Journal of Vascular Surgery最新文献

{"title":"Infection of an NBCA-Embolized Internal Iliac Artery Aneurysm after EVAR Requiring Radical Surgical Salvage.","authors":"Takuya Narita, Hiroshi Okada, Daisuke Ishii","doi":"10.1016/j.jvs.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.10.011","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224541","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":"Implementation of the Universal Femoral Access Protocol Decreases Complications of Peripheral Vascular Interventions.","authors":"Ocean Setia, Joshua Huttler, Martin Slade, Samuel Hahn, Carlos Mena-Hurtado, Robert Attaran, Charles Matouk, Juan Carlos Perez-Lozada, Edouard Aboian, Jonathan Cardella, Raul J Guzman, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.10.010","url":null,"abstract":"<p><strong>Objectives: </strong>Common femoral artery (CFA) is the most common access site for peripheral vascular interventions (PVI). Ultrasound (US) use has been shown to decrease access-related complications. However, the recommended site for femoral artery puncture has not been well defined, and the access technique varies significantly based on the operator specialty and training. This study describes the development of a multidisciplinary universal femoral access (UFA) protocol and its implementation at a tertiary care centre.</p><p><strong>Methods: </strong>Femoral artery access zones in relation to the femoral head were described based on prior cadaveric groin dissection study. The UFA was developed with an emphasis on dual image guidance using US and fluoroscopy for optimal access. A technical video was created and shared with the specialists and trainees performing PVI, and via online platforms. A single center retrospective review of pre-UFA patients from September 2020 to November 2020 and post-UFA patients from September 2022 to November 2022 was conducted. The institutional Vascular Quality Initiative database was used to compare patient characteristics and access complications before the development of the UFA (pre-UFA) and after its implementation (post-UFA). All fluoroscopic images of the procedures were retrospectively reviewed to assess the needle location and use of dual imaging guidance during PVI.</p><p><strong>Results: </strong>A total of 375 procedures were analysed with 63.2% in the pre-UFA group (n=237). After the implementation of the UFA, the rate of overall access complications significantly decreased from 12.7% pre-UFA vs 5.1% post-UFA, p=0.019. There was a statistically significant decrease in thrombotic complications (3.7% pre-UFA vs 0% post-UFA, p=0.029), with a trend towards a decrease in the bleeding rates without reaching a statistical significance (9.3% pre-UFA vs 5.1% post-UFA, p=0.154). A significant increase in the use of dual image guidance was observed in the post-UFA group (27.4% pre-UFA vs 55.8% post-UFA, p<0.001).</p><p><strong>Conclusions: </strong>The UFA protocol emphasizing use of dual image guidance and a comprehensive understanding of femoral anatomy can reduce access site complications during PVI. Expansion of the UFA to other procedures using femoral artery access and to other institutions can improve patient care.</p><p><strong>Clinical relevance: </strong>CFA access can lead to limb or life-threatening complications. Understanding of the femoral anatomy, and optimization of access technique with dual imaging can reduce complications. This study highlights the importance of establishing a standardized femoral access protocol to improve patient outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207228","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":"ArtAssist Sequential Compression Biomechanical Device as a Cost-Dominant Limb-Salvage Strategy for No-Option Chronic Limb-Threatening Ischaemia: A Decade and Half, Single-Centre Cohort Study with Health Economic and Q-TWiST Analysis.","authors":"Sherif Sultan, Asimina-Sissy Tsapara, Peter Harrison, Henri Bartolozzi, Adam Sultan, Liam Kilraine, Mohamed Modawi, Abdul-Rahman Albader, Anwer Gowey, William Wijns, Osama Soliman","doi":"10.1016/j.jvs.2026.09.051","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.051","url":null,"abstract":"<p><strong>Background: </strong>Major lower limb amputation for no-option chronic limb-threatening ischaemia (CLTI) costs the Irish Health Service Executive (HSE) a median €88,820 per patient; long-term health economic and quality-adjusted survival evidence for ArtAssist SCBD is lacking.</p><p><strong>Methods: </strong>Longitudinal cohort analysis of 428 patients with non-reconstructible CLTI managed with ArtAssist SCBD at a single tertiary centre (January 2008-June 2025). Primary endpoints were limb salvage, cost-effectiveness versus primary amputation, and Q-TWiST. Kaplan-Meier analysis of limb salvage, multivariable Cox regression for major amputation, competing-risks analysis, and health economic modelling using contemporaneous cost data were performed.</p><p><strong>Findings: </strong>Overall crude limb salvage, defined as freedom from major amputation, was achieved in 85% (294/347 patients). At last follow-up, 48% of patients were alive without major amputation. Kaplan-Meier estimated 5-year limb salvage at 95%. The cumulative incidence of major amputation at 5 years was 8% when accounting for death as a competing event, confirming durable limb preservation despite substantial long-term mortality in this elderly, comorbid population. Male sex, hypertension, and ischaemic heart disease independently predicted major amputation or limb-salvage failure (HRs 1·70, 1·80, 1·71; all P ≤ ·012). Comorbidity burden showed a dose-response relationship (P = ·008). 90-day rental (€1,373/patient) reduced total expenditure six-fold versus primary amputation (€5·3M vs €30·8M), saving €76,500/patient. Q-TWiST yielded a gain of 3·37 QALYs per patient; ICER €21,900/QALY confirms a dominant strategy.</p><p><strong>Interpretation: </strong>ArtAssist SCBD achieves a six-fold reduction in costs versus primary amputation, +3·37 QALYs/patient, and an ICER of €21,900/QALY a dominant strategy supported by durable limb preservation, with 85% overall crude limb salvage and an estimated 5-year limb salvage of approximately 95% in the largest single-centre cohort reported. These findings support universal commissioning of ArtAssist SCBD for non-reconstructible CLTI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207295","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":"EARLY STROKE AFTER AORTIC ARCH REPAIR: COMPARATIVE AND PROPORTIONAL META-ANALYSES OF OPEN, HYBRID, AND TOTAL ENDOVASCULAR STRATEGIES.","authors":"M Lourdes Del Río Solá, Marina Jiménez Caja, Clara de la Torre Casaseca, Eva Álvarez García, Carlos García Padrón, Sandra Pérez Fernández","doi":"10.1016/j.jvs.2026.09.048","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.048","url":null,"abstract":"<p><strong>Objective: </strong>Early stroke remains one of the most devastating complications after aortic arch repair. This systematic review and meta-analysis evaluated early stroke after open, hybrid, and total endovascular aortic arch repair using separate comparative and proportional frameworks.</p><p><strong>Methods: </strong>PubMed, Scopus, and Web of Science were searched from inception through July 27, 2026. Observational studies reporting neurological outcomes after adult open, hybrid, or total endovascular aortic arch repair were included. The primary comparative meta-analysis pooled propensity score-matched or weighted studies comparing hybrid with open repair using random-effects restricted maximum likelihood models with Hartung-Knapp adjustment. Separate proportional random-effects meta-analyses estimated pooled stroke incidences for each strategy. Risk of bias was assessed using ROBINS-I and the Joanna. Briggs Institute Critical Appraisal Checklist. The protocol was prospectively registered in PROSPERO (CRD420261461659).</p><p><strong>Results: </strong>Thirty-four studies were included. Seven propensity score-matched or weighted cohorts comprising 948 patients (474 open and 474 hybrid repairs) contributed to the primary comparative meta-analysis. No significant difference in early stroke was identified between hybrid and open repair (OR 1.99, 95% CI 0.46-8.58; P=.292; I²=52.9%). Post hoc comparative analyses restricted to dissection cohorts (3 cohorts; 572 patients) and Zone 0 hybrid repair (3 cohorts; 448 patients) were also inconclusive and highly imprecise. In descriptive proportional analyses, pooled early-stroke incidences were 5.3% after open, 7.5% after hybrid, and 6.4% after total endovascular repair. Technique-stratified incidences were 6.1% for conventional open repair, 4.4% for open repair with frozen elephant trunk, and 5.3% for branched total endovascular repair.</p><p><strong>Conclusion: </strong>Adjusted comparative evidence showed no significant difference in early stroke between hybrid and open aortic arch repair. Evidence for total endovascular repair remains predominantly non-comparative. Treatment should be individualised according to aortic pathology, urgency, anatomy, operative risk, and institutional expertise.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207266","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":"Limb Salvage is Possible in Select Patients with Arterial Injuries and Elevated Mangled Extremity Severity Scores.","authors":"Priscilla Tanamal, William Delahoussaye, Claudia Leonardi, Marie Unruh, Amit Chawla, Malachi Sheahan, Claudie Sheahan","doi":"10.1016/j.jvs.2026.08.045","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.08.045","url":null,"abstract":"<p><strong>Introduction: </strong>Lower extremity trauma with vascular compromise is frequently associated with other injuries and requires emergent and complex decision-making. The Mangled Extremity Severity Score (MESS) is widely utilized to predict the need for amputation in these cases. As the tool was developed over 30 years ago, its accuracy in a modern trauma setting remains a topic of investigation and discussion. The purpose of this study was to investigate the correlation of an elevated MESS with the need for amputation in patients with traumatic lower extremity arterial injuries.</p><p><strong>Methods: </strong>A retrospective chart review was performed on patients ≥18 years old with traumatic lower extremity arterial injuries at a level I trauma center from July 2012 to December 2023. Demographics, injury characteristics, interventions, and outcomes including amputation upon presentation, amputation during hospitalization, and amputation after discharge following limb salvage attempts were recorded.</p><p><strong>Results: </strong>In our cohort of 238 limbs with lower extremity arterial injury, median age was 33 years and majority of the patients were male (84.1%). The predominant mechanism was penetrating (65.1%). Eighty-four lower extremity injures had concomitant injuries (35.3%). The median MESS was 5 (IQR 3-6). Vascular repair was performed on 179 lower limbs (75.2%); 168 were open repairs (93.9%), nine endovascular (5.0%), and two hybrid (1.1%). Ninety-two limbs underwent concomitant orthopedic repair (38.7%). Six limbs underwent primary amputation (2.5%) after multidisciplinary consensus, all of which had a MESS ≥7. Of the 179 lower limbs that underwent vascular repair, 8.4% required amputation prior to discharge, and another 2.8% after discharge. Thirty-three lower extremities with a MESS ≥7 underwent vascular repair. The majority did not require a subsequent amputation (22/33, 66.7%). In the entire cohort, a MESS ≥ 7 was found to be significantly associated with any amputation (P<.0001) when compared to MESS <7. MESS ≥7 had significantly greater odds of amputation in both univariable (OR = 10.6; 95% CI: 4.65-24.1; p<0.0001) and multivariable analysis after adjusting for age, ischemia time, mechanism of injury, concomitant injuries, arterial injury location, and fracture status (aOR = 5.40; 95% CI: 1.79-16.3; p=0.003).</p><p><strong>Conclusion: </strong>Lower extremity arterial injuries are frequently associated with complex orthopedic and soft tissue trauma. An increasing MESS, blunt mechanism, and the presence of multiple vascular injuries are significantly associated with the risk of limb loss. While a MESS of 7 or greater is predictive of an increased risk of amputation, limb salvage can still be achieved in many patients with prompt vascular repair despite high MESS.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195047","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":"Reintervention Burden and Patency of Hemodialysis Vascular Access in a 15-Year Single-Center Cohort.","authors":"Sungsin Cho, Jin Hyun Joh","doi":"10.1016/j.jvs.2026.09.050","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.050","url":null,"abstract":"<p><strong>Objective: </strong>Maintaining a hemodialysis access typically requires repeated intervention, yet the cumulative reintervention burden-as distinct from patency-is rarely quantified, and configuration-specific estimates from Asian centers are scarce. We evaluated patency and quantified the configuration-specific reintervention burden of upper-extremity arteriovenous accesses over 15 years at a single center.</p><p><strong>Methods: </strong>We retrospectively analyzed 871 consecutive upper-extremity arteriovenous accesses (648 fistulas; 223 grafts) created in 810 patients between 2009 and 2024. Every subsequent procedure was adjudicated from operative records as patency-maintaining or access-abandoning; operations unrelated to the access under study, including kidney transplantation, catheter procedures, and peripheral arterial interventions, were excluded. Patency was estimated by the Kaplan-Meier method according to accepted reporting standards and compared across configurations-radiocephalic fistula, brachiocephalic fistula, basilic vein transposition, and graft. The reintervention burden was expressed as interventions per access-year. Predictors of loss of primary patency were assessed by multivariable Cox regression, and a competing-risk analysis treated kidney transplantation as a competing event.</p><p><strong>Results: </strong>Median follow-up was 14.7 months. Overall primary, assisted-primary, and secondary patency were 60.3%, 50.5%, and 44.6%; 87.1%, 81.5%, and 77.1%; and 96.8%, 95.7%, and 94.1% at 1, 2, and 3 years, respectively. One-year primary patency differed by configuration: 70.1% for radiocephalic fistulas, 63.3% for brachiocephalic fistulas, 71.6% for basilic vein transpositions, and 36.2% for grafts (P < .001). Across 2211 access-years, 743 patency-maintaining interventions were performed (0.336 per access-year), and 37.2% of accesses required at least one reintervention. The burden was concentrated in grafts: 1.09 interventions per access-year for grafts versus 0.25 for autogenous fistulas, an approximately 4.4-fold difference. Graft configuration (hazard ratio, 2.39; 95% confidence interval, 1.86-3.06), female sex (1.37; 1.10-1.71), ischemic heart disease (1.42; 1.04-1.94), and diabetes (1.26; 1.00-1.57) independently predicted loss of primary patency. Findings persisted after excluding maturation-assisting procedures and in the competing-risk analysis (graft subdistribution hazard ratio for reintervention, 2.32).</p><p><strong>Conclusions: </strong>High secondary patency was achieved at the cost of substantial reintervention concentrated in grafts, which required roughly 4.4 times the maintenance of autogenous fistulas. Reporting an explicit reintervention burden alongside patency supports autogenous-first, configuration-aware access planning and patient counseling.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195050","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":"In-hospital vascular surgery consultation is associated with improved follow-up and earlier identification of aneurysmal degeneration after acute Type A aortic dissection.","authors":"Blake E Murphy, Amanda E Lee, Kyle W Stone, Scott C DeRoo, Christopher R Burke, Matthew C Smith, Matthew P Sweet, Sara L Zettervall","doi":"10.1016/j.jvs.2026.09.047","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.047","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Acute Type A aortic dissections (TAAD) are historically managed by cardiac surgery. However, subsequent treatment of residual dissection within the thoracoabdominal aorta often requires vascular surgical intervention and lifelong surveillance. This study assesses long-term outcomes by completeness of follow-up after operative intervention for acute TAAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent surgical intervention for acute TAAD from 2014 to 2025 were identified. Patients who experienced death within 30-days or those with dissection limited to Zone 0/Zone 1 were excluded. Vascular surgery evaluation and time to consultation (index-hospitalization, outpatient, none) was documented. Follow-up was classified as complete, incomplete, or lost (LTF) according to the frequency of contrasted thoracoabdominal imaging, consistent with clinical practice guidelines. Trends in completeness of follow-up were described. Demographics, anatomic/operative characteristics, and perioperative outcomes were compared between complete follow-up and incomplete follow-up/LTF groups. Long-term outcomes (aortic degeneration, planned secondary intervention, survival) were assessed with Kaplan-Meier and multivariable Cox regression analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;241 patients were included; 80% had vascular surgery consultation (70% inpatient, 30% outpatient) and 86% of consultations occurred within 1-year of index procedure. In total, 46% of patients had complete follow-up, 41% had incomplete follow-up, and 13% were LTF. In-hospital consultation increased by 58% over the study period. Demographics, comorbidities, and anatomic characteristics were similar between groups. Patients with complete follow-up had higher rates of complex arch repair (Zone 1-3) (complete 56% vs. incomplete/LTF 27%, p&lt;0.001), were more likely to undergo genetic testing (complete 52% vs. incomplete/LTF 18%, p&lt;0.001), in-hospital TEVAR extension (7% vs. 2%, p=0.028), and TEVAR extension within 3 months (complete 17% vs. incomplete/LTF 5%, p=0.002). In time-to-event analysis, complete follow-up was associated with more planned secondary interventions (complete: 12% vs. incomplete: 5%, p=0.007) and identified aneurysmal degeneration (32% vs. 15%, p=0.002) within 1-year of acute dissection. Long-term survival differed by completeness of follow-up; 1-year (complete: 97% vs. incomplete: 97% vs. LTF: 91%), 3-years (complete: 92% vs. incomplete: 95% vs. LTF: 81%, p=0.021). There were no aortic-related deaths for patients with complete follow-up and five aortic-related deaths (5%) in patients with incomplete follow-up (p=0.13). In-hospital vascular surgery consultation was associated with complete follow-up (HR 2.87, 95% CI 1.6-5.1) and planned secondary interventions (HR 2.07, 95% CI 1.1-3.9).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Vascular surgery consultation is associated with increased identification of aneurysmal degeneration, planned secondary interven","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194934","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":"Endoscopic versus open great saphenous vein harvesting for lower extremity arterial bypass: A systematic review, meta-analysis and meta-regression.","authors":"Mihaela Ioana Maris, Ahmed Eissa-Garces, Gabriel Cedeño Pérez, Asimina Tsapara, Dario Madera, Mihaela-Flavia Avram, Karen Ho, Ahsley Vavra, Tulio Navarro, Lara Lopes","doi":"10.1016/j.jvs.2026.09.040","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.040","url":null,"abstract":"<p><strong>Objective: </strong>To compare postoperative outcomes of patients undergoing lower extremity arterial bypass (LEAB) for peripheral artery disease (PAD) with endoscopic great saphenous vein harvest (EVH) versus open vein harvest (OVH), and to investigate the impact of publication year on bypass patency.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception through January 2025 for comparative studies of EVH versus OVH in LEAB. Individual patient data were reconstructed from Kaplan-Meier curves and analysed using Cox proportional hazards models. Binary and continuous outcomes were pooled using random-effects models. Meta-regression and subgroup analyses by publication year (≤2015 vs >2015) were performed to explore temporal trends in patency.</p><p><strong>Results: </strong>Thirteen retrospective cohort studies comprising 12 401 patients were included. EVH was associated with higher risk of primary patency loss compared with OVH (HR 1.32; 95% CI 1.04-1.68; p=.030) and a borderline longer operative time (MD 58.98 minutes; 95% CI 0.63-117.32; p=.050; I²=96%), but significantly lower wound complications (RR 0.68; 95% CI 0.57-0.80; p<.001). No differences were observed in primary-assisted patency, secondary patency, length of stay, major amputation, limb salvage, or mortality. Subgroup analysis showed that the primary patency disadvantage was driven by studies published up to 2015 (HR 1.49; p=.010), with no significant difference in studies published after 2015 (HR 0.97; p=.900), although the interaction test was not significant (p=.100). Meta-regression did not demonstrate an association between publication year and primary patency effect size (p=.890).</p><p><strong>Conclusion: </strong>EVH significantly reduces wound complications but is associated with lower primary patency and potentially longer operative times compared with OVH, disadvantages that do not translate into differences in secondary patency, limb salvage, major amputation, or mortality. Further prospective studies are needed to define the role of EVH to better inform LEAB operative planning.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182701","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":"Clinical Outcomes of Transperitoneal vs Retroperitoneal Approaches of Open Aortic Repair for Abdominal Aortic Aneurysm Stratified by the Iliac Bifurcation Involvement.","authors":"Narek Veranyan, Dong-Jin E Kang Sim, Sadia Ilyas, Sophie Wang, Ahmed Abou-Zamzam, Mahmoud B Malas","doi":"10.1016/j.jvs.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.10.005","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Aortic aneurysm involving the iliac bifurcation (AAAIB) is associated with higher rates of systemic comorbidities and increased complexity of open aortic repair (OAR), resulting in worse outcomes compared to OAR for isolated abdominal aortic aneurysm (IAAA). The Society for Vascular Surgery (SVS) practice guidelines recommend the retroperitoneal approach (RPA) for OAR in certain patients with abdominal aortic aneurysm (AAA). However, there is limited evidence to determine whether the relative advantages and disadvantages of RPA and the transperitoneal approach (TPA) change depending on whether the aneurysm distally involves the iliac bifurcation. This study aims to compare the outcomes of TPA and RPA for AAA, stratified by the iliac bifurcation involvement, in a multi-institutional, real-world setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The SVS Vascular Quality Initiative (VQI) database was queried for patients who underwent OAR for AAA from January 2003 to September 2024. Patients were stratified as AAAIB or IAAA based on whether the aneurysm involved the iliac bifurcation and required a distal anastomosis beyond the common iliac artery (CIA) bifurcation, or not. Baseline characteristics, as well as outcomes such as overall 30-day mortality, Major Adverse Cardiovascular Events (MACE: death, myocardial infarction, stroke), and 1-year survival, were compared between the TPA and RPA groups in patients with IAAA and AAAIB. Univariable and multivariable analyses, as well as a confirmatory analysis with inverse probability-weighted regression (IPWR), were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of all reviewed patients, 17,009 were included in the final analysis, of whom 15,218 (89.5%) had IAAA, and 1,791 (10.5%) had AAAIB. Among patients with IAAA, compared to RPA, TPA was associated with higher odds of overall 30-day mortality (OR: 1.26, 95%CI: 1.05-1.49, p=0.011), MACE (OR: 1.26, 95%CI: 1.11-1.44, p=0.001), and a lower 1-year survival rate (HR: 1.23, 95%CI: 1.09-1.39, p=0.001). Among patients with AAAIB, TPA was associated with lower odds of lower extremity (LE) ischemia (OR: 0.47, 95%CI: 0.25-0.91, p=0.024) without significant differences in 30-day mortality (OR: 0.80, 95%CI: 0.42-1.51, p=0.485), MACE (OR: 0.86, 95%CI: 0.52-1.42, p=0.563), and 1-year survival (HR: 0.93, 95%CI: 0.59-1.47, p=0.768).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this real-world study, involvement of the iliac bifurcation in AAA was an effect modifier for the outcomes of different OAR approaches. For patients with IAAA, compared with RPA, TPA was associated with worse 30-day mortality, MACE, and 1-year survival. Whereas for patients with AAAIB, TPA was associated with lower odds of LE ischemia, without significant differences in 30-day mortality, MACE, or 1-year survival. This study suggests that RPA may be the procedure of choice for IAAA if it is otherwise feasible. However, TPA may be the procedure of choice for patients with AAAIB who are ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182622","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 among Patients with Single-Vessel Tibial Runoff Undergoing Revascularization for Chronic Limb-Threatening Ischemia, and the Role of Peroneal Communicating Branch Quality.","authors":"Jeremy D Darling, Camila R Guetter, Leigh Friedman, Michael A Ciaramella, Isa F van Galen, Christina Marcaccio, Patric Liang, Andy Lee, Lars Stangenberg, Mark C Wyers, Allen D Hamdan, Marc L Schermerhorn","doi":"10.1016/j.jvs.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.10.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Data evaluating outcomes among patients with single-vessel tibial runoff are limited. Our aim was to compare outcomes across patients with sole anterior tibial (AT), peroneal, or posterior tibial (PT) runoff following revascularization for chronic limb-threatening ischemia (CLTI), and to evaluate whether the quality of peroneal communicating branches affects outcome risk within the peroneal runoff population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients undergoing first-time revascularization for CLTI were retrospectively reviewed (2005-2022) and stratified by sole runoff vessel (AT, peroneal, PT). Primary outcomes were wound healing, major amputation, major adverse limb events (MALE), and amputation/death, assessed by Kaplan-Meier analysis and multivariable Cox regression. A subset analysis stratified single-vessel peroneal runoff patients into a three-tiered, Peroneal Communicating Branch (PCB) Grade: Both branches present with at least one robust (PCB Grade 1), a single robust branch (PCB Grade 2), or no robust branch (PCB Grade 3), and compared each to the single-vessel AT/PT reference group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 732 patients had single-vessel below-knee runoff: 225 AT, 315 peroneal, and 192 PT. Groups differed significantly in age, sex, and diabetes prevalence. Unadjusted two-year major amputation rates were significantly higher in the peroneal group (19% vs. 9.4% [AT] vs. 8.7% [PT]; P&lt;.001), as were MALE rates (30% vs. 14% vs. 26%; P=.01). After adjustment, peroneal runoff was independently associated with higher risk of major amputation (HR 1.81 [1.04-3.13]) and MALE (HR 1.52 [1.03-2.25]) compared with AT/PT runoff. These associations persisted in the endovascular cohort (major amputation: HR 2.09 [1.06-4.13]; MALE: HR 1.59 [1.08-2.35]) but did not reach significance in the bypass cohort, which was limited by low event rates. When patients with single-vessel peroneal runoff were stratified by PCB Grades, unadjusted one-year major amputation rates followed a clear anatomically-driven pattern (6.9% (AT/PT) vs. 5.4% (PCB Grade 1) vs. 15% (PCB Grade 2) vs. 32% (PCB Grade 3); P&lt;.001). After adjustment, when compared to AT/PT runoff, patients without any robust branch (PCB Grade 3) had significantly higher risk of major amputation (HR 3.21 [1.76-4.84]) and MALE (HR 2.41 [1.53-3.79]), while those with two branches with at least one being robust (PCB Grade 1) demonstrated higher rates of complete wound healing (HR 1.69 [1.09-2.62]) and no difference in major amputation or MALE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Peroneal runoff is independently associated with worse limb outcomes following revascularization for CLTI, but this risk may be primarily driven by patients with absent or diminutive communicating branches. Those with robust branching demonstrate outcomes comparable to AT/PT runoff, underscoring the importance of further evaluation and pre-operative assessment of peroneal communicating b","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148099","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}