Journal of Vascular Surgery最新文献

{"title":"A Systematic Review to Examine the Impact of Socioeconomic Status on Revascularization for PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States.","authors":"Ahsan Zil E Ali, Billal Alamarie, Leana Dogbe, Alpha Tall, Abdul Wasay Paracha, Faisal Aziz","doi":"10.1016/j.jvs.2024.09.040","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.09.040","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aims to study the available literature on the impact of SES on the surgical outcomes of peripheral arterial disease (PAD), carotid artery disease, and aortic aneurysms in the United States. The review also aims to report the diverse tools utilized to compute SES within the vascular surgery literature.</p><p><strong>Methods: </strong>A systematic review of English literature was conducted based on the English literature review using literature databases PubMed and Scopus from inception till November 2023. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. It included studies reporting socioeconomic factors, income, social determinants of health, social class, and health status disparities in patients undergoing vascular surgical procedures. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. 1,133 studies were initially selected and only 19 passed the complete inclusion criteria for final assessment and reporting.</p><p><strong>Results: </strong>A total of 19 studies were examined that assessed the relationship between socioeconomic status and vascular surgery outcomes. All analyses were published between 2018-2023 and included a broad spectrum of patients undergoing multiple vascular procedures. A total of 10 publications addressed the role of these factors in patients with PAD, 3 analyzed the impact of these factors in patients with Carotid Artery Disease, and 6 explored the role of these factors in patients with aortic repairs. No high risk of bias was reported for any selected study, and most studies (15/19) were based on national or large registries. The results of these studies showed widespread reporting measures of SES. The findings reported describe that lower SES is associated with a higher risk of amputation and stroke following revascularization for PAD and carotid artery surgery. Among the patients undergoing aortic repair, lower SES was more likely to present with ruptured aneurysms or symptomatic at the time of surgery. .</p><p><strong>Conclusion: </strong>Multiple metrics are utilized to assess SES in the vascular surgery literature. All studies associated lower SES with poorer outcomes or higher acuity of symptoms at the time of revascularization for PAD, Carotid Artery Disease, and aortic repair.. This highlights the need to consider SES in improving surgical outcomes and reducing healthcare disparities.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564427","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":"French Multicentric Registry on LUMINOR Drug-Eluting Balloon for Superficial Femoral and Popliteal Arteries.","authors":"Caroline Caradu, Claire Webster, Bahaa Nasr, Jonathan Sobocinski, Nicolas Louis, Benjamin Thévenin, Gilles Goyault, Yann Goueffic, Eric Ducasse","doi":"10.1016/j.jvs.2024.10.068","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endovascular interventions using drug-coated balloons (DCBs) have shown promise in improving outcomes for femoropopliteal revascularizations. Luminor, nanotechnology-based paclitaxel coated balloon, has demonstrated efficacy and safety in the Effpac trial. The LUMIFOLLOW registry, a large-scale, prospective, multicenter study, aims to assess the real-world performance of Luminor in femoropopliteal lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;LUMIFOLLOW enrolled 542 patients with 580 lesions across 15 French centers. It included both de novo and restenotic lesions, with calcified and/or long occlusions. Primary endpoints were medical safety (defined as freedom from peri-procedural death, index limb amputation, and/or all-cause mortality) and efficacy (primary patency defined as freedom from target lesion revascularization (f-TLR) and/or binary restenosis); secondary endpoints included acute device success, procedural and clinical success, major adverse events, and functional assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean age was 71.2 years, with 67.2% male patients. Prevalent comorbidities included diabetes (42.6% n=231/542), hypertension (72.1%, n=391/542), hyperlipidemia (56.3%, n=305/542) and current smoking (27.2%, n=147/540); 23.8% were classified as Rutherford classification (RC) 2 (n=129/542), 43.2% as RC 3 (n=234/542), 16.8% as RC 4 (n=91/542) and 16.2% as RC 5 (n=88/542). Lesions were located in the superficial femoral artery (57.5%, n=329/572) and could extend to the popliteal artery (42.5%, n=243/572), with 43.6% classified TASC II C-D; 24.2% were restenosis (n=139/575) with a 44.3% rate of total occlusions (n=255/576). Mean lesion length was 140.55±99.42mm. Provisional stenting was required in 43.1% (n=249/580) with a mean stent length shorter than the initial lesion length at 87.21±42.30mm. The acute procedural success rate was 99.4% (n=536/539), with 2 in-hospital deaths and one thrombosis of target lesion. Acute clinical success was achieved in 93.5% (n=504/539). The 12-month composite safety endpoint was 82.7% (5.7% all-cause mortality, 0.7% index limb major amputation) and estimated primary patency was 87.4% (95%CI: 84.1;90.1%), with f-TLR at 96.2% (95%CI: 93.9;97.6%) and from target vessel revascularization at 94.9% (95%CI: 92.5;96.6%). The EQ-5D-5L questionnaire indicated significant improvements in quality of life at 12 months, with 67.4% improved mobility, 63.5% reduced pain and discomfort, and 47.8% enhanced usual activities. Walking Impairment Questionnaire scores increased significantly in walking distance, speed, and stair-climbing ability (from 31.4±24.7 to 62.5±31.0, p&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The LUMIFOLLOW registry demonstrates that Luminor DCBs are effective and safe for femoropopliteal interventions. The significant improvement in quality of life and walking ability, along with high primary patency and low complication rates, underscore the benefits of Luminor DCBs ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546198","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":"Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia.","authors":"Mohammed Hamouda, Sina Zarrintan, Nishita Vootukuru, Sneha Thandra, Jon G Quatromoni, Mahmoud B Malas, Ann C Gaffey","doi":"10.1016/j.jvs.2024.10.069","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.069","url":null,"abstract":"<p><strong>Objectives: </strong>The optimal conduit for infrainguinal bypass (IIB) is single segment great saphenous vein (GSV). Unfortunately, GSV is not always available in patients with chronic limb threatening ischemia (CLTI). Other graft choices include arm vein grafts (AV), prosthetic grafts (PG) or biologic grafts (BG). Current data regarding the durability and limb salvage rates of those options is scarce, hence we aimed to investigate the impact of alternative graft types on post-operative and long-term outcomes on IIB in patients with CLTI.</p><p><strong>Methods: </strong>The Vascular Quality Initiative (VQI) database was queried for patients undergoing IIB from January 2003 to April 2024. Patients were stratified into three groups: arm vein (cephalic, basilic), prosthetic grafts [Dacron, polytetrafluoroethylene (PTFE)], and biologic grafts (cadaveric, homograft, or xenograft). Saphenous vein grafts (greater and lesser saphenous) were excluded. Multivariate logistic regression analyzed postoperative outcomes: 30-day mortality, major adverse cardiovascular events (MACE), graft occlusion, prolonged length of stay >7days (PLOS), packed red blood cell (pRBC) transfusion >2 units, and infection. Cox Regression was used to report one-year outcomes: mortality, major amputation (above-ankle), and major adverse limb events (MALE defined as major amputation, thrombectomy or reintervention).</p><p><strong>Results: </strong>A total of 9165 IIB procedures have been analyzed: AV 417 (4.55%); PG 7520 (82.05%); BG 1228 (13.40%). Compared to AV, patients receiving PG had higher odds of infection (aOR 2.89, p=0.045) and higher hazard of one-year mortality (aHR 1.51, p=0.035). On the other hand, patients receiving BG had higher risk of graft occlusion (aOR 4.55, p=0.040) and infection (aOR 2.78, p=0.046) as well higher hazard of one-year mortality (aHR 1.53, p=0.040), amputation (aHR 1.72, p=0.019) and amputation or death (aHR 1.52, p=0.005) compared to AV. After stratifying by bypass configuration, AV had the highest overall survival and amputation-free survival among the three alternative conduits in below-knee popliteal and tibial bypass targets.</p><p><strong>Conclusions: </strong>In this large multi-institutional study investigating alternative conduits to GSV, AV are found to be the most resistant to infections and are associated with the best overall survival and limb salvage outcomes compared to PG and BG particularly in below-knee distal targets. In cases where no GSV is available, AV and PG are acceptable alternatives with comparable one-year amputation-free survival and MALE-free survival rates. On the other hand, BG are associated with higher risk of graft occlusion and lower freedom from major amputation and death compared to AV.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569042","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":"Whole aorta imaging shows increased risk for thoracic aortic aneurysms and dilatations in relatives of abdominal aortic aneurysm patients.","authors":"Heng Liu, Arne S IJpma, Jorg L de Bruin, Hence J M Verhagen, Jolien W Roos-Hesselink, Jos A Bekkers, Hennie T Brüggenwirth, Heleen M M van Beusekom, Danielle Majoor-Krakauer","doi":"10.1016/j.jvs.2024.10.067","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.067","url":null,"abstract":"<p><strong>Objective: </strong>For relatives of abdominal aortic aneurysm (AAA) patients, guidelines recommend abdominal imaging aimed at early detection and management of AAA, and do not include screening for thoracic aortic aneurysms (TAA). We aimed to investigate if TAA occur in undiagnosed relatives of AAA patients without a known genetic susceptibility for aneurysms, similar to families with identified genetic susceptibilities for aneurysms like in Marfan and Loeys-Dietz syndrome, where both AAA and TAA occur.</p><p><strong>Methods: </strong>Relatives of AAA patients were invited for non-contrast whole aorta CT screening. Systematic measurements of the CT scans were used to detect aneurysms and dilatations. Classification into familial and non-familial was based on reported family histories. In addition, aneurysm gene panel testing of AAA index cases was used for the classification of high vs unknown genetic risk (high genetic risk: familial aneurysm or a (likely) pathogenic variant (P/LP) in an aneurysm gene; unknown genetic risk: no family history or P/LP).</p><p><strong>Results: </strong>Whole aorta imaging of 301 relatives of 115 abdominal aortic aneurysm index-patients with non-contrast CT scans showed a 28-fold increase in thoracic aortic aneurysms in relatives (1.7%, p<0.001 versus the age adjusted population) and a high frequency of thoracic dilatations in 18% of the relatives. Thoracic aneurysms and dilatations in relatives occurred even when index patients were unaware of familial aneurysms. AAA was increased in the relatives compared to the age adjusted population (8%, p<0.001).</p><p><strong>Conclusions: </strong>An increased risk for thoracic aneurysms and dilatations was detected by whole aorta imaging of relatives of AAA index patients, even when index patients were unaware of familial aneurysms. These results indicate -still unknown- shared genetic susceptibilities for thoracic and abdominal aneurysms. Therefore, imaging of the whole aorta of relatives of all abdominal aneurysm patients, will improve early detection of aortic aneurysms in relatives of all AAA patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569044","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":"Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database.","authors":"Keyuree Satam, Anand Brahmandam, Xinyan Zheng, Jialin Mao, Philip Goodney, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.026","url":null,"abstract":"<p><strong>Introduction: </strong>The best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single center studies suggest open popliteal aneurysm repair (OPAR) is more durable than endovascular (EPAR), but large randomized multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the VQI-VISION database.</p><p><strong>Methods: </strong>Vascular Quality Initiative (VQI) Medicare-linked VISION database (2010-2019) for peripheral vascular interventions and infrainguinal bypass were reviewed for elective PAR. Patients undergoing OPAR and EPAR were propensity-matched to compare outcomes.</p><p><strong>Results: </strong>There were 1,159 PAA repairs (65.1% open). EPAR patients were older (77 vs 73 years, p<0.001) and more likely to be on P2Y12 inhibitors (26.5% vs 17.0%, p<0.001). After matching, there were 396 patients in each group with similar baseline characteristics. EPAR patients were more likely to be discharged home (87.6% vs 48.5%, p<0.001) and have shorter hospital length-of-stay (1 vs 3 days, p<0.001). Kaplan-Meier curves showed no difference in mortality, reintervention, or major amputation at 1, 3, and 5 years. Cox proportional hazards regression showed no significant association between revascularization strategy and mortality, reintervention, or major amputation. Subgroup analysis of patients undergoing OPAR with great saphenous vein (GSV) bypass compared to EPAR showed that OPAR with GSV bypass was associated with lower mortality without difference in reintervention or major amputation.</p><p><strong>Conclusion: </strong>Elective EPAR is durable and comparable to OPAR in terms of limb outcomes, even when GSV is used as conduit. However, bypass with GSV was associated with increased survival after open popliteal aneurysm repair compared to endovascular therapy.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502948","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":"Successful endovascular treatment for acute type A aortic dissection in a Jehovah's Witness patient.","authors":"Kei Mukawa, Tsuyoshi Shibata, Yutaka Iba, Ayaka Arihara, Kenta Yoshikawa, Nobuyoshi Kawaharada","doi":"10.1016/j.jvs.2024.10.023","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.023","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502952","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":"Operative Times and Outcomes of Complex Endovascular Repairs of Thoracoabdominal Aneurysms.","authors":"Ariela Zenilman, Tomaz Mesar, Virendra I Patel, Kirsten D Dansey, Marc Schermerhorn, Sara L Zettervall, Adam W Beck, Karan L Garg, Hiroo Takayama, Thomas Fx O'Donnell","doi":"10.1016/j.jvs.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.021","url":null,"abstract":"<p><strong>Introduction: </strong>Owing to the significant morbidity and mortality of open thoracoabdominal aortic aneurysm surgery, complex endovascular repairs (eTAAA) have become increasingly common, but still carry substantial risk. These repairs require large bore access, with resultant pelvic and lower extremity ischemia. We therefore hypothesized that operative timing would be associated with outcomes, as efficient surgery would limit the ischemic time as well as anesthesia time.</p><p><strong>Methods: </strong>We studied all eTAAA repairs (Crawford Types 1-3, 5) incorporating at least one branch vessel from 2014 to 2021 in the Vascular Quality Initiative, and categorized them into quartiles of total operating time. To account for variations in case complexity and intraoperative events, we performed a sub-analysis stratifying each surgeon by their median operating time. Multilevel logistic regression was employed to compare perioperative outcomes including mortality, thoracoabdominal life altering events (TALE:composite of perioperative death, stroke, permanent paralysis and/or dialysis), spinal cord ischemia (SCI), acute kidney injury (AKI), major adverse cardiac events (MACE), myocardial infarction, and dialysis.</p><p><strong>Results: </strong>There were 2,925 eTAAA repairs during the study period. Procedure times ranged from <204 minutes in the first quartile to >365 minutes in the fourth. Longer cases more commonly involved older patients who were more often female, and higher rates of prior stroke, and preoperative anemia. They involved larger, more extensive aneurysms, with higher rates of prior aortic surgery, and more commonly employed PMEGs or parallel grafting to incorporate more branch vessels. In addition, they were less often staged procedures, and used more spinal drains, femoral cutdowns, and upper extremity access. Operating time decreased as experience increased. In adjusted analyses, the odds of mortality and every morbidity studied increased stepwise with operating time, with 4 to 13-fold higher odds in the highest quartiles. Spinal cord ischemia had the strongest association with procedure times, with seven-fold higher odds (OR 7.2 [2.9-17.9], P<.001) of any SCI in the highest quartile compared to the lowest, and 13-fold higher odds of permanent SCI (OR 13.1 [3.9-44.7], P<.001). These results were consistent when surgeons were grouped into quartiles by their median operating times. Medium-term mortality was also higher in the upper quartile of operating time (HR 2.7 [1.4-5.1], P=.002).</p><p><strong>Conclusion: </strong>Longer operating times for complex eTAAA repairs were associated with markedly higher rates of morbidity and mortality, especially spinal cord ischemia. These results emphasize the importance of expeditious repairs by experienced teams.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502950","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":"Open and Endovascular Treatment of the Common Femoral Artery in a Tertiary Care Center.","authors":"Nicholas Wells, Addiskidan Hundito, McKenzie Tuttle, Dana Alameddine, Edouard Aboian, Isibor Arhuidese, Uwe Fischer, Juan Carlos Perez-Lozada, Raul J Guzman, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2024.10.027","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.027","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular treatment of peripheral arterial disease (PAD) involving the common femoral artery (CFA) remains controversial. This study compares the perioperative and long-term outcomes of open and endovascular lower extremity revascularization (LER) involving the CFA.</p><p><strong>Methods: </strong>A retrospective analysis of all patients undergoing LER for PAD in a tertiary-care center was performed. Patients were divided into the open or endovascular group based on the first LER that involved the CFA. Patient characteristics were compared, and outcomes analysis focused on the ipsilateral CFA reintervention rate. Multivariable regression was used to determine the association between the CFA revascularization strategy and CFA reintervention. Analysis was stratified based on indication.</p><p><strong>Results: </strong>A total of 1,954 patients underwent 4,879 LER (including all reinterventions) between 2013-2020. The CFA was treated in 22.9% of patients (N=447/1954) and 15.0% of LER procedures involved the CFA (N=734/4,879). Patients treated for CLTI were more likely to undergo open CFA treatment compared to patients with claudication (60.6% vs 42.7%, p<0.001). Patients treated for CLTI with endovascular therapy were more likely to be male compared to patients treated with open surgery (66.7% vs 51.2%, p=0.025). On the other hand, patients treated for claudication with endovascular therapy were more likely to have CAD (64.9% vs 50.5%, p=0.027) and diabetes (49.3% vs 33.0%, p=0.013) compared to open surgery. There was no difference in perioperative amputation or mortality but patients undergoing CFA endarterectomy were more likely to have post-operative bleeding in the claudication group as well as wound infections and longer hospital length of stay in both indication groups. On follow up, patients receiving endovascular LERs were more likely to require an ipsilateral CFA reintervention for both claudication (35.1% vs 21.0%, p=0.019) and CLTI (33.3% vs 20.9%, p=0.043) with no difference in major amputation or survival between the groups. Among claudicants, CFA endarterectomy was significantly more likely in patients initially treated with endovascular therapy (conversion to open endarterectomy) compared to patients initially treated with open surgery (redo endarterectomy) (14.9% vs 5.0%, p=0.015). Multivariable logistic regression revealed an independent association between endovascular therapy and CFA reintervention for claudication (OR= 2.29 [1.16-4.66]) and CLTI (OR=2.38 [1.18-4.90]). Kaplan-Meier analysis showed no difference in MALE-free survival.</p><p><strong>Conclusion: </strong>Endovascular treatment of the CFA is associated with higher reintervention of the CFA regardless of indication. CFA endarterectomy is associated with higher perioperative complications and longer hospital stay. Understanding the severity of CFA disease could improve patient selection for optimal therapy.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502949","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":"Prehabilitation for delirium prevention in elderly patients with chronic limb threatening ischemia.","authors":"Anne Lise Meulenbroek, Gerdjan Lanssens, Inge Fourneau, Matthijs G Buimer, Hans G W de Groot, Eelco J Veen, Gwan H Ho, Rebecca van Gorkom, Fleur Toonders, Ewout W Steyerberg, Miriam C Faes, Lijckle van der Laan, René van Alphen, Tobias Jiran, Karolien van Overveld, Mettie Pijl, Nathalie Verbogt","doi":"10.1016/j.jvs.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.024","url":null,"abstract":"<p><strong>Objective: </strong>Elderly patients with Chronic Limb Threatening Ischemia (CLTI) undergoing revascularization are prone to delirium and prolonged hospitalization. Preoperative prehabilitation may prevent delirium and reduce the length of stay. This study investigates the effect of multimodal prehabilitation on delirium incidence in elderly CLTI patients undergoing revascularization.</p><p><strong>Methods: </strong>A comparative observational cohort study conducted in a large teaching hospital (intervention cohort n=101, retrospective control cohort n=207) and a university hospital (prospective control cohort n=48) from 2020 to 2023. Patients aged ≥ 65 years undergoing revascularization were included, with acute treatment or severe cognitive impairment as exclusion criteria. The three-week prehabilitation program included screening of general health and presence of delirium risk factors by a vascular nurse practitioner, screening and provision of personalized, home-based exercises by a physiotherapist, provision of nutritional advice by a dietician, and if indicated comprehensive geriatric assessment by a geriatrician, assessment of self-reliance and home situation by a prearranged homecare nurse, guidance and support for smoking cessation by a quit smoking coach, and anaemia treatment. Primary outcome was 30-day delirium incidence, analysed using regression models adjusting for potential confounders (age, physical impairment, history of delirium, preoperative anaemia and revascularization type). Secondary outcomes were length of stay, postoperative complications, 30-day mortality, and patient experiences.</p><p><strong>Results: </strong>Median age (IQR) was 76 years (71-82). Delirium incidence was lower in the prehabilitation cohort (n=2/101, 2%) compared to controls (n=23/255, 9%; OR=0.21, 95%CI 0.05-0.89, p=.04). Adjusted analysis showed a non-significant delirium reduction (OR=0.28, 95%CI 0.06-1.3, p=.097). The prehabilitation cohort had a significantly shorter length of stay (2 [1-5] vs 4 [2-9] days; p=<.001), and fewer minor complications (14% vs 26%, p=.01). No differences were present in major complications and 30-day mortality. Patients reported high compliance and satisfaction (median score 8/10, IQR 7-9).</p><p><strong>Conclusions: </strong>Prehabilitation among elderly CLTI patients is safe and has the potential to yield multiple beneficial effects on general outcomes following revascularization, while also achieving high levels of patient satisfaction. Further validation and considering implementation in surgical settings is recommended.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502951","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":"Successful Factors for Improving Aortic Remodeling with Thoracic Endovascular Repair and Bare Stent Extension.","authors":"Mio Kasai, Kenichi Hashizume, Tadashi Matsuoka, Mitsuharu Mori, Toshiaki Yagami, Kiyoshi Koizumi, Hiroaki Kaneyama, Yuika Kameda, Tsutomu Nara, Mayu Nishida, Misato Tokioka, Hideyuki Shimizu","doi":"10.1016/j.jvs.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.025","url":null,"abstract":"<p><strong>Objective: </strong>Proximal ExTension to Induce COmplete ATtachment (PETTICOAT), which utilizes downstream bare metal stents for structural support, demonstrates potential, yet its adoption is limited by variable outcomes. This study elucidates the potential of PETTICOAT in aortic dissection, emphasizing the determinants that guide patient selection.</p><p><strong>Methods: </strong>A retrospective analysis of 60 patients who underwent full PETTICOAT for aortic dissections was conducted. A multivariate logistic regression model identified predictors of favorable aortic remodeling. Patients underwent standardized follow-up with CT scans to assess size, volumetric changes, and anatomical conditions. Selection criteria included full PETTICOAT application and a minimum three-month follow-up. Demographics, preoperative conditions, and procedural details were collected and analyzed.</p><p><strong>Results: </strong>The analysis identified predictors of favorable aortic remodeling, including age over 60, a larger downstream aorta stent graft, a smaller abdominal aorta (<450mm²), and oral angiotensin II receptor blocker (ARB) administration. Over a median 47.5-month follow-up, survival rates in the favorable remodeling (97.3%) and unfavorable groups (100%) were similar. Downstream aortic event-free survival rates did not significantly differ (89.2% vs. 73.9%), although the unfavorable group had a relatively higher incidence of distal stent-induced new entries (26.1% vs. 8.1%).</p><p><strong>Conclusions: </strong>The PETTICOAT concept effectively enhances aortic remodeling in complex aortic dissections. Predictors for favorable remodeling, including age, stent graft sizing, aortic diameter, and ARB therapy, offer insights for optimizing patient selection. This approach improves survival outcomes, mitigates risks associated with untreated aortic segments, and provides a minimally invasive solution for aortic dissections. Despite some outcome variations, the technique holds promise for addressing the challenges of aortic dissections, with the potential for further refinement in patient selection and technique application.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468758","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}