Background: Popliteal venous aneurysms (PVA) are an uncommon but potentially severe condition due to their association with increased risk of recurrent pulmonary embolisms. Because of their rarity, their aetiology, natural history, and optimal treatment strategies have been poorly defined. The aim of this paper is to report a comprehensive systematic review on the treatment strategies and outcomes in PVA, summarizing current evidence. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science, covering studies published from database inception through February 2025 (protocol registered on PROSPERO CRD420251008927). The primary endpoint was the analysis of outcomes and complications associated with surgical and conservative management. Results: Nine studies, including 173 adult patients with popliteal venous aneurysms, were included. The mean age was 56 years (range 18–86 years, mean aneurysm diameter 25.4 mm). Most of the patients were female (73, 42.2%). Overall, 85 (49.1%) aneurysms were saccular and 74 (42.8%) fusiform, although morphology was not consistently reported across all studies. Intraluminal thrombus was reported in 26 cases (15.0%), and pulmonary embolism upon presentation in 21 (12.1%). Surgical treatment was performed in 119 patients (68.8%), while 54 (31.2%) were managed conservatively. Fifteen patients (13.0%) experienced postoperative complications, including wound infections (4, 3.5%), hematomas (7, 6.0%), and nerve injury (4, 3.5%), but no cases of postoperative pulmonary embolisms were observed. Following surgery, anticoagulation was indicated in most cases for 3–6 months or a long life. During follow-up (mean 35 months, range 1–262), thrombosis of the surgical reconstruction was observed in 1 patient (0.8%). Death occurred in 3 cases (5.5%), all in the non-surgical group: 2 (3.7%) due to malignancy and 1 (1.9%) from myocardial infarction. Conclusions: PVA is a rarely described condition potentially associated with the risk of PE. In their management, surgical strategies in association with oral anticoagulation represent the most commonly described approach, allowing for satisfactory results and a low rate of complications.

Background: True aneurysms of the superior mesenteric artery (SMAA) are rare but clinically significant due to the risk of severe complications such as mesenteric ischemia and fatal hemorrhage upon rupture. While the European Society for Vascular Surgery (ESVS) recommends endovascular repair as the first-line treatment, open surgery remains a valuable option when endovascular repair is not feasible due to clinical or technical constraints. Method: A systematic literature review was conducted covering the period from 2010 to 2024. Twenty-five surgically treated SMAA cases were identified. Data were collected on patient characteristics, surgical indications, procedures performed, and clinical outcomes. Result: The majority of patients were male (80%) with a mean age of 46 years. Indications for open repair included mycotic aneurysm (48%), collagenous disease or fibrodysplasia (20%), emergency repair for hemoperitoneum (4%), and unfavorable anatomy for endovascular treatment (28%). Surgical techniques included simple aneurysmectomy (56%) and aneurysm resection with graft reconstruction (44%). No intra- or postoperative bleeding or major complications were reported. In-hospital mortality was 16%, primarily due to acute bowel ischemia (12%). Among survivors, vascular reconstructions demonstrated 100% patency at a mean follow-up of 14 months (range 1–48 months), with no need for reintervention and no deaths during follow-up. Conclusion: Open surgical repair remains a viable treatment option in cases of infected SMAA, collagenous disease, or complex anatomy unsuitable for endovascular repair. It ensures satisfactory survival, favorable clinical outcomes, and durable mid-term patency without the need for reintervention.

Background/Objectives: The aim of this study was to assess the current management strategies of Isolated Left Vertebral Artery (ILVA) arising directly from the aortic arch during total endovascular or hybrid repair of aortic arch pathologies and their safety and efficacy. Methods: A systematic literature review was undertaken to assess the current management strategies for ILVA during total endovascular or hybrid repair of aortic arch pathologies on three databases (PubMed, SCOPUS and Web of Science) from inception to February 2025, according to PICO and PRISMA guidelines (PROSPERO CRD42024562104). The safety (overall and aortic-related mortality; neurological complications) and efficacy (revascularization patency, endoleak and reintervention rate) of both approaches were investigated. Results: Out of 224 articles found, seven retrospective cohort studies (178 patients) were included. Overall, 149 patients (74.2% male, mean age 63 years) underwent ILVA revascularization. Two studies reported open ILVA revascularization through transposition; three studies reported endovascular revascularization strategies, and one study reported both open and endovascular techniques. The overall mortality rate was 1.3% at 30 days and 5.4% at a mean follow-up of 46 months (range 6–120) with a reported rate of aortic mortality of 0.7%. In the transposition group (55 patients), the rate of minor neurological complications was 16.6%, and the rate of major neurological complications was 7.3%; loss of patency rate was 16.3% and reintervention rate was 11.7%. Endovascularly treated patients (94 patients) experienced a rate of minor neurological complications of 2.1% and major neurological complications of 1%; the loss of patency rate was 2.1%, and the reintervention rate was 3.1%. Conclusions: Both surgical and endovascular techniques for ILVA revascularization seem to assure an acceptable rate of mortality and neurological complications during treatment of arch pathologies. However, currently available data are poor, non-standardized and based on single-center experiences. Therefore, until more robust data are available to indicate the superiority of one approach over another, the management strategies for aberrant ILVA should be individualized based on the anatomic characteristics and the center experience. Our findings underscore the need for prospective studies with standardized protocols.

Current international guidelines indicate endovascular approach as the gold standard for treatment of superior mesenteric artery aneurysms (SMAAs). However, some cases require open surgery because of anatomical or pathologic constraints. We report 2 cases of SMAAs treated with open repair at our institution: a 46-year-old man with suspected Ehlers-Danlos syndrome and a thrombosed SMAA who underwent an aortomesenteric bypass using a saphenous vein graft and a 65-year-old man with a dissecting SMAA and rapid aneurysm growth who received an interposition graft with the superficial femoral artery. Both had uneventful recoveries. Despite the advantages of endovascular repair, open surgery is crucial for cases with infection, collagenous diseases, or complex anatomy. A tailored approach optimizes outcomes. Open surgery remains necessary for complex SMAAs. Alternative arterial grafts, such as the superficial femoral artery, can be valuable substitutes.