Currently, there is a wide range of commercially available endografts for infrarenal abdominal aortic aneurysm (AAA) repair. Results of long-term follow up after endovascular aneurysm repair (EVAR) are limited. Thereby, the durability of these endografts and the difference between manufacturers is not fully clear. In this review, studies with mid- and long-term results, with a minimum median follow up of 36 months per endograft, were included describing results with Cook Zenith� Flex� endograft (Cook Medical Inc., Bloomington, Indiana) (n=6), Cordis Corporate INCRAFT� (Cordis Corporation, Freemont, California) (n=1), Gore� EXCLUDER� (W.L. Gore & Associates Inc., Flagstaff, Arizona) (n=3), Medtronic Endurant� (Medtronic plc, Santa Rosa, California) (n= 6), and Vascutek Anaconda� (Vascutek Ltd., Inchinnan, Scotland) (n=2). The assisted technical success varied between 83% and 100%, and the perioperative mortality, early reintervention, and early conversion rates were comparable for the studied endografts. At three-year follow up, the freedom from AAA-rupture and AAA-related death varied between 98% and 100%. The results demonstrated an increasing complication and reintervention rate over time. When adhering to the instruction for use, minor differences were seen during follow up between the endografts. Latest generation endografts continue to have good postoperative results, the reintervention-rate of 10-20% over time mandates an ongoing close patient follow up. The choice of a specific design depends on native patient anatomy and the experience of the implanting surgeon.

A 69-year-old man presented with abdominal pain. Enhanced computed tomography (ECT) showed abdominal aortic aneurysm (AAA) with vessel wall thickening. Follow-up ECT on day 3 of admission showed expansion of the AAA. Endovascular abdominal aortic repair (EVAR) was urgently performed. Since preoperative blood cultures revealed Campylobacter jejuni infection, the antibiotics imipenem/cilastatin were administered for five weeks, followed orally by Clarithromycin. The patient was discharged on postoperative day 45. There was no recurrence of the aneurysm at 9 months after EVAR. To the best of our knowledge, this is the first report of EVAR for infected AAA caused by Campylobacter jejuni.

Objective: This study was performed to determine whether open surgical decompression (OSD) decreased the mortality associated with abdominal compartment syndrome (ACS) following open repair (OR) of ruptured abdominal aortic aneurysm and iliac aneurysm (rAAA), and to investigate the risk factors associated with OSD. Material and Methods: Total 113 consecutive patients with rAAA underwent OR in our institution. Ninety patients underwent primary abdominal closure; however, three of them developed ACS and required OSD. Prophylactic OSD was performed at the initial OR in 23 patients. Results: The in-hospital mortality rate was higher in those who underwent OSD than in those who did not undergo OSD [27.0% (7/26) vs. 6.9% (6/87), respectively; p=0.01]. However, no ACS-related death occurred in the OSD group. Multivariate analyses revealed that a preoperative/intraoperative base excess (BE)<-11 [p=0.045; odds ratio (OR), 3.33; 95% confidence interval (CI), 1.021-10.850], performance of left thoracotomy (p=0.038; OR, 5.17; 95%CI, 1.098-24.357), and intraoperative blood transfusion >1,800 mL (p=0.012; OR, 4.30; 95%CI, 1.386-13.322) were associated with OSD. Conclusion: The prevalence and mortality rates of ACS were low at our institution. OSD is considered to be useful for the prevention and treatment of ACS after repair of rAAA. OSD should be considered in patients with the above-mentioned factors.

Abdominal aortic aneurysm (AAA) is a vascular disease that involves the gradual dilation of the abdominal aorta followed by its rupture. AAA is closely associated with weakening of the vascular wall due to oxidative stress, chronic inflammation, and degradation of the extracellular matrix. No effective drug therapy is currently available for preventing aneurysm progression or rupture. Adipocytes in the vascular wall are reportedly closely associated with AAA development and rupture. Fiber degradation in the aneurysm wall is enhanced by increased numbers of adipocytes, and rupture risk may increase as well. Recent studies suggested that appropriate control of adipocytes in the vascular wall may be an important strategy to prevent AAA rupture, and further studies may aid in the establishment of a method for preventing AAA rupture by therapeutic drugs or functional foods. In this review, we summarize adipocyte function and the correlation between AAA and adipocytes.

Peripheral artery disease (PAD) affects a growing number of women, with a prevalence equal to that of men. Still, little is known about sex-specific differences in disease manifestations of PAD and how these differences in presentation impact outcomes of surgical and endovascular intervention. Women have also been consistently underrepresented in clinical trials evaluating treatment options for vascular disease. Thus, many of the practice guidelines in place today were generated from clinical trial data that either included a small number of women or excluded them entirely, and, consequently, whose findings may not be applicable to female patients. This review discusses key differences in outcomes based on sex for intervention of lower extremity, carotid, and abdominal aortic aneurysmal (AAA) disease. Elucidating sex-specific differences in disease manifestation and outcomes will provide insight into ways to optimize patient care, particularly for women afflicted with vascular disease.

Despite recent publications indicating billowing (aneurysmal degeneration of the outer fabric material manifesting as a bulging sac of contained contrast due to weakening of the fabric material between the metal struts) as a benign finding, we present a unique case of billowing that resulted in aneurysmal rupture with the AFX2® stent-graft (Endologix, Inc., Irvine, CA). AFX2® consists of an inner metallic endoskeleton with multiple metallic struts covered by a polytetrafluoroethylene graft fabric (PTFE). It allows for the flow of blood or contrast beyond the border of the metallic endoskeleton without evidence of endoleak or rupture secondary to the outer cover being anchored to the endoskeleton with polypropylene sutures only at the proximal and distal ends. Our report raises the concern that although billowing may be a relatively common manifestation with Endologix stent-grafts, clinicians have to be diligent as the phenomenon may progress to AAA rupture.

The rupture of an abdominal aortic aneurysm into the inferior vena cava with fistula formation is a rare condition but is associated with high mortality. Classical symptoms and findings vary in a wide range, and early diagnosis and intervention can be life-saving. In this study, we present a case of abdominal aortic aneurysm associated with aorto-caval fistula formation accompanied by mortality.