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Background: Vascular surgical training is evolving towards simulation-based methods to enhance skill development, ensure patient safety, and adapt to changing regulations. This study aims to investigate the utilization of simulation training among vascular surgeons in France, amidst ongoing shifts in teaching approaches and educational reforms., Methods: A national survey assessed the experiences and perceptions of vascular surgery professionals regarding simulation training. Participation was open to self-reported health professionals specialized (or specializing) in vascular surgery, including interns or fellows. Participants were recruited through various channels, and data were collected via a questionnaire covering participant characteristics, simulation experiences, and perceptions., Results: Seventy-six participants, predominantly male (74%) took part in the survey. While 58% reported access to simulation laboratories, only 17% had organized simulation sessions 1-3 times a year, and 5% had sessions more than 10 times annually. High fidelity simulators were available in 57% of institutions, while low fidelity simulators were available in 50%. Regarding funding, 20% received financial assistance for training, predominantly from industry (18%). One-third of the participants experienced 9 or more sessions (34%), lasting between 1 and 2 hours (34%), 30% expressed satisfaction with access to simulation, while 33% were dissatisfied with communication of simulation training opportunities., Conclusions: Despite recognizing the benefits of simulation training, its integration into vascular surgery education in France remains incomplete. Challenges such as limited access and communication barriers hinder widespread adoption. Collaborative efforts are needed to ensure uniformity and enhance the effectiveness of simulation training in vascular surgery education., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Chimney endovascular aortic aneurysm repair (ch-EVAR) has become a valid alternative to treat complex aneurysms but the occurrence of contrast-induced kidney injury (CI-AKI) is poorly known. This study investigated the incidence and the impact of CI-AKI on post-operative outcomes after ch-EVAR. Consecutive patients who underwent ch-EVAR between July 2010 and 2021 were retrospectively included. CI-AKI was defined based on plasma creatinine levels within 7 days after the intervention according to the "Kidney Disease Improving Global Outcomes" (KDIGO) classification. Among 102 patients included, CI-AKI occurred in 14 cases (13.7%). The 30-day post-operative mortality and complications were significantly higher in patients who developed CI-AKI compared with those who did not (50 vs 9.1%, P = .001 and 57.1 vs 20.5%, P = .007). Over a median follow-up of 24 months (3-39), overall mortality was also significantly higher (78.6 vs 33.0%, P = .002). The pre-operative platelet-to-lymphocyte ratio (PLR) was significantly higher in patients who developed CI-AKI (224.5 vs 147.6, P = .008). CI-AKI is frequent after ch-EVAR and is associated with worse post-operative outcomes. This should increase awareness of clinicians to optimize preventive and therapeutic strategies.

Background: There is currently a lack of consensus and tools to easily measure vascular calcification using computed tomography angiography (CTA). The aim of this study was to develop a fully automatic software to measure calcifications and to evaluate the interest as predictive factor in patients with aorto-iliac occlusive disease., Methods: This study retrospectively included 171 patients who had endovascular repair of an aorto-iliac occlusive lesion at the University Hospital of Nice between January 2011 and December 2019. Calcifications volumes were measured from CTA using an automatic method consisting in three sequential steps: image pre-processing, lumen segmentation using expert system, and deep learning algorithms and segmentation of calcifications. Calcification volumes were measured in the infrarenal abdominal aorta and the iliac arterial segments, corresponding to the common and the external iliac arteries., Results: Among 171 patients included with a mean age of 65 years, the revascularization was performed on the native external and internal iliac arteries in, respectively: 83 patients (48.5%), 107 (62.3%), and 7 (4.1%). The mean volumes of calcifications were 2,759 mm 3 in the infrarenal abdominal aorta, 1,821 mm 3 and 1,795 mm 3 in the right and left iliac arteries, respectively. For a mean follow-up of 39 months, target lesion re-intervention was performed in 55 patients (32.2%). These patients had higher volume of calcifications in the right and left iliac arteries, compared with patients who did not have a re-intervention (2,274 mm 3 vs. 1,606 mm 3 , P = 0.0319 and 2,278 vs. 1,567 mm 3 , P = 0.0213)., Conclusions: The development of a fully automatic software would be useful to facilitate the measurement of vascular calcifications and possibly better inform the prognosis of patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Advances in virtual, augmented (AR) and mixed reality have led to the development of wearable technologies including head mounted displays (HMD). The aim of this study was to investigate the feasibility to use HMD during endovascular surgery., Methods: We propose an adaptation of AR-HMD using Microsoft HoloLens. Software was developed to enable visualization of the vascular system during endovascular procedures. A video was performed to present an overview of the device and show its use in real conditions., Results: The device allowed a successful visualization of perioperative angiography during peripheral angioplasty, carotid angioplasty and aortic aneurysm endovascular repair. The device was operated on voice command, preserving the environment sterility., Conclusion: This video illustrated the feasibility of the application of holographic AR during endovascular intervention and brings perspectives to use artificial-intelligence derived tools for image-guided surgery., (Copyright © 2021. Published by Elsevier Inc.)

The aim of this nationwide study was to analyze the impact of diabetes on post-operative mortality in patients undergoing AAA repair in France. This 10-year retrospective, multicenter study based on the French National electronic health data included patients undergoing AAA repair between 2010 and 2019. In-hospital post-operative mortality was analyzed using Kaplan-Meier curve survival and Log-Rank tests. A multivariate regression analysis was performed to calculate Hazard Ratios. Over 79,935 patients who underwent AAA repair, 61,146 patients (76.5%) had at least one hospital-readmission after the AAA repair, for a mean follow-up of 3.5 ± 2.5 years. Total in-hospital mortality over the 10-year study was 16,986 (21.3%) and 4581 deaths (5.8%) occurred during the first hospital stay for AAA repair. Age over 64 years old, the presence of AAA rupture and hospital readmission at 30-day were predictors of post-operative mortality (AdjHR = 1.59 CI 95% 1.51-1.67; AdjHR = 1.49 CI 95% 1.36-1.62 and AdjHR = 1.92, CI 95% 1.84-2.00). The prevalence of diabetes was significantly lower in ruptured AAA compared to unruptured AAA (14.8% vs 20.9%, P < 0.001 for type 2 diabetes and 2.5% vs 4.0%, P < 0.001 for type 1 diabetes). Type 1 diabetes was significantly associated with post-operative mortality (AdjHR = 1.30 CI 95% 1.20-1.40). For type 2 diabetes, the association was not statistically significant (Adj HR = 0.96, CI 95% 0.92-1.01). Older age, AAA rupture and hospital readmission were associated with deaths that occurred after discharge from the first AAA repair. Type 1 diabetes was identified as a risk factor of post-operative mortality. This study highlights the complex association between diabetes and AAA and should encourage institutions to report long-term follow-up after AAA repair to better understand its impact., (© 2021. The Author(s).)

Objective: The Nellix EndoVascular Aneurysm Sealing (EVAS) system has offered a novel approach in the treatment of abdominal aortic aneurysm (AAA). While it is currently indicated as a primary procedure in patients with infrarenal AAA with suitable anatomy according to the indications for use, a few studies aimed to address its potential interest in failed endovascular aneurysm repair (EVAR). The aim of this systematic review was to analyze the postoperative outcomes of patients with prior EVAR who underwent EVAS., Design of the Study: A literature search was performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines in May 2019 and included patients with prior EVAR who underwent EVAS. The publications had to report at least one of the basic postoperative outcomes (technical success rate, all-cause complications, mortality, length of in-hospital stay, length of stay in intensive care unit, the need of re-intervention)., Results: Eleven studies fulfilled the inclusion criteria, for a total of 46 patients. EVAS was used to treat endoleaks in 45 cases (97.8%): 29 type Ia endoleaks (63%), 6 type IIIa endoleaks (13%), and 10 type IIIb endoleaks (21.7%). Standard EVAS procedure was performed in 21 patients (45.7%), and 25 patients (54.3%) had chimney-EVAS. The technical success was achieved in all the studies. Two patients (4.9%) died during the 30-day postoperative period, but no aneurysm-related mortality was reported. The presence of endoleaks was reported in five patients (9.8%) during the follow-up., Conclusion: The results suggest the safety and the efficiency of EVAS in the treatment of complications following EVAR including type Ia, type IIIa, and type IIIb endoleaks. Further studies on larger cohorts and longer follow-up periods are required to confirm the interest of EVAS in the endovascular management of failed EVAR.

Background: The aim of this study was to report the treatment of type Ia and type III endoleaks after endovascular aneurysm repair (EVAR) or chimney EVAR using endovascular aneurysm sealing (EVAS) and chimney EVAS., Methods: Ten consecutive patients who underwent the EVAS procedure to treat endoleaks after EVAR were retrospectively included between July 2015 and July 2017. Technical success of EVAS was defined as a successful sealing of the Nellix endograft with visceral vessel patency on intraoperative completion angiography., Results: The median time between EVAR and EVAS procedure was 41.5 months (29-81.8). Eight patients had an elective procedure, whereas 2 were treated in emergency. Chimney endografts were placed during the EVAS procedure in 4 patients, whereas classic EVAS was performed for the other 6 patients. The median procedural time was 222.5 min (138.8-418.8). The technical success was achieved for all patients. The median length of stay after EVAS was 7 days (6.8-14). No death related to abdominal aortic aneurysms or vascular complications were reported for a median follow-up duration of 13.5 months (6.3-25.5). A reintervention was required for 2 patients who developed persistent type II and type Ia endoleaks, which were successfully treated using an embolization procedure., Conclusions: EVAS and chimney EVAS in the treatment of type Ia and type III endoleaks after EVAR and chimney EVAR are technically feasible. Short-term follow-up suggests that the procedure is a safe and efficient therapeutic alternative to manage disabled EVAR., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Fenestrated endovascular aortic repair (FEVAR) of complex aneurysm can require the coverage of polar renal artery. The aim of this study was to investigate the impact of the procedure on postoperative outcomes in patients with juxtarenal or thoracoabdominal aortic aneurysms., Methods: Patients who had FEVAR for juxtarenal or type IV thoracoabdominal aortic aneurysm were retrospectively included between January 2010 and October 2017. The estimated glomerular filtration rate (eGFR) was recorded before and at 1 day, 7 days after surgery, and at the last follow-up. The occurrence of renal infarct was analyzed on the injected computed tomography scan images., Results: Forty-three patients deemed at high-risk for open repair underwent FEVAR; 10 patients (23.3%) had polar renal artery coverage and were compared to patients without polar renal artery. The eGFR did not differ between the groups at 1 day and 7 days after FEVAR (69 vs 61.6 mL/mn/1.73 m 2 , P = 0.8708 and 68.4 mL/mn/1.73 m 2 vs 68, P = 0.9440, respectively). For a median follow-up of 233 days, the eGFR at the latest follow-up was 38 mL/mn/1.73 m 2 (21.8-56.3) in patients who had polar renal artery covered and 57 mL/mn/1.73 m 2 (46.5-76) in patients without polar renal artery (P = 0.0748). Patients who had polar renal artery had a higher rate of postoperative kidney renal infarct (60% vs 21.2%, P = 0.0441). The proportion of vascular complications did not differ (30% vs 30.3%, P = 0.9999). No endoleak related to polar renal artery coverage was observed. The 30-day postoperative mortality was 4.7%., Conclusions: Polar renal artery coverage during FEVAR is not associated with critical renal and vascular short-term outcomes but could impact long-term renal function., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Purpose: To evaluate impact of polar renal artery coverage on early renal function after chimney endovascular aneurysm repair (EVAR)., Materials and Methods: Consecutive patients who underwent chimney EVAR for treatment of asymptomatic juxtarenal abdominal aortic aneurysm were retrospectively included. Estimated glomerular filtration rate (eGFR) was recorded before the intervention and at 1-, 5-, 7-, and 30-day follow-up. Patients without a polar renal artery were compared with patients with an uncovered polar renal artery and patients with a polar renal artery covered by the endograft., Results: Among 76 patients who underwent chimney EVAR, 15 (19.7%) had a polar renal artery. Four patients (5.3%) had an uncovered polar renal artery and 11 (14.5%) had a covered polar renal artery. The median polar renal artery diameter was 3.3 mm (interquartile range, 2.2-3.8 mm). Preoperative eGFR was similar between the 3 groups (65.5 mL/min/1.73 m 2 , 61.1 mL/min/1.73 m 2 , and 53 mL/min/1.73 m 2 , P = .488). For the 3 groups, postoperative eGFR tended to decrease after the intervention compared with preoperative values, and this decrease reached statistical significance at 5 days and 30 days in patients without a polar renal artery. No significant difference was observed between the 3 groups at any time point. No correlation was observed between the diameter of the covered polar renal artery and eGFR changes postoperatively., Conclusions: Polar renal artery coverage during chimney EVAR does not significantly impair early renal postoperative function, suggesting the safety of the procedure., (Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.)

Introduction:: The predictive value of the platelet to lymphocyte ratio (PLR) has been demonstrated in several cardiovascular diseases. The aim of this study was to investigate the interest of the preoperative PLR as a predictor of 30-day postoperative outcome in patients with abdominal aortic aneurysm (AAA) undergoing open or endovascular surgical repair., Material and Methods:: Two hundred twenty-four consecutive patients with infrarenal AAA were retrospectively included and divided into 4 quartiles according to the value of the preoperative PLR: PLR < 91.5 (group I), 91.5 < PLR < 120.8 (group II), 120.8 < PLR < 163.3 (group III), and PLR > 163.3 (group IV)., Results:: The AAA diameter was similar among the groups (54.9 mm vs 58.6, 57.5, and 58.7 mm; P = .4655). The proportion of symptomatic AAA and the procedural characteristics did not differ. Patients from group I and IV had significantly higher rates of all-cause postoperative complications compared to group II and III (55.4% and 64.3% vs 39.3% and 46.4%, respectively; P = .0478). The all-cause mortality tended to be higher in group I and IV (7.1% and 8.9% vs 0% and 3.6%, respectively; P = .1305)., Conclusion:: Extreme values of PLR are associated with a higher risk of complications following AAA surgical repair, suggesting its interest as a biomarker to evaluate the surgical risk.

An accessory renal artery (ARA) represents an anatomic variation which can challenge endovascular aortic aneurysm repair (EVAR). The aim of this review was to summarize the current knowledge on postoperative outcomes following ARA coverage during EVAR. We performed a systematic literature review. The MEDLINE database was searched on September 2017, and 8 relevant studies were included. The frequency of ARA in patients undergoing EVAR varied between 9.5% and 16.2%, and the frequency of ARA coverage varied between 5.2% and 9.4%. Four reports did not observe any significant changes on postoperative renal function, whereas 1 study reported an early transient increase in creatinine after ARA coverage. The occurrence of renal infarct varied from 20% to 84%. Five studies did not observe endoleaks related to ARA coverage, whereas one reported the occurrence of type II endoleaks in 3 of 18 patients who had ARA coverage. No significant change in blood pressure, mortality, and mean length of hospital stay was observed. The ARA coverage can potentially have renal and vascular consequences, but none of them were critical. Further studies may be useful to identify preoperative criteria that may help to choose the most appropriate surgical approach before ARA coverage.

Background: Abdominal aortic aneurysm (AAA) represents a major health concern and the curative treatment relies on surgical approaches including open and endovascular aortic repair (EVAR). While epidemiological studies have addressed the major outcomes including mortality and life threatening complications, the impact of surgical intervention on sexual function has been less well described. The aim of this review was to summarise current knowledge on the occurrence of sexual dysfunction in the context of AAA surgical repair and to explore whether surgical techniques could have differential impact., Methods: The MEDLINE database was searched in May 2017 and all studies related to sexual dysfunction assessment following AAA surgical repair were included. Given the heterogeneity of the definitions of sexual dysfunction and its assessment, a comprehensive literature review was performed rather than a meta-analysis., Results: The published literature search identified 29 studies including prospective, retrospective, and single centre and multicentre trials. The post-operative erectile dysfunction prevalence varied from 7.4% to 79% following open repair and from 4.7% to 82% following EVAR. The incidence of de novo erectile dysfunction was estimated, respectively, at 20%, 26.6%, and 83% after open repair and at 11% and 14.3% after EVAR. Erectile dysfunction rates varied from 5.3% to 8.2% in patients who had EVAR with unilateral hypogastric artery exclusion and from 5.1% to 46.6% in patients who had bilateral hypogastric artery exclusion. The rates of retrograde ejaculation after surgery varied from 3.3% to 9% after open repair and from 6% to 6.6% after laparoscopic repair., Conclusion: Clinical studies demonstrated heterogeneous results, which could be attributed mainly to methodology including study design and criteria used to evaluate sexual dysfunction. Given the potential consequences of sexual dysfunction on quality of life, this review highlights the real need to inform patients and to better assess this potential side effect to improve its management in patients undergoing AAA surgical repair., (Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)