Journal of Vascular Surgery最新文献

{"title":"Outcomes of Routine Surveillance of Grade 1 Blunt Traumatic Aortic Injury.","authors":"S Taha Zaidi, Ezra Y Koh, Gregory Estrera, Joshua Wong, Thaddeus J Puzio, Gustavo S Oderich, Anthony L Estrera, Naveed U Saqib","doi":"10.1016/j.jvs.2025.07.035","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.035","url":null,"abstract":"<p><strong>Introduction: </strong>Blunt traumatic aortic injury (BTAI) can present with a wide range of severity from mild intimal injuries (grade 1) to rupture (grade 4). While there is consensus that patients with grade 3 and 4 injuries should undergo immediate thoracic endovascular aortic repair (TEVAR), the optimal treatment strategy for milder injuries is less clear due to the lack of data regarding the natural history of these injuries. Grade 1 injuries are typically treated with anti-impulse therapy and surveillance imaging. However, the efficacy of this approach remains unclear and therefore the aim of this study was to assess the outcomes of routine surveillance in grade 1 BTAI.</p><p><strong>Methods: </strong>Electronic medical records of all patients who presented to our institution with BTAI between 1999 and 2024 were reviewed retrospectively. Initial CT scans were reviewed, and patients with grade 1 BTAI were included for further review. All initial follow-up studies were assessed and compared to the initial CT scan.</p><p><strong>Results: </strong>A total of 542 patients were initially reviewed, of which 165 (18%) presented with grade 1 BTAI. Of these patients 162 (98%) were managed non-operatively whereas 3 (2%) underwent immediate surgical intervention for BTAI. Two patients in the early part of our series underwent diagnostic thoracic aortography without further intervention, and one patient underwent repair of a common carotid injury in addition to TEVAR due to multiple grade 1 injuries. Of these patients, 125 (77%) underwent repeat imaging at a median interval of 7 days (interquartile range 3 - 8 days). The initial surveillance imaging showed absence of injury or improvement in 67 patients (54%), stable grade 1 BTAI in 55 (43%), progression to grade 2 BTAI in 1 patient (0.8%), and progression to grade 3 BTAI in 2 patients (1.6%). The 3 patients who showed progression of BTAI on repeat CT underwent further assessment with thoracic aortography and/or intravascular ultrasound. The patient with progression to grade 2 injury underwent assessment with intravascular ultrasound which ruled out pseudoaneurysm formation, and no further intervention was performed. Of the 2 patients with progression to grade 3 injuries, 1 patient underwent thoracic aortography without further intervention as the injury appeared more consistent with grade 2, whereas the other patient underwent TEVAR.</p><p><strong>Conclusion: </strong>In our series of patients with grade 1 BTAI who underwent non-operative management and surveillance imaging, the rate of progression of injury on CT was 2.4%. Only 1 patient (0.8%) ultimately underwent interval TEVAR. These findings suggest that the utility of serial imaging in mild BTAI is low in the setting of appropriate non-operative management.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse Postoperative Outcomes in Geriatric Population with a History of Cognitive Impairment or Falls Undergoing Vascular Surgery.","authors":"Aditya Safaya, Ahsan Zil-E-Ali, Kristine L So, Faisal Aziz","doi":"10.1016/j.jvs.2025.07.034","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.034","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association of preoperative cognitive impairment/dementia (CI/D) and recent fall history with 30-day postoperative outcomes in patients aged >65 years undergoing vascular surgery.</p><p><strong>Methods: </strong>American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for vascular surgery patients >65 years in 2021, the first year CI/D and fall history were captured. Patients were categorized into two groups: those without CI/D or falls (Group I) and those with either or both (Group II). Outcomes included 30-day mortality, unplanned return to operating room (OR), non-home discharge, and length of stay. Multivariable logistic regression was used to identify independent associations, adjusting for demographic and clinical covariates.</p><p><strong>Results: </strong>Among 7,057 patients, 458 (6.5%) had CI/D or fall history. Compared to Group I, Group II patients were older (81.7 vs. 74.3 years), more likely to be functionally dependent (34.7% vs. 5.4%), and had higher comorbidity burdens. Group II experienced significantly worse outcomes: 30-day mortality (7.4% vs. 2.1%), return to OR (12.0% vs. 7.7%), and non-home discharge (35.6% vs. 11.0%) (all p<0.001). On adjusted analysis, CI/D or falls were independently associated with increased odds of mortality (AOR 2.08, 95% CI 1.28-3.37), return to OR (AOR 1.49, CI 1.06-2.22), and non-home discharge (AOR 2.28, CI 1.77-2.93). Isolated CI/D was associated with mortality (AOR 2.26, CI 1.14-4.51), while falls alone were associated with return to OR (AOR 1.62, CI 1.04-2.52) and non-home discharge (AOR 2.89, CI 2.09-3.99).</p><p><strong>Conclusions: </strong>In geriatric vascular surgery patients, preoperative CI/D and falls are significant, independent predictors of postoperative mortality and morbidity. These readily identifiable clinical features should be incorporated into preoperative risk assessments to improve surgical decision-making and resource allocation.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of Cerebrospinal Fluid Drainage after Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair.","authors":"Yuki Ikeno, Gregory A Estrera, Nicholas Ray, Michael J Troncone, Harleen Sandhu, Charles C Miller, Shao Feng Zhou, Akiko Tanaka, Hazim J Safi, Anthony L Estrera","doi":"10.1016/j.jvs.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.031","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to review a 10-year experience, identify cerebrospinal fluid drainage (CSFD)-related complications, and evaluate its utility in spinal cord protection.</p><p><strong>Methods: </strong>This retrospective study reviewed all open descending thoracic aneurysm and thoracoabdominal aortic aneurysm (DTA/TAAA) repairs performed at our institution between January 2013 and September 2024. The analysis focused on patients who underwent CSFD for preoperative spinal cord protection.</p><p><strong>Results: </strong>Of the 428 patients who underwent open DTA/TAAA repair, 339 received CSFD and were included in the analysis. DTA was performed in 107 patients (31.7%), while TAAA was performed in 232 (68.4%). Emergency surgeries were required in 40 patients (11.8%). Operative mortality was 5.3% (18 patients). Early SCI was observed in 2.9% (10), while delayed SCI occurred in 10.6% (36). The mean duration of CSFD drainage was 3.4 ± 1.9 days. CSFD-related complications were observed in 85 patients (25.1%), with major complications, including intracranial hemorrhage in 7 (2.1%), one of which required surgical intervention (0.3%). Meningitis was noted in 2 patients (0.6%). Minor complications included spinal headache in 55 (16.2%) and CSFD leakage in 27 (8.0%). Bloody drainage occurred in 29 (8.6%) and CSFD catheter malfunction in 9 (2.7%), rendering CSFD unusable in 18 patients (5.3%).</p><p><strong>Conclusion: </strong>Open DTA/TAAA repairs with CSFD showed acceptable outcomes. Although minor complications were relatively frequent, major complications were rare at this experienced center.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vanishing Aortic Occlusion.","authors":"Makoto Toyoda, Hisato Takagi, Kouki Nakashima","doi":"10.1016/j.jvs.2025.07.028","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.028","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kinetic Endovascular Micro-Incision Creation Prior to Plain Balloon Angioplasty in Real-World Hemodialysis Patients with Vascular Access Dysfunction.","authors":"Ari Kramer, Scott R Schultz, Sanford D Altman","doi":"10.1016/j.jvs.2025.07.026","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.026","url":null,"abstract":"<p><strong>Objective: </strong>A large population of people with end stage kidney disease relies on hemodialysis for renal replacement therapy. Dysfunction of hemodialysis access is common yet current treatment with percutaneous transluminal balloon angioplasty to restore access functionality introduces concomitant short-term risk with high rate of re-intervention. This study was performed to assess the safety and efficacy of kinetic endovascular micro-incision creation prior to percutaneous transluminal balloon angioplasty with a plain (non-drug coated) balloon, the predominant modality in real-world dialysis access interventions due to its broad availability, favorable cost profile, and lack of payer parameters.</p><p><strong>Methods: </strong>This multicenter observational registry enrolled hemodialysis subjects who were scheduled for plain balloon angioplasty of their arteriovenous fistula or graft due vascular access dysfunction. Follow-up occurred at 1, 6 and 12 months. The primary safety endpoint was freedom from serious adverse events through 1 month following the procedure. Primary efficacy endpoints at 6 months post-intervention were primary patency of the target lesion and freedom from clinically-driven target lesion revascularization. Secondary endpoints were post-procedure anatomic success, procedural success, clinical success, circuit patency, and secondary patency.</p><p><strong>Results: </strong>A total of 176 lesions were treated with kinetic endovascular micro-incisions prior to plain balloon angioplasty in 130 subjects at 4 clinical sites. Target lesion characteristics were 29+ 21mm length with mean pre-procedure stenosis of 75.4% + 14.6%. One stent graft was required for a single angioplasty-related procedural dissection; no serious adverse events were observed. . One participant did not complete the follow-up evaluation. Six-month target lesion primary patency was 70.7%. Target lesion primary patency for arteriovenous fistula cases (n=97) and arteriovenous graft cases (n=32) were 75.6% and 55.2%, respectively. For treatment of arteriovenous fistula cephalic arch stenosis(n=35), 6-month target lesion primary patency was 76.3%. Six-month secondary patency was 97.7%.</p><p><strong>Conclusion: </strong>This registry demonstrates the safety and effectiveness of kinetic endovascular micro-incision creation prior to plain balloon percutaneous transluminal angioplasty to treat hemodynamically-significant dialysis access stenoses of arteriovenous fistulas and grafts, including cephalic arch stenoses.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term Results of Aneurysmorrhaphy for Enlargement After EVAR.","authors":"Yuko Wada, Yuki Takagi, Shuji Chino, Tohru Mikoshiba, Haruki Tanaka, Hajime Ichimura, Noburo Ohashi, Tatsuichiro Seto","doi":"10.1016/j.jvs.2025.07.025","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.025","url":null,"abstract":"<p><strong>Objective: </strong>Although endovascular aneurysm repair (EVAR) is a standard treatment for abdominal aortic aneurysms, postprocedural aneurysm expansion caused by types II and V endoleaks remains challenging. Aortic graft replacement is a definitive solution but is associated with high morbidity and mortality-especially in elderly patients. Aneurysmorrhaphy has emerged as a less invasive alternative. This study evaluated the mid-term outcomes of aneurysmorrhaphy after EVAR and identified factors associated with aneurysm re-expansion.</p><p><strong>Methods: </strong>This retrospective study included 50 patients who underwent aneurysmorrhaphy after EVAR in 2016-2021. Indications included aneurysm expansion due to type II or V endoleaks. Surgery was performed using the transperitoneal approach with aneurysm sac opening, thrombus removal, and plication without graft replacement. Intraoperative endoleak diagnosis and preoperative computed tomography (CT) findings were compared. Survival, reintervention, and risk factors for re-expansion were assessed by Kaplan-Meier analysis and logistic regression.</p><p><strong>Results: </strong>The intraoperative morbidity rate was 6%, the perioperative mortality rate was 0%, and the postoperative morbidity rate was 12%. Compared with preoperative CT findings, the diagnosis was changed in 13 cases (26%). Among the cases initially diagnosed as Type II EL alone, 2 cases had concomitant Type Ib EL, and 7 cases were Type 3b EL. The mean follow-up period was 4.5 years. The 5-year survival and reintervention-free rates were 90% and 92%, respectively. Notably, the 5-year freedom from aneurysm re-expansion rate was only 84%. Residual endoleaks and dead-space areas were notable predictors of re-expansion. Receiver operating characteristic analysis identified a dead-space threshold of 70%, above which re-expansion risk was significantly higher.</p><p><strong>Conclusions: </strong>Aneurysmorrhaphy is a viable alternative to graft replacement for post-EVAR aneurysm expansion, especially in high-risk patients. However, the risk of re-expansion remains critical, particularly when dead-space reduction is inadequate. Careful patient selection and further research can optimize long-term outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vein Harvest Technique Is Not Associated with Major Adverse Limb Events.","authors":"Andrew Lee, Catherine Go, Frank Annie, Ryan Butcher, Mohammad H Eslami","doi":"10.1016/j.jvs.2025.07.024","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.024","url":null,"abstract":"<p><strong>Background: </strong>Benefits of vein conduits in lower extremity bypasses (LEB) are known but there is debate about the harvesting technique. We aimed to compare the impact of conduit harvest on major adverse limb event (MALE) and MALE-free survival (MFS).</p><p><strong>Methods: </strong>We conducted a retrospective review of LEB patients with vein from 2013-2022 at our single-center institution. Patients were divided into groups: EVH (n=80) and OVH (n=204). The primary endpoints were MALE and MFS, while secondary endpoints included 30-day infection rate (IR), operative time, discharge status, post-operative length-of-stay (LOS), and estimated blood loss (EBL). MALE and MFS were compared using log ranks and Kaplan-Meier analysis. Adjusted analyses to determine factors associated with MALE and MFS at 1-, and 3-years were performed.</p><p><strong>Results: </strong>At 1- and 3-years, MALE and MFS were not statistically different. At 1-year, EVH MALE was 35% vs. 37% for OVH (p=0.871), and 61% vs. 55% (p=0.434) at 3-years. At 1-year, EVH MFS was 63% vs. 65% for OVH (p=0.434), and 39% vs. 45% (p=0.44) at 3-years. There were no significant differences in 30-day IR (1.25% vs. 3.88%; p=0.30), EBL (397.31 ± 336.00 vs. 479.57 ± 493.81 mL; p=0.12), discharge home vs. other facility (88.61% vs. 85.92%; p=0.63), and LOS (7.09 ± 4.98 vs. 7.92 ± 6.24 days; p=0.30). On adjusted analyses, harvest technique was not associated with MALE or MFS at 1- and 3-years. Adjusted analyses revealed no association between vein harvest technique and MALE at 1-year. It did show significant differences in MALE at 1-year for bypasses whose proximal anastomoses originated in the below-knee popliteal and tibial artery segments (HR, 2.50; 95% CI, 1.30-4.80; p=0.01) and bypasses that consisted of 2 or more vein segments (HR, 1.86; 95% CI, 1.25-2.76; p<0.01); both findings were still significant at 3-years and neither were associated with vein harvest technique. There were no co-morbidities that affected MALE at 1-year, but patients with MALE at 3-years were associated with COPD (HR, 1.46; 95% CI, 1.08-1.99; p=0.02) and diabetes (HR, 1.51; 95% CI, 1.12-2.03; p=0.01). There were no variables associated with a return to the operating room except for female sex (OR, 2.317; 95% CI, 1.214-4.424; p=0.011). There was still no difference in 30-day IR even after adjusted analysis.</p><p><strong>Conclusion: </strong>Although EVH is not associated with improved infection rates and LOS, this technique does not affect MALE or MFS compared to OVH. Economic impact and patient satisfaction of EVH require further studies to define the role of less invasive approaches to vein harvest.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Imaging Surveillance Compliance and Long-Term Outcomes after Endovascular Abdominal Aortic Aneurysm Repair at VA Hospitals.","authors":"Laura E Newton, Aravind Ponukumati, Gabrielle Zwain, Caroline Korves, Jialin Mao, Kayla Moore, Shipra Arya, Olamide Alabi, Salvatore Scali, Erin Greenleaf, Bjoern Suckow, David Stone, Emily Spangler, Philip Goodney","doi":"10.1016/j.jvs.2025.06.113","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.06.113","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between compliance with guideline-recommended annual imaging surveillance after endovascular aortic aneurysm repair (EVAR) and long-term outcomes.</p><p><strong>Methods: </strong>Veterans who underwent EVAR between 1/1/2000-12/31/2023 in VA facilities were retrospectively examined. The exposure was imaging surveillance compliance, defined as at least one study (CT, US, or MRI) per year after EVAR. Outcomes were all-cause mortality, reintervention, and rupture. Using a method called landmark analysis, surveillance compliance was assessed during a two-year landmark period. Each patient was categorized as non-compliant (no imaging obtained during the landmark period), partially compliant (imaging obtained in one year of the landmark period), or fully compliant (imaging obtained in both years of the landmark period). Kaplan-Meier survival curves evaluated each outcome in the 10 years following the landmark period. This analysis was repeated using different two-year landmark periods spanning years 0-9 after EVAR, then again using a 3-year landmark period. Separately, we used Cox proportional hazard regression to evaluate the association between imaging compliance in a given year and outcomes during the following year. Models were adjusted for age, sex, race, VA priority group, and baseline Charlson Comorbidity Index.</p><p><strong>Results: </strong>We identified 27,792 veterans (mean age 71.7 years, 82.8% white, 99.4% male) who underwent EVAR during the study period. Within the first decade of surveillance, 45.3% of veterans died, 21.1% had reinterventions, and 0.27% experienced late rupture. The number of patients by compliance category was 2,430 (13.2%) non-compliant, 4,799 (26.0%) partially compliant, and 11,228 (60.8%) fully compliant. In the primary analysis where the landmark period was post-EVAR years 1 and 2, the median survival (95% CI) [years] for each group (non-compliant, partially, and fully) was 6.0 (5.7, 6.3), 6.3 (6.1, 6.6), and 6.3 (6.2, 6.5), respectively. Freedom from reintervention [rupture] among surviving veterans was: non-compliant 0.72 (0.68, 0.76) [1.00 (1.00, 1.00)], partially compliant 0.68 (0.66, 0.71) [0.99 (0.98, 0.99)], and fully compliant 0.69 (0.67, 0.70) [0.99 (0.99, 1.00)]. These findings were similar regardless of the landmark period's start or size. In the adjusted Cox proportional hazard models, compliance was associated with reintervention (aHR 1.33; CI 1.22, 1.45) but not with mortality or rupture.</p><p><strong>Conclusions: </strong>This study found no association between less frequent imaging surveillance after EVAR and long-term outcomes of rupture or mortality. These results call into question the benefit of existing paradigms given the unclear clinical benefit and should guide policymakers in refining post-EVAR imaging surveillance recommendations.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of new classification from the Society for Vascular Surgery and Society of Thoracic Surgeons on acute Stanford type A aortic dissection.","authors":"Yuki Ikeno, Akiko Tanaka, Michael J Troncone, Ezra Y Koh, Adrian Ramirez, Muhammad Arbaz Khan, Harleen Sandhu, Charles C Miller, Hazim J Safi, Anthony L Estrera","doi":"10.1016/j.jvs.2025.07.023","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.07.023","url":null,"abstract":"<p><strong>Objectives: </strong>The Stanford classification categorizes aortic dissection based on ascending aortic involvement, whereas the newer Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification emphasizes tear location. Thus, traditional Stanford type A dissection may be an SVS/STS type A dissection or SVS/STS type B0 dissection. We evaluated the impact of SVS/STS classification on perioperative characteristics and outcomes after acute Stanford type A dissection repair.</p><p><strong>Methods: </strong>We retrospectively reviewed 794 patients undergoing acute Stanford type A dissection repair between January 1999 and March 2025, excluding those with unidentified entry tears (SVS/STS type I). Perioperative variables and outcomes were compared between SVS/STS type A (n=632) and type B0 (n=162).</p><p><strong>Results: </strong>SVS/STS type B0 patients had lower rates of malperfusion and hypotension but larger arch, descending, and abdominal aortic diameters. Operative mortality was similar between groups (13.9% vs. 14.8%, P=0.778). Long-term survival did not differ significantly (10-year survival: 59.3% vs. 54.5%, P=0.277). However, freedom from distal aortic reintervention was significantly lower in the SVS/STS type B0 group (76.2% vs. 65.3% at 10 years, P=0.008).</p><p><strong>Conclusion: </strong>The SVS/STS classification identifies distinct subgroups within Stanford type A dissection. SVS/STS type B0 dissections present with more stable hemodynamics but larger aortic dimensions and higher distal reintervention rates. This classification provides valuable prognostic information for both early and late outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information for Readers","authors":"","doi":"10.1016/S0741-5214(25)01331-X","DOIUrl":"10.1016/S0741-5214(25)01331-X","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 2","pages":"Page A17"},"PeriodicalIF":3.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}