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In the last decades, the main evolution in the field of vascular surgery was correlated to the development and introduction of vascular substitutes. Currently, two types of synthetic vascular substitutes have been widely adopted: polyethylene terephthalate and expanded polytetrafluoroethylene. Ideally, they should demonstrate a behavior as close as possible as that of human arteries in terms of mechanical and biological properties. However, no vascular substitute has been found to compare with the patency rates of gold-standard autologous conduits, and major drawbacks of current vascular substitutes remain both thrombogenicity and infectability.

Endovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?

Intermittent claudication is frequently encountered in vascular surgical practice in atherosclerotic patients. However, it may also be observed in a younger subset of patients without any cardiovascular risk factors and can represent a challenging diagnosis. Popliteal artery entrapment syndrome is rare but can cause intermittent claudication in young people. There is a lack of consensus about optimal strategies or diagnosis and management, particularly for variants such as functional popliteal entrapment. Since the first description in 1959, knowledge of the pathology and the underlying anatomic abnormalities was advanced through sporadic publications of case reports and small case series, but popliteal artery entrapment syndrome still remains a rare anatomic abnormality. It can be difficult to differentiate from other causes of lower limb pain in young patients, and diagnosis can be challenging. We propose to review clinical symptomatology, classification, radiological diagnosis and treatment of popliteal entrapment syndrome.

In the last decades, main evolutions in the field of vascular surgery have been correlated to the development of devices allowing more reliable and safe sustainable treatment. First devices that have been proposed were vascular prostheses made of polymeric materials. The second generation of devices was stents made of metals and alloys. The third generation, endografts, associated these both materials. Materials used as vascular and endovascular devices must meet a number of requirements based on dimensional, physical and mechanical criteria. Ideally, they should demonstrate a behavior as close as possible as that of human arteries in terms of mechanical properties such as compliance, long-term durability, and in terms of biological properties such as biocompatibility, luminal surface healing and thrombogenicity. We propose in the present manuscript a review of properties of materials currently used for the construction of vascular and endovascular devices, future challenges in the fields of new materials and scientific approaches and tests to understand and predict the behavior of the next generations of devices.

Endovascular treatment and stent implantation for peripheral arterial disease have been proposed for over 20 years. However, the first experiments with stainless stents were relatively disappointing. The first improvement consisted in the introduction of nitinol self-expanding stents. This technology allowed an initial improvement of clinical performances, but the first generation of nitinol stents demonstrated a relatively high rate of fractures. Better knowledge of arterial biomechanics and advances in technology allowed to propose a second generation of nitinol stents with improved flexibility, which decreased the rates of fracture. In-stent restenosis related to neointimal hyperplasia has also led to the development of new concepts to improve patency rates after stenting: drug-eluting stents (coated-stents), biodegradable stents, and covered stents. These technologies will help to treat more complex lesions in the future, but we are still waiting for results of ongoing studies.

Aim: The aim of this study was to analyze the Literature covering the characteristics of secondary ruptured abdominal aortic aneurysm (AAA) following endovascular repair with aortic stent graft (ASG)., Methods: The study based on a Pubmed search of articles describing the characteristics of secondary ruptured AAA after ASG between January 1995 and May 2008. A total of 105 articles were selected, including the following characteristics: aneurysm diameter evolution, delay between implantation and rupture, average follow-up time, mechanisms implicated, results following further repair., Results: Out of a total of 23 002 ASG cases reported, of which 47.4% (10 911) were carried out by ASG suppliers themselves, 227 ruptures (1%) have been described. After exclusion of the perioperatory ruptures (occurring within the first month), the average duration of implantation at rupture was 27+/-16 months, with an average follow-up of 22.4+/-14 months. When the evolution of the sac was mentioned, AAA diameter decreased or remained stable before rupture in 55.7% of the cases. Mechanisms of rupture have been reported in 168 cases and consisted in a failure of the ASG in 76.1% of the cases. When patients were operated, the mortality rate was 39%., Conclusion: This study showed how little is actually known about rupture of stented AAA. The available data were provided by studies sponsored by companies in 47.4% of the cases, and had usually too short follow-up considering the average of duration of implantation at rupture. Rupture mechanisms were not reported in all cases, but a failure of the ASG was considered as responsible for the rupture in a majority of the cases. The absence of warning signs of rupture emphasizes the need of caution about the durability of ASG and also the need to undertake further studies with longer follow-ups.

We report the case of a surgically treated congenital Budd-Chiari syndrome related to agenesia of the retrohepatic inferior vena cava. The first symptoms of the disease were noticed in childhood. The increasing symptomatology led to propose, at the age of 30 years, first a percutaneous transluminal angioplasty which failed, because of the impossibility to recanalize the obstructed segment. Then a surgical procedure consisting of the implantation of ePTFE prosthesis between the right atria and the retrohepatic inferior vena cava was performed. The hepatic biopsy showed a centrolobular fibrosis and an old subglissonian infarction. The patient was improved, allowing him to recover a normal life. However, three years later, an angiographic evaluation performed because of a recurrence of a slight abdominal pain, showed a thrombosis of the bypass. An attempt at thrombolysis failed. Since the patient did not present major clinical and biological consequences we only proposed a surveillance and no endovascular procedure because of the fear of a pulmonary emboli. The purpose of this case report is to review the literature and discuss the etiopathology of congenital Budd-Chiari syndrome with regard to the different therapeutic options.