The aim of this study was to evaluate the efficacy and safety of urgent carotid endarterectomy (UCEA) compared with elective carotid endarterectomy (ECEA) in the treatment of crescendo transient ischemic attack (cTIA), a rare syndrome characterized by recurrent progressive neurological symptoms.

We conducted a retrospective analysis of 87 patients who underwent UCEA within 6 hours of the onset of cTIA symptoms and compared their results with 8168 patients who underwent ECEA during the same period. Patients were followed for an average of 94 months (early period <30 days, late period >30 days). Outcomes were defined as total mortality, stroke, myocardial infarction (MI), as well as the presence of significant restenosis (>50%).

In the early postoperative period, all patients in the UCEA group had an excellent recovery without fatal outcomes. During the late follow-up period, 1.1% in this group had stroke and 2.3% had significant restenosis, for an overall mortality of 3.5%. In the ECEA group, 30-day mortality was 1.3%. At late follow-up, a mortality rate of 2.1% was recorded, as was 4.3% of patients with significant restenosis. No significant differences were found in the characteristics of early and late postoperative complications, neurological and total mortality between the two groups. In patients with cTIA, ulcerated plaque was significantly more common compared to patients in the ECEA group (p=0.001). The ABCD2 score in cTIA patients was found to be 6.7±0.7, indicating a high two-day risk of stroke requiring urgent treatment. Perioperative complications in the form of hematoma, peripheral nerve damage, or wound infection were not significantly different between the two groups.

UCEA may be a safe and effective treatment for patients with cTIA. The early and long-term outcomes of patients who underwent UCEA for cTIA were comparable to those who underwent ECEA.

Laparoscopic, robotic and endovascular technique represent latest technological procedures in vascular surgery. The aim of this retrospective study was to describe and evaluate our single center experience with robotic aortic and non-aortic vascular surgery to treat mostly occlusive disease and aneurysms.

From November 2005 to August 2023, 615 robot assisted vascular operations were performed. 389 patients were prospectively evaluated for occlusive disease, 163 patients for abdominal aortic aneurysm (AAA), 8 for a common iliac artery aneurysm, 11 for a splenic artery aneurysm, 1 for a internal mammary artery aneurysm, 22 patients for median arcuate ligament release, 15 for endoleak II treatment post endovascular aneurysm repair (EVAR), 2 for renal artery reconstruction, 1 paraaortic biopsia and 3 cases were inoperable. 6 hybrid procedures in study were performed. 4 patients underwent combined robotic incisional hernia prosthetic mesh repair with robotic vascular procedure and 1 patient with type B dissection and heavy stenosis of the renal artery was treated by robotic ilio-renal bypass and thoracic stent graft implantation.

590 cases (96%) were successfully completed robotically, 3 patient’s surgery (0,5%) was discontinued due to heavy aortic calcification and severe peri-aortitis respectively. In 22 patients (3,5%) conversion was necessary. The thirty-day mortality rate was 0,3% (2 patients), and prothesis infection were observed in 2 patients (0,3%).

Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The robotic system provides a real opportunity for minimally invasive surgery in the field of vascular surgery and offers true mini-invasive surgical vascular interventions with all its advantages. Robotic AAA treatment and aorto-femoral represent the standard operations in vascular surgery, and they are not only possible but also safe and successful.

The application of endovascular therapies in the treatment of aortic pathologies is gaining increasing popularity. However, a major limitation of current endovascular devices are large bore sheaths in combination with calcified access vessels. Although iliac artery calcification may not always result in stenosis, calcification can contribute to the loss of elasticity and compliance. In contrast to conventional angioplasty, Shockwave intravascular lithotripsy (IVL; Shockwave Medical) uses ultrasonic waves to induce micro-fracturing in calcified plaque. IVL allows for enhanced vessel compliance by fracturing calcifications of both intimal and medial layers without injuring the vessel.

To report the use of Shockwave Intravascular Lithotripsy (IVL) in the management of hostile iliac access during endovascular aortic repair.

All patients who underwent endovascular aortic repair for infrarenal, pararenal or thoracoabdominal aneurysm with hostile access vessels (circumferential calcifications extended to more than 50% of the vessel length, hemodynamic stenosis, or occlusions) were included in the present study. Pre-, intra-, and postoperative data were collected and retrospectively analyzed. Technical success, early complications, reinterventions and mortality were recorded.

From January 2023 to March 2024, 233 patients underwent endovascular aneurysm aortic repair at our department. Thirteen patients (5.6%) had hostile iliac access, where IVL was used. Technical success was achieved in all cases; there were no cases of dissection, peripheral embolization or vessel rupture. During the follow-up period, no case of restenosis or limb occlusion was recorded.

Our experience shows that IVL in hostile iliac access during endovascular aneurysm aortic repair is safe and effective. The IVL system is an additional tool in the vascular surgeon’s armamentarium to obtain large-bore access in hostile access vessels. Further studies are needed to better assess the clinical effectiveness of the IVL system.

From January 2010 to February 2024, 8 patients (all males, median age 71.37±8.78 years) underwent open surgery for the treatment of mycotic aortic aneurysm. In all cases, the mycotic aneurysm was documented by a combination of clinical findings, laboratory tests, imaging, and microbiologic tests.

A total of 7 patients presented with abdominal, while one patient with IV thoracoabdominal aortic aneurysm. Among all patients, 3 were presented with aneurysm rupture, while 5 patients were presented with fever, septicemia and abdominal or lumbar pain. Pathogens involved were methicillin-susceptible Staphylococcus aureus (MSSA; 1 patient), Staphylococcus hominis (1 patient), Klebsiella spp. (2 patients), Mycobacterium tuberculosis (1 patient), Mycobacterium bovis (1 patient) and in 2 patients the pathogen was not isolated. Regarding treatment, 4 patients were treated using bovine pericardium, 3 had Neoaortoiliac System (NAIS) operation, while one patient was treated with endovascular aortic repair (EVAR) and drainage of the aortic sac. A transabdominal approach was used in 6 and retroperitoneal in two patients. In-hospital mortality was 25% (2/8). All patients received long-term antibiotic therapy. During follow-up, 2 patients developed recurrence of infection with gastrointestinal bleeding with aorto-enteric fistula and died after 4 and 10 months.

Bovine pericardium and autologous veins may be a valuable option for the treatment of mycotic aneurysm repair.

A variety of endografts are currently available for standard endovascular repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA). The purpose of this study was to report the clinical outcomes of the Minos abdominal aortic stent-graft system, which was recently introduced to the European market.

Between February 2020 and February 2024, we treated 91 consecutive AAA patients (mean age 73.4±8.7 years, 82 males) with elective standard EVAR using the Minos stent-graft. The mean maximum diameter of AAA was 57.7±7.5 mm, the mean proximal neck’s (PN) diameter was 24.6±2.8 mm, while the relevant length and angulation were 16.0±7.2 mm and 28.9±10.2°, respectively. Overall, 32 (35.2%) patients presented with shorter and angulated PN, according to the stent-graft’s instructions of use. Twenty-four (26.4%) cases were with concomitant significant iliac artery narrowing and tortuosity. Finally, in 39 (42.3%) cases, the distal iliac landing zone was aneurysmatic and were treated with the bell-bottom technique in 35 patients and with limb extension to the external iliac artery in 4 cases.

Primary technical and clinical success of index procedures was 100%. During a median 24-month clinical and 18-month radiological follow-up the clinical success was 98.9%. No rupture or EVAR-related death was documented. No type III endoleak or stent-graft migration was documented. There were 2 (2.19%) type Ib endoleaks that were treated with iliac extension. One (1.1%) limb occlusion was documented and treated accordingly. Total reintervention rate was 3.3%. Eleven (12.1%) type II endoleaks were detected with stable AAA sac diameter. The overall incidence of sac regression >5mm was 34.1%.

The results of our series showed that the Minos stent-graft provided excellent feasibility and safety features, even through angulated and tortuous iliac vessels and in short and angulated PN. The overall success at 2 years suggests that the performance of Minos stent-graft follows very high standards. Further validation of these promising results with long-term data is essential to complete the evaluation of this recently introduced stent-graft system.

Ischemic reperfusion (IR) injury plays a critical role in adverse neurological outcomes following carotid endarterectomy (CEA). In this context, we continue to investigate a novel surgical technique called ischemic postconditioning (IPCT), which is designed to mitigate the effects of IR injury. The primary objective of our study was to evaluate the effects of the IPCT on neurological outcome in patients with high risk of IR injury after CEA.

This is an observational case-control investigation from December 2015 to December 2023. It involved 728 patients identified as “high-risk reperfusion” candidates, divided equally into two groups: those undergoing IPCT and those who did not receive IPCT. The classification of high risk for IR injury after CEA was based on several criteria, including: severe internal carotid artery (ICA) stenosis (>90%), severe bilateral ICA stenosis (>80%), severe ICA stenosis (>80%) with contralateral ICA occlusion, and severe ICA stenosis with a recent history of transient ischemic attack (TIA) or stroke. The extent of carotid stenosis before CEA was assessed through multidetector CT angiography. The IPCT procedure was implemented by executing six cycles of alternating 30 seconds of reperfusion (achieved by declamping the ICA) and 30 seconds of ischemia (through reclamping the ICA), immediately following the completion of the initial CEA.

Cumulative incidence of intrahospital postoperative TIA/stroke was significantly higher in the non-IPCT group when compared to IPCT group 5.7%% vs. 0.6% (OR 0.077; CI 95% 0.010 – 0.616; p ≤ 0.003). Throughout the follow-up period, there were no reported TIAs, strokes, or neurological mortality in either patient group.

In our study IPCT significantly reduced the incidence of postoperative cerebral ischemic events after CEA in patients with high-risk of IR after CEA.