Journal of Vascular Surgery最新文献

{"title":"Comparative Effectiveness of Suction Thrombectomy vs. Catheter-Directed Thrombolysis in Intermediate-Risk Pulmonary Embolism.","authors":"Fanny S Alie-Cusson, Marissa Jarosinski, Katherine M Reitz, Pamela El Hayek, Hind Anan, Dana Semaan, Elizabeth Andraska, Belinda Rivera-Lebron, Rabih Chaer, Natalie D Sridharan","doi":"10.1016/j.jvs.2025.06.020","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.06.020","url":null,"abstract":"<p><strong>Objectives: </strong>Catheter-directed thrombolysis (CDT) has been shown to rapidly reverse hemodynamic and echocardiographic abnormalities seen in intermediate-risk pulmonary embolism (IRPE). Suction thrombectomy (ST) devices have emerged as alternative treatment modalities demonstrating immediate results, obviating the need for thrombolytics. Comparative data between the two methods are sparse.</p><p><strong>Methods: </strong>We retrospectively reviewed interventions for IRPE (CDT or ST) at a multihospital healthcare system (2017-2022). IRPE was defined by evidence of right heart strain (RHS) on imaging (echocardiogram and/or CT-angiography) or elevated biomarkers (troponin or B-natriuretic peptide). Patients with high-risk PE (systolic blood pressure<90 mm Hg) or those who received systemic thrombolytics were excluded. The primary endpoint was a composite of 7-day all-cause mortality, intracranial bleeding, major bleeding, clinical deterioration and/or need for bailout therapy. Secondary outcomes included the primary endpoint individual components, intensive care unit length-of-stay (ICULOS), 30-day mortality and resolution of RHS at 3 months. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances between groups, generating weighted odds ratios (wOR).</p><p><strong>Results: </strong>332 patients were included with 152 CDT and 180 ST. IPTW successfully balanced baseline differences between groups (Table I). On univariable analysis, the primary outcome did not differ between groups (CDT 6.6% vs ST 12.8%; p=0.06), but ST was associated with increased 30-day mortality (CDT 1.3% vs ST 5.5%, p=0.039) and the need for bailout intervention (CDT 4.6% vs ST 11.1%, p=0.031). Major bleeding occurred in 3.3% CDT vs 2.2% ST (p=0.551). There were no intracranial bleeds. Post-IPTW analysis showed a significantly higher rate of the primary outcome in the ST group (wOR 4.4, 95% CI [1.27-15.3], p=0.02). There were no differences in 7-day mortality, 30-day mortality, major bleeding or intracranial bleeding. The need for bailout intervention was significantly higher in the ST group (wOR 3.7, 95% CI [1.04-13.4], p=0.044). The use of ST was significantly associated with resolution of RHS (wOR 3.46, 95% CI [1.32-9.11], p=0.012).</p><p><strong>Conclusion: </strong>ST is associated with significantly increased odds of the primary outcome in patients with IRPE when compared to CDT after IPTW. These results were mainly driven by the bailout intervention rate. There was no statistically significant reduction in major bleeding or ICULOS compared to CDT. RHS resolved more frequently in patients after ST suggesting there may be benefit to rapid thrombus removal in appropriately selected IPRE patients despite the increased need for bailout therapy. CDT should remain an integral part of the interventional armamentarium in IRPE.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340252","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":"Development and validation of a novel prognostic score to improve prognostic prediction in patients with type B aortic dissection.","authors":"Xingfeng Chen, Linfeng Xie, Qingsong Wu, Siying Luo, Zhisheng Wang, Yikun Jiang, Xinfan Lin, Xu Han, Zhihuang Qiu, Liangwan Chen","doi":"10.1016/j.jvs.2025.06.018","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.06.018","url":null,"abstract":"<p><strong>Objective: </strong>Type B aortic dissection (TBAD) is a life-threatening aortic disease with an increasing incidence, which requires accurate risk stratification tools for thoracic endovascular aortic repair (TEVAR). This multicenter retrospective study aimed to enhance the risk prediction of severe adverse events(SAEs) post TEVAR in TBAD patients by improving the Age, Creatinine, and Ejection Fraction (ACEF) score.</p><p><strong>Methods: </strong>This multicenter retrospective study enrolled 547 patients with TBAD who underwent TEVAR between 2015 and 2020. The training cohort (n=382) from Fujian Medical University Union Hospital was used for model development, while the validation cohort(n=165) from two external centers evaluated performance. Independent risk factors were identified using multivariate logistic regression. The novel composite risk score (ACEF-TBAD) combined Age, Creatinine and Ejection Fraction with Hypertension, D-dimer/Fibrinogen Ratio (DFR), and Interleukin-6 (IL-6). Model performance was assessed using receiver operating characteristic curve (ROC), calibration curves, decision curve analysis, and reclassification indices.</p><p><strong>Results: </strong>The ACEF-TBAD score demonstrated superior predictive accuracy compared to the original ACEF, modified ACEF, and EuroSCORE II models, with area under the curve (AUC) value of 0.922 in the training dataset and 0.829 in the validation dataset. Key determinants included hypertension (odds ratio[OR] 4.84, 95% confidence interval[CI] 2.03-11.58, p<0.001), D-dimer/Fibrinogen Ratio (OR 1.30, 95% CI 1.16-1.45, p<0.001), ACEF score (OR 4.05, 95% CI 1.76-9.32, p=0.001), and Interleukin-6 (OR 1.41, 95% CI 1.11-2.32, p<0.001). The score showed excellent calibration (p>0.05) and net clinical benefit (decision curve analysis curve). Reclassification analysis revealed significant improvements in risk stratification (Net Reclassification Index 0.366 in training, 0.206 in validation). The survival curves clearly demonstrated that the ACEF-TBAD score effectively stratified patients into distinct risk categories, which underscores the clinical utility of the ACEF-TBAD score in predicting SAEs and supports its use in risk assessment for TBAD patients.</p><p><strong>Conclusions: </strong>The ACEF-TBAD score is a novel and simple risk-stratification tool. This enables early identification of high-risk patients, facilitating personalized treatment and improving patient outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336683","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":"Anatomic Profile of Arterial Occlusive Disease in the BEST-CLI Trial.","authors":"Katharine L McGinigle, Christina W Zhou, Nikki L B Freeman, Michael S Conte, Michael B Strong, Neal Barshes, Marc Bonaca, Alik Farber, Kenneth Rosenfield, Matthew T Menard","doi":"10.1016/j.jvs.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.06.019","url":null,"abstract":"<p><strong>Objective: </strong>The results of BEST-CLI trial indicated that when eligible for both open surgical or endovascular therapy, a single segment great saphenous vein bypass is the superior revascularization strategy for patients with chronic limb threatening ischemia (CLTI). Having detailed anatomic information about the burden of arterial occlusive disease is important in understanding the technical difficulty of the cases performed in the trial, and what trial investigators considered equally suitable for either revascularization strategy.</p><p><strong>Methods: </strong>The BEST-CLI trial, an international multi-site randomized controlled trial (RCT) comparing endovascular to open surgical revascularization in patients who were candidates for both, was analyzed. At the time of each participant's trial enrollment, anatomic location and the degree of arterial occlusive disease was characterized by the combination of stenosis severity (<50%, 50-69%, 70-99%, occluded). Participants were classified as having severe arterial occlusive disease in a vessel segment if they had 70-99% stenosis or a chronic total occlusion. Descriptive statistics and data visualization were used for the analysis of the entire BEST-CLI trial cohort.</p><p><strong>Results: </strong>Of the 1830 BEST-CLI trial participants, 1786 (98%) had severe arterial occlusive disease in at least one infrainguinal artery. There were no differences in observed severity or patterns of occluded vessel segments between the open surgical and endovascular treatment groups, indicating that randomization was effective with regard to anatomic complexity. Long-segment disease was predominant regardless of whether patients had arterial occlusive disease in femoral, popliteal, or tibial segments, or a combination of those vessels. Forty-four percent of patients had total occlusions in more than one artery and 9.5% had total occlusions in all three femoral, popliteal, and tibial arterial segments. Only 17.1% of patients had isolated femoropopliteal disease. Nearly half of the participants with multi-level or isolated tibial disease (46.2% and 48.7%, respectively) had concomitant pedal arterial occlusive disease.</p><p><strong>Conclusion: </strong>The subjects enrolled in the BEST-CLI trial had multi-focal and severe atherosclerosis throughout the infrainguinal arterial tree.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336682","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":"Editor's Choice – A European Delphi Consensus on the Management of Abdominal Aortic Aneurysms in Patients with Heritable Aortic Diseases","authors":"D. Gil-Sala,&nbsp;J. De Backer,&nbsp;I. Van Herzeele,&nbsp;G. Teixidó-Tura,&nbsp;A. Wanhainen,&nbsp;S. Bellmunt-Montoya,&nbsp;Consensus Participants","doi":"10.1016/j.jvs.2025.04.047","DOIUrl":"10.1016/j.jvs.2025.04.047","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page 295"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298794","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 Quality of Life, Health Status, and Residential Destination after Emergency Abdominal Aortic Aneurysm Repair","authors":"T.F.C.M. Nederstigt,&nbsp;D. van der Veen,&nbsp;J.-W.H.P. Lardenoije,&nbsp;M.M.P.J. Reijnen","doi":"10.1016/j.jvs.2025.04.050","DOIUrl":"10.1016/j.jvs.2025.04.050","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page 296"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298792","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":"Trends in the utilization of drug-eluting stents to treat femoropopliteal peripheral artery disease","authors":"D. Kadian-Dodov,&nbsp;A.O. Williams,&nbsp;R. Sato,&nbsp;L. Vang,&nbsp;M.R. Jaff","doi":"10.1016/j.jvs.2025.04.055","DOIUrl":"10.1016/j.jvs.2025.04.055","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page A16"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298490","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":"Thoracic outlet syndrome in division 1 athletes: Ready for prime time","authors":"Jason T. Lee MD","doi":"10.1016/j.jvs.2025.03.187","DOIUrl":"10.1016/j.jvs.2025.03.187","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page 163"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298849","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":"Effect of Skin Closure with Metal Staples vs. Intradermal Suture on Groin Infections after Vascular Surgery: A Randomised Controlled Trial","authors":"V. Nikulainen,&nbsp;P. Helmiö,&nbsp;P. Salminen,&nbsp;S. Hurme,&nbsp;T. Kukkonen,&nbsp;T. Koskinen,&nbsp;H. Hakovirta","doi":"10.1016/j.jvs.2025.04.051","DOIUrl":"10.1016/j.jvs.2025.04.051","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page 296"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297075","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":"Delayed bridging stent placement for rescue of spinal cord ischemia during complex endovascular repair of thoracoabdominal aortic aneurysms","authors":"M.H. Parker,&nbsp;M.C. Soult,&nbsp;C.F. Bechara","doi":"10.1016/j.jvs.2025.04.053","DOIUrl":"10.1016/j.jvs.2025.04.053","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page A15"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298488","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":"Employing the Vascular Quality Initiative to improve outcomes in everyday clinical practice","authors":"Benjamin S. Brooke MD, PhD, DFSVS","doi":"10.1016/j.jvs.2025.02.005","DOIUrl":"10.1016/j.jvs.2025.02.005","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Page 257"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298790","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}