Evolution of the covered endovascular reconstruction of the aortic bifurcation technique for complex aorto-iliac occlusive disease.

INTRODUCTION: The covered endovascular reconstruction of aortic bifurcation (CERAB) technique was introduced as a more anatomical and physiological configuration of stents to overcome the limits of standard endovascular technique with kissing stenting in terms of patency and reintervention rates in the treatment of complex aorto-iliac occlusive disease in particular when the aortic bifurcation is involved. The purpose of this systematic review is to report the evolution of this technique during recent years. EVIDENCE ACQUISITION: Data were retrieved from retrospective studies and case series excluding letters, editorial, and reviews conducted from 2000 to September 2022. EVIDENCE SYNTHESIS: The literature analysis provided data on the evolution of CERAB technique and the current evidence about clinical results. CONCLUSIONS: Since its introduction in 2009, CERAB technique has grown as a safe and effective endovascular therapeutic option for aorto-iliac occlusive disease. Data from prospective multicenter registries with dedicated stent grafts and comparative trials are needed to validate the technique.

Mechanical thrombectomy in acute limb ischemia: ad Interim results of the INDIAN UP Trial.

BACKGROUND: Penumbra/Indigo aspiration thrombectomy Systems (Penumbra Inc.) in patients with acute lower limb ischemia (ALLI) is becoming a fundamental alternative to surgical and intra-arterial thrombolysis. The INDIAN UP trial represents the second phase of the Italian national multicenter trial evaluating the safety and effectiveness of the device in the treatment of ALLI. METHODS: To assess vessel patency, the TIPI (Thrombo-aspiration In Peripheral Ischemia), is used. The TIPI flow in three different moments: at presentation, immediately after thromboaspiration, and after all adjuvant procedures. The primary outcome is the technical success of the thrombo-aspiration with the investigative system, defined as near complete or complete revascularization TIPI 2 - 3. Safety and clinical success rate were collected at one month follow-up. RESULTS: A total of 250 patients were enrolled. The mean age was 72.2±13.1 years and 72.1% were male. Rutherford grade on enrolment was I in 10.8%, IIa in 34.9%, and IIb in 54.4%. Primary technical success (TIPI 2-3 flow) was achieved in 90.8% of patients. Adjunctive procedures were needed in 158 cases. After all interventions, assisted primary technical success was 96.4%. No systemic bleeding complications or device related serious adverse events were reported. At one month follow up, survival rate was 97.2%, limb salvage was 97.6%. Primary patency was 89.6% and 13 (5.4%) reinterventions were registered. CONCLUSIONS: The updated results of the INDIAN UP trial have confirmed the high value of the mechanical thromboaspiration device Indigo Penumbra in the treatment of ALLI in a large variety of clinical and anatomical settings.

Current results of balloon expandable visceral stent-grafts in fenestrated endografting.

Endovascular repair of thoracoabdominal and juxtarenal aortic aneurysm has recently become a valuable alternative to open surgery especially in high-risk patients. Progressive improvements in graft materials and low-profile devices allow treatment of complex aneurysms even in adverse anatomical settings. However, all published experiences report risks of occlusion and reinterventions due to visceral stent-graft failures in the long term. The purpose of this systematic review is to analyze the results of currently used balloon expandable bridging stent-grafts and to evaluate the newest developments for fenestrated endovascular aortic repair (FEVAR) in juxtarenal endovascular repair. Data were retrieved from retrospective analyses, case series and case reports conducted from 2000 to September 2019. The literature analysis provided a list of the most commonly used balloon-expandable bridging stent-grafts for FEVAR. For each stent-graft a brief summary of structural characteristics and performances have been described. No randomized controlled trials (RCTs) or comparative data between the stent-grafts are available for this specific topic. Several balloon-expandable stent-grafts have been used as bridging stents during FEVAR but the ideal bridging stent-graft is far to be designed. The better understanding of the system FEVAR-native aorta and the strict collaboration and exchange of expertise between physicians and engineers are mandatory in order to increase the performances of these important components and to reduce re-interventions and complications in FEVAR.