisis caused by high grade stenosis of the renal arteries and review of previous tissue biopsies the diagnosis of Takayasu's arteritis was established, but the results were inconclusive. When presenting with a penetrating aneurysm of the renovisceral aorta, a complete reconstruction was performed of the renovisceral aorta due to impending rupture. Pre-operative imaging incidentally showed a sarcoma of the femur which was interpreted as an unrelated entity at the time. Finally, two years after the onset of the first symptoms, the diagnosis of an undifferentiated intimal sarcoma was established after extensive histological workup. However, the patient's condition deteriorated too quickly for her to recover as she had already developed multiple distant metastases and she died within three months of surgery. Due to its extreme rarity, this disease is not widely recognised, even among specialists. Accordingly, the patient was initially misdiagnosed and a malignant process was not considered. An accurate diagnosis at the time of the first open surgery might have presented the opportunity for radical resection of the affected aorta. Unfortunately, there are no non-invasive tools available to diagnose intimal sarcoma and, given the rapid progression of the disease, the prognosis remains poor, with a survival of only a few months.

Background/Objectives: The frozen elephant trunk (FET) technique was introduced as a possible single-stage procedure for treating aortic arch pathologies. However, up to a third of patients are reported to need subsequent completion (extension). This retrospective analysis aimed to evaluate the impact of early (within 30 days; EC group) versus late (>30 days; LC group) endovascular completion with thoracic endovascular aortic repair (TEVAR) in patients treated with FET. Methods: A single-center, retrospective analysis of all consecutive patients for the period between June 2017 and December 2023 who underwent FET and received endovascular extension was conducted. Indications for endovascular extension were aneurysms of the descending aorta, aneurysmal progress, endoleak, malperfusion, distal stent-induced new entry (dSINE), and aortic rupture. Results: A total of 37 of 232 FET patients received endovascular extension (15.9%). Average age at the time of TEVAR was 63.3 ± 10.3 years. There was an increase in the maximum total aortic diameter post-FET from 40.8 ± 9 mm to 45.1 ± 14 mm prior to TEVAR. Only 14 patients (37.8%) had the desired complete occlusion of the false lumen or aneurysm prior to extension; 23 (62.2%) still had relevant perfusion of the false lumen or aneurysm. The EC and LC groups were defined by time between FET and TEVAR: a mean of 4.8 ± 5.2 days in the EC group and 18.4 ± 18 months in the LC group. The EC group had markedly more complex procedures, reflected in intensive care (10.7 ± 6.9 vs. 0.1 ± 0.3 days, p < 0.001) and hospitalization (22.4 ± 14.0 vs. 8.1 ± 5.6 days, p = 0.003) durations. There was one early death due to multiorgan failure in the EC group and there were none in the LC group. There were no major cardiac events in either group. In the EC group, seven patients (50%) suffered from postoperative respiratory failure and four (28.6%) developed acute kidney failure requiring dialysis. Only one patient in the LC group (4.3%) experienced complications. During follow-up, another three patients (21.4%) of the EC group died, but none of the LC group did. Post-extension aortic remodeling was similar in both groups, with complete occlusion achieved in 27 cases (72%) during early follow-up and increased to 90.6% after a mean of 22.0 ± 23.4 months. Conclusions: Following aortic arch repair using FET, there is still a need for second-stage repair in 16% of patients. Endovascular completion post-FET is safe and feasible with a technical success rate of 100%, but early completion is associated with greater morbidity and mortality. TEVAR extension surgery may be better delayed, if possible, until after recovery from the hybrid arch repair.