Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

PURPOSETo evaluate the technical, radiological, and clinical outcomes after type 2 endoleak (T2EL) embolization in patients with a growing aneurysm sac after endovascular aortic aneurysm repair (EVAR). Additionally, to determine clinical and imaging-based factors for outcome prediction after embolization of a T2EL.METHODSA single-institution, retrospective analysis was performed of 60 patients who underwent a T2EL embolization procedure between September 2005 and August 2016 to treat a growing aneurysm sac diameter following EVAR. The patients’ electronic medical records and all available pre- and post-embolization imaging were reviewed. Statistical analysis methods included logistic regression models for binary outcomes, proportional odds models for ordinal outcomes, and linear regression models for continuous outcomes. The Kaplan–Meier method was used to estimate the overall survival probability.RESULTSTechnical, radiological, and clinical success rates after T2EL embolization were 95% (n = 57), 26.7% (n = 16), and 76.7% (n = 46), respectively. Persistent aneurysm sac expansion was found in 31 patients (51.7%). Unsharp or blurred T2EL delineation on pre-interventional computed tomography (CT) was a predictive factor for a post-embolization persistent visible endoleak and persistent growth of the aneurysm sac (P = 0.025). Median survival after T2EL embolization was 5.35 years, with no difference observed between patients with persistent sac expansion compared with patients with stable or decreased sac diameter.CONCLUSIONProgression of the aneurysm sac diameter was observed in half the study patients, despite technically successful T2EL embolization. Unsharp or blurred T2EL delineation on pre-interventional CT seemed to be an imaging-based predictor for a persistent T2EL and progressive aneurysm sac growth after embolization

Corrigendum to 'Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections' [European Journal of Vascular & Endovascular Surgery 59/3 (2020) 339-384]

peer reviewe

European training requirements in vascular surgery

The Union Europénne des Médecins Spécialistes (UEMS) is a non-governmental organization representing national associations of medical specialists (over 1.6 million) at the European level. It has strong links and relations with European institutions (Commission and Parliament), the other independent European medical or-ganizations and the European medical/scientific societies. With a current membership of 40 national associations and 43 specialist sections and European boards, the UEMS promotes the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens. The UEMS areas of expertise notably encompass Continuing Medical Education, Post-Graduate Training and Quality Assurance. It is the UEMS conviction that the quality of medical care and expertise is directly linked to the quality of train-ing provided to the medical professionals. Therefore, the UEMS committed itself to contribute to the improvement of medical training at the European level through the de-velopment of European standards in the different medical disciplines. One of the added values of the UEMS is the development of new harmonized models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for pa-tients throughout Europe. It is not important where doc-tors are trained, they should have at least the same core competencies.peer-reviewe

Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections.

peer reviewe

Jean-Marie Baud (1776-1852). Professor at the faculty of medicine in two consecutive universities of Louvain

status: publishe

Jan Palfijn (1650-1730). Een verlostang en zoveel meer

edition: Firststatus: publishe

How to avoid and manage complications in aorto-iliac interventions

Although less invasive than the open surgical alternatives by far, endovascular surgery is not free of complications. In a systematic review of endovascular treatment of extensive aorto-iliac occlusive disease mortality ranged from 1.2% to 6.7%. Complications were reported in 3% to 45% of the patients. In this article we give a systematic overview of the most frequent complications of endovascular aorto-iliac interventions, including suggestions how to manage and how to avoid them. Careful case selection, a high level of expertise of the operator and continuous monitoring of outcome are factors that can help to reduce complications, but also the alternative of open and laparoscopic surgery should kept in mind. The lowest complication rate will result from a treatment tailored on the individual patient and the available local experience.status: publishe

Host factors that affect outcome of total hip arthroplasty

status: publishe