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Clinical case video describing urgent correction of a proximal type I endoleak, in previous standard EVAR procedure, which caused a rapid growth of the residual aneurysmal sac. The patient was unfit for open surgery due to multiple severe comorbidities. Considering the urgency setting, the use of a market available custom-made device was not reasonable. For this reason, the patient underwent endovascular correction using a “surgeon modified” endograft (Medtronic Valiant Navion Thoracic Endograft) designed with four custom fenestrations for visceral and renal vessels.

This video/audio tutorial explains all the passage to obtain a correct pre-operative planning and sizing for ChEVAR.

Learning Objective:
Gain knowledge on endovascular treatment in complex aortic diseases.
Understand the technical and clinical value of covered balloon-expandable grafts.  Share experience and data

This is a round table discussion about CO2 during EVAR and complex EVAR in the framework of the annual meeting of Angiodroid in Bologna, Italy. In this round table discussion, 5 European experts present current evidence and their experience about the use of CO2 in the treatment of aortic diseases (s. chapters). Moreover, the panellists discuss all important benefits and drawbacks of the technique and present for the first time the study protocol of the prospective CO2 EVAR registry.

This presentation aims to highlight the usefulness of surgical drawing in practice. It sums up experiences, planning and real cases of the past 5 years of practice in vascular surgery. As I got tremendous positive feedback from patients, colleagues, GP’s, relatives and artists, I decided to share this experience with the vascular community.

Dr. Gustavo Oderich summarizes in his presentation all important aspects of the endovascular repair of complex aortic aneurysms. The evolution from EVAR to more complex techniques, the upcoming trials, the different stent designs, the current strategies regarding the reduction of SCI, first data about the quality of life in these patients and the impact of simulation on the outcomes of complex endovascular repair are some key issues that are discussed in this paper.

Preloaded custom-made fEVAR (Cook) in a 63 y.o. male with pararenal abdominal aortic aneurysm 55 mm. This video shows all the procedural steps and the CT scan at 1 month.

– Chronic ischaemic heart disease with left ventricular apex aneurysm
– Left mild intermittent claudication 500 mt (Left common iliac artery chronic occlusion)
– COPD
– Chronic celiac artery occlusion

We used Begraft 10×37 in SMA, 8×27 for left renal and 7×18 in right renal.

We report a case of pararenal pseudoaneurysm endovascular correction with triple chimney technique and the following gutter embolization procedure

Key points:

-Previous fEVAR attempt (failed because of extremely tortuous accesses)
-Emergency procedure during the night
-Bilateral percutaneous femoral access
-Double axillary puncture on both sides
-Challenging endograft advancement on through and through guidewire
-Triple ChEVAR (SMA, RRA, LRA)
-Subsequent gutter embolization

“Who will do my aortic surgery when my time comes” was a common refrain among my mentors, only half jokingly. Now, the question has gained a sharpness. I think the tide will turn and the kids will do fine, but we all have to do a bit of reclamation, or open surgery will become the habit of strange eccentric artisans. I recommend calling up the retired surgeon and inviting them in for conferences and cases. Reprint masterwork atlases like Wiley’s. Connect with likeminded. Before it’s too late.

Since India’s Sushruta (800-600 BC) first reported that “aneurysms can be cured only with the greatest difficulty”, the majority of surgeons shared a fear of aortic surgery till the first half of the 20th century. The surgical treatment of AAA became available only in the second half of the 20th century. This presentation summarizes the most important historical milestones in AAA surgery.

Giovanni Torsello (Vascular Surgeon, GER) presents and discusses with the experts the latest results from an experimental head-to-head investigation of different bridging stent-grafts (BSG) used in fenestrated aortic endografting.
How does the material respond to balloon dilatation? Which are the forces that might lead to the dislocation of the BSG from a fenestration? Endoleak of unknown origin after fEVAR: could be associated with material fatigue?

Despite the latest advances in both endovascular field and open repair, a ruptured AAA still remains one of the most challenging situations in vascular medicine. This case shows the use of chimney and periscope grafts for the treatment of a Type Ia Endoleak in patient presenting with a ruptured AAA.

In this video case, we present our standard practice of open surgical repair for pararenal AAA. In general, we performed open repair with the “clamp and sew” technique, and the application of cold renal perfusion is limited to the cases with renal revascularization. Sometimes, division of left renal vein is imperative for better access to the suprarenal aorta. Retrospective analysis of our series revealed no negative impact of the division on long-term renal function – J Vasc Surg 2018;67:1042-1

This is a case report describing the different steps of the implantation of a fenestrated preloaded endograft to treat a juxtarenal aneurysm with calcified and tortuous iliacs.

This presentation summarizes the results of the first topic of the polling station about asymptomatic juxta- and suprarenal aortic aneurysms.
Total number of votes: 103.
The results are now open for discussion.