The aortic arch is a particularly challenging region in vascular surgery, both as the site of primary pathologies and as a frequent proximal landing zone in extensive thoracoabdominal aortic disease. Its anatomical complexity - defined by curvature, supra-aortic branches, and proximity to the heart - gives rise to intricate hemodynamics characterized by helical secondary flow, vortices, and disturbed wall shear stress. These flow disturbances are implicated in disease progression, thrombus formation, and complications after repair, yet remain incompletely understood. Computational fluid dynamics (CFD) enables quantification of key hemodynamic biomarkers such as wall shear stress, oscillatory shear index, and relative residence time, linking them to outcomes including aneurysm growth, dissection propagation, endoleak, and branch malperfusion. Applications span the treatment spectrum, from preoperative planning and device design to postoperative surveillance and risk stratification. However, routine clinical translation remains limited by reliance on high-quality imaging, complex workflows, and lack of standardization or prospective validation. This review summarizes the current state of CFD in aortic arch pathologies, highlighting advances in modeling strategies, validation approaches, and clinical applications. Finally, we discuss key limitations and future directions, including workflow automation, machine learning integration, and real-time simulation, to support the adoption of CFD as a clinical decision-making tool in precision vascular surgery.

Aortic diseases represent major public health concern and are associated with high rates of morbidity and mortality. Artificial Intelligence (AI) has the potential to revolutionize healthcare, with various potential applications for aortic patients. The aim of this review is to summarize the main applications of AI in aortic diseases, highlighting current trends, key findings and discussing current limitations and future opportunities. A scoping literature review was performed to identify the main applications of AI in aortic aneurysm and dissection. The main applications included detection and diagnosis, prognosis assessment, assistance for aortic repair, development of virtual assistants and support for education, and new tools for vascular research. Current results highlighted several limitations related to technical considerations as well as challenges in link with ethic and legal framework. AI offers a wide range of opportunities for the management of aortic diseases including new tools for clinical practice, education and research. While current applications showed a proof-of-concept, further efforts of validation are required for implementation in daily clinical practice. International multicenter research will play a major role to develop, validate, follow and establish guidelines to ensure a safe and efficient use of AI-tools to improve patients care.

Centralization of abdominal aortic aneurysm (AAA) care is widely promoted by societal guidelines and patient-safety organizations due to the well-established inverse relationship between procedural volume and outcomes. However, consistent regionalization remains difficult to achieve globally, as patient- and provider-level factors, economic considerations, and geographic barriers vary widely across different countries and care delivery models. As new aortic programs emerge, it remains unclear whether newly founded centers - particularly those staffed by experienced surgeons - can achieve outcomes comparable to high-volume institutions, and whether these centers should be excluded from providing AAA care. This study evaluates short- and mid-term outcomes of elective AAA repair at a newly established vascular surgery center.

Acute limb ischemia (ALI) is one of the most common arterial emergencies and is associated with a high risk of limb loss, morbidity, and mortality. Among endovascular techniques, catheter-directed thrombolysis (CDT) is the most widely used, though it presents limitations related to slow thrombus resolution and bleeding risk. Pharmacomechanical thrombectomy (PMT) has emerged as a faster and potentially more effective alternative. However, the comparative efficacy and safety of these two modalities remain a matter of debate.

While outcomes after surgical or transcatheter aortic valve replacement between bicuspid aortic valve (BAV) and tricuspid aortic valve have been reported, the natural history of unrepaired BAV is sparse in the literature.

The artificial intelligence (AI) is revolutionizing vascular surgery by enhancing arterial healing, remodeling, and predictive analytics. The AI-driven models, particularly machine learning (ML) and deep learning (DL) algorithms, provide unprecedented insights into endothelial recovery, smooth muscle migration, and extracellular matrix remodeling, optimizing preoperative planning, intraoperative guidance, and postoperative monitoring. Advanced imaging techniques, such as convolutional neural networks (CNNs) for ultrasound and MRI analysis, improve early detection of restenosis, thrombosis, and atherosclerotic plaque vulnerability. Additionally, AI-powered computational fluid dynamics (CFD) simulations facilitate personalized hemodynamic modeling, predicting aneurysm growth, rupture risk, and post-intervention outcomes. In vascular surgery, AI enhances precision medicine through tailored therapeutics, robotic-assisted procedures, and AI-enabled intraoperative navigation, improving surgical accuracy and efficiency. The AI-driven remote monitoring systems employ recurrent neural networks (RNNs) and biosensors to detect early complications, reducing adverse events and improving patient prognosis. Despite these advancements, challenges remain, including the need for high-quality annotated datasets, algorithmic interpretability issues, and ethical concerns regarding data privacy. Future research should focus on multimodal AI integration, validation through clinical trials, and standardized regulatory frameworks to ensure safe and effective implementation. AI continues to evolve, promising to redefine vascular interventions by advancing diagnostic accuracy, therapeutic innovation, and patient-specific care in cardiovascular medicine.

Venous thromboembolism (VTE) is a common and potentially life-threatening condition associated with high morbidity rates. Diagnosing deep vein thrombosis (DVT) involves a complex clinical pathway that includes risk assessment tools like the Wells Score, D-dimer testing, and Duplex ultrasound, often resulting in extended waiting periods. Traditionally, compression ultrasound performed by skilled radiologists is the preferred imaging modality, with sensitivity and specificity rates above 90%. The integration of artificial intelligence (AI) into diagnostic imaging, particularly point-of-care ultrasound, has emerged as a promising approach to address these challenges. AI-guided ultrasound devices, such as the ThinkSono Guidance System (ThinkSono GmbH), are being studied and used to assist non-ultrasound-trained healthcare professionals in acquiring DVT ultrasound images, a compelling and rapidly evolving innovation. Based on several pilot clinical studies and a few thousand patients enrolled, when AI guided ultrasound is combined with expert review, it can achieve diagnostic accuracy comparable to gold-standard duplex ultrasound and can offer significant cost savings. There is potential to transform how medical imaging is being conducted in a busy tertiary hospital or even in primary care and diminish pressure on overloaded radiology departments. The opportunities can be endless such as in remote environments lacking radiologists, intensive care units, following-up endovenous procedures and a lot more. As research continues, efforts are now focusing on validation across heterogeneous populations to establish clear ethical and regulatory frameworks to support its safe and responsible use.

Artificial intelligence (AI) holds great potential in vascular surgery and healthcare, with various perspectives of applications. Despite these promising developments, the integration of AI into daily vascular surgical critical challenges persist. The aim of this review is to evaluate the future perspectives of AI in vascular surgery, seeking to identify key opportunities and obstacles on the ongoing integration of AI technologies within vascular surgical practice. A scoping literature review was performed to analyze perceptions and feedback on AI by vascular surgeons. Current challenges mainly include technical and ethical concerns. Future opportunities to integrate AI in vascular surgery highlighted the need to improve education and develop international collaboration. While AI offers great potential in vascular surgery, its integration in daily clinical practice requires further efforts and research. Such approach needs to be integrated into an efficient ecosystem, contributing to e-health revolution.

Artificial intelligence-based decision support systems (AI-DSS) are gaining attention in medicine as tools for diagnosis, risk assessment, and treatment planning. By processing large, heterogeneous datasets, these systems can recognize patterns and generate predictions that complement clinical expertise. Vascular surgery is a relevant case, given its reliance on imaging, patient-specific risk stratification, and complex perioperative choices. Applications in vascular surgery span imaging, intraoperative guidance, and predictive modeling. Deep learning methods support segmentation of aneurysms and peripheral arteries, detection of plaques, and classification of stenoses, achieving accuracy comparable to expert analysis. Intraoperative models aid endoleak detection and graft visualization during endovascular repair. Predictive approaches refine management of abdominal aortic aneurysms by combining imaging, biomechanical modeling, and biomarkers to improve on diameter-based thresholds. Postoperative models forecast complications, survival, and reintervention, while emerging concepts such as digital twins and wearable monitoring suggest more continuous, personalized vascular care. Despite promise, adoption faces barriers. Many models remain "black boxes," raising concerns about interpretability, generalizability, and integration with electronic records. Ethical and legal issues - including accountability, fairness, informed consent, and patient autonomy - are central, with frameworks such as the EU AI Act and FDA guidance beginning to set standards. High development costs and uncertain reimbursement further limit implementation. Building trust will require transparency, reliability, and assurance that AI supports rather than replaces human judgment. Future progress depends on rigorous external validation, workflow integration, and co-design with clinicians. Meeting these conditions could allow AI-DSS to evolve into reliable tools that enhance precision, safety, and personalization in vascular surgery while preserving human values in care.

The aim of this study was to compare the effectiveness and the safety of endovascular therapy with rheolytic thrombectomy using the AngioJet™ vs. aspiration thrombectomy using the Penumbra CAT for treatment of the visceral ischemia caused by occluding lesions in the visceral arteries.

The aim of this paper was to compare the patient characteristics, procedural details, 30-day postoperative outcomes of carotid artery stenting (CAS) performed through radial access versus femoral access.

Thrombosis of the reconstructed artery after carotid endarterectomy (CEA) may be cause of the postoperative stroke or transitory ischemic attack (TIA). Secondary procedure with the aim to restore carotid flow is required in order to potentially improve patients' condition. Results of such intervention are scarce in the literature. The aim of this study was to assess the outcomes of early reintervention in patients who developed early neurological complications after CEA.

Thoracic endovascular aortic repair (TEVAR) has become the cornerstone surgical operation of choice for treatment of type B aortic dissection (TBAD), especially in acute and subacute phases. The primary goal of TEVAR in these situations to seal proximal entry tear in the aortic dissection to promote false lumen thrombosis, prevent aneurysmal degeneration and rupture. In patients with large fenestrations between the true and false lumen in the perivisceral aorta, false lumen may still be perfused via retrograde flow from the fenestrations. As a result, complete FL thrombosis is achieved in only 40% of patients who undergo TEVAR for TBAD. Management of large fenestrations in chronic TBAD is not standardized and there is no single technique which can be used in all cases. This review summarizes different techniques that can be used to obliterate large fenestrations between true and false aortic lumens. For thoracic FL involvement without abdominal aortic segment, Knickerbocker, Candy-Plug and Cork-in-the-Bottle techniques have demonstrated good outcomes. In cases where the dissection flap extends into the perivisceral segment, PETTICOAT and STABILISE techniques can be useful. More complex dissections involving visceral branches coming off the false lumen may require F/BEVAR. Additional techniques include septotomy, transcatheter fenestration, re-entry specific therapy using plug embolization and the streamliner multilayer flow modulator. While current data support these strategies, further prospective studies are needed to establish clear guidelines for optimizing long-term management of TBAD.

Coral reef aorta represents a distinct vascular pathology characterized by large calcified exophytic plaques that grow into the aortic lumen typically at the level of the visceral and renal arteries. In most cases, these arteries are also heavily calcified and stenosed or occluded. Symptoms vary depending on the affected artery and differ from renovascular hypertension, and renal insufficiency to cardiac decompensation and chronic limb threatening ischemia. This report describes two patients with a coral reef aorta and stenosed aortic side branches. Both patients had experienced episodes of pulmonary flash edema, suffered from lower extremity arterial disease and renal insufficiency. The second patient also had complaints of chronic mesenteric ischemia. Open surgery was considered very high risk in both patients and therefore endovascular treatment was performed. Covered endovascular reconstruction of the aorta and side branches (CERAS) was successfully performed in both patients. The first patient underwent simultaneous stenting of the coeliac artery, superior mesenteric artery, both renal arteries and the aorta. In the second patient, the superior mesenteric artery, both renal arteries and the aorta were stented. During follow up, all stents were patent and symptoms were resolved. CERAS is a novel endovascular technique to treat a coral reef aorta and its affected side branches. CERAS may offer a solution for patients in which endovascular treatment is often considered "not feasible."

Chronic limb-threatening ischemia resulting from infrapopliteal artery disease is associated with a high risk of limb loss and mortality. Endovascular treatments such as percutaneous transluminal angioplasty, drug-coated balloons (DCBs), and bare metal stents have demonstrated suboptimal long-term outcomes in this challenging patient population. Spur is an innovative retrievable scaffold therapy (RST) designed to improve the efficacy of DCB angioplasty in infrapopliteal lesions by providing acute mechanical support and facilitating improved drug delivery, without leaving a permanent implant. This review examines the current limitations of existing treatments for infrapopliteal disease, summarizes the evidence from three prospective clinical trials using RST, and illustrates the use of the device with two case reports. These studies consistently demonstrated that vessel preparation using RST prior to DCB provided high primary patency rates with a low risk of major amputation and target lesion reintervention over mid-term follow-up. While these findings compare favorably with previous studies of endovascular therapy for infrapopliteal artery disease, future randomized trials with RST are necessary to confirm these benefits.

Post-EVAR morphometric remodeling beyond sac diameter is incompletely characterized. We evaluated longitudinal aortoiliac elongation/tortuosity and their prognostic value for endoleak and sac dynamics.

To describe the feasibility and outcomes of the transaxillary branch-to-branch-to-branch carotid catheterization technique for aortic arch endovascular repair. This technique optimizes endovascular procedures and eliminates the need for carotid artery cutdown during surgery.

The aim of this study was to compare the postoperative morbidity and mortality between total replacement of the aortic arch using the frozen elephant trunk technique versus replacement of the hemiarch in patients with acute type A aortic dissection and dissection of arch branch vessels without cerebral malperfusion.

In recent years, thrombo-aspiration (TA) and mechanical thrombectomy (MT) have emerged as endovascular alternatives to conventional treatments such as surgical thrombectomy or catheter-directed thrombolysis (CDT) for acute limb ischemia (ALI). To date, no meta-analysis has assessed the outcomes of TA and MT in this setting. This study aims to evaluate the short-term safety and effectiveness of these techniques in patients with ALI.