The Endo Vascular Aneurysm Repair (EVAR) has revolutionized the treatment of Abdominal Aortic Aneurysm (AAA) with low rate morbidity and mortality. A strong growth of EVAR with a progressive reduction of Open Repair (OR) is expected for the coming years. Despite this, there are important reasons in favour of open surgery: Patients unfit for EVAR with complex aortic anatomy, increasing risk of cancer related to computed tomography studies for endovascular graft surveillance, secondary interventions post EVAR, critically ill patients with ruptured - AAA not transferable to specialist vascular centres. In several cases AAA will still need open surgery and a new generation of vascular surgeons prepared for complex aortic anatomy will be required as well. In the last decades, the evolution of Endo Vascular Aneurysm Repair has radically revolutionized the approach in vascular surgery of Abdominal Aortic Aneurysm with a reduced perioperative rate of mortality and adverse events [1]. Italian Vascular Society Registry - AAA shows over the time a progressive reduction of Open Repair from 1930 patients in 2008 to 887 in 2014 with a short-term mortality of 1.1% for EVAR vs 6.2% for OR [2]. The availability of various devices with low risks (fenestrated devices, branched devices, parallel stent-grafts CHIPS: Chimney - Periscope-Sandwich, Off the shelf devices) and new investigational endovascular Aneurysm Sealing Systems (Neck angulation up to 90°, Inflatable Proximal Rings, and Inflatable Endobag-Nelly System) have expanded EVAR indications. The forecast growth of EVAR for the coming years shows an increase in Italy from 62% in 2013 to 72% in 2023 [3]. Facing these results is there yet a space for open surgery (Figure 1).

Background: A reduction in the density of capillaries (rarefaction) is known to occur in many tissues in patients with essential hypertension and play a role in increasing Blood Pressure (BP). The aim of this trial was to assess in a randomized, double blind, design the effects of treatment of hypertension with candesartan versus amlodipine on microvascular rarefaction and other indices of vascular function. Methods: We recruited twenty-two individuals with mild-to-moderate hypertension. After a 2-week placebo run-in period, patients who remained hypertensive (≥140/90 mmHg) were randomized to 8-weeks treatment with Candesartan tablets 8mg daily (with forced titration to 16mg) or Amlodipine tablets 5mg daily (with forced titration to 10mg). The capillary microcirculation was studied using CapiScope system CAM1. Pulse wave velocity, central BP and aortic Augmentation Index were also measured. Results: We observed significant reductions in brachial BP, and central BP after 4 and 8 weeks treatment with either candesartan or amlodipine but there was no significant effect on basal (functional) or maximal (structural) capillary densities, or pulse wave velocity. Conclusion: Eight weeks treatment of hypertension with either amlodipine or candesartan significantly reduced brachial and central BP but was not sufficient to induce a regression in functional or structural microvascular abnormalities.

Coarctation of aorta is a congenital anomaly characterized by a narrowing segment between the aortic arch and the descending aorta. This stenosis is responsible for upper body hypertension and the recruitment of a collateral network via the intercostal arteries to improve lower body perfusion. However, hemodynamic perturbations along the aorta have not been completely studied. The objective of this work is to analyze the collateral network of patients with aortic coarctation who required surgical repair. MRI was performed to obtain hemodynamic parameters such as the variation of flow along the descending thoracic aorta and an estimation of the collateral flow. The shape of the aorta was also studied. Both morphological elements and hemodynamic parameters of aortic coarctation may be quite useful to determine consequences of aortic narrowing and the best moment to propose surgical repair or imaging monitoring. We also expect giving more information on the collateral network to develop modelisation of this element.