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Introduction: The technique of conventional EVAR with a main body and bifurcated limbs has progressed little in the last 10 years. The need for cannulation of the contralateral limb extends procedure times and radiation exposure. The ipsilateral delivery system diameter, plus the time taken for completion of device implantation, often cause limb ischaemia and subsequent patient agitation, leading many to avoid true local anaesthetic EVAR. Reducing the invasiveness of the procedure reduces patient morbidity and increases the opportunity for short stay management. The Altura stent graft is a low-profile (14Fr) dual aortic stent design with 'D' shaped components that are placed back-to-back into the juxta-renal aorta. It has the potential to be simpler to deploy and to reduce radiation exposure, while its low profile could yield benefits in patient morbidity, anaesthesia selection and post-operative management. Methods: The prospective study of consecutive patients treated with the Altura device in single clinical site between 2014 and 2019. Patients underwent clinical and CTA followup at 1 month and then annually after the implantation. Evaluation of CT scans were done by independent radiologist. We report here on initial surgical success and longer term outcomes for these patients. Results: 100 patients (age 71.6 AE 8.7 years) with abdominal aortic aneurysm (AAA) (diameter 57.8 AE 6.7 mm) were treated. Endografts were successfully implanted in all patients (100%).There been no peri-operative deaths within the first 30 days. Mean fluoroscopy time was 24+11 minutes, mean deployment time was 14 minutes (11-54). Eight patients (8%) were treated with distal aorta < 16mm of diameter, 22 (22%) aortic 'D' shaped componentswere placed using offset. Locoregional anaesthesia was used in 91% of cases, with percutaneous access successful in 94% of patients. Cumulative major adverse event rate (MAE: death, stroke, paraplegia, MI, respiratory failure, bowel ischemia and blood loss !1000ml) was 0% at 1 year, 5.7% at 2 years (2/35) with no additional events up to 5 years. Clinical success (freedom from type I/III endoleak or reintervention) was 96% at 30 days (4/100), 100% at one year (58/58), 94.3% at 2 years (2/35). 11 (11%) type II endoleaks were observed. During median follow-up of 28.5 months (3-60), there have been no aneurysm ruptures or AAA-related deaths. Secondary procedures were performed in 11 patients: 3 for type Ia endoleak, one for type Ib endoleak, 2 for iliac stenosis and 5 for type II endoleak. Conclusion: Early and mid-term outcomes to 5 years are very encouraging in this cohort. The potential of the device to reduce implant times and radiation exposure, whilst delivering excellent results, warrants further investigation. Disclosure: Research support from Lombard Ltd.

3 Summary Introduction. The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage. Aim of the Study. The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period. Material and Methods. We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We used Alteplase as a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16. Results. The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data. Conclusions. Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.