Acute pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality, with clinical presentations ranging from asymptomatic disease to obstructive shock and sudden death. Although anticoagulation is effective in most hemodynamically stable patients, a substantial proportion present with or progress to right ventricular (RV) failure and require reperfusion therapy. Surgical embolectomy (SE), first introduced in the early 20th century, was historically associated with prohibitive mortality, and largely abandoned following the advent of systemic thrombolysis. However, advances in diagnostic imaging, cardiopulmonary bypass, perioperative management, and multidisciplinary care have led to renewed interest in this approach. Contemporary series demonstrate that, when performed at experienced centers, SE is associated with acceptable operative mortality, favorable long-term survival, preserved RV function, and low rates of recurrent PE or chronic thromboembolic pulmonary hypertension. Outcomes appear to be driven primarily by preoperative clinical status - particularly cardiogenic shock and cardiac arrest - rather than by surgical technique alone, underscoring the importance of careful patient selection and timely referral. Although systemic thrombolysis and catheter-directed therapies remain central to acute PE management, available evidence suggests that SE achieves outcomes comparable to those of non-surgical reperfusion strategies, with a potentially lower risk of intracranial hemorrhage in selected high-risk patients. This narrative review summarizes the historical evolution, contemporary surgical techniques, clinical outcomes, and comparative effectiveness of surgical embolectomy in the treatment of acute pulmonary embolism, with the aim of clarifying its current role within modern multidisciplinary management strategies.

Pulmonary embolism (PE) is associated with high cardiovascular morbidity and mortality. Timely diagnosis and accurate prognostication are extremely important for guiding patient management and treatment selection. Risk stratification and clinical scoring systems are crucial for rapid assessment, effective triage, and accurate outcome prediction. Traditional tools have demonstrated strong prognostic value, and the role of dynamic risk assessment is increasingly recognized. Pretest probability scores including the Wells clinical prediction rule and the revised Geneva score, act as first line assessments to determine the need for further diagnostic testing. The Hestia criteria, Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) help to identify patients appropriate for outpatient management. For hospitalized patients, several additional scoring systems, imaging findings, and biomarkers can be used for further risk stratification and treatment planning. The development of multidisciplinary pulmonary embolism response teams (PERTs) and the integration of hybrid predictive models are demonstrating a shift toward a multimodal approach to PE risk stratification. The objective of this review is to summarize current approaches to risk assessment in pulmonary embolism, evaluate existing and emerging prediction models, as well as discuss future directions aimed at improving individualized care in the management and treatment of pulmonary embolism.

Ruptured sinus of Valsalva aneurysm (RSVA) is a rare but potentially life-threatening cardiac anomaly. Although transcatheter closure (TCC) has gained popularity as a less invasive option, anatomical complexity may compromise its success and necessitate urgent surgical conversion. We present the case of a 57-year-old male with a bicuspid aortic valve and ruptured RSVA forming a fistulous connection to the right atrium. Initial management with TCC was attempted based on anatomical feasibility and hemodynamic stability. However, the occluder device became dislodged immediately after deployment, prompting emergent surgical intervention. A successful surgical repair was performed via a median sternotomy with a reverse-U aortotomy (Kırali incision), allowing complete device retrieval and dual-site closure of the fistula. The patient's postoperative course was uneventful, with no residual shunting or aneurysmal recurrence on follow-up. This case underscores the limitations of transcatheter techniques in anatomically complex RSVA and highlights the critical role of early surgical conversion in preventing catastrophic complications. Adequate anatomical assessment and readiness for surgical backup are essential when considering percutaneous options in such scenarios.

The aim of the study is to review the literature available about in-situ fenestration (ISF) techniques and their applicability to "zone 2" TEVAR for the revascularization of left subclavian artery (LSA), and retrospectively analyze a cohort of patients submitted to this type of endovascular approach in a single center. It is a single-center, retrospective, physician-initiated cohort study of patients treated in our institution from November 2023 to May 2024. Inclusion criteria were isolated left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was the technical feasibility and the technical success of the procedure. Secondary outcomes were perioperative complications and follow-up. During the study period, 7 patients (all men; mean age of 73 + 9 [62-83] years) received ISNF for LSA revascularization, urgently in 4 patients (57%). In all cases (100%), it was possible to obtain the technical success with correct ISNF and exclusion of the aortic pathology. In the first two cases (28%), the procedure highlighted focal dissection of the axillary artery, necessitating PTA and stenting to properly restore the flow. No perioperative major adverse event occurred within 30 days. No patient underwent reoperation for aortic pathology; all patients are still alive today. Overall, postoperative CTA showed regular follow-up of the aortic pathology. Our initial case series analysis, in agreement with the current literature, suggests that ISNF for LSA revascularization in TEVAR provides encouraging midterm results and seems to be feasible and effective. ISF using the Ankura™ device showed promising outcomes.

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.

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 CATTM for treatment of the visceral ischemia caused by occluding lesions in the visceral arteries. A retrospective data collection was conducted from patients treated between January 2013 and December 2024. Totally of 57 cases have been diagnosed with mesenteric or renal ischemia and treated by endovascular means in a tertiary institution. Fifteen patients were treated with only with AngioJet™ device, whereas 34 patients were treated primarly with PenumbraTM device. Primary endpoints were a combination of technical success and mortality, secondary endpoint were return to the operating theatre within 30 days, major cardio and cerebrovascular events, access site complications, end organ damage which includes dialysis or bowel resection. A total of 57 endovascular thrombectomies were performed on 49 patients with visceral ischemia using the AngioJet™and Penumbra CATTM devices with an average age of 68.27 years (68.27±10.4), including 36 males and 13 females. The overall success rate was 89.94% (51 out of 57), and the patients were discharged with a patent target artery. A total of 15 procedures were performed using the AngioJet™ device. In 7 cases, the superior mesenteric artery was the affected artery, and in the remaining 8 cases, the renal arteries were affected. This resulted in a technical success rate of 93.33% (14 out of 15). No recurrence was observed. Overall, 80.00%(12 cases) were performed through surgical cutdown and under general anesthesia. A total of 34 procedures were performed with the PenumbraTM device, with 15 cases targeting mesenteric arteries, 19 targeting renal arteriesA total of eight recurrent cases were documented. In 85.29% (29 out of 34) of cases, vascular access was obtained through a surgical cut technique, while in 94.1% (32 out of 34) of cases, the intervention was conducted under general anesthesia. The documented technical success rate was found to be 88.23% (30 out of 34). In this single center experience both devices are both feasible and safe. However, the AngioJet™ demonstrated higher safety and effectiveness, as well as reduced invasiveness and the recurrence rate.

The management of thoracoabdominal aortic aneurysms (TAAAs) has evolved from traditional open surgery to endovascular approaches, offering reduced operative times, shorter hospital stays, and lower perioperative morbidity and mortality. Fenestrated and branched endovascular aortic repair (FB-EVAR) has expanded the applicability of endovascular techniques to complex aneurysms. Hybrid repair, combining open surgical debranching with endovascular stent grafting, was introduced as an alternative for patients unsuitable for open or fully endovascular repair. However, outcomes from high-volume centers and national registries indicate significant mortality and morbidity rates associated with hybrid procedures. This article summarizes indications, technical aspects and outcomes of hybrid repair of complex abdominal and thoracoabdominal aortic aneurysms.

Oral anticoagulation (OAC) and exclusion of the left atrial appendage (LAA) greatly reduce the risk of thromboembolic events in patients with atrial fibrillation (AF). Patients with known intolerance to OAC, however, have limited options for transcatheter management of both AF and the LAA. Previous investigation has suggested that minimally invasive LAA exclusion via epicardial clip placement is feasible without OAC but is associated with variable increase in morbidity and mortality. This study aims to assess the safety and long-term efficacy of robotic-assisted LAA exclusion (RA-LAAE) in patients intolerant to OAC. Retrospective, single-center, analysis of patients with AF and OAC intolerance that underwent RA-LAAE between 2019 and 2023. The primary objective assessed was freedom from cerebral and systemic thromboembolic events at 90 days and 1 year. Secondary outcomes included radiographic assessment of successful LAAE, rates of readmission, and overall mortality. Twenty-nine patients (mean age 74.6 years, 28% female), with a diagnosis of paroxysmal (48%), persistent (10%), or long-standing (41%) AF, CHA<inf>2</inf>DS<inf>2</inf>VASc 4.4±1.4, HAS-BLED 3.8±0.9, and left atrial volume index 49.1±15.2 underwent RA-LAAE. All procedures were completed successfully with an operative duration of 100±40 minutes. Postoperative length of stay was 1.7±1.3 days. Follow-up imaging at 90 days confirmed successful LAAE for all cases. MACCE within 90 days occurred in 1 (3%) patient and in no additional patients at 1 year. RA-LAAE in patients intolerant to OAC appears to be safe and effective with low MACCE and mortality rates.

Fenestrated and branched endovascular aortic repair (F/B-EVAR) is increasingly used in the treatment of chronic aortic dissection (cAD), particularly for post-dissection thoracoabdominal aortic aneurysms (PD-TAAA). These aneurysms differ significantly from degenerative aneurysms due to the presence of a true and false lumen, complex target vessel (TV) anatomy, and the higher potential for ongoing aortic remodeling. These factors contribute to technical challenges in target vessel cannulation and raise concerns about the long-term stability of target vessel bridging stents. Although bridging stents play a critical role in achieving durable sealing and target vessel patency, there are currently no clear guidelines for their selection in the setting of PD-TAAA, where anatomical complexity and luminal remodeling pose unique challenges. Bridging stent performance may be influenced by stent design, anatomical configuration, and procedure type, yet evidence specific to this patient population remains limited. This scoping review aims to assess the applicability and outcomes of available bridging stents in the endovascular treatment of PD-TAAA. This scoping review followed PRISMA-ScR guidelines. A systematic search was conducted in Ovid Medline using keywords related to chronic aortic dissection, bridging stents, FEVAR, and BEVAR. Studies were included if they reported on ≥10 patients with CTBAD treated by FEVAR or BEVAR, with target vessel-specific outcomes. Physician-modified endografts were excluded. Data on patient numbers, stent types, follow-up, and target vessel outcomes (stenosis, occlusion, endoleaks) were extracted. Of 50 records screened, three studies met the inclusion criteria, encompassing 375 patients and 1396 treated TVs. All studies were retrospective analyses of prospectively collected data in patients with PD-TAAA. Two studies provided selection criteria for FEVAR vs. BEVAR and specified bridging stent preferences. Fenestrations were typically bridged with balloon-expandable covered stents (BESG), while branches used either BESG or self-expanding covered stents (SESG). Target vessel stenosis or occlusion was more frequently associated with branches, with FEVAR showing superior target vessel patency in one study. No study directly compared BESG and SESG patency. TV-related endoleaks occurred in all studies; two reported no significant difference between FEVAR and BEVAR. Reinterventions were common across all cohorts, primarily due to TV-related complications, with rates approaching 50% at two years. In PD-TAAA, the choice between FEVAR, BEVAR, and bridging stent type is largely driven by anatomy and physician preference. The high rate of reinterventions due to target vessel-related complications highlights the need for close postoperative surveillance. Further research is essential to guide optimal bridging stent selection and enhance long-term outcomes.