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Purpose: To investigate early- and long-term outcomes of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) in young and low surgical risk patients. Methods: The global registry for endovascular aortic treatment (GREAT) was queried for all patients with AAA undergoing standard EVAR; patients were excluded if had previous AAA repair or underwent concomitant procedures. Young patients were defined if age 11) risk. Young versus older patients and low-risk versus average/high-risk patients were compared. The primary endpoints were early (30 days) major adverse events (MAEs), 5-year freedom from overall mortality, aortic-related mortality, and freedom from device-related reinterventions. Time-to-event endpoints were calculated by Kaplan–Meier curves. Results: Of 3217 included patients, 182 (6%) were Conclusion: In this real-world registry, EVAR was more often offered in cases with suitable anatomy in young and low-risk patients. Low operative risk, rather than young age alone, predicted excellent early outcomes and low 5-year mortality, aortic-related mortality, and reintervention rates.

Objective: To report our long-term experience in using the hybrid technique in complex thoracoabdominal aortic aneurysms (TAAAs). Methods: Between March 2005 and September 2013, 10 patients with TAAA underwent hybrid procedures with open renovisceral revascularization and thoracoabdominal aortic endografting. Patients were analyzed retrospectively. Results: Six men and 4 women with a mean age of 66 years (range 54-81 years) were treated electively during the study period. All 4 visceral vessels were revascularized in 8 patients, whereas 1 patient underwent 3-vessel revascularization and another 2-vessel revascularization. The primary technical success rate was 100%. Eight of the procedures were single staged, and the 2 most recent cases were performed in 2 stages. Perioperative and 30-day mortality was 0%. The mean follow-up was 55 months (4-133 months). None of the patients died due to aortic complications. Major complications included paraplegia (10%, n = 1) and bowel ischemia (n = 1). Postoperative cerebrospinal fluid (CSF) pressure and mean arterial pressure measurements were systematically monitored and corrected. The CSF drainage solved another 4 cases of paraparesis. Three patients required postoperative dialysis, but none of them required permanently. Postoperative spinal cord ischemia and renal complications accumulated in extensive TAAA cases. One renal graft was occluded 45 days after the initial procedure but was successfully treated with thrombolysis. One type I and 1 type III endoleak were noted and successfully treated with an additional stent graft. Two cases of type II endoleak were detected—one with a growing aneurysm sac was treated successfully and another showed no growth and further procedures were abandoned after 2 embolization attempts. In long-term follow-up, 90% of the aneurysms showed shrinkage by a mean of 23 mm (range 7-45 mm). Conclusion: The results of hybrid repair on high-risk patients with complex TAAAs are encouraging, and this approach is a valuable alternative when branched and fenestrated endovascular techniques are not considered an option.

Purpose: To report the long-term results of thoracic endovascular aortic repair (TEVAR) in both elective and emergency cases of thoracic aortic aneurysm (TAA) and type B dissection. Material and Methods: A prospective single-center study of 78 TEVAR patients treated between February 1998 and February 2013. Stent-graft implantation was performed in 51 (65%) patients for TAA (43 elective and 8 emergency cases) and in 27 (35%) patients for type B dissection (11 elective and 16 emergency cases). Short- and long-term results were evaluated, and a subgroup of patients with left subclavian artery (LSA) coverage was also analyzed. Results: The patients were followed for a mean of 55 months (1-160 months). The technical success rate was 81% and 30-day mortality 6.4% (n = 5). The stroke rate was 7.7% (n = 6) and permanent paraparesis 2.6% ( n = 2). In follow-up, there were 28 (36%) primary (15 type I and 13 type II) and 10 secondary endoleaks (8 type I and 2 type II). Multivariate analysis showed no significant predictive factors for developing a type I endoleak. Secondary interventions were required in 24% of the patients. There was 1 late thoracic aortic rupture and 1 late conversion (1.3%). Patients with LSA coverage had a higher incidence of stroke (12.5% vs 4.3%, P = .18) and paraparesis (3.1% vs 2.2%, P = .79) compared to those without LSA coverage, although this difference was not statistically significant. Stroke rates were significantly higher in patients treated in an emergency setting ( P = .048). Conclusion: Thoracic endovascular aortic repair is a relatively safe and effective therapy for different aortic pathologies with good long-term success. The risk of stroke and paraparesis is notable whether the LSA is covered, and strokes clearly accumulate in the emergency setting. A type I endoleak is the most common complication, but there are no predictive factors for its development.

Background and Aims: With any new technology complications are possible, and problems with first-generation aortic stentgrafts have been extensively reported. The long-term outcome of this patient population and the magnitude of additional secondary procedures are, however, less well covered. Materials and Methods: Between February 1997 and November 1999, 48 patients (44 men and 4 women; mean age 70 years; range 54–85) with AAA (average 57mm, range 40–90mm) were treated with a Vanguard® endoprosthesis. Stentgrafts were sized by CT and angiography-based measurements. Results were continuously assessed using contrast-enhanced CT before discharge, 1, 3, 6 and 12 months after the procedure and thereafter annually. Since 2001 plain abdominal X-rays have been performed annually. Results: The technical implant success rate was 100%. Median follow-up was 91 months (range 7.6–120 months). None of the patients was lost during this period. Hospital mortality was 0%. There were 25 subsequent deaths (52%), the most common cause being coronary artery disease. There were ten late conversions to open surgical repair, including three emergency operations: two due to rupture and one to thrombosis. EVAR-related complications were encountered in 43 patients (90%): 12 primary endoleaks (all type II), 36 late endoleaks (16 type I, 2 type II and 18 type III), 22 migrations, 25 row separations, 20 thromboses, one endotension and 3 ruptures of the AAA. Secondary procedures were required in 39 patients (81%): 1 re-endografting by aortoiliac bifurcated graft and 3 with a uni-iliac graft; 33 limb graft repairs were performed and 19 infrarenal cuffs were placed. There were 4 late embolizations and 4 attempts, and 6 thrombolyses, four of which were successful. Further, 9 femoro-femoral crossover by-pass and 2 axillo-femoral by-pass operations and 2 amputations were carried out during the follow-up. Only one patient was alive without complications. Conclusions: The impact of long-term follow-up of patients treated with the new technology was emphasized in this patient population. A careful surveillance protocol and active endovascular treatment of complications can yield acceptable results and low AAA rupture and aneurysm mortality rates, also with the first-generation endovascular graft. A new technology, however, may involve unpredictable problems which can magnify the workload and incur high costs over several years after the initial procedure.

Objective: To observe the clinical and anatomical features of acute iliofemoral deep venous thrombosis (DVT). Methods: A consecutive sample of phlebographically confirmed DVT cases during a 25-month period were retrospectively assessed. There were 390 DVT cases, including 73 patients with iliofemoral DVT. The phlebograms of iliofemoral DVTs were reviewed and the location of the thrombus mapped. The patients' files were completely reviewed in all patients with DVT, including concomitant diseases and mortality after the diagnosis of DVT. Results: The average age of the patients with iliofemoral DVT was 63 years compared with 57 years in the cases of infrainguinal DVT ( P Conclusions: According to anatomical findings iliofemoral DVT is typically left-sided and multisegmental. However, clinical findings show that patients with this condition are relatively aged, and the frequency of concomitant diseases is high. The prognosis among the patients with pre-existing malignant disease was very poor. Prevention of post-thrombotic syndrome by using invasive treatment should be considered only in selected cases.

Background and Aims: Autogenous fistula should be constructed in a minimum of 50 of all new ESRD patients scheduled for haemodialysis. The radio-cephalic fistula described by Brescia and colleagues in 1966 is considered to be the access of choice due to its good patency and low complication rate. The aim of this study was to evaluate the outcome of primary access surgery in a well-defined geographical region in Finland. Material and Methods: All primary vascular access procedures between 1990–1999 were selected in the local vascular registry. Additional data was collected from patients' case records. Kaplan-Meier method was used to calculate fistula patency. Multivariate analysis of four variables (age, gender, diabetes mellitus, smoking) was done to determine their association with primary success Results: 407 primary procedures were done during the 10-year period including 405 (99.5 %) autogenous fistulas and two prosthetic grafts (0.5 %). 230 (56.8 %) fistulas were used for haemodialysis during the study. Cumulative primary functional patency at one year was 84.1 %, at two years 75.2 % and at five years 50.1 %. An attempt to salvage failing or failed fistula was done in only 15 (6.5 %) cases with insignificant impact on outcome. None of the tested variables was associated with poor functional success. Conclusions: The strategy of using native radio-cephalic fistula as a first access site results in excellent early and long-term functional patency for ESRD patient.

Objective: To evaluate the role of subjective symptoms, grade of disability and axial reflux in superficial veins in different clinical stages of varicose veins (VVs). Methods: A total of 172 legs with primary venous insufficiency from 126 patients were studied. The examination involved evaluation of the CEAP clinical class and clinical disability score (CDS), recording of any symptoms of varicose disease, and a hand-held Doppler (HHD) examination of the superficial veins. Colour-flow duplex imaging (CFDI) was also performed in 22% of the legs. Results: The rate of insufficiency of the great saphenous vein (GSV) was 83% in complicated legs (C4-6), and 68% in uncomplicated legs (C2-3), ( P > 0.05). There was a difference between complicated and uncomplicated legs in the insufficiency of the whole GSV [C4-6: n = 18 (39%) versus C2-3: n = 12 (12%), P < 0.005]. Sensation of pain was noted in 68% of the legs in class C1, 60% of those in class C2-3 and 81% of those in class C4-6. Sensation of oedema was recorded in 70% of the legs in class C1, 65% of those in class C2-3 and 86% of those in class C4-6, respectively. CDS classes 2-3 were significantly more frequent among complicated legs (C4-6: 54% versus C2-3 12%, P < 0.005). Conclusions: Leg symptoms are frequent throughout classes C1-6. Their clinical usefulness is therefore limited. CDS parallels well with the clinical classification. In complicated disease the whole saphenous vein is more frequently insufficient.