Background The COVID-19 pandemic has led to widespread postponement and cancelation of elective vascular surgeries in Switzerland. The consequences of these decisions are poorly understood. Patients and methods In this observational, retrospective, single-center cohort study, we describe the impact of COVID-19 pandemic containment strategies on patients with lower extremity peripheral arterial disease (PAD) referred during the period March 11 th -May 11 th , 2020, compared to the same time frames in 2018-2019. Patients admitted for acute limb ischemia (ALI) or chronic PAD and undergoing urgent or elective vascular surgery or primary amputation were included. Patients’ characteristics, indications for admission, and surgical features were analyzed. The occurrence of 30-day outcomes was assessed, including length of stay, rates of major adverse cardiovascular events (MACE) and major adverse limb events (MALE), and procedural and hemodynamic success. Results Overall, 166 patients were included. Fewer subjects per 10-day period were operated in 2020 compared to 2018-2019 (6.7 vs. 10.5, respectively; p < 0.001). The former had higher rates of chronic obstructive pulmonary disease (COPD) (25% vs. 11.1%; p = 0.029), and ASA score (3.13 vs. 2.90; p = 0.015). The percentage of patients with ALI in 2020 was about double that of the same period in 2018-2019 (47.5% vs. 24.6%; p = 0.006). Overall, the types of surgery were similar between 2020 and 2018-2019, while palliative care and primary amputations occurred only in 2020 (5 out 40 cases). The rate of post-operative MACE was significantly higher in 2020 (10% vs. 2.4%; p = 0.037). Conclusions During the first state of emergency for COVID-19 pandemic in 2020, less regular medical follow-up and hindered hospital access could have resulted in more acute and advanced clinical presentations of patients with PAD undergoing surgery. Guidelines are needed to provide appropriate care to this vulnerable population and avoid a large-scale disaster.

Background Although open surgery remains the gold standard for the treatment of post-dissection thoraco-abdominal aneurysms (TAAAs), the endovascular approach using fenestrated or branched endografts has emerged as a valid alternative for patients considered at high risk for surgery. The use of inner branch devices (iBEVAR) combining benefits of fenestrations and outer branches could offer an ideal configuration in this context. Aims Our aim was to report our preliminary monocentric experience with iBEVAR in the treatment of post-dissection TAAAs. Methods A retrospective analysis of prospective data retrieved from 1 center between Mars 2020 and January 2023 was done. Endpoints were immediate technical success, postoperative morbidity, rate of endoleaks, re-intervention and mortality. Results During this period, 18 patients (mean age 66,5 years, range 41-80) were identified. All were asymptomatic and operated in a 2-steps procedure with a TEVAR first. There were 5 off-the-shelf E-nside (28%) and 13 custom-made Extra-Design grafts (72%). Despite successful endograft deployment in all patients and branch catheterization in 68/70 cases (97%), the technical success was 94% due to an open conversion for ilio-mesenteric bypass. The 30-days mortality was 0%. During the post-operative period, 17% of patients (3/18) presented complications with 1 case of mesenteric ischaemia requiring a visceral resection and 2 cases of paralytic ileus, treated conservatively. No spinal cord ischemia was observed. During the median follow-up of 16 months (range 1-36), 4 patients (22%) had a re-intervention: one case of type-Ic endoleak treated with an additional renal stent and 3 cases of type-III endoleaks in the celiac trunk requiring a relining. The overall target vessel patency was 100%. In all cases, the sac diameter remained stable. Conclusions The use of iBEVAR appears to be safe and effective for the treatment of post-dissection TAAAs with an acceptable rate of complications. Further patients and longer follow-up are needed.

Objective Vascular patients suffer some of the highest complications rates. Surprisingly, there is no uniformly accepted medical therapy to reduce complications in these patients. Time restricted feeding (TRF) is an approach that emphasizes energy intake limited to certain windows of time within the 24-hour cycle, without restrictions on any calories or macronutrients. In healthy young human, TRF improves cardio-metabolic fitness. However, there is a lack of research on TRF in patient undergoing surgery, and suffering from cardiovascular diseases. This study aims to investigate the feasibility and efficacy of a pre-operative 2-week, 10-hour TRF in patient undergoing vascular surgery. Methods The OptiSurg Study is a randomized open-label clinical trial, that plan to enroll 40 patients, undergoing elective femoral endarterectomy. Only Fontaine stage II peripheral artery disease, and a BMI ≥ 20 kg/m2 are included. Patients are randomized with a 1:1 ratio to either the control or intervention group. The control group receives diet nutritional counselling (standard of care, SOC). The intervention group receives the same SOC and a self-selected 10-hour TRE window. After the surgery, patients will be on SOC only, and followed every 3 months up to 1 year. Primary endpoint is a composite of death, myocardial infarction, stroke, and surgical re-intervention at 1 month post-operative. Blood glucose, body weight, body composition, biomarkers (neuroendocrine, inflammatory and metabolic), sleep and quality of life will also be examined. Temporal calorie intake is monitored with the smartphone application myCircadianClock preoperatively. VascuQoL-6 is used to monitor quality of life. Results 9 participants were enrolled since the start of the recruitment in February 2021, 4 were randomized in the 8 hours TRF intervention, and 5 to SOC. They all completed the study: 7 men and 2 women, age 73, 53–87 (median, min-max) years. Using the myCircadianClock app, adherence to the TRF was &gt;90% (Figure 1). Conclusion Our preliminary experience seems to demonstrate that a 2-week TRF regimen before vascular surgery is feasible. The complete results will be disseminated through future peer-reviewed manuscripts, reports and presentations.