Management Of Aneurysms Research Articles

Treatment of Unruptured Small and Medium-Sized Wide Necked Aneurysms Using the 64-Wire Surpass Evolve: ASubanalysis From the SEASE International Registry.

Flow diversion has revolutionized the management of wide-necked intracranial aneurysms (IAs). We aimed to assess the effectiveness and safety of the new generation 64-wire Surpass Evolve for the treatment of unruptured small/medium-sized IAs. This is a subanalysis from the SEASE (Safety and Effectiveness Assessment of the Surpass Evolve) registry, an observational cohort study including 15 academic institutions in North America and Europe between July 2020 and October 2022. Patients with wide-necked saccular IAs, measuring <12 mm along the internal carotid artery and vertebrobasilar system, and treated with the Surpass Evolve were included. Primary effectiveness was complete occlusion (Raymond-Roy class 1) at follow-up (core laboratory adjudicated), and primary safety was major stroke (ischemic/hemorrhagic) in the territory supplied by the target artery or death. A total of 129 cases with 135 IAs were included (median age 59 years, 85.3% women). Median maximum IAs size and neck size were 5.1 and 3.9 mm, respectively. Most IAs were in the internal carotid artery C6 (65.9%, 89/135) and C7 (14.1%, 19/135) segments. At a median follow-up time of 10.2 months (interquartile range, 6.4-12.8), complete occlusion was 77.1% (101/131), ≥50% in-stent stenosis was 8.8% (11/125), and retreatment was 0.8% (1/125). Major stroke and mortality were reported in 2 (1.6%) patients and 1 (0.8%) patient, respectively. Size was the only factor associated with higher odds of incomplete occlusion (adjusted odds ratio, 1.2 [95% CI, 1.02-1.5]; P=0.03). Patients with small/medium-sized IAs can be effectively treated using the Surpass Evolve, a new generation, 64-wire, cobalt-chromium flow diverter.

Surgical management of giant coronary artery aneurysms.

Surgical management of giant coronary artery aneurysms.

A review of intracranial aneurysm imaging modalities, from CT to state-of-the-art MR.

Traditional guidance for intracranial aneurysm (IA) management is dichotomized by rupture status. Fundamental to ruptured aneurysm management is the detection and treatment of subarachnoid hemorrhage, along with securing the aneurysm by the safest technique. On the other hand, unruptured aneurysms first require a careful assessment of natural history versus treatment risk, including an imaging assessment of aneurysm size, location, and morphology, along with additional evidence-based risk factors such as smoking, hypertension, and family history. Unfortunately, a large proportion of ruptured aneurysms are in the lower risk size category (<7mm), putting a premium on discovering a more refined non-invasive biomarker to detect and stratify aneurysm instability prior to rupture. In this review of aneurysm work-up, we cover the gamut of established imaging modalities (e.g., CT, CTA, DSA, FLAIR, 3D-TOF-MRA, CE-MRA) as well as more novel MR techniques (MR-VWI, DCE-MRI, CFD). Additionally, we evaluate the current landscape of AI software and their integration into diagnostic and risk stratification pipelines for IAs. These advanced MR techniques, increasingly complemented with AI models, offer a paradigm shift by evaluating factors beyond size and morphology, including vessel wall inflammation, permeability, and hemodynamics. Additionally, we provide our institution's scan parameters for many of these modalities as reference. Ultimately, this review provides an organized, up-to-date summary on the array of available modalities/sequences for IA imaging to help build protocols focused on IA characterization.ABBREVIATIONS: IA = intracranial aneurysm; LP = lumbar puncture; UIA = unruptured intracranial aneurysm; VWI = vessel wall imaging; 3DRA = 3D Rotational Angiography.

Management of a Rare Case of Superior Mesenteric Artery Aneurysm Associated with a Pancreatic Cyst Complicated by Acute Rupture: A Case Report and Review of Literature

Superior mesenteric artery aneurysms are a rare pathology, and rupture due to a pancreatic cyst in the context of alcohol-induced pancreatitis is an even rarer condition. The first line of treatment is usually an endovascular approach. We present the case of a 51-year-old male with alcohol-induced pancreatitis, diagnosed with a superior mesenteric artery aneurysm with active bleeding in close contact with a large pancreatic cyst. A covered stent was used to treat this condition. The patient developed hemorrhagic shock 12 h after the procedure and an urgent laparotomy was performed. A second rupture of the arterial wall at the distal end of the stent was observed and in order to obtain distal perfusion, first, an infrarenal aorta to superior mesenteric artery bypass distal to the rupture was performed in order to exclude the aneurysm. Secondly, a bypass originating from the distal end of the first bypass to the distal end of the superior mesenteric artery was performed. The patient had an uneventful recovery and was discharged after 10 days. We reviewed the literature regarding the incidence and the therapeutic management of superior mesenteric artery aneurysm complicated by pancreatic cyst. An advanced search on PubMed from 2004 to 2024 returned 194 results and after applying the inclusion–exclusion criteria, 11 publications were selected. Although the endovascular approach is usually the first line of treatment with obvious advantages for the patient, a patient-tailored approach should be made in such cases and surgery could be the first option, when considering that the mechanism of aneurysm rupture is due to erosion of the arterial wall by the pancreatic enzymes. Surgery has the advantage of cyst drainage and aneurysm exclusion and in our case proved lifesaving.

Comprehensive Management of Intracranial Aneurysms in Rare and Variant Arterial Locations: A Detailed Case Report

AbstractAneurysms on variant arteries, especially involving the persistent trigeminal artery (PTA), azygos artery, and lenticulostriate arteries (LSAs), are rare. This report presents a case and subsequent management of a patient with multiple unruptured aneurysms arising from variant anatomical structures. A 48-year-old patient with a history of worsening headaches presented with three unruptured aneurysms at the PTA, azygos artery, and left LSA, confirmed via catheter angiography with three-dimensional reconstruction. Given the potential effects on conventional cerebrovascular structures, managing multiple aneurysms in rare and variant locations requires a tailored strategy. This case was successfully treated with an endovascular approach and a period of observation, emphasizing the need for individualized treatment planning.

Safety and efficacy of flow diverter stents in the treatment of bifurcation cerebral aneurysms: single-center experience.

The use of flow diverter (FD) stents is continually expanding. Aneurysms on arterial bifurcation typically have an undesirable anatomical form, are frequently wide-necked, and include one or more side-branch arteries. In recent years, the off-label use of flow diversion in treating intracranial aneurysms beyond the internal carotid artery has become increasingly popular. This study reports our center's initial experience treating bifurcation aneurysms with FD devices, documenting occlusion outcomes using the O'Kelly-Marotta and modified Cekirge-Saatci scales, as well as the safety of FD usage in bifurcation locations. This retrospective, single-center study analyzed a prospectively maintained database of patients with cerebral aneurysms treated endovascularly. The study identified bifurcation aneurysms that were treated between January 2019 and May 2022 by placing an FD device covering the neck of the aneurysm. Our short series suggests that flow diversion is a viable therapeutic option for bifurcation aneurysms with favorable angiographic outcomes. In highly selective cases, flow diversion may be considered for treating bifurcation aneurysms in patients who will undergo follow-up examinations in the future. Flow diversion has emerged as a valuable technique in the management of bifurcation aneurysms, offering the potential for satisfactory occlusion and long-term outcomes.

Exclusion of a left main pseudo aneurysm complicating SCAD by two overlapping DES - a case report.

SCAD is now recognized as an important cause of ACS in women, and its treatment is generally based on conservative therapy leading to complete cure. However, complete cure is not systematic, and data are lacking to identify patients at risk of malignant progression and to define the best therapeutic strategy.A 36-year-old woman with STEMI on SCAD extending from the LM to the middle LAD and circumflex artery, evolving under medical treatment to a large LM pseudo aneurysm. After CT evaluation and IVUS measurement, the patient underwent pseudo aneurysm exclusion by implantation of two overlapping DES on his collar. The choice of conservative treatment in the initial phase, given the extension of SCAD to all left coronary arteries, and the management of this voluminous LM pseudo aneurysm by implantation of two overlapping DES rather than by a covered stent or coil embolization, can be discussed here.

Incidence, Management, and Outcomes of Pediatric Infectious Aneurysms.

Infectious intracranial aneurysms (IIAs) are rare cerebrovascular complications of infective endocarditis (IE) accounting approximatively for 0.5% to 6.5% of all aneurysms. In children, mycotic aneurysms secondary to IE are uncommon. This is a retrospective study of patients treated for pediatric IIA secondary to IE at our institution with an emphasis on presentation, etiologies, nuances in management, and outcomes. One hundred fifty-one patients were treated for IE secondary to congenital or acquired heart disease, of which 13 patients (8.6%) presented with intracranial hemorrhage. IIA occurred in 5 patients (2.6%) with IE. IIA accounted for 15% of intracranial aneurysms treated during the study period. Pediatric patients with ruptured IIAs have a high rate of rerupture, and early surgical intervention should be considered through an open or endovascular route when available.

Interventional Management of Visceral Artery Aneurysms: Simple to Complex

AbstractVisceral artery aneurysms (VAAs) are uncommon but potentially life-threatening vascular disorders that can involve the celiac, superior, and inferior mesenteric arteries or their branches. They are often asymptomatic but can present with vague abdominal pain, secondary effects, or signs of hemorrhage. The most common site of involvement is the splenic artery, followed by the hepatic artery, the celiac axis, and mesenteric arterial branches. VAAs can be classified into two types: true aneurysms (TAs) and pseudoaneurysms (PSAs). Imaging, particularly multidetector computed tomography angiography, is the cornerstone in diagnosing VAAs. Treatment decisions are based on the risk of rupture and clinical deterioration in a patient with a VAA. The endovascular approach remains the mainstay in the treatment of VAAs. As a general guideline, PSAs, even when asymptomatic, should always be treated. TAs are treated based on their size and location. Deconstructive and reconstructive strategies are the standard treatment options for any VAA, and assessing the vascular anatomy and collateral circulation is paramount for treatment decisions.

Open Aneurysmorraphy Following Branched and Fenestrated Endovascular Repair of Complex Thoracic Aneurysms

We present a review of our hybrid management (endovascular + open surgery) of large thoracic aortic aneurysms (>80mm). The strategy comprises a primary endovascular repair using Thoracic Endovascular Aortic Repair (TEVAR), and/or Fenestrated and Branched endografts (FBEVAR), followed by open thoracotomy and aneurysmorraphy, specifically without the need for aortic cross-clamping. We performed a retrospective review of all patients who had undergone aneurysmorraphy via thoracotomy following TEVAR & FBEVAR in two high volume aortic centers between December 2017 and March 2024. We performed aneurysmorraphy in two clinical situations: 1) in the setting of a planned staged treatment, shortly after TEVAR or FBEVAR in young patients with aneurysm diameter > 100mm; and 2) as a secondary intervention during follow-up for patients with persistent sac enlargement and aneurysm diameters > 80mm. The primary end-points were 30-day survival and aneurysm related mortality during follow-up. Secondary endpoints were sac size evolution, peri-operative and post-operative complications, freedom from further re-intervention and late aortic complications. Twelve patients underwent aneurysmorraphy following TEVAR and/or FBEVAR during the study period. Mean patient age was 60 +/- 12 years, and the mean sac diameter before thoracotomy was 101 +/- 25 mm. Endovascular embolization of intercostal arteries prior to aneurysmorraphy was performed in 4 patients. The 30-day survival rate was 100%. During the mean follow up period of 21 months, 2 patients died - one of COVID and another of intra-cerebral hemorrhage. No aneurysm-related mortality occurred and sac regression was achieved in all patients except one experiencing aortic growth below the aneurysmorraphy. This study demonstrates that thoracic aneurysmorraphy performed after TEVAR and FBEVAR for complex thoracic aneurysms is a safe and effective technique. This procedure allows the eradication of endoleaks and an immediate sac volume reduction, which prevents aorta-bronchial or esophageal fistulation and secures the endovascular repair; the reduction of the aneurysm mass effect restores normal lung parenchyma expansion. This hybrid management strategy drastically reduces the morbidity associated with standard open surgery performed for thoracic endograft explantation.

Thermal modeling and its role in management of bifurcation aneurysms and associated ischemic complications in the middle cerebral artery

Bifurcated aneurysm of cerebral artery is a common cerebrovascular disease, which can easily lead to serious ischemic complications. Traditional treatments face challenges of risk and effectiveness. Therefore, it is particularly important to explore new therapeutic strategies. In recent years, the application of thermal modeling techniques in medical biological systems has provided a new perspective for the analysis of hemodynamics and tissue thermal response. The purpose of this study was to investigate the role of heat model in the treatment of bifurcated cerebral artery aneurysms and their associated ischemic complications, and to evaluate its potential value in understanding disease mechanisms and optimizing treatment protocols. In this study, a three-dimensional thermal model was used to simulate the heat conduction and blood flow characteristics of the bifurcated parts of cerebral arteries. Combined with the clinical data of patients, the influence of the thermal model on the formation mechanism of aneurysms and the prognosis evaluation of ischemic complications were analyzed through numerical calculation and experimental verification. Compare the performance of different treatment methods in thermal models. The thermal model shows that the temperature distribution at the aneurysm site is closely related to the blood flow velocity, and the local temperature increase may promote thrombosis and lead to ischemic complications. The treatment regimen optimized by the thermal model showed significant improvement in the simulation, reducing the risk of complications and improving hemodynamic parameters. Heat model can reveal the dynamic relationship between blood flow and temperature in the study of cerebral artery bifurcation aneurysm, and provide theoretical support for clinical treatment.

A Dedicated Algorithm for Endovascular Approach as a First-Line Treatment Option for Visceral Artery Aneurysms

Few data are reported in literature about visceral artery aneurysms (VAAs) management. The aim of the present study was to analyze VAAs management in a single institution, with a dedicated algorithm for endovascular approach as the first line treatment. A single-center retrospective cohort study was performed. Patients with a VAA submitted to either endovascular repair or open surgery from 2016 to 2023 were included. A dedicated algorithm was used to evaluate the endovascular approach feasibility assessing on the preoperative computed tomography angiography the following parameters: (a) the tortuosity of the involved artery (<150°), (b) the healthy arterial diameter (>4mm), (c) the VAA proximity to the hilum and/or the presence of a bifurcation of the aneurysmatic artery, and (d) the circumferential calcium presence. An endovascular approach was chosen if (a) and (b) criteria were satisfied without (c) and (d) ones. Otherwise, it was deemed a challenging anatomy, and an open surgical treatment was considered. In the absence of (a) and/or (b) criteria open surgery was the preferred option. Thirty-one asymptomatic aneurysms (28 patients) were treated electively. The most frequent VAA location was the splenic artery (18 cases; 58%), followed by the renal arteries (6 cases; 19%), the common hepatic artery (5 cases; 16%), the gastroepiploic artery (1 case, 3.2%) and the pancreatoduodenal artery (1 case; 3%). Twenty-two aneurysms (71%) were initially treated by an endovascular approach (stent-graft deployment and/or transcatheter embolization) with 3 (13%) of them needing a surgical conversion. Nine aneurysms (29%) were submitted directly to a surgical treatment (aneurysm resection with or without interposition bypass) with no peri-operative and long-term complications. Technical success was 90.3%. Endovascular management as a first line approach is safe and effective in most cases. A preoperative dedicated algorithm is useful to identify suitable cases. Open surgery can be considered an alternative option in specific challenging anatomical situations or in case of endovascular failure.

Age- and sex-specific biomechanics and extracellular matrix remodeling of the ascending aorta in a mouse model of severe Marfan syndrome.

Thoracic aortic aneurysm (TAA) is associated with Marfan syndrome (MFS), a connective tissue disorder caused by mutations in fibrillin-1. Sexual dimorphism has been recorded for TAA outcomes in MFS, but detailed studies on the differences in TAA progression in males and females and their relationships to outcomes have not been performed. The aims of this study were to determine sex differences in the diameter dilatation, mechanical properties, and extracellular matrix (ECM) remodeling over time in a severe mouse model (Fbn1mgR/mgR = MU) of MFS-associated TAA that has a shortened life span. Male and female MU and wildtype (WT) mice were used at 1-4 mo of age. Blood pressure and in vivo diameters of the ascending thoracic aorta were recorded using a tail-cuff system and ultrasound imaging, respectively. Ex vivo mechanics and ECM remodeling of the aorta were characterized using a biaxial test system and multiphoton imaging, respectively. We showed that mechanical properties, such as structural and material stiffness, and ECM remodeling, such as elastic and collagen fiber content, correlated with diameter dilatation during TAA progression. Male MU mice had accelerated rates of diameter dilatation, stiffening, and ECM remodeling compared with female MU mice which may have contributed to their decreased life span. The correlation of mechanical properties and ECM remodeling with diameter dilatation suggests that they may be useful biomarkers for TAA progression. The differences in diameter dilatation and life spans in male and female MU mice indicate that sex is an important consideration for managing thoracic aortic aneurysm in MFS. NEW & NOTEWORTHY Using a mouse model (Fbn1mgR/mgR = MU) of severe thoracic aortic aneurysm in Marfan syndrome (MFS), we found that male MU aorta had an accelerated time line and increased amounts of dilatation, stiffening, and extracellular matrix (ECM) remodeling compared with female MU aorta that may have contributed to an increased risk of fatigue failure with cyclic loading over time and a reduced life span. We suggest that aortic stiffness may provide useful information for clinical management of aneurysms in MFS.

The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review

Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients.

Sex Differences in Intracranial Aneurysms: A Matched Cohort Study.

Background: Aneurysmal subarachnoid hemorrhage (SAH) predominantly affects women, accounting for 65% of cases. Women have a 1.3 times higher relative risk than men, with the incidence rising particularly in women aged 55-85 years. Women also have a higher prevalence of unruptured intracranial aneurysms (IAs), especially after the age of 50 years, and are at greater risk of aneurysm growth and rupture. This study aimed to isolate the influence of sex on rupture rate, bleeding severity, functional outcomes, and complications by using a matched cohort, while also examining the impact of sex on aneurysm localization and multiplicity. Methods: We utilized a retrospectively collected database of 300 patients with 511 IAs. Inclusion criteria included the availability of clinical data and 3D angiography for semi-automatic reconstruction of IA morphology. Female patients and their IA were matched with male patients according to clinical parameters and 21 morphological characteristics using an interactive visual exploration tool for multidimensional matching. Results: Contrary to previously published results, our study found no significant sex differences in rupture rates or vasospasm rates between male and female patients. The severity of SAH, functional outcomes, and complications such as hydrocephalus were also similar in women and men. However, women exhibited a higher prevalence of multiple aneurysms and distinct localization patterns. Conclusions: This study underscores the complex role of sex in IA development and rupture. Although sex-specific biological factors influence aneurysm characteristics, they do not necessarily translate into differences in clinical outcomes. Further research is needed to explore these factors and their impact on aneurysm development and management.

Ruptured mycotic abdominal aortic aneurysm in the setting of an adjacent perinephric abscess

Arterial aneurysms are most commonly present due to progressive vessel wall injury. They may then act as a nidus for bacterial seeding that can lead to the formation of a mycotic aneurysm in 2.5% of all abdominal aneurysms, which is associated with high mortality. Management of mycotic aortic aneurysm has been challenging always. Here we present a rare case of a ruptured mycotic aneurysm secondary to contiguous extension of a perinephric abscess. The patient required emergent surgery and underwent reconstruction of the aorta using a Dacron graft with a good 18 months outcome.

Anaesthetic concerns in a patient with aortic aneurysm for non-cardiac surgery: A case report.

Abdominal aortic aneurysm poses a significant risk of rupture, with mortality rates of 80% to 90% if untreated. Management focuses on identifying and repairing the aneurysm before rupture, considering factors like size, type and symptoms. We report successful anaesthetic management in a case of intertrochanteric fracture of femur of an elderly patient who was to undergo elective surgery for abdominal aortic aneurysm. Few cases detail abdominal aortic aneurysm management during non-cardiac surgery, emphasising careful anaesthesia titration. This case report underscores the importance of precise intraoperative anaesthesia management in emergency non-cardiac surgery for abdominal aortic aneurysm patients.

Efficacy of pCONUS Devices in the Management of Intracranial Aneurysms: Outcomes of 190 Patients.

Intracranial aneurysms (IAs) pose a significant health concern, necessitating effective treatment modalities. The pCONUS device has emerged as a promising option for managing complex IAs, particularly wide-necked bifurcation aneurysms. Evaluating its efficacy across multiple studies is essential for establishing therapeutic guidelines.A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies assessing the efficacy of pCONUS devices in treating cerebral aneurysms. PubMed, Google Scholar, and Scopus were searched for relevant articles published from January 1, 2000, to December 31, 2021. Inclusion criteria encompassed clinical trials examining pCONUS device benefits for ruptured or unruptured cerebral aneurysms. Data extraction and quality assessment were performed independently by two reviewers.Out of 390 initially identified articles, eight studies met the inclusion criteria. These studies collectively involved 190 participants with intracranial aneurysms. The sample sizes ranged from seven to 40 patients, predominantly in retrospective designs. Complete occlusion rates varied from 46.8% to 100%, with a mean diameter of treated aneurysms ranging from 2.5 mm to 8.83 mm. This systematic review suggests that pCONUS devices are feasible and effective for treating complex bifurcation cerebral aneurysms, with acceptable complication rates. Despite limitations such as retrospective study designs and limited follow-up durations, the findings support the beneficial role of pCONUS devices in managing challenging intracranial aneurysms. Larger collaborative efforts with longer follow-up durations are warranted to validate these findings and establish wider therapeutic guidelines.

Comparative analysis of characteristics, management and clinical outcome of blood blister-like aneurysms treated with flow diverter devices: a systematic review and meta-analysis of 30 studies.

Because of relatively little data for blood blister-like aneurysms (BBAs) treated with flow diverter (FD) devices, existing studies failed to provide comprehensive analysis for the characteristics, management, clinical outcome of the disease. Therefore, we collected and analyzed current evidence aiming to provide quantitatively pooled results for the management, complication, clinical and angiographic outcomes as well as the risk factors of prognosis of BBAs treated with FD devices. A systematic search of PubMed, SCOPUS, Cochrane Library and Web of Science up to May 1, 2024 was conducted for relevant studies. The primary outcomes were to expound the management, characteristics and clinical outcomes of BBAs treated with FD devices. The secondary outcomes were to determine the difference of characteristics and outcomes, as well as risk factors of BBAs treated with FD devices. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0. A total of 30 reports with 311 of 783 BBA patients were identified. The pooled results indicated that 76.3% BBAs located in internal carotid artery (ICA) and 85% and 84% patients experienced complete occlusion and modified Rankin scale (mRS) score 0-2 respectively at follow-up time. Female BBAs patients (69.9%) were more prevalent and 88.5% patients experienced a favorable outcome at discharge. The overall and periprocedural complications account for 16.8% and 9.1% respectively. The pooled results showed that the incidence of complete occlusion was 50% (95% CI: 31%－69%), 80% (95% CI: 67%－92%) and 84% (95% CI: 77%－91%) at immediate, short and longterm angiographic results respectively. In addition, the favorable, moderate and poor clinical outcomes evaluated with mRS were 89% (95% CI: 85%－94%), 13% (95% CI: 5%－21%), and 8% (95% CI: 3%－13%) respectively. We found that compared to moderate or poor outcomes, patients with good outcomes experienced significantly lower preoperative scores (MD -1.24; 95% CI -1.94－-0.53), more complete occlusion (OR 5.17; 95% CI 1.26－21.15) and less complications (OR 0.20; 95% CI 0.08－0.47) respectively. It was observed that patients experienced a complication had higher onset Hunt-Hess scale (MD 0.49; 95% CI 0.03－0.96) and Fisher's score (MD 1.43; 95% CI 0.72－2.13) respectively. Patients with good outcomes experienced younger age (MD -5.76 years; 95% CI -11.31－-0.21) and lower onset Hunt-Hess scale (MD -0.96; 95% CI -1.45－-0.47) respectively. BBA was middle-aged female predominant and common in ICA. The majority of patients generally experienced favorable outcome with low incidence of periprocedural complications. In addition, good outcomes benefited from lower preoperative scores, more complete occlusion, less complications and younger age. Higher onset Hunt-Hess scale and Fisher's score may increase the risk of complications. Future studies with enough sample size and long follow-up are required to clear the management, long-term outcome and risk factors of BBAs.

Impaired Pre-operative Ambulatory Capacity in Patients Undergoing Elective Endovascular Infrarenal Abdominal Aortic Aneurysm Repair is Associated with Increased Peri-operative Death

While ambulatory capacity is a readily assessable clinical indicator of functional status, its association with outcomes after endovascular aneurysm repair (EVAR) remains underexplored. This study aimed to investigate the association between pre-operative ambulatory status and outcomes following elective EVAR. A retrospective review of the multi-institutional Vascular Quality Initiative database was conducted for all patients who underwent elective infrarenal EVAR from 2009 - 2022. Patients were categorised into independent ambulation and impaired ambulation groups. A propensity score matched analysis was performed to produce two well matched cohorts in a 1:1 ratio without replacement. The primary outcome was 30 day death. Secondary outcomes included one year survival and in hospital major complications. Among 11 474 patients, 10 539 (91.8%) were independently ambulatory pre-operatively. Propensity score matching resulted in 885 matched pairs. The impaired ambulation group, although older (mean 77.6 vs. 76.3 years; p= .001), showed comparable baseline characteristics. Post-operatively, the impaired ambulation group had higher cumulative in hospital complications and death as well as 30 day death. Even after adjustment for age, impaired pre-operative ambulation was associated with increased in hospital and 30 day death (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.26 - 3.95; p= .006). Multivariable analysis demonstrated increasing cumulative risk of 30 day death in the setting of impaired pre-operative ambulatory status with age > 75 years requiring post-operative red blood cell transfusion > 2 units (HR 5.75, 95% CI 2.09 - 15.88; p < .001). Beyond 30 days, impaired pre-operative ambulation was not associated with increased one year death (HR 1.09, 95% CI 0.81 - 1.48; p= .570). Among patients who underwent elective infrarenal EVAR in this matched analysis, impaired pre-operative ambulatory capacity was associated with an increased risk of in hospital and 30 day death, further compounded by advanced age and post-operative transfusion. As such, a threshold higher than the traditional size criteria should be considered in shared decision making when determining options for the management of abdominal aortic aneurysm in this high risk cohort.