Background: The exact benefit of locking plates over nonlocking plates in patients with lateral malleolus fractures remains unclear. The primary aim of this study was to compare the functional outcome of locking plates vs nonlocking plates in patients with a lateral malleolus fracture. The secondary aims were to compare the number of complications and hardware removals and to compare whether results differed for older patients and for patients treated with anatomical locking plates. Methods: The PubMed/MEDLINE, Embase, Cochrane, and CINAHL databases were searched for studies comparing locking plates with nonlocking plates in patients with fixated lateral malleolus fractures. All included studies were assessed on their methodologic quality using the MINORS. Subgroup analyses were performed on older patients and patients treated with anatomical locking plates. Results: A total of 11 studies were included. The meta-analysis showed that functional outcome did not differ between patients treated with locking plates and nonlocking plates (MD 2.38, 95% CI −2.71 to 7.46). No difference in both complication rate (OR 1.10, 95% CI 0.74-1.63) and the amount of hardware removals (OR 0.77, 95% CI 0.52-1.14) was found. Even after analyzing older patients and patients treated with anatomical locking plates, no benefit was shown. Conclusion: This meta-analysis demonstrates no clear benefit in selecting locking plates over nonlocking plates in the treatment of lateral malleolus fractures. Clinical Relevance: Locking plates are increasingly being used in the treatment of lateral malleolus fractures. Biomechanical studies have shown an increased stability with use of locking vs nonlocking plates. This clinical review does not support a benefit of use of locking plates for these fractures.

OBJECTIVES: This study evaluates a staged selective hybrid approach for acute type A aortic dissection. The approach involves a zone 2 aortic arch replacement with debranching of the brachiocephalic trunk and left common carotid artery to create a landing zone for thoracic endovascular aortic repair. This repair is performed either pre-emptively in the subacute phase to promote remodelling or electively in the chronic phase to manage aneurysm formation. METHODS: Between January 2022 and December 2023, data from patients undergoing this approach were prospectively collected and retrospectively analyzed. The study included all patients treated with zone 2 arch replacement and debranching for acute type A aortic dissection. Preoperative characteristics, surgical outcomes and follow-up interventions, including thoracic endovascular aortic repair, were assessed. RESULTS: Of the 91 patients treated for acute type A aortic dissection, 25 underwent zone 2 arch replacement. No perioperative stroke or mortality occurred in this group (mean age 62.7 years, 52% male). Eleven patients (44%) underwent thoracic endovascular aortic repair during follow-up (median interval 152 days, range 38–574). Seven repairs were performed within 6 months of the initial operation. All procedures were technically successful without complications. Early imaging showed stable or reduced aortic diameters in all thoracic endovascular aortic repair patients. In the 14 patients managed conservatively, no relevant aortic growth was observed. CONCLUSIONS: Zone 2 aortic arch replacement with debranching in acute type A aortic dissection can be performed safely. Selective pre-emptive thoracic endovascular aortic repair promoted favourable remodelling, potentially reducing the need for complex, open surgical reinterventions.

Type B aortic dissection (TBAD) presents a complex clinical challenge requiring coordinated, multidisciplinary care to optimize patient outcomes. While rapid intervention is crucial for complicated TBAD, the optimal management of uncomplicated cases remains less well-defined. Historically, uncomplicated TBAD was managed medically, but recent years have seen a shift toward selective interventional approaches. Updated American and European guidelines now recommend thoracic endovascular aortic repair (TEVAR) for high-risk, uncomplicated cases, characterized by factors including a large aortic diameter, large entry tears, or persistent pain. Observations from the International Registry of Acute Aortic Dissection highlight a significant shift toward endovascular management and reduced mortality over time. The acute dissection stentgraft or best medical treatment and investigation of stent grafts in aortic dissection trials suggested that pre-emptive TEVAR may benefit certain high-risk patients by promoting favorable aortic remodeling. However, routine use of TEVAR in all uncomplicated cases is presently still controversial due to risks such as stroke and spinal cord ischemia, which emphasize the importance of careful patient selection. Current evidence supports a tailored approach that integrates clinical and imaging risk factors to identify patients most likely to benefit from pre-emptive TEVAR. In addition, ongoing randomized controlled trials, including IMPROVE-AD, SUNDAY, and EARNEST, will hopefully provide critical data on the risks and benefits of TEVAR in uncomplicated TBAD. Moving forward, interdisciplinary collaboration among different medical and engineering specialties, and refined risk stratification will be essential to advance TBAD management, enhancing outcomes for both complicated and uncomplicated cases.

Objectives: Stentgrafts in the thoracic aorta, whether placed during the frozen elephant trunk procedure or thoracic endovascular repair, have been associated with thrombosis. This study aimed to evaluate its incidence, risk factors, and clinical consequences. Methods: PubMed, Web of Science, and SCOPUS were systematically searched for relevant studies. Quality assessment was performed using the Risk of Bias in Non-Randomized Studies of Interventions tool for cohort studies and the Joanna Briggs Institute checklist for case reports. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Seventeen studies were included: 4 cohort studies (825 patients) and 3 case reports on frozen elephant trunk, 3 cohort studies (142 patients), and 12 case reports on thoracic endovascular repair. The pooled incidence of intra-stent graft thrombosis after frozen elephant trunk was 8.6% (95% CI: 5.7-12.9), typically occurring within 1 week and significantly associated with older age, female sex, aneurysmal disease, and higher rates of dialysis (43% vs 16%) and mortality (25% vs 8%). Thoracic endovascular repair cohorts were heterogeneous and could not be pooled; therefore, findings were synthesized narratively. One trauma cohort reported an incidence of 20.6%. All 12 case reports involved patients treated for trauma, with a mean time to diagnosis of 12 ± 6.3 months; 8 presented with spinal cord injury; 11 underwent an intervention to address the thrombosis. Conclusions: Intra-stent graft thrombosis is relatively common after frozen elephant trunk and may be underrecognized after thoracic endovascular repair, particularly in trauma patients. Structured imaging follow-up and individualized treatment strategies are warranted.

Our case report documents the first type A aortic dissection in a patient with Kabuki syndrome (KS) and emphasize the need for intensive cardiovascular risk monitoring in patients with KS. It stresses the importance of further research to establish a correlation and awareness for patients with KS.

Background: Mock circulatory loops (MCLs) are benchtop experimental platforms that reproduce key features of the human cardiovascular system, providing a safe, controlled, and reproducible environment for haemodynamic investigation. This scoping review aims to systematically map the current landscape of MCLs used for aortic simulation and identify major areas of application. Methods: A systematic search of PubMed, Scopus, and Web of Science identified original studies employing MCLs for aortic simulation. Eligible studies were categorized into predefined themes: (I) (bio)mechanical aortic characterization, (II) hemodynamics, (III) device testing, (IV) diagnostics, and (V) training. Data on MCL configurations, aortic models, and study objectives were synthesized narratively. Results: Eighty-four studies met the inclusion criteria. Twenty-five investigated aortic biomechanics, 23 hemodynamics, 22 device or product testing, 13 validated diagnostic imaging techniques, and one training application. Models included porcine (n = 22), human cadaveric (n = 7), canine (n = 1), ovine (n = 1), bovine (n = 1), and 3D-printed or molded aortic phantoms (n = 55). MCLs were employed to study parameters such as aortic stiffness, flow dynamics, dissection propagation, endoleaks, imaging accuracy, and device performance. Conclusions: This review provides a comprehensive overview of MCL applications in aortic research. MCLs represent a versatile pre-clinical platform for studying aortic pathophysiology and testing endovascular therapies under controlled conditions. Standardized reporting frameworks are now required to improve reproducibility and accelerate translation to patient-specific planning.