Journal of Vascular Surgery最新文献

{"title":"Corrigendum.","authors":"","doi":"10.1016/j.jvs.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.003","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225749","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":"CTA Identifies Non-stenotic Extracranial Plaque Features Susceptible to Stroke.","authors":"Yuhang Zhao, Yu Lun, Liwei Pang, Shiyue Wang, Han Jiang, Qingwei Gang, Shikai Shen, Yao Qi, Han Zhang, Mingyu Liu, Yixian Wang, Bingchen Hou, Guangwen Xu, Minhao Li, Jian Zhang","doi":"10.1016/j.jvs.2025.09.043","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.043","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between CTA-derived plaque features and composition and ipsilateral embolic stroke of undetermined source (ESUS) in patients with non-stenotic (<50%) extracranial carotid atherosclerosis.</p><p><strong>Methods: </strong>Patients with acute neurological symptoms who underwent head and neck CTA between May 2021 and May 2024 were retrospectively enrolled. Those with non-stenotic extracranial carotid plaques were included, comprising individuals with anterior circulation ESUS and controls without ESUS. Plaque morphology and compositional profiles were assessed.</p><p><strong>Results: </strong>A total of 161 carotid arteries were analyzed, including 70 ipsilateral to an ESUS and 91 from controls. Morphological features of non-stenotic carotid plaques differed significantly between the ESUS and control groups. Plaque subcomponent volumes were quantified by using 3D Slicer software and the relative proportions of lipid, fibrous, and calcified components differed significantly between groups. Multivariate analysis identified internal carotid artery (ICA) and common carotid artery (CCA) diameters, positive remodeling (PR), and a smaller calcification volume percentage as independent predictors of ESUS [odds ratio (OR): 8.37, P = 0.015; OR: 4.50, P < 0.001; OR: 0.23, P = 0.008]. A nomogram incorporating these factors demonstrated predictive utility for ESUS risk.</p><p><strong>Conclusions: </strong>CTA-derived characteristics of non-stenotic carotid plaques effectively identified plaque features associated with ESUS. Larger ICA and CCA diameters, PR, and reduced calcification volume percentage were independent predictors of high-risk plaques. These findings can refine risk stratification and help guide individualized therapeutic strategies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186319","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 Snuffbox Arteriovenous Fistula as a First Line Approach to Dialysis Access in Patients with End Stage Kidney Disease.","authors":"Mohamed H Khalaf, Amr Fares","doi":"10.1016/j.jvs.2025.09.040","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.040","url":null,"abstract":"<p><strong>Objective: </strong>The persistent shortage of organs for kidney transplantation necessitates long-term renal replacement therapies like hemodialysis. Arteriovenous fistula (AVF) creation is a well-established method for vascular access to be used for hemodialysis, with the wrist radio-cephalic AVF being common. While the anatomical snuffbox radio-cephalic AVF is less frequently used, it remains a potential site for AVF creation. The objective of this study was to evaluate our long-term outcomes of using the snuffbox arteriovenous fistula as a first-line approach for vascular access in patients with end-stage kidney disease.</p><p><strong>Methods: </strong>This retrospective single center study included all patients undergoing primary snuffbox AVF creation at our institution from November 2005 to December 2022. Preoperative ultrasound assessed vessel suitability for the procedure. Procedures were performed under local anesthesia with procedural sedation, involving dissection of the radial artery and cephalic vein within the anatomical snuffbox, and side-to-side anastomosis. Post-procedure, patients were followed for fistula patency. Data collected included demographics, baseline laboratory values, comorbidities, previous vascular access, and anticoagulant use. Primary patency and primary assisted patency was analyzed.</p><p><strong>Results: </strong>Snuffbox AVF procedures were performed on 258 patients (77.9% male, median age 53 years). Primary patency rates were 94% at 1 month, 87% at 6 months, and 79% at 1 year. 6.6% of patients required endovascular intervention. 18.6% underwent kidney transplantation. No deaths were related to fistula creation.</p><p><strong>Conclusion: </strong>Snuffbox arteriovenous fistulas are a safe and viable alternative to wrist AVF in suitable candidates, demonstrating comparable rates of complications and patency. Snuffbox AVF can help patients maintain long-term vascular access for dialysis and while awaiting transplant.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182067","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 Open Bypass and SMA Endarterectomy for Patients with Chronic Mesenteric Ischemia Resulting from Long-segment SMA Occlusive Disease.","authors":"Michael J Fassler, Salvatore T Scali, Griffin Stinson, Brian Fazzone, Christopher R Jacobs, Benjamin N Jacobs, Dan Neal, Martin R Back, Thomas S Huber","doi":"10.1016/j.jvs.2025.08.053","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.08.053","url":null,"abstract":"<p><strong>Background: </strong>Chronic mesenteric ischemia(CMI) from atherosclerotic occlusive disease commonly involves the origin of the superior mesenteric artery(SMA) and is often treated with covered endoluminal stents. Notably, diffuse SMA arterial occlusive disease(>4 cm) extending beyond the ostium precludes standard endovascular treatment and may require open mesenteric bypass with endarterectomy(OMB-EA); however, the outcomes and durability of this approach remain incompletely defined. This study was designed to examine the impact of OMB-EA in CMI patients with diffuse SMA occlusive disease.</p><p><strong>Methods: </strong>A single-center, retrospective review of patients undergoing OMB for CMI from 2002 to 2024 was completed. Patients receiving OMB-EA were compared to those undergoing OMB alone. The primary endpoint was 30-day mortality. Secondary outcomes included perioperative complications, reintervention, symptom recurrence, primary patency and overall survival. Kaplan-Meier survival analysis and propensity-matched comparisons were used to assess differences between groups.</p><p><strong>Results: </strong>Among 166 patients undergoing OMB for CMI, 138 (83%) had OMB alone and 28 (17%) underwent OMB-EA. Demographics were similar (median age 71 [IQR 65-76]; 69% female), although OMB-EA patients were more likely to have end-stage kidney disease (7% vs. 0; p=.03), but had lower rates of peripheral arterial disease (11% vs. 50%; p=.001) and congestive heart failure (4% vs. 19%; p=.05). OMB-EA patients more often underwent retrograde bypass (39% vs. 19%; p=.03) and received greater intraoperative transfusion (median[IQR]: 3[0.25,4.75] vs. 1[0,3] units; p=.04). There were no differences in 30-day mortality (4% vs. 3%; p=1.0) or major complications (46% vs. 54%; p=.5). Median follow-up time was 2.0 years and overall survival at 1 and 2-years was similar between groups (OMB: 86±3% and 67±5% vs. OMB-EA: 89±7% and 72±13%; log-rank p=.2). Rates of symptom recurrence (8% vs. 4%; p=.7), reintervention (5% vs. 7%; p=.6), and readmission (10% vs. 11%; p=.7) were also comparable. However, OMB-EA patients had shorter time to reintervention (0.03 vs. 1.2 years; p=.04) and lower 1-year primary patency (93±7% vs. 100%; log-rank p=.007). Similarly, propensity-matched analysis(N=27 pairs) showed no significant differences in mortality or complication outcomes.</p><p><strong>Conclusions: </strong>OMB with SMA endarterectomy is associated with similar survival and complication rates compared to OMB alone, despite greater procedural complexity. These findings support an aggressive approach to using SMA endarterectomy and OMB for patients with CMI and diffuse SMA occlusive disease.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176254","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 Results of the Neo-Aorto-Iliac System Procedure as a Compelling Choice for the Treatment of Aortic Infections.","authors":"Félix H Savoie-White, Ievgen Gegiia, Rose Gorak Savard, Florence Gervais, Julien Bernatchez, Valérie Gauvin, Pascal Rhéaume","doi":"10.1016/j.jvs.2025.09.038","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.038","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the short- and long-term clinical outcomes of the Neo-Aorto-Iliac System (NAIS) procedure for primary and secondary aortic infections, focusing on mortality, reintervention, and patency rates over 24 years.</p><p><strong>Methods: </strong>We performed a retrospective analysis of all consecutive patients who underwent a NAIS procedure at the Centre Hospitalier Universitaire de Québec (CHU de Québec) between January 1, 2000, and August 1, 2024. Collected data included demographic, preoperative, operative, and postoperative outcomes. Kaplan-Meier analysis was used to assess survival and patency rates. Student's t-tests analyzed continuous variables, and Chi-squared or Fisher's exact tests were applied for categorical variables. A P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>135 patients (75% male) with significant comorbidities underwent NAIS. Primary mycotic aortitis accounted for 35% of cases, while secondary infections comprised 65%, including aortoenteric fistulas (24%) and graft infections (41%). Abdominal pain was the most common initial presentation (44%), and blood cultures were positive in only 33% of cases. Half of the reconstructions were aorto-bi-iliac bypasses, with a mean operative time of 6 hours and 32 minutes (±129 min) and an average blood loss of 3.5 L (±3.0 L). Early complications included acute kidney injury (31%), pneumonia (28%), elevated troponin (24%), anastomotic rupture (8%), and major amputation (4%). In-hospital mortality was 9%, with survival rates of 87%, 68%, 48%, 35% and 15% at 1, 5, 10, 15 and 20 years, respectively. Predictors of mortality included older age, anastomotic rupture, pneumonia, and troponin elevation. Primary patency rates at 1, 5, and 20 years were 93%, 85%, and 83%, while secondary patency rates were 97%, 96%, and 96%. Reintervention was required in 23% of cases, with 5% involving early (less than 30 days) procedures for bleeding. Delayed reinterventions included 22 open surgeries (e.g., femoral angioplasty, anastomosis revision) and 18 endovascular procedures (e.g., iliac stenting, EVAR). The mean follow-up period was 5.2 years, with a maximum of 21.3 years.</p><p><strong>Conclusions: </strong>The NAIS procedure offers excellent long-term survival, high patency rates, and manageable reintervention rates, supporting its role as the leading treatment option for primary and secondary aortic infections.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176265","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":"An International, Expert-based, Multispecialty Delphi Consensus Document on Stroke Risk Stratification and the Optimal Management of Patients with Asymptomatic and Symptomatic Carotid Stenosis.","authors":"Kosmas I Paraskevas, Ali F AbuRahma, Wesley S Moore, Peter Gloviczki, Bruce A Perler, Daniel G Clair, Christopher J White, Carlo Setacci, Eric A Secemsky, Peter A Schneider, Clark J A M Zeebregts, Armando Mansilha, Luca Saba, Ian M Loftus, Jeffrey Jim, Christos D Liapis, Vincenzo Di Lazzaro, Alan Dardik, Pavel Poredos, Ankur Thapar, Salvatore T Scali, Mario D'Oria, Ales Blinc, Alexei Svetlikov, David H Stone, Sherif A H Sultan, Deniz Bulja, Michael C Stoner, Piotr Myrcha, Maarten Uyttenboogaart, Mark A Farber, Gianluca Faggioli, Domenica Crupi, Csaba Csobay-Novak, Jens Eldrup-Jorgensen, Gaetano Lanza, Gert J de Borst, Francesco Stilo, Meghan Dermody, Mauro Silvestrini, Christopher J Abularrage, Guillaume Goudot, Robert M Proczka, Gary S Roubin, Francesco Spinelli, Gabor Menyhei, Saeid H Shahidi, Jose Ignacio Leal Lorenzo, Arkadiusz Jawien, Tilman Reiff, Laura Capoccia, José Fernandes E Fernandes, Piotr Musiałek, Victor S Gurevich, Matthew Blecha, Caitlin W Hicks, Young M Erben, Mark F Conrad, Mahmoud B Malas, Sean P Lyden, Seemant Chaturvedi, Marc L Schermerhorn, Andrew N Nicolaides","doi":"10.1016/j.jvs.2025.09.039","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.039","url":null,"abstract":"<p><strong>Objective: </strong>The optimal management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis is controversial and includes intensive medical management (i.e., best medical therapy [BMT]) with/without an additional carotid revascularization procedure (i.e., carotid endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS] or TransCarotid Artery Revascularization [TCAR]). The aim of this international, expert-based, multispecialty Delphi Consensus document was to reconcile the conflicting views regarding the optimal management of AsxCS and SxCS patients.</p><p><strong>Methods: </strong>A three-round Delphi Consensus process was performed including 63 experts from Europe (n=37) and the United States (n=26). A total of 6 different clinical scenarios were identified involving patients with either AsxCS or SxCS. For each scenario, 5 treatment options were available: (i) BMT alone, (ii) BMT plus CEA, (iii) BMT plus TFCAS, (iv) BMT plus TCAR, or (v) BMT plus CEA/TFCAS/TCAR. Differences in treatment preferences between U.S. and European participants were assessed using Fisher's Exact Test, and odds ratios were used to quantify the magnitude and direction of association. Consensus was achieved when >70% of the Delphi Consensus participants agreed on a therapeutic approach.</p><p><strong>Results: </strong>Most participants concurred that BMT alone is not adequate for the management of a 70-year-old fit male or female patient with 80-99% AsxCS (52/63; 82.5% and 45/63; 71.5%, respectively). In contrast, most panelists would opt for BMT alone for an 80-year-old male AsxCS patient with several co-morbidities (48/63; 76.2%). The majority of participants would opt for BMT plus a carotid revascularization procedure for an 80-year-old male SxCS patient with a recent ipsilateral cerebrovascular event, an ipsilateral 70-99% SxCS and a 5-year predicted risk of ipsilateral ischemic event of 10% (54/63; 85.7%), 15% (59/63; 93.6%), or 20% (63/63; 100%). The opinion of U.S.-based participants varied from that of Europe-based respondents in some scenarios.</p><p><strong>Conclusions: </strong>The panel agreed that BMT alone is insufficient for most patients with SxCS, and that select subgroups of AsxCS patients may also benefit from revascularization, especially when high-risk features are present. Patients should be stratified according to their predicted stroke risk, as well as their individual clinical/anatomical/imaging features and should be treated accordingly.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176228","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":"Five-year outcomes of the ICEBERG study, an international, prospective, multicenter registry on the GORE® EXCLUDER® Iliac Branch Endoprosthesis for aorto-iliac aneurysms.","authors":"Daphne van der Veen, Suzanne Holewijn, Raffaello Bellosta, Luca Attisani, Steven M M van Sterkenburg, Jan M M Heyligers, Ilaria Ficarelli, Francisco J Gómez Palonés, Nicola Mangialardi, Nilo J Mosquera, Andrew Holden, Michel M P J Reijnen","doi":"10.1016/j.jvs.2025.09.037","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.037","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to provide insight in the long-term outcomes of patients treated with the Gore Excluder Iliac Branch Endoprosthesis (IBE) for aneurysms involving the common iliac artery. Both technical, clinical, and patient reported outcomes were evaluated.</p><p><strong>Methods: </strong>This is an investigator initiated, international, real world post-market, multicenter, prospective cohort study, enrolling patients with an indication for elective treatment of an (aorto)iliac aneurysm using the Gore Excluder IBE. Technical and clinical outcomes were collected through 5-year follow-up, together with questionnaire data.</p><p><strong>Results: </strong>Of the initially 100 enrolled patients, 69 patients completed the 5-year follow-up. The 5-year freedom from all-cause and aneurysm-related mortality was, respectively, 82.9% and 96.0%. The 5-year primary patency of the hypogastric artery was 84.0%. The median abdominal aortic aneurysm and common iliac artery diameters decreased significantly between baseline and 5-year follow-up (-8.0mm, p=0.001, -6.8mm, p<0.001, respectively). One type 1b and one type 1c endoleak were detected between 2-5 years follow-up which were successfully treated. Two type III endoleaks were discovered during follow-up. There were no significant differences in the occurrence nor severity of intermittent claudication between baseline and 5-year follow-up. The outcomes on the IIEF-5 questionnaire on erectile dysfunction showed a significant decrease between baseline (median 12.5; IQR 3.0-20.0) and 5-years follow-up (median 4.0; IQR 1.0-16.0), p=0.001. The EQ5D and WIQ showed no differences between baseline and 5-years follow-up.</p><p><strong>Conclusions: </strong>The results of this study support the continued use of the Gore Excluder IBE in the treatment of aortoiliac aneurysms, demonstrating favorable long-term outcomes in terms of patency, sac remodeling, clinical outcomes and questionnaire outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176226","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":"Preoperative smoking cessation impacts presentation and neurologic outcomes of carotid endarterectomy.","authors":"Andrew W Schwartz, Warren Carter, Britt Tonnessen, Isibore Arhuidese, Jonathan Cardella, Alan Dardik, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.032","url":null,"abstract":"<p><strong>Objective: </strong>Smoking increases perioperative mortality after carotid endarterectomy (CEA), but the effect of smoking cessation duration on outcomes remains unclear. This study evaluates how different durations of smoking cessation impact long-term outcomes after CEA in the Vascular Quality Initiative (VQI).</p><p><strong>Methods: </strong>Patients in the VQI database undergoing CEA (2012-2023) with \"current smoking\" were compared to 3 groups of former smokers based on the duration of quitting: <9, 9-21, or >21 months before CEA. These intervals align with VQI's follow-up window and permit assessment of specific cessation durations. Patients with missing or changed smoking status at follow-up were excluded. Long-term outcomes were compared. Regression analysis was performed to assess independent associations with outcomes.</p><p><strong>Results: </strong>There were 20,390 current smokers, 3,437 former <9m, 2,368 former 9-21m, and 6,370 former >21m patients identified. Former smokers were more likely to be older and Hispanic, and were more likely to have diabetes, chronic kidney disease, and cardiac disease while current smokers were more likely to have chronic obstructive pulmonary disease (COPD). Current smokers were more likely to present with a stroke and undergo surgery urgently. After a mean follow-up of 415 days, smokers had a significantly higher rate of mortality (<9m, 4.8% vs 7.1%, p<0.001; 9-21m, 5.6% vs 7.1%, p=0.007; >21m, 5.1% vs. 7.1%, p<0.001), or transient ischemic attack (TIA) or stroke (<9m, 0.8% vs 1.3%, p=0.041; 9-21m, 0.7% vs 1.3%, p=0.015; >21m, 0.8% vs. 1.3%, p=0.005). Kaplan-Meier analysis revealed only former 9-21m (p=0.04) and former >21m (p=0.02) but not former <9m (p=0.1) had significantly lower long-term TIA or stroke compared with smokers. On regression, only former >21m was independently associated with lower long-term TIA or stroke (HR=0.71[0.52, 0.96]), with similar statistically non-significant trend among former <9m (HR=0.71 [0.48, 1.05]) and former 9-21m (HR=0.63[0.38, 1.05]) smokers. Female sex, diabetes, and symptomatic presentation demonstrated consistent association with increased risk of long-term TIA or stroke regardless of cessation duration.</p><p><strong>Conclusion: </strong>A smoking cessation duration of greater than 21 months prior to CEA is associated with decreased long-term ipsilateral neurologic events. These findings suggest that sustained preoperative and postoperative smoking cessation may be necessary to detect statistically significant risk reduction in neurological events.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137997","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":"Vascular Diagnosis in the Pediatric Patient.","authors":"Bethany J Slater, Sean Pfaff, Manish N Shah, Joseph Cao","doi":"10.1016/j.jvs.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.031","url":null,"abstract":"<p><p>Imaging is an important component for vascular diagnoses in pediatric patients, however, it is important to minimize radiation exposure in children. The pediatric population is up to 10 times more sensitive to the effects of radiation than adults due to increased tissue radiosensitivity of their developing organs and tissues, and they have a longer lifespan in which the effects can manifest. In general, the choice of imaging modality for vascular diseases depends on individual patient needs, balancing diagnostic accuracy with potential risks and limitations. A thorough understanding of the advantages and disadvantages of each technique is essential for clinicians to make informed decisions regarding diagnosis and monitoring. This manuscript will discuss some important aspects regarding imaging of vascular diagnoses in pediatric patients including preoperative imaging for access and vascular lesions, vascular malformations, the role of angiography, and diagnosis and monitoring of pediatric brain vascular diseases.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113677","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":"Direct comparison of frailty scores and their association with post-operative outcomes in patients undergoing lower extremity revascularization.","authors":"Brandon T Gaston, Tiffany R Bellomo, Brett Salomon, Bianca Mulaney-Topkar, Falen Demsas, Aderike Anjorin, Micah Thornton, Austin Gregg, Mohit Manchella, Felita Zhang, Mansi Totwani, Anahita Dua, Abhishek Mohapatra, Sunita D Srivastava, Matthew J Eagleton, Nikolaos Zacharias","doi":"10.1016/j.jvs.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.033","url":null,"abstract":"<p><strong>Background: </strong>Frailty is increasingly recognized as a key driver of postoperative risk in vascular surgery. Yet the relative accuracy of the major frailty indices in a purely vascular cohort remains unclear.</p><p><strong>Objective: </strong>To compare the predictive accuracy of the Modified Frailty Index (mFI), Risk Analysis Index (RAI), Vascular Quality Initiative Frailty Index (VQI-FI), and VQI Procedure-Based Index (VQI-PBI) in predicting adverse postoperative outcomes in patients undergoing lower extremity revascularization.</p><p><strong>Methods: </strong>In this retrospective single-center cohort study, 193 patients who underwent open or endovascular lower extremity revascularization between January 1 and December 31, 2023, were included. Frailty scores were retrospectively calculated based on data available at the time of the preoperative evaluation. Primary outcomes were 30-day and one-year mortality and 30- and 60-day hospital readmission. Secondary outcomes included new dialysis within 30 days, and myocardial infarction. Statistical associations were evaluated using logistic regression models.</p><p><strong>Results: </strong>The cohort's mean age was 69.4 years, 32 % were female, and 74 % presented with critical limb ischemia. All four indices predicted 1-year mortality and initiation of dialysis within 30 days. The mFI, VQI-FI, and VQI-PBI also predicted 30-day readmission, but only the VQI scores were associated with 60-day readmission. The RAI was the only score associated with in-hospital mortality. The VQI-FI demonstrated the greatest number of statistical associations with good discriminatory ability.</p><p><strong>Conclusions: </strong>Vascular specific frailty indices (VQI-FI and VQI-PBI) provide superior risk stratification compared to generic measures. Incorporating these tools into preoperative evaluation may improve patient selection and shared decision-making.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113716","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}