Objective: To evaluate the outcome of TEVAR for TBAD and revascularization of LSA with Castor single-branched stent-graft. Summary background data: One-stage thoracic endovascular aortic repair (TEVAR) and revascularization of left subclavian artery (LSA) of type B aortic dissection (TBAD) with off-the-shelf stent-graft is limited. Methods: A multicenter study consisting of consecutive patients from four different centers in China treated with Castor single-branched stent-graft for TBAD was conducted. Rate of technical success, mortality, complications, and reinterventions were evaluated. Results: Between September 2018 and April 2022, 180 consecutive patients with TBAD received TEVAR with Castor single-branched stent-graft. Technical success was achieved in all patients. The mean oversize ratio at the proximal landing zone was 4.9±3.8% (median, 3.7; IQR, 2.0–6.9%). Five patients died within the first 30 days after the operation or during hospitalization. Early reintervention was performed in one case. The median follow-up was 18.0 months (IQR, 13–24 months). Five patients died during follow-up, including three cases of respiratory failure, one case of immune thrombocytopenia purpura, and one case of a cerebral hemorrhage. Three patients had reintervention. In total, three cases of stroke were recorded, which were all within 30 days after the operation. Image data at 1 year presented complete thrombosis in 97.1% cases for the false lumen covered by the stent-graft. Conclusions: TEVAR with Castor device for treatment of TBAD and revascularization of LSA is a feasible and safe technique. The deployment procedure is safe, easy, and accurate. Castor devices meets the hemodynamical and biomechanical requirement of elastic aorta and could restore the physiological blood flow pattern of LSA.

Objectives: This study evaluated the feasibility and safety of total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft on zone 0 landing for aortic arch pathologies. Methods: Between June 2016 and October 2019, 37 consecutive patients underwent total endovascular arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and branch artery patency. Results: During the study period, 37 patients were treated with total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft. Twenty-one (56.8%) patients were diagnosed with aortic dissections, 15 (40.5%) patients with aneurysms, and 1 (2.7%) patient required reintervention due to endoleak and sac expansion from previous thoracic endovascular aortic repair for thoracoabdominal aneurysm. The proximal landing zone for all patients were in zone 0, and all branch arteries of aortic arch were reconstructed. Technical success was achieved in 34 cases (91.9%). Three (8.1%) patients had fenestrations misaligned with target arteries, and the chimney technique was applied as a complementary measure. Thirty-day mortality rate was 5.4% (n=2). Thirty-day stroke rate was 5.4% (n=2). Thirty-day reintervention rate was 2.7% (n=1). At a median follow-up of 20 months (range, 3–49 months), 5 (13.5%) patients died, including 2 aortic-related deaths, 1 nonaortic-related death, and 2 deaths of unknown reason. One (2.7%) patient had stroke. Four patients (10.8%) had reintervention during the follow-up, including 2 cases of left subclavian artery occlusion and 2 cases of type II endoleak. The estimated survival (±SE) at 2 years was 72.4%±9.7% (95% CI 53.4%–91.4%). The estimated freedom from reintervention (±SE) at 2 years was 87.4%±5.9% (95% CI 75.84%–98.96%). Conclusions: Total endovascular aortic arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing is an alternate option for the treatment of aortic arch pathologies in experienced centers.

Endovascular therapy has emerged as a crucial therapeutic method for treating vascular diseases. Endovascular surgical robots have been used to enhance endovascular therapy. However, to date, there are no universal endovascular surgical robots that support molds of different types of devices for treating vascular diseases. We developed a novel endovascular surgical robotic system that can independently navigate the intravascular region, advance and retract devices, and deploy stents. This robot has four features: (1) The bionic design of the robot can fully simulate the entire grasping process; (2) the V-shaped relay gripper waived the need to redesign special guidewires and catheters for continuous rotation; (3) the handles designed based on the feedback mechanism can simulate push resistance and reduce iatrogenic damage; and (4) the detachable design of the grippers can reduce cross-infection risk and medical costs. We verified its performance by demonstrating six different types of endovascular surgeries. Early evaluation of the novel endovascular robotic system demonstrated its practicability and safety in endovascular surgeries.

Objective: Type II endoleak (T2EL) worsens the long-term results of endovascular aneurysm repair (EVAR). How to prevent T2ELs remains controversial. This study aimed to evaluate the efficacy and safety of fibrin glue sac filling (FGSF) to prevent T2ELs after EVAR. Methods: A prospective randomized controlled trial was conducted. Patients were randomly divided into group A (standard EVAR + FGSF) and group B (standard EVAR). The follow-up plans included outpatient or telephone consultation at 1 and 3 months and computed tomography (CT) angiography at 6 months, 1 year, and once a year after EVAR. Results: A total of 64 abdominal aortic aneurysm (AAA) patients were randomized to the 2 groups. All patients were followed up for more than 6 months. The 2 groups showed similar baseline characteristics. The rate of T2ELs on immediate angiography in group A (9.6%) was significantly lower than that in group B (33.3%, p=0.033). Moreover, the sac area change was significantly reduced in group A at 6 months after EVAR (p=0.021). However, T2EL incidence was similar at the 6-month (p=0.055) and 1-year (p=0.057) follow-ups, and AAA diameter change was also similar at 1 year. There were similar operation times, radiation doses, severe adverse events (SAEs), and reinterventions between the 2 groups. Conclusion: Fibrin glue sac filling could prevent short-term type II endoleaks and promote AAA shrinkage after 6 months. The FGSF procedure is swift and straightforward; however, patients are at risk of bowel ischemia, especially after previous bowel resections or concomitant superior mesenteric artery (SMA) disease. Clinical Impact: Standard endovascular aneurysm repair (EVAR) couldn’t prevent type II endoleak (T2EL). In this study, we found fibrin glue sac filling (FGSF) could prevent T2EL and promote AAA shrinkage in a short term. And the FGSF procedure is easy, it will be a useful supplement to standard EVAR for clinicians. And FGSF might have potential usefulness on ruptured aneurysms, although without direct evidence.Fibrin glue is often used to hemostasis and tissue adhesion in surgical patients and burn patients, we firstly carry out a randomized controlled study and prove that fibrin glue sac filling could prevent T2EL and promote sac remodeling.

Ruptured abdominal aortic aneurysm (RAAA) is a fatal disease. This study aimed to assess the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with RAAA undergoing endovascular aneurysm repair (EVAR). This retrospective study included patients with RAAA who underwent EVAR from 2012 to 2022. NLR and PLR were measured when patients were first admitted to the hospital before receiving any treatment. Risk factors associated with overall survival in this patient group were identified through univariate and multivariate analyses. Nomograms and artificial neural networks were developed to evaluate the prognosis of these patients. A total of 50 patients were included in this study. The optimal cut-off points for predicting overall survival were an NLR of 19.6 and a PLR of 190.5. Univariate and multivariate analyses revealed that NLR (hazard ratio 0.271, p = 0.024) and PLR (hazard ratio 0.272, p = 0.041). Were independent risk factors for overall survival. Nomograms and artificial neural networks also showed the prognostic value of preoperative NLR and PLR in this patient group. Preoperative NLR and PLR are independent and valid predictors of prognosis in patients with RAAA undergoing EVAR. The higher the preoperative NLR and PLR of the patients, the worse their prognosis.