There are significant differences in frequency of limb occlusion and endoleak between groups with different endovascular devices. Knowledge of these and other differences is instructional in development of next-generation endovascular devices, incorporating design features linked to satisfactory outcome while abandoning those associated with device failure.

Elective EVAR conversion, although technically challenging may be done with mortality similar to primary open repair. Mortality for conversion for infected grafts and ruptured aneurysms remains high. EVAR is associated with continued risk of conversion, and surveillance may identify late complications that require removal, justifying lifelong monitoring. Aggressive management of late complications and elective conversion may minimize the mortality associated with this procedure.

Current endovascular devices are associated with a relatively high rate of complications over mid-term follow-up, culminating in frequent need for secondary remedial procedures. With strict follow-up imaging compliance, however, risk for rupture and aneurysm-related death remain exceedingly low. Newer technology may achieve improved durability and a lower requirement for secondary procedures, while maintaining the minimally invasive nature of presently available devices.

Outcome after endovascular repair of abdominal aortic aneurysm depends on size; results appear inferior in patients with larger aneurysms. These differences attain importance when choosing between observation and repair, balancing risk for rupture against size-dependent outcome.

With the exception of slightly older age and somewhat smaller aneurysm, female patients are similar to male patients undergoing endovascular aneurysm repair. A greater frequency of graft limb occlusion was observed in female patients, but no statistically significant differences were detected in survival, rupture risk, or need for secondary procedures. Moreover, a more rapid rate of aneurysm sac shrinkage was detected in women. These observations suggest that endovascular aneurysm repair should be offered to suitable candidates irrespective of gender.

Reports of a rare form of cerebral venous sinus thrombosis with profound thrombocytopenia have emerged following introduction of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccines. Between March and June 2021, seven cases of refractory vaccine-induced immune thrombotic thrombocytopenia were referred to our institution for mechanical thrombectomy. The condition of 1 patient deteriorated during interhospital transfer, and the remaining 6 underwent successful recanalization. No procedure-related adverse events were reported. At the time of this writing, 3 patients have been discharged with a good functional outcome (mRS 0-1), one required rehabilitation for mild dysarthria and vocal cord palsy (mRS 3), and 2 have died due to severe mass effect. Our anecdotal experience suggests that endovascular therapy may be safe and effective in reducing thrombus burden in selected cases of postvaccination cerebral venous sinus thrombosis.ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; CVST ¼ cerebral venous sinus thrombosis; HIT ¼ heparin-induced thrombocytopenia; ICH ¼ intracerebral hemorrhage; PF ¼ platelet factor; VITT ¼ vaccine-induced immune thrombotic thrombocytopenia

We report a case of acute limb-threatening ischemia from blunt traumatic tibial arterial disruption managed with endoluminal techniques. An otherwise healthy 37-year-old man involved in a motorcycle crash sustained a compound fracture of his right tibia and fibula. Arterial insufficiency developed after surgical reduction of the orthopedic injuries that warranted selective angiography of the involved extremity. This demonstrated complete occlusion of the infrageniculate circulation at the level of the ankle. Recanalization of the posterior tibial artery was achieved by using coronary balloon-expandable stents, thereby reestablishing in-line flow to the foot. Clinical and noninvasive surveillance at 2 years confirmed patency of the recanalized artery with the absence of any ischemic symptoms. Arterial reconstruction of the infrapopliteal arterial tree poses a formidable challenge in the setting of blunt trauma. Recent improvements in endovascular skills, endoluminal technology, and imaging capabilities have allowed percutaneous reconstruction of challenging arterial pathology. Endovascular treatment of blunt tibial injuries is an alternative to complex open reconstructions. These patients require close long-term postoperative surveillance because the durability of such a repair remains unknown.

Background Postthrombotic syndrome is a common complication of deep vein thrombosis, with limited treatment options. Methods and Results ACCESS PTS (Accelerated Thrombolysis for Post‐Thrombotic Syndrome Using the Acoustic Pulse Thrombolysis Ekosonic Endovascular System) is a multicenter, single‐arm, prospective study evaluating patients with chronic deep vein thrombosis and postthrombotic syndrome (Villalta score ≥8) who received minimum 3 months of anticoagulation. Patients underwent percutaneous transluminal venoplasty and ultrasound‐accelerated thrombolysis, with data collected on clinical characteristics, postthrombotic syndrome, imaging, and quality of life to 1 year. The primary efficacy outcome was a reduction of ≥4 points in the Villalta score 30 days after procedure. The primary safety outcomes were major bleeding episodes within 72 hours and symptomatic pulmonary embolism during the index hospitalization. A total of 82 limbs (78 patients) were treated (age, 54.6±12.7 years; 32.1% women; mean Villalta score, 15.5±5.2). The primary end point was met in 64.6% (51/79). At 1 year, 77.3% (51/66) of limbs continued with a Villalta reduction ≥4. At 365 days, >90% of segments had patency with ultrasound flow present. Baseline to 1‐year Physical Component Summary mean score of the Short Form‐36 increased from 38.9±9.5 to 45.2±9.8 ( P ≤0.0001), and mean VEINES ‐ QOL (Venous Insufficiency Epidemiological and Economic Study–Quality of Life) increased from 61.9±19.7 to 82.6±20.8 at 1 year ( P <0.0001). Iliofemoral venous stenting was performed in 42 patients, with similar improvements seen in all outcomes, regardless of stenting status. One patient developed severe bleeding within 72 hours of the intervention and died at 32 days after procedure (1.3% mortality rate). Conclusions Percutaneous transluminal venoplasty and ultrasound‐accelerated thrombolysis resulted in successful recanalization of chronic venous obstruction with improved postthrombotic syndrome severity and quality of life. Results were sustained at 1‐year after procedure. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 02159521.