{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:16:00Z","timestamp":1784200560137,"version":"3.55.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The introduction of off-the-shelf (OTS) multibranch stent-grafts represented an advancement in the endovascular treatment of thoraco-abdominal aortic aneurysms (TAAAs), particularly in urgent settings. In certain cases (e.g, target vessel [TV] occlusion), unused directional branches (DBs) require proper occlusion with a vascular plug to prevent type III endoleaks. However, no standardized technique for DB closure has been established. We aim to evaluate the safety, feasibility, time-effectiveness and cost-effectiveness of using single-disk vascular plug (Amplatzer Vascular Plug [AVP]) for DB closure during urgent branched endovascular aneurysm repair (B-EVAR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Retrospective analysis of 16 patients (16\/101, 15.8%) undergoing urgent B-EVAR with OTS devices requiring intentional occlusion of at least 1 DB using vascular plug due to unavailable TVs or anatomical constraints. Amplatzer Vascular Plugs were deployed in 2 different techniques: with or without DB elongation with balloon-expandable stent-grafts. Technical success, clinical outcomes, side branches plugging time, and plug-constrained length after its deployment were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Balloon-expandable stent-graft plus AVP were used to occlude 7 unused DBs (36.8%), whereas AVP without elongation was used in 8 (42.1%), with a median oversizing rate of 58.7%. The technical success rate was 100%, with no instances of plug migration or endoleak during a median follow-up of 20.9\u00b114.4 months. Perioperative mortality rate was 25%, exclusively in patients with ruptured aneurysms. Clinical success was maintained in all patients, with no late reinterventions or DBs recanalization. Side-branch plugging time was significantly shorter when performed without elongation (3.9\u00b10.6 vs. 6.4\u00b11.3 minutes;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      =.0003). Despite greater oversizing, even without elongation, the mean plug-constrained length (15.1\u00b14.5 mm) did not exceed the shortest DB, effectively reducing the risk of complications associated with increased plug-constrained length while ensuring proper and secure deployment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Single-disk vascular plugs without DB elongation provide a safe, feasible, time-effective and cost-effective solution for DB closure during B-EVAR, with favorable outcomes and reduced procedural complexity, even in urgent setting. Multicenter studies are needed to validate these findings and establish standardized DB management techniques for challenging anatomical and urgent cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>Our study demonstrated the feasibility, safety, and time- and cost-effectiveness of single-disc vascular plug (AVP) embolization for directional branches during urgent or emergent branched endovascular aortic aneurysm repair using off-the-shelf devices, even without elongation using balloon-expandable stent-grafts. This technique simplifies the procedure, reducing complexity and potential complications. It is particularly advantageous in urgent scenarios, where minimizing procedural time is critical to improve patient outcomes and survival. Moreover, it offers significant benefits in resource-limited settings by ensuring efficient use of healthcare resources. Overall, this approach represents a practical, effective solution that can enhance procedural efficiency and broaden clinical applicability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028251322704","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T00:14:18Z","timestamp":1743207258000},"page":"1977-1985","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Single-Disk\u2019s Plug-Based Embolization of Directional Branches During Urgent Complex Endovascular Aortic Aneurysm Repair"],"prefix":"10.1177","volume":"33","author":[{"given":"Paolo","family":"Bonanno","sequence":"first","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1867-6151","authenticated-orcid":false,"given":"Simone","family":"Cuozzo","sequence":"additional","affiliation":[{"name":"Vascular Surgery Division, Department of Surgery \u201cParide Stefanini\u201d Policlinico Umberto I, \u201cLa Sapienza\u201d University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5134-7069","authenticated-orcid":false,"given":"Federica","family":"Donato","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma\u2014Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Grasselli","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Concetta","family":"Gugliotta","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Proietti Silvestri","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimondo","family":"Micheli","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Ottavi","sequence":"additional","affiliation":[{"name":"Unit of Vascular Surgery, Azienda Ospedaliera Santa Maria, Terni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2024.05.056"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14232612"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1526602817690730"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028211047967"},{"issue":"6","key":"e_1_3_2_6_2","first-page":"515","article-title":"Impact of frailty on outcomes of patients undergoing elective endovascular thoraco-abdominal aortic aneurysm repair","volume":"65","author":"Cuozzo S","year":"2024","unstructured":"Cuozzo S, Sbarigia E, Jabbour J, et al Impact of frailty on outcomes of patients undergoing elective endovascular thoraco-abdominal aortic aneurysm repair. 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