Journal of Vascular Surgery最新文献

{"title":"Endoscopic Vein Harvest and its Effect on Lower Extremity Arterial Bypass Patency.","authors":"Justin M Robbins, Charles Cush, Brian Schutter, Dawn Szeltner, Haley Ehrlich, Michaella Thomas, Sarah Katchen, Timothy Crawford, Stacie Singleton, Louisa Pecchioni, Muhammud Rishi, Jonathan Velasco","doi":"10.1016/j.jvs.2025.03.205","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.205","url":null,"abstract":"<p><strong>Objective: </strong>The use of endoscopic vein harvest (EVH) versus open vein harvest (OVH) for lower extremity arterial bypass has been an area of continued interest. Previous studies have suggested wound complication rates are improved with EVH, but there has been concern for decreased patency of these grafts long term from possible damage with EVH techniques. This study aims to evaluate the effect of EVH and patency rates.</p><p><strong>Methods: </strong>This retrospective study evaluated 340 patients who underwent any infrainguinal bypass with continuous segment GSV from 2013-2023 with OVH (n= 111) vs EVH (n= 229). Demographics, harvest technique, incisional breakdown and need for arterial procedure from 1-5 years were evaluated. Primary, primary assisted and secondary patency rates were evaluated.</p><p><strong>Results: </strong>The average age was 62.6 ± 8.8 years and the majority of individuals were male (71.5%). The majority of participants were white (88.8%), current smokers (52.2%), had hypertension (78.0%), and an average BMI was 27.9 ± 6.0. Of these, 254 (75%) had below knee (BK) outflow targets and 86 (25%) with above knee (AK). Mean operative time was 193 minutes for EVH and was 228 minutes for OVH (p=0.03). Hospital length of stay was similar between the groups. Primary patency rates including above and below knee targets were 43.8% EVH vs 49.6% OVH [p=0.43], primary-assisted patency of 89.0% EVH vs 91.0% OVH [p=0.52], and secondary patency of 81% EVH vs 75.0% EVH [p=0.35]. Patients with EVH were less likely to have incision breakdown compared to OVH (11.9% vs 21.1%, p=0.04). A logistic regression model showed that EVH had a lower odd of failure of initial bypass requiring new bypass creation compared to OVH (adjusted OR: 0.66; 95% CI 0.33-0.99). Additionally, there was also a reduction in the odds of wound complications and need for amputation with EVH vs OVH.</p><p><strong>Conclusions: </strong>This study found no significant difference in primary, primary-assisted and secondary patency rates when comparing EVH to OVH. The benefits of decreased operative time, similar patency rates and decreased wound complications is promising. When EVH is performed by experienced providers this technique could be considered for vein harvest, but future studies are needed to better evaluate its long-term efficacy.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788645","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":"The Incidence and Significance of Delayed Bleeding Events After Lower Extremity Revascularization in Patients with Advanced Peripheral Arterial Disease.","authors":"Addiskidan Hundito, Nicholas Wells, McKenzie Tuttle, Dana Alameddine, Joshua Huttler, Martin Slade, David Strosberg, Alfred Lee, Raul J Guzman, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2025.03.394","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.394","url":null,"abstract":"<p><strong>Objectives: </strong>As novel medications are used in various combinations to prevent thrombosis, few studies have focused on bleeding events after lower extremity revascularization (LER) in patients with peripheral artery disease (PAD). Moreover, the impact of bleeding events on long-term outcomes and the prescription of antithrombotic therapy is not well reported. This study examines the incidence of bleeding events after LER and their significance in patients with advanced PAD.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing LER for PAD in a tertiary care center was performed. Bleeding was classified into major and minor based on the International Society of Thrombosis definitions and captured outside the 30-day perioperative period of LER. Characteristics and outcomes of patients who experienced bleeding events more than 30 days after initial LER were compared to patients who did not.</p><p><strong>Results: </strong>A total of 1,932 patients underwent LER and 529 (27.4%) experienced a bleeding event (53% major, 47% minor) over 4.3 years. Patients who experienced a bleeding event were more likely to have hypertension (93% vs 89%, p = .005), coronary artery disease (58% vs 53% p = .047), chronic renal insufficiency (25% vs 16%, p < .001), end-stage renal disease (12% vs 6.8%, p < .001), a history of smoking (84% vs 79% p = .007), and be on dual antiplatelet therapy (DAPT) (31% vs 25%, p = 0.029) at baseline. Patients who experienced a bleeding event after 30 days were also more likely to have developed perioperative bleeding (7.6% vs 5.2% p = 0.049) after the first LER. On follow-up, patients with bleeding were more likely to have reinterventions (51% vs 43%, p = .002), major amputation (14% vs 7.1%, p < .001), myocardial infarction (33% vs 17%, p <0.001), stroke (9.5% vs 5.1%, p <0.001), and mortality (48% vs 38%, p < .001). The most common type of bleeding was gastrointestinal (47%) followed by surgical site unrelated to LER (13%), and intracranial. Blood transfusion was used in 48%. Moreover, 40% of patients with an initial bleeding episode had at least one recurrent bleeding episode with a mean of 2.9 bleeding episodes per patient. After the first bleeding episode, 15% of patients were discharged without any antithrombotic therapy and 13%, 16%, and 11% had discontinuation of ASA, P2Y12 inhibitors, and anticoagulation respectively.</p><p><strong>Conclusion: </strong>Bleeding events are common after LER for advanced PAD and are associated with worse overall outcomes. Recurrent bleeding events are likely and significantly affect antithrombotic medication prescriptions.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788600","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":"The Value of Volume over Maximum Diameter for Following abdominal aortic aneurysm Growth and Reducing Surveillance Visits in Patients with a Subthreshold aneurysms.","authors":"Alexander Vanmaele, Elke Bouwens, Sanne E Hoeks, Jorg L de Bruin, Sander Ten Raa, K Martijn Akkerhuis, Felix van Lier, Ricardo Pj Budde, Bram Fioole, Hence Jm Verhagen, Eric Boersma, Isabella Kardys","doi":"10.1016/j.jvs.2025.03.395","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.395","url":null,"abstract":"<p><strong>Objective: </strong>To describe and compare abdominal aortic aneurysm (AAA) volume to maximum diameter regarding follow-up of AAA-progression, and investigate its added value in AAA surveillance.</p><p><strong>Methods: </strong>This prospective, observational cohort study included 126 patients enrolled in the multicenter BIOMArCS-AAA study who were under surveillance for an AAA. Participants underwent CT-scans at study inclusion and after one and two years, alongside CT-scans for clinical care. Maximum diameter and total volume were measured after center lumen line reconstruction. Mixed-effects regression was used to evaluate maximum diameter and volume changes over time. The value of volume alongside maximum diameter to distinguish patients that will/will not experience the composite endpoint (qualifying for surgery, or AAA-rupture/AAA-related death) was evaluated using Cox-models and cumulative incidence based positive/negative predictive values (PPV/NPV).</p><p><strong>Results: </strong>A median of 3 scans were available per patient. The baseline median (25^th-75^th percentile) maximum diameter and volume were 48 (45, 52) mm and 109 (90, 130) mL, respectively. The observed median (25^th-75^th percentile) growth at one-year follow-up was 2.3 (1.3, 3.1) mm in maximum diameter, and 10.8 (7.0, 16.4) mL in volume. Changes in aneurysm size at the next recommended surveillance visit lay within the boundaries of the inter-observer variability for 81 (65%) patients when measuring maximum diameter, compared to 43 (34%) patients when measuring volume (p<0.001). Using a single maximum diameter measurement, 32 (26%) patients could be exempt from surveillance imaging at one year, while ensuring that the risk of qualifying for surgery remains below 10%. When combining this with a simultaneous volume measurement, 54 (44%) patients could similarly be safely exempt from surveillance imaging (p=0.002). Moreover, simultaneously measuring volume refines the identification of patients that will qualify for surgery at two years (PPV diameter vs. diameter & volume: 57.7% and 72.5%, p<0.001).</p><p><strong>Conclusions: </strong>AAA volume is more sensitive to detect small changes in aneurysm size at the currently recommended surveillance intervals, and could be used to safely prolong surveillance intervals for patients with a small AAA. The use of volume should be encouraged in research and could prove valuable in AAA surveillance.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788604","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":"Digital calcification is associated with increased mortality and interval revascularization in Veterans with foot wounds.","authors":"James M Dittman, Graham J Harris, My H Nguyen, Betka H Douglas, Gale Tang","doi":"10.1016/j.jvs.2025.03.396","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.396","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In patients with foot wounds related to chronic limb-threatening ischemia, pedal medial arterial calcification (pMAC) scoring has been proposed to predict risk of amputation and mortality. As pMAC scoring is complex, requiring assessment of five imaging regions, we investigated whether a simpler assessment of digital calcification at the hallux where toe brachial indices (TBI) are typically measured would predict outcomes in patients with foot wounds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following IRB approval, all patients with ABI/TBI performed at a single VA medical center from 10/1/2015-9/31/22 were screened for foot wounds, TBI performed within 3 months of initial wound visit, and ipsilateral foot X ray. Patient demographics, comorbidities, and outcomes including wound healing, mortality, and major amputation were recorded to 12/31/23. Calcification was assessed via pMAC scoring, as well as present versus absent at the hallux (digital artery calcification, DAC). Wounds in patients with and without DAC were then compared, with sub-analysis by TBI and toe pressure ranges. Multivariable binary logistic regression was performed in IBM SPSS utilizing the covariates of DAC, age, TBI, smoking, CAD, ESRD, CHF, and interval revascularization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over the study period, 559 Veterans with ABI/TBI studies had foot wounds, of whom 248 also had a foot X-ray. These patients had 253 total wounds for analysis. 75 (30%) of wounds were in patients with DAC, which was associated with the presence of comorbidities including older age (72.6±9.3 vs 69.6±10.9 years, P=.04), ESRD (10% vs 2%, P=.02), CAD (53% vs 32%, P&lt;.01), CHF (35% vs 19%, P=.02), and higher pMAC score (2.8±1.3 vs 0.5±0.9, P&lt;.01), and inversely associated with smoking (11% vs 29%, P&lt;.01). Wounds in patients with DAC had similar presenting wound length (2.1±2.0 vs 1.7±1.5 cm, P=.08), diabetes (64% vs 57%, P=.33), hypertension (79% vs 80%, P=.74), mean WIfI score (2.6±1.1 vs 2.5±1.2, P=.54), and history of prior revascularization (25% vs 18%, P=.23) as wounds in patients without DAC. Time to wound healing without major amputation (32±30 vs 28±28 weeks, P=.38), proportion of healing (72% vs 77%, P=.26), and major amputation (9% vs 4%, P=.15) were similar between groups. Patients with DAC were more likely to be treated with interval revascularization during the wound course (39% vs 23%, P=.01). One-year mortality was higher for patients with DAC generally (28% vs 11%, P&lt;.01) without significant difference in any specific TBI range. Following multivariate adjustment, DAC was not associated with impaired wound healing (OR:1.1, 95% CI:0.6-2.1) or increased major amputation (OR:1.1, 95% CI:0.3-3.6), however DAC remained associated with increased odds for one year mortality (OR:2.3, 95% CI:1.1-5.0).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Digital calcification did not predict the inability to heal a foot-level wound however it was independently associated wi","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788643","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":"Textbook outcomes after revascularization for chronic limb threatening ischemia remain rare.","authors":"Cuneyt Koksoy, Ilse Torres Ruiz, Zachary S Pallister, Ramyar S Gilani, Joseph L Mills, Jayer Chung","doi":"10.1016/j.jvs.2025.03.202","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Suggested performance outcome metrics and traditional surgical benchmarks may be inadequate proxies for evaluating the quality of revascularization in chronic limb threatening ischemia (CLTI). Textbook outcomes (TO) following revascularization in CLTI are poorly described, and limited to cohorts studying open bypass only. We aim to propose a TO in CLTI to provide a more comprehensive evaluation of modern CLTI outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A nine-year retrospective, single-center analysis of consecutive CLTI patients undergoing revascularization (open, endovascular, or hybrid) was performed. Data on demographics, length of stay, comorbidities, procedural data, Wound, Ischemia, and foot Infection (WIfI) scores, limb salvage, post-operative complications, wound-healing, return to baseline, and/or normalized ambulatory status and survival were collected. TO was defined as a composite of survival, limb-salvage, without re-interventions (wound or vascular), freedom from major complications and reinterventions, 1 ≤ wound-related procedure, return to baseline function and complete wound-healing. Descriptive statistics and binary logistic regression were used to evaluate factors associated with TO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over nine years, 702 CLTI patients (N=445 male; 63.4%, median age 66.6, IQR 59.2, 73.9 years; 915 limbs; median follow-up 25, IQR 11,47 months) were studied. Significant patient-level co-morbidities include diabetes mellitus (N=458, 65.3%); chronic kidney disease (N=451, 64%) and dialysis dependence (N=225, 32%). Initially, 915 limbs were treated with 646 (71%) endovascular, 215 (24%) open, and 49 (5%) hybrid procedures. TO was achieved in 225 limbs (24.6%). For the overall cohort, each component of TO at one-year were as follows: survival (n=610, 86.9%), limb-salvage (n=787, 86%), freedom from major postoperative complications (n=788, 86%), freedom from re-interventions (n=513, 56%), &lt; 1 wound procedure (n=607, 66%), return to baseline, and/or normalized ambulatory status(n=587, 64.2%), and complete wound healing (n=347, 62%). Multivariable analysis identified factors associated with TO as follows: anticoagulant use (OR 0.5, 95% CI 0.4-0.8, p&lt;0.01); WIfI Stage 1 (OR 2.6 95% CI 1.5-4.5; p &lt; 0.001), diabetes OR 0.42 95% CI 0.29-0.60)&lt;.001 and residence in an assisted living facility (OR 0.13(0.03-0.55) 95% CI p=.006).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite excellent survival and limb-salvage, TO was achieved in less than one-fourth of patients undergoing re-vascularization for CLTI. Patients with WIfI stage 1 have a greater than two-fold odds of having a TO compared to all other WIfI stages, whereas those living in an assisted living facility, diabetics and/or taking oral anticoagulants were less likely to achieve a TO. Our data highlight the fact that current performance metrics fail to capture the true procedural burden associated with revascularization, which merits consideration","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788649","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":"Accuracy of Post-Hospitalization Stroke Detection following Carotid Revascularization in Medicare Claims.","authors":"Jesse A Columbo, Sanuja Bose, Jialin Mao, Alana C Keegan, Christopher J Abularrage, David H Stone, Philip P Goodney, Caitlin W Hicks","doi":"10.1016/j.jvs.2025.03.201","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.201","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stroke after carotid revascularization is a key effectiveness and quality metric relevant to patients, clinicians, and policymakers. To date, the accuracy of stroke rates reported from Medicare claims-based datasets for patients who underwent carotid revascularization remain unknown. The objective of this study was to validate the accuracy of using International Classification of Diseases, Tenth Revision (ICD-10) codes to detect stroke after carotid artery revascularization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed all patients who underwent carotid revascularization at two institutions from January 2016 to December 2019. We used a list of ICD-10 codes to detect stroke that we previously derived and validated in two prospective cohorts with atherosclerosis. We applied the list to all patients who underwent carotid revascularization at the two institutions to identify patients with an ICD-10 code for stroke, either as the indication for the index procedure or postprocedure. We then performed a comprehensive medical record review for all stroke patients, as well as a 1:1 random sample of patients who underwent revascularization during the same time interval and did not have an ICD-10 code for stroke. Our primary outcome was the sensitivity and specificity of the ICD-10 codes to detect post-hospitalization stroke (i.e., after the index hospitalization) compared to a gold-standard of chart review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We performed a comprehensive medical record review of a cohort oversampled for stroke that included 199 patients (mean age 73.5±7.6 years, 62.3% male, 95.0% non-Hispanic white, and 61.8% symptomatic) who underwent carotid revascularization during the study interval. The majority of patients underwent carotid endarterectomy (82.4%), followed by transcarotid artery revascularization (12.1%) and transfemoral carotid artery stenting (5.5%). Twelve patients had a stroke during their index hospitalization, creating a final cohort of 187 patients eligible for assessment of post-hospitalization stroke. After a median follow-up time of 453 days (IQR 82, 803), 10 asymptomatic patients and 10 symptomatic patients had a post-hospitalization stroke based on chart review. Among asymptomatic patients, the sensitivity and specificity of ICD-10 codes to detect a post-hospitalization stroke were 100% (95% CI: 69.2-100.0%) and 96.8% (95% CI: 88.8-99.6%), respectively when considering all linked diagnosis codes. Among symptomatic patients, the sensitivity and specificity of ICD-10 codes to detect a post-hospitalization stroke were 80.0% (95% CI: 44.4-97.5%) and 94.3% (95% CI: 88.0-97.9%), respectively, when considering all diagnosis codes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Post-hospitalization stroke can be accurately measured after carotid revascularization using ICD-10 codes in Medicare claims data. The reliability of the algorithm is higher among asymptomatic patients than symptomatic patie","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780389","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":"Comparative Analysis of Arch Vessel Revascularization Techniques in Proximal Arch Thoracic Endovascular Aortic Repair.","authors":"Hassan Chamseddine, Mouhammad Halabi, Alexander Shepard, Timothy Nypaver, Mitchell Weaver, Andi Peshkepija, Yasaman Kavousi, Kevin Onofrey, Kyle Miletic, Loay Kabbani","doi":"10.1016/j.jvs.2025.03.203","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.203","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular stent-grafting extending into the ascending aorta (Zone 0) is increasingly used in the treatment of aortic arch disease. This study aims to evaluate the risk of stroke in patients undergoing Zone 0 arch thoracic endovascular aortic repair (TEVAR) based on the technique used for head vessel revascularization.</p><p><strong>Methods: </strong>Patients undergoing Zone 0 Arch TEVAR covering all the aortic arch vessels were identified in the Vascular Quality Initiative (VQI) between 2014 and 2023. Patients treated for aortic rupture or trauma were excluded. Head vessel revascularization techniques were classified into three groups: open revascularization (OR), endovascular revascularization (ER), and hybrid revascularization (HR). Multivariate logistic regression analysis was used to evaluate the association of head vessel revascularization technique with the primary outcomes of perioperative mortality and stroke.</p><p><strong>Results: </strong>A total of 409 patients underwent Zone 0 Arch TEVAR covering all the aortic arch vessels, of which 50% (207/409) underwent OR, 20% (80/409) underwent ER, and 30% (122/409) underwent HR of the head vessels. The in-hospital mortality and stroke rates were 9% and 12% respectively. Survival at 30 days, 1 year, and 2 years were 88%, 79%, 74% respectively. Patients undergoing ER of the head vessels had significantly higher stroke compared to those undergoing OR and HR (OR 11%, ER 21%, HR 8%, p=0.02). ER was associated with a two-fold higher risk of perioperative stroke compared to OR (odds ratio = 2.16; 95% confidence interval, 1.08-4.30; p=0.03), whereas no difference in perioperative stroke was observed between OR and HR (p=0.40). While OR and HR of the head vessels had a significantly lower rate of perioperative stroke compared to ER in 2017-2020 (OR 10% vs ER 30% vs HR 10%, p=0.02), this difference diminished over time with no significant difference observed in the most recent interval (2021-2023) studied (OR 9% vs ER 12% vs HR 8%, p=0.76). Trends revealed an increase in the use of HR (from 4% in 2014 to 57% in 2023) alongside a significant decline in ER (from 39% in 2020 to 14% in 2023).</p><p><strong>Conclusion: </strong>Stroke remains a significant concern during Zone 0 Arch TEVAR. Total endovascular repair of the aortic arch is associated with a greater than two-fold higher risk of stroke compared to open and hybrid revascularization of the head vessels. However, advances in ER techniques and increased use of hybrid strategies highlight an ongoing evolution toward safer and less invasive approaches resulting in a reduction in perioperative stroke rates over time.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780313","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":"Comparison of Restenosis and Reintervention Rates in Closed Cell Stents Compared to Open Cell Stents After Carotid Artery Stenting.","authors":"Camilo Polania-Sandoval, James F Meschia, Josephine Huang, Camila Esquetini-Vernon, Ana Fuentes-Perez, Suren Jeevaratnam, Kevin M Barrett, W Christopher Fox, David A Miller, Xindi Chen, Christopher Jacobs, Richard D Beegle, Rabih Tawk, Sukhwinder J S Sandhu, Houssam Farres, Young Erben","doi":"10.1016/j.jvs.2025.03.199","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.199","url":null,"abstract":"<p><strong>Objective: </strong>To compare short- and mid-term outcomes after carotid artery stenting (CAS) related to stent configuration.</p><p><strong>Methods: </strong>This is a retrospective study of all CAS including transcarotid and transfemoral approaches, performed at our institution from 2015 to 2024. Groups were identified according to the stent used at the index procedure by open-cell stents (OCS) and closed-cell stents (CCS). Subgroup analysis by symptomatic status was also performed. Stroke, myocardial infarction (MI), and death were analyzed including those occurring within 30 days of procedure and on last follow-up (14.5±15.1 months). Restenosis and need for re-intervention were also assessed.</p><p><strong>Results: </strong>Two-hundred and forty-six patients were included in our study cohort, with 128 OCS (Enroute stent [Silkroad Medical, Sunnyvale, CA]=76; Protégé stent [Medtronic, Minneapolis, MN]=34; Precise stent [Cordis, Miami Lakes, FL]=15; Acculink stent [Abbott, Abbott Park, IL]=3), and 118 CCS (Wallstent [Boston Scientific, Marlborough, MA]=118). Baseline characteristics and comorbidities of the overall cohort showed differences in BMI (CCS: 28.57±6.19, OCS: 29.79±5.98; p=0.018) and symptomatic status (CCS: 78, 66.1%, OCS: 34, 26.6%; p<0.001). In subgroup analysis within symptomatic and asymptomatic patients, these differences did not persist. Of note, in symptomatic patients, a higher rate of diabetics received CCS (33.3%) compared to OCS (14.7%, p=0.043). Composite outcomes of stroke, MI and death were no different at 30-days and on mid-term follow-up (14.5±15.1 months). Only MI at follow-up in the overall cohort was significantly higher in the OCS group (4.7%) compared to CCS (0%; p=0.03); however, this difference did not persist in subgroup analysis among symptomatic and asymptomatic patients. Restenosis (CCS: 16, 13.6%, OCS: 2, 1.6%; p<0.001) and re-interventions (CCS: 13, 11%, OCS: 0, 0%; p<0.001) were higher in the CCS group. Furthermore, this difference persisted for both outcomes in symptomatic and asymptomatic subgroup analysis. Multivariate analysis showed increased risk for restenosis in CCS (adjusted hazard ratio: 10.28, 95% Confidence Interval: 2.25-47.09; p=0.003).</p><p><strong>Conclusion: </strong>No difference in short- and mid-term outcomes was present in either CCS or OCS regarding stroke, MI, or death. On mid-term follow-up, CCS patients had a higher rate of restenosis and re-intervention, and this difference persisted in both symptomatic and asymptomatic subgroups.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780314","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":"Ischemia targeted coronary revascularization improves five-year survival following carotid endarterectomy.","authors":"Dainis Krievins, Sanda Jegere, Gustavs Latkovskis, Aigars Lacis, Edgars Zellans, Indulis Kumsars, Davis Putrins, Janis Vetra, Edgars Supols, Ligita Zvaigzne, Arnis Kirsners, Andrejs Erglis, Patricija Ivanova, Janis Jurkans, Christopher K Zarins","doi":"10.1016/j.jvs.2025.03.197","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.197","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Long-term survival following carotid endarterectomy (CEA) is limited by adverse cardiac events with 5% annual mortality. We sought to determine whether diagnosis of silent coronary ischemia together with elective ischemia-targeted coronary revascularization can reduce death and myocardial infarction (MI) and improve long-term survival of patients following CEA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Observational cohort study of patients with no cardiac history or coronary symptoms undergoing elective CEA. Patients enrolled in a prospective study of pre-operative cardiac evaluation using coronary CT-derived fractional flow reserve (FFR&lt;sub&gt;CT&lt;/sub&gt;) to detect silent (asymptomatic) coronary ischemia together with elective post-operative ischemia-targeted coronary revascularization were compared to matched Controls with standard pre-operative cardiac evaluation and no elective coronary revascularization. Lesion-specific coronary ischemia was defined as FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.80 distal to &gt;30% stenosis with severe ischemia defined as FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.75. Endpoints included all-cause death, cardiac death, MI, stroke and MACE (major adverse cardiovascular events = cardiovascular (CV) death, MI or stroke) during 5-year follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;FFR&lt;sub&gt;CT&lt;/sub&gt; (n=100) and Control (N=100) cohorts were well matched with no significant differences in age, gender, comorbidities or indications for CEA. Asymptomatic lesion-specific coronary ischemia (FFR&lt;sub&gt;CT&lt;/sub&gt; ≤0.80) was present in 57% of FFR&lt;sub&gt;CT&lt;/sub&gt; patients, with severe ischemia in 44%, and left main ischemia in 7%; 43% had no coronary ischemia (FFR&lt;sub&gt;CT&lt;/sub&gt; &gt;0.80). The status of coronary ischemia was unknown in Controls. CEA was performed successfully in both cohorts with no deaths or neurologic events and all patients received optimal post-operative medical therapy. Elective ischemia-targeted coronary revascularization was performed in 33% of FFR&lt;sub&gt;CT&lt;/sub&gt; patients within 3 months of CEA. Controls had no elective coronary revascularization. During 5-year follow up, compared to Control, the FFR&lt;sub&gt;CT&lt;/sub&gt; group had fewer all-cause deaths (11% vs 24%, hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.17-0.77, P=.016); fewer cardiac deaths (3% vs 13%, HR 0.15, 95% CI 0.03-0.69, P=.009); fewer MIs (3% vs 21%, HR 0.07, 95% CI 0.02-0.31, P&lt;.001) and fewer MACE events (10% vs 33%, HR 0.21, 95% CI 0.10-0.44, P&lt;.001) with no difference in stroke. There were no cardiac deaths or MIs among patients with no coronary ischemia (FFR&lt;sub&gt;CT&lt;/sub&gt; &gt;0.80). Annual mortality in FFR&lt;sub&gt;CT&lt;/sub&gt; was 2.2% per year compared to 4.8% per year in Control.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Diagnosis of silent coronary ischemia together with elective ischemia-targeted coronary revascularization following CEA reduced the 5-year risk of all-cause death, cardiac death, MI and MACE by more than 50% and improved survival (89%) compared to patients receiving standard ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753238","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":"Predictive value of tibial and coronary artery calcification scores for cardiac and lower extremity events.","authors":"Andrew W Schwartz, Ethan Maahs, Alexa Berezowitz, Hamid Mojibian, Raul J Guzman","doi":"10.1016/j.jvs.2025.03.196","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.03.196","url":null,"abstract":"<p><strong>Objective: </strong>The extent of calcification in tibial and coronary arteries predicts major ischemic events. Tibial calcification predicts ischemic events in a manner independent of the degree of associated atherosclerotic occlusive disease while coronary calcification can improve risk stratification in patients at intermediate risk for cardiovascular disease. We thus assessed the relationship between tibial and coronary calcification, the influence of cardiovascular risk factors on their extent, and their individual predictive value on major adverse limb and cardiac events (MALE and MACE).</p><p><strong>Methods: </strong>We retrospectively reviewed images and collected demographic and cardiovascular risk factor data of patients who underwent CT scans of the lower extremities and chest. Calcification in the tibial and coronary arteries were identified and scored using a semi-automated method. A spearman correlation coefficient was calculated using tibial and coronary artery calcification scores (TAC and CAC). Ordinal logistic regression and multiple linear regression were performed using cardiovascular and demographic factors as covariates. Log-rank test and Kaplan-Meier estimate were completed to assess MACE and MALE free probability.</p><p><strong>Results: </strong>A total of 101 patients were identified who met inclusion criteria. There was a strong correlation (r=0.76) between CAC and TAC scores. Severe CAC (defined as > 400) and severe TAC (defined as > 500) scores were both associated with advanced age, male sex, a history of smoking, and diabetes. Renal disease was associated with a high TAC score but not CAC. An increasing TAC score was associated with increased MACE (p<0.0001) and MALE (p=0.039). However, increasing CAC was only associated with increased MACE (p=0.0036).</p><p><strong>Conclusion: </strong>We provide data suggesting that TAC and CAC share similar risk factors and are highly correlated. Interestingly, TAC predicts both MACE and MALE, while CAC is best at predicting coronary, but not lower extremity events. Further studies are needed to understand the contributions of arterial calcification to myocardial and lower extremity ischemia.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753241","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}