Matthias Trenner

Summary: Background: Blunt thoracic aortic injury (BTAI) is a life-threatening condition. Comprehensive nationwide data from European healthcare systems are limited. This study aims to analyse temporal trends in hospital incidence, treatment strategies, and outcomes of BTAI in Germany. Materials and methods: This retrospective secondary analysis used nationwide German Diagnosis-Related-Groups hospital episode statistics. All BTAI cases between 2010 and 2023 were included. Treatment strategies were classified as open repair, endovascular repair or conservative management based on Operations and Procedures Classification codes. Primary outcome was in-hospital mortality. Adjusted multivariable logistic regression was performed. Age, sex, Elixhauser comorbidity score, treatment modality, treatment period, and treatment in a vascular surgery department were included in the statistical model. Results: In total 3,530 cases were identified ( Mdn _age 58 years; 70.1% male). TEVAR was performed in 30.5%, open repair in 16.4%, and 53.1% were managed conservatively. Overall, in-hospital mortality was 24.4% (16.0% after endo, 25.8% after open repair and 28.7% in not-treated cases). Increasing age (adjusted odds ratio [aOR] 1.12 per 10 years, 95% Confidence interval [CI] 1.07–1.17) and higher comorbidity burden (aOR 1.03 per point, CI 1.02–1.04) were independently associated with mortality. Both endo (aOR 0.55, CI 0.44–0.68) and open repair (aOR 0.69, CI 0.54–0.89) were associated with lower mortality compared with conservative management. Conclusions: In Germany, BTAI hospital incidence showed temporal variation with pandemic-related decline. Endovascular repair was the predominant active treatment and was associated with lower in-hospital mortality. Outcomes were strongly influenced by age, comorbidity, and specialised vascular care.

Summary: Background: Bridging Stent Grafts (BSG) are an essential element of fenestrated and branched endovascular aortic repair (FEVAR and BEVAR respectively). Until CE marking of a dedicated stent in late 2024, a variety of BSG were used. The aim of this study was to evaluate the outcomes of the iCover stent graft in this application. Patients and methods: We retrospectively analysed 22 consecutive patients treated at our institution with FEVAR and BEVAR between 05/2023 and 09/2024. The primary endpoint is a composite of target vessel (TV) technical success and freedom from target vessel instability (TVI) in the early and short-/mid-term phase. Secondary endpoints consisted of early, short- and mid-term clinical outcomes. Results: Ninety-seven iCover stent grafts were used to bridge 90 target vessels: 23 for the coeliac arteries (CA), 23 for the superior mesenteric artery (SMA) and 50 for the renal arteries (RA); one iCover stent could not be implanted. The underlying aortic pathology was juxtarenal and pararenal aneurysm (12/22; 54,5%), penetrating aortic ulcer (PAU) (2/22; 9%), type Ia endoleak following infrarenal EVAR (3/22; 13,6%), chronic type B aortic dissection with aneurysmal degeneration (1/22; 4,5%), Safi type IV (3/22; 13.6%) and Safi type V (1/22; 4.5%) thoraco-abdominal aortic aneurysm (TAAA). The mean aneurysm diameter was 60,5 mm (+/– 10,6 mm). Four (18,2%) patients underwent urgent procedures. The median follow-up was 291,5 days (IQR 63-425,2). 3 patients (13,6%) died from non–aneurysm-related causes. Assisted primary TV technical success was 98,88% (89/90). One non-iCover related loss of TV was excluded from mid-term analysis. The TV patency was 98,88% (89/90) in the early phase and 98,87% (88/89) at mid-term follow-up. Cumulative freedom from TVI was 92,13% (82/89). Conclusions: The iCover is effective and safe to use as a BSG in fenestrated endovascular aortic repair. Our results align with the available literature, but further studies are needed to validate iCover as BGS, especially in BEVAR.

Summary: Background: Acute abdominal aortic occlusion is a rare vascular emergency associated with high morbidity and mortality. To date, the topic has hardly been addressed scientifically. Most case series are afflicted with small cohort numbers. The aim of this study was to identify risk factors after invasive treatment of acute abdominal aortic occlusion and changes over time. Patients and methods: Using case-based nationwide hospital statistics (diagnosis-related group [DRG] statistics) from 2009 to 2020, all cases with ICD-10 codes for embolism and thrombosis of the abdominal aorta in conjunction with acute limb ischaemia and consecutive invasive treatment (endovascular or open surgery) were included. The analysis included patient characteristics, treatment, mortality, amputation, and complications. The primary outcome was in-hospital death. A multivariable regression model was applied to detect risk factors. Results: A total of 1160 cases (66% male) with acute abdominal aortic occlusion were identified (941 open; 219 endovascular). Between 2009 and 2020, the rate of endovascular treatments (2010: 6%; 2020: 29%; p<.001) increased significantly over the years. Older patients (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.64–0.9, p=.002) and women (OR 0.65; 95% CI 0.48–0.88, p=.006) were more likely to receive endovascular care. In-hospital mortality was 13% after open surgery and 14% after endovascular treatment, with no significant change in open surgery, but high variability in endovascular treatment during the observation period (2009–2011: open 14%; endovascular 25%; 2018–2020: 10%; 11%). In-hospital mortality increased significantly with higher age (OR 2.19 per 10-year increase; 95% CI 1.79–2.7, p<.001) and comorbidities (OR 1.1 per Elixhauser point; 95% 1.07–1.11, p<.001). Conclusions: Acute aortic occlusion remains a rare but life-threatening emergency. Use of endovascular revascularization techniques is increasing, while in-hospital mortality rates remain high, specifically for older and morbid patients.

Background: Endovascular aortic repair (EVAR) has become the standard approach for intact abdominal aortic aneurysm (iAAA) repair in recent decades. This retrospective single-centre study analyzed real-world treatment trends, early outcomes, and risk factors for in-hospital mortality following EVAR and open surgical repair (OSR) in patients treated for iAAA from 2005 to 2022. Methods: In-hospital mortality was the primary outcome. Univariate and multivariable logistic regression analyses were performed. Logistic and logarithmic regression models were established to assess temporal changes. Results: In total, 1237 patients (90% male, mean age 72 years) were included, comprising 863 EVAR and 374 OSR procedures. In-hospital mortality was lower after EVAR than OSR (0.93% vs. 3.48%; p = 0.001). After risk adjustment, higher age (adjusted odds ratio [OR] 2.39, 95% confidence interval [CI] 1.26–4.78; p = 0.007) and chronic obstructive pulmonary disease (OR 4.43, 95% CI 1.82–10.8; p = 0.001) were associated with higher in-hospital mortality. Conversely, EVAR (vs. OSR; OR 0.16, 95% CI 0.06–0.43; p < 0.001) was associated with a lower hospital mortality risk. Throughout the study, in-hospital mortality rates for EVAR and OSR remained stable. With a median follow-up of 21 months, OSR-treated patients presented prolonged survival during follow-up (p = 0.021). Conclusions: EVAR represents a reliable alternative for elderly patients with multiple comorbidities considered unfit for OSR. Although EVAR was associated with lower in-hospital mortality, survival was lower during the 5-year follow-up compared to OSR.