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Objective: The objective of this study was to evaluate the incidence, timing, and potential risk factors of late endograft migration after thoracic endovascular aortic repair (TEVAR)., Methods: A retrospective analysis was conducted of 123 patients receiving TEVAR for thoracic aortic aneurysms (TAAs), dissections, penetrating aortic ulcer, intramural hematoma, or traumatic transection between January 2005 and December 2015 with a minimum imaging-based follow-up of 6 months. Imaging analysis was performed by three independent readers. Migration was defined according to the reporting standards as a stent graft shift of >10 mm relative to a primary anatomic landmark or any displacement that led to symptoms or required therapy. A standardized measurement protocol in accordance with the reporting guidelines was used. Median follow-up was 3 years (range, 0.5-10 years)., Results: Migration occurred in nine (7.3%) patients and took place at the proximal landing zone (n = 1), overlapping zone (n = 4), or distal landing zone (n = 5), resulting in type I or type III endoleaks in 44% (n = 4/9) of the cases. All cases of migration with endoleaks underwent reintervention; 75% (n = 3/4) of the migration associated with endoleaks could have been identified on previous imaging before an endoleak occurred. Freedom from migration was 99.1% after 1 year, 94.0% after 3 years, and 86.1% after 5 years. Aortic elongation and TAA were identified as predisposing factors for migration (P = .003 and P = .01, respectively). No influence of the proximal landing zone (zone 0-4), type of aortic arch (I-III), or type of endograft on the incidence of migration was found., Conclusions: Graft migration after TEVAR occurs in a relevant proportion of patients, predominantly in patients with TAA and aortic elongation. Follow-up imaging of these patients should be specifically evaluated regarding the occurrence of migration., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to investigate the long-term outcome after open repair of inflammatory infrarenal aortic aneurysms., Methods: A total of 62 patients (mean age, 68.9 ± 8.8 years; 91.9% male) undergoing open surgery for inflammatory aortic aneurysm from 1995 until 2014 in a high-volume vascular center were retrospectively evaluated. The patients' demographics, preoperative and postoperative clinical characteristics, imaging measurements, and procedural data were collected. Study end points were preoperative and postoperative sac diameter, evolution of periaortic fibrosis and development of hydroureteronephrosis detected by computed tomography (CT) scan, and mortality and morbidity after 30 days and at the time of maximum follow-up., Results: The mean abdominal aortic aneurysm diameter was 67.3 ± 16.7 mm. A total of 30 patients (48.4%) were asymptomatic, 27 patients (43.5%) were symptomatic, and 5 patients (8.1%) were treated for ruptured aneurysm. In 25 patients (40.3%), an aorta-aortic tube graft was implanted; in 37 patients (59.7%), an aortic bifurcation graft was used. Median operating time was 208 minutes (range, 83-519 minutes). Median aortic clamping time was 31 minutes (range, 14-90 minutes); in 25 patients (40.3%), suprarenal aortic cross-clamping was necessary. Hydroureteronephrosis was preoperatively diagnosed by CT scan in 16 patients (25.8%), with the need for a ureteral stent in 11 patients (17.7%). Aneurysm- and procedure-associated 30-day mortality was 11.3% (n = 7), with septic multiple organ failure in four patients and cardiac arrest in three patients. The overall perioperative complication rate was 33.9% (n = 21 patients). Median follow-up was 71.0 months (range, 0.2-231.6 months). At 1 year, 2 years, 4 years, and 6 years, overall survival was 83.4%, 79.6%, 79.6%, and 72.6%, respectively. Six patients (9.7%) required a reintervention during follow-up, predominantly aneurysm related and caused by aortoenteric fistula and graft infection (three of five patients). Median maximum thickness of preoperative perianeurysmal inflammation on CT was 10 mm (range, 2-22 mm), which decreased in 15 of 16 (94%) patients with available postoperative CT scans. Postoperative median thickness of perianeurysmal inflammation on CT was 6 mm (range, 0-13 mm). Hydroureteronephrosis persisted in two of nine (22.2%) patients at the end of follow-up., Conclusions: Surgery in patients with inflammatory abdominal aortic aneurysms is associated with a substantial amount of perioperative complications. After surgery, the perianeurysmal inflammation decreases in most patients on follow-up CT. However, because the inflammatory process does not totally resolve, patients require lifelong surveillance for hydroureteronephrosis and development of aortoenteric fistulas., (Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

This report describes flow patterns derived by three-dimensional (3D) three-directional velocity-encoded cine (VEC) magnetic resonance imaging (MRI), in a patient with chronic Stanford type B aortic dissection. Acquired 3D VEC MRI data illustrated an acceleration of blood flow through the primary entry toward the vessel wall of the false lumen, leading to disturbed intraluminal flow. Furthermore, accelerated blood flow was observed in the partially compressed true lumen. 3D VEC MRI data may be helpful to guide physicians for a more comprehensive preoperative and postoperative assessment of complex aortic pathologies., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)