Journal of Vascular Surgery最新文献

{"title":"A Systematic Review and Meta-Analysis of Cancer Risk in Patients with Abdominal Aortic Aneurysm.","authors":"Zhixiong Zhang, Chi Shu, Julin Wang, Huanrui Hu, Jichun Zhao, Bin Huang, Vidalack Vilayphone, Wenjie Zhao, Yazhou He, Yi Yang","doi":"10.1016/j.jvs.2026.04.032","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.032","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis aim to determine whether patients with abdominal aortic aneurysm (AAA) have an elevated risk of developing cancer compared to non-AAA individuals, and to compare the cancer risk among patients who have undergone different types of AAA repair.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed, Embase, and Web of Science was performed up to August 27, 2025, to identify studies investigating cancer risk in patients with abdominal aortic aneurysm. The primary objective was to determine whether the risk of cancer is higher in patients with abdominal aortic aneurysm compared with those without abdominal aortic aneurysm. The secondary objective was to compare the cancer risk among patients who underwent different abdominal aortic aneurysm repair procedures. Two reviewers independently selected studies for inclusion and extracted the data. All statistical analyses were performed using standard statistical procedures in R software.</p><p><strong>Results: </strong>Twelve original studies were included. A significant association was observed between AAA and an elevated risk of cancer compared with non-AAA individuals (RR = 1.69, 95% CI: 1.28-2.22, P < 0.001). Subgroup analyses revealed associations with elevated risks of respiratory, hepatic, bladder, pancreatic, and hematological malignancies. Additionally, endovascular aortic repair (EVAR) was associated with a higher cancer risk compared with open aortic repair (OAR) (RR = 1.11, 95% CIs: 1.06-1.16, P < 0.001).</p><p><strong>Conclusion: </strong>This meta-analysis suggests that AAA is associated with an elevated cancer risk compared with the general population, and also suggests a higher cancer risk and/or a higher likelihood of cancer detection associated with EVAR compared with OAR.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856814","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":"Leveraging Natural Language Processing Software to Implement and Execute Abdominal Aortic Aneurysm Surveillance.","authors":"Laura T Boitano, Stacy Brown, Lisa O'Neil, Lauren O'Connell, Steven Okuhn, Donald F Chute, Emily Y Fan, Eric Finnesgard, Douglas W Jones, Jessica P Simons, Andres Schanzer","doi":"10.1016/j.jvs.2026.04.029","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.029","url":null,"abstract":"<p><strong>Background: </strong>Long-term follow-up is essential for patients with abdominal aortic aneurysms (AAA). Our health system implemented an AAA surveillance program in 2021. We sought to evaluate the program's nearly five-year outcomes and identify the benefits and challenges in maintaining a large-scale AAA surveillance program.</p><p><strong>Methods: </strong>A commercially available AAA-specific natural language processing (NLP) algorithm (Illuminate, Overland Park, KS) was applied to all electronic medical record imaging reports at a large, academic, tertiary hospital (1/1/2010-6/2/2021) to identify AAA. Beginning 6/3/2021, imaging reports were reviewed prospectively. A nurse-navigator team utilized Society for Vascular Surgery surveillance guidelines to then interface with patient/providers to establish/re-establish care with the goal of increasing guideline adherence. The outcomes evaluated included yield of surveillance as measured by imaging, new clinic visits, AAA repairs, and the direct contribution margin among new or re-established patients.</p><p><strong>Results: </strong>During the study period (January 2021-November 2025), 7,516,363 imaging reports were processed. Optimization of workflows and efficiency resulted in a reorganization from a single nurse-navigator (1.0FTE) to a nurse-navigator team (total 0.7 FTE). After filtering for studies that included the abdominal aorta, 16,923 patients were identified. Of these, 12,952 (76.5%) cases were closed; the most common reasons for closing a case were: surveillance not indicated (n=1,211), no AAA (n=4,423), or patient deceased (n=2,587), In our population of patients evaluated, 2,856 (16.9%) with AAA were being appropriately followed. An additional 492 patients (2.9%) were newly identified; 333 (67.6%) were never followed, and 155 (32.3%) had been lost to follow-up. The program yielded 1,008 new imaging studies (438 CT, 43.5%; 519 ultrasound, 51.5%, 51 other, 5.1%), 1,080 new clinic visits, and 47 AAA repairs, resulting in a direct contribution margin of $3,330,928. In August 2024, this program was expanded to imaging performed at a newly acquired hospital; the first 15 months yielded 22 patients, 51 clinic visits, 45 imaging studies, and 5 AAA repairs, resulting in a direct contribution margin of $321,397.</p><p><strong>Conclusions: </strong>The AAA surveillance program established aneurysm care for over 500 patients, improved system-wide monitoring for AAA, and generated significant clinical activity and financial contribution margins, highlighting the program's value to patients and the health system. This demonstrates the potential to leverage technology to improve long-term patient care. Adjustments to the team structure ensured the program's sustainability and scalability, as evidenced by successful expansion to a newly acquired hospital.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839596","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":"Popliteal artery aneurysm repair with endovascular stent grafting matches surgical bypass at a cost of higher reintervention burden over a 16-year experience.","authors":"Thomas A Cook, Hosam F El Sayed, Nicholas L Bandy, Benjamin B Samberg, Emily D Burnett, Jacob A Hoffman, David J Dexter, Jean M Panneton","doi":"10.1016/j.jvs.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.024","url":null,"abstract":"<p><strong>Objective: </strong>To compare long-term outcomes of open and endovascular repair for popliteal artery aneurysms (PAAs) and identify factors associated with patency and limb loss.</p><p><strong>Methods: </strong>A retrospective review of all PAAs treated from 2008-2024 across a single healthcare system was conducted with comparison of endovascular and open surgical repair techniques. Long-term outcomes (≥ 5 years) included primary, primary-assisted, and secondary patency, major adverse cardiac events (MACE), major adverse limb events (MALE), freedom from reintervention, freedom from major amputation, and all-cause mortality. Statistical analysis was done with Kaplan-Meier, Fisher's exact test, t-tests, Chi-square, negative binomial regression, Mann-Whitney U, Breslow's test, and Cox proportional hazards utilizing SPSS.</p><p><strong>Results: </strong>A total of 222 limbs in 183 patients underwent PAA repair, including 171 open and 51 endovascular repairs. Patients were followed for a mean of 47.9 ± 41.6 months, with similar median length of follow-up between endovascular and open repair groups (interquartile range [IQR] 36.0 [IQR 8.7-57.1] vs. 37.4 [IQR 13.9-75.2] months, P = 0.207) respectively. Endovascular repair patients had shorter hospital length of stay (1 [IQR 0-1] vs. 3 [IQR 2-5] days, P < 0.001), and experienced significantly higher cumulative reinterventions per limb (incidence rate ratio [IRR] 1.70, 95% confidence interval [CI] 1.05-2.73, P = 0.003). Freedom from reintervention did not differ significantly between repair methods (P = 0.064), however the Breslow test reached significance (P = 0.045), suggesting endovascular repairs experienced a greater frequency of early reintervention events. Primary patency in the open and endovascular repair groups at 1, 3, and 5 years was (79.8% vs. 72.1%, 70.8% vs. 58.5%, and 67.3% vs. 58.5%, P = 0.036) respectively, but there were no significant differences in primary-assisted and secondary patency, and freedom from major amputation at 1, 3, and 5 years (98.1% vs. 98.0%, 97.3% vs. 95.4%, and 96.1% vs. 95.4%, P = 0.489). On multivariate analysis, endovascular repair demonstrated a trend toward increased risk of 1-year loss of primary patency (hazard ratio [HR] 1.97, 95% CI 0.98-3.93, P = 0.056) and independently predicted 1-year MALE (HR 2.06, 95% CI 1.02-4.17, P = 0.045).</p><p><strong>Conclusions: </strong>Endovascular and open repair of PAAs offer comparable long-term primary-assisted and secondary patency as well as limb salvage. Endovascular repair is associated with shorter hospital length of stay but lower primary patency, higher reintervention burden, and higher MALE at 1 year. Technique selection should consider patient comorbidities and symptomatology to optimize surgical outcomes.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839575","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":"Utilization of the Stop-Short Technique in Transcarotid Artery Revascularization Is Associated with Intraoperative Common Carotid Artery Dissection.","authors":"Y H Andrew Wu, Roberto G Aru, Solomon Mulugeta, Morgan Colling, Chen Dun, Midori P White, Jamie Schwartz, Andres Carvajal, Christopher J Abularrage, Michael C Stoner, Jesse A Columbo, Sumaira Macdonald, Caitlin W Hicks","doi":"10.1016/j.jvs.2026.04.023","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.023","url":null,"abstract":"<p><strong>Background: </strong>Transcarotid artery revascularization (TCAR) has gained widespread adoption for carotid stenosis since the U.S. Food and Drug Administration (FDA) approved it for use in 2015. Intraoperative common carotid artery (CCA) dissection during the procedure remains a feared complication. However, data describing CCA dissection incidence and ways to mitigate it remain limited. We analyzed a contemporary, manufacturer-maintained registry to determine the incidence, risk factors, management strategies, and clinical outcomes of CCA dissection during TCAR.</p><p><strong>Methods: </strong>We retrospectively analyzed the Silk Road Medical (Sunnyvale, CA) registry, which included all TCAR procedures performed between January 2023 and January 2024. We identified cases of CCA dissection, recorded the procedural step during which they occurred, and reviewed management strategies and perioperative acute stroke events. We used multivariable logistic regression to identify patient and procedural characteristics associated with CCA dissection and compared procedural metrics between patients with vs. without CCA dissection.</p><p><strong>Results: </strong>Of 25,346 patients undergoing TCAR (median age of 74 years, 61.9 % male), 300 (1.18%) experienced a CCA dissection. CCA dissections occurred most commonly during arterial sheath insertion (61.7%), followed by micropuncture access (21.7%), and guidewire manipulation (12.0%). Surgeons managed dissections with additional stent deployment (41.0%), carotid endarterectomy conversion (22.0%) or other open surgical repairs (6.7%). Acute stroke events occurred in 2.3% of patients with CCA dissection (7/300). After risk adjustment, factors associated with CCA dissection included age ≥85 years (vs <65 years; aOR, 1.82; 95% CI, 1.17-3.02), female sex (aOR, 1.65; 95% CI, 1.31-2.07), and use of the stop-short technique (i.e maintaining the stiff guidewire within the CCA during sheath insertion instead of advancing to the external carotid artery [aOR, 2.25; 95% CI, 1.70-3.02]). Patients with CCA dissection had longer procedure times, greater fluoroscopy exposure, higher contrast use, and more frequent use of ≥2 stents (all P < 0.001).</p><p><strong>Conclusion: </strong>Nearly a decade after its FDA approval, TCAR continues to demonstrate a favorable safety profile, with a low incidence of intraoperative CCA dissection. Use of the stop-short technique was associated with a twofold increase in the risk of CCA dissection. Surgeons should engage the external carotid artery during sheath insertion whenever possible to minimize the risk of CCA dissection.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Frailty on Enhanced Recovery Protocol Compliance and Postoperative Outcomes After Infrainguinal Arterial Bypass.","authors":"Lara Lopes, Calvin L Chao, Nicola Habash, Deena El-Gabri, Margaret Reilly, Veronica M Boratyn, Gabrielle Osher, Ashley K Vavra","doi":"10.1016/j.jvs.2026.04.026","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.026","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the impact of frailty on enhanced recovery protocol (ERP) compliance and the impact of ERP on adverse postoperative outcomes in frail patients undergoing infra-inguinal arterial bypass (IB).</p><p><strong>Methods: </strong>We performed a retrospective single-institution study of patients undergoing IB (2021-2024). Patients were categorized into three frailty groups using the NSQIP 5-item frailty index where F1=less frail (F1=0-1 risk factor; F2=2 risk factors; F3=3-5 risk factors). The association between frailty and both ERP compliance and postoperative outcomes were analyzed. Chi-square and Fisher's exact tests were used for categorical variables while continuous variables were analyzed by Kruskal-Wallis test. Time-to-event outcomes were assessed using Kaplan-Meier survival analysis in the elective intervention cohort, with follow-up truncated at 30 days.</p><p><strong>Results: </strong>257 patients were identified and stratified by frailty (F1=32.7%; F2=36.6%; F3=30.7%). F1 patients were significantly younger (mean age in years F1=65.0; F2=71.6; F3=71.6; p <0.001) and less likely to present with tissue loss (F1=31.0%; F2=47.9%; F3=62.0%; p<0.001). ERP compliance was not associated with frailty (F1=57.1%; F2=54.8%; F3=61.5%; p=0.739). Overall, patients who underwent ERP had a significantly shorter median postoperative LOS compared to non-ERP patients (4.8 vs. 7.0 days, p<0.001). Within the F3 cohort, ERP compliance was associated with lower reintervention rate (ERP=15.0% vs. non-ERP=33.3%; p=0.050); lower postoperative length of stay (ERP=7.9 days vs. non-ERP=9.8 days, p=0.016); and a reduction in 30-day mortality (ERP=2.5% vs. non-ERP=7.7%; p=0.298). In time-to-event analysis of elective procedures, no differences were observed in the 30-day freedom from reintervention, readmission or mortality.</p><p><strong>Conclusion: </strong>High frailty was not a barrier to the implementation of ERP and ERP was associated with improved postoperative outcomes in highly frail patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839573","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":"Corrigendum.","authors":"","doi":"10.1016/j.jvs.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.001","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817089","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 Versus Endovascular Abdominal Aortic Aneurysm Repair in Standard Surgical-Risk Patients Using a Medicare-Matched Registry.","authors":"Mohammed Hamouda, Shima Rahgozar, Dong-Jin E Kang Sim, Sina Zarrintan, Peter J Rossi, Mahmoud B Malas","doi":"10.1016/j.jvs.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.025","url":null,"abstract":"<p><strong>Objectives: </strong>Open surgical repair (OSR) offers the most durable option for abdominal aortic aneurysm (AAA) repair, yet over 80% of repairs in the US are performed using endovascular repair (EVAR). While EVAR suits high-risk patients, both approaches are viable for standard-risk patients, with the choice often based on operator experience and patient anatomy and preference. This study investigates which technique offers better long-term outcomes in standard-risk patients.</p><p><strong>Methods: </strong>The Medicare-matched VISION database was queried from 2011 to 2019 for standard-risk patients undergoing OSR or EVAR. Patients with high surgical risk features were excluded: age>70, BMI>35, GFR<30, moderate-severe CHF, recent MI, positive stress test, home oxygen, dialysis-dependent, and patients unfit for OSR based on surgeon's judgement. Patients presenting with rupture or with prior aneurysm repair were also excluded. Propensity score matching was used to match baseline characteristics (26 variables) in both groups. Cox regression analyzed mortality, aneurysm-related reintervention, and rupture up to 7 years.</p><p><strong>Results: </strong>Before matching, our study had 7,409 standard-risk patients [EVAR 5,933 (80.1%); OSR 1,476 (19.9%)]. PSM produced two well balanced cohorts of 1,017 pairs. There was no significant difference in 7-year mortality [HR=1.08, (0.85-1.38), p=0.511]. However, EVAR was associated with higher risk of reintervention at 7 years compared to OSR [20.8% vs 12.4%; HR=1.56, (1.17-2.07), p=0.002]. Furthermore, the hazard of rupture was almost 4-folds higher with EVAR [3.2% vs 0.4%; HR=3.87, p=0.018].</p><p><strong>Conclusions: </strong>In the current era where EVAR is the predominant choice even in low surgical risk patients, reasons to undergo OSR are limited. However, our study demonstrates superior durability of OSR in standard-risk patients with significantly lower rates of reintervention and rupture up to seven years. Our findings provide a strong rationale for performing OSR in physiologically fit patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839590","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":"Discharge Destination and One-Year Mortality in Acute Limb Ischemia Survivors after Revascularization: A Multicenter Registry Study.","authors":"Naoki Yoshioka, Yosuke Hata, Takuya Haraguchi, Shunsuke Kojima, Kenji Ogata, Tatsuro Takei, Shuko Iwata, Riho Suzuki, Haruya Yamane, Daichi Yoshii, Daisuke Matsuda, Eiji Koyama, Tomoki Uchikawa, Yasuhiro Morita, Osamu Iida, Itsuro Morishima","doi":"10.1016/j.jvs.2026.04.027","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.027","url":null,"abstract":"<p><strong>Objective: </strong>Acute limb ischemia may impair functional status and hinder return home after hospitalization, even in patients who survive to discharge. However, the associations among discharge destination, clinical characteristics, and outcomes have not been fully evaluated.</p><p><strong>Methods: </strong>Using a multicenter registry, we analyzed 769 patients with acute limb ischemia who underwent revascularization between July 2011 and March 2025 and survived to discharge. Non-home discharge was defined as transfer to another hospital or nursing facility. Multivariable logistic regression incorporating baseline and procedural variables was performed to identify determinants of non-home discharge. One-year mortality after discharge was compared between the home and non-home discharge groups.</p><p><strong>Results: </strong>Non-home discharge occurred in 287 (37.3 %) patients. Multivariable analysis demonstrated that advanced age, non-ambulatory status, frailty, prior cerebrovascular disease, hypoalbuminemia, and receipt of public assistance were independently associated with non-home discharge, as was severe ischemia (Rutherford category IIb/III). Procedural factors, including the need for surgical revascularization and inadequate distal perfusion (final Tibial Infrapopliteal Perfusion Index grade 0-1) were also associated with non-home discharge. When stratified by cumulative risk burden (0-2, 3-5, ≥6 factors), the incidence of non-home discharge increased stepwise (18%, 50%, and 92%, respectively; p < 0.001). One-year mortality was significantly higher among patients with non-home discharge than among those discharged home (21.2% vs. 7.6%; log-rank p < 0.001).</p><p><strong>Conclusions: </strong>More than one-third of patients with acute limb ischemia were unable to return home after revascularization. Discharge destination was independently associated with baseline vulnerability, disease severity, and procedural factors, and was linked to increased 1-year mortality.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839593","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":"Non-Syndromic Familial Type B Aortic Dissection Exhibits Distinct Clinical Profiles and Operative Outcomes.","authors":"Tiffany Lian, Chih-Wen Pai, Elise Woznicki, Maral Ouzounian, Eduardo Bossone, Kevin M Harris, Patrick O'Gara, Jean Bismuth, Anil Bhan, Clayton Kaiser, Edward P Chen, Christoph Nienaber, Eric Isselbacher, Mark Lindsay, Kim Eagle, Arturo Evangelista, Sherene Shalhub","doi":"10.1016/j.jvs.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.022","url":null,"abstract":"<p><strong>Background: </strong>While a heritable nature of type A aortic dissection is well established, the contribution of family history to type B aortic dissection (TBAD) remains less clearly characterized. This analysis evaluates the prevalence, clinical characteristics, and outcomes of familial TBAD (FTBAD) compared to sporadic TBAD and Marfan syndrome (MFS)-related TBAD to determine whether familial TBAD exhibits features consistent with increased underlying aortic vulnerability.</p><p><strong>Methods: </strong>This is a retrospective analysis of TBAD patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2024. Based on standardized clinical abstraction, patients were categorized as familial TBAD (FTBAD), sporadic TBAD, or MFS-associated TBAD. Baseline characteristics, imaging features, surgical management, in-hospital outcomes, and post-discharge events across groups using bivariate and time-to-event analyses for up to 4-years post discharge were compared. Time-to-event analysis included re-intervention, rupture, and survival.</p><p><strong>Results: </strong>Among 2,726 patients (mean age 63.0±14.6 years; 64.2% male), 223 (8.2%) had FTBAD and 128 (4.7%) had MFS. Patients with FTBAD presented at a younger age than those with sporadic TBAD (60.8 vs. 64.3 years, p<.001) but older than patients with MFS (42.4 years). ompared with sporadic TBAD, FTBAD patients were more frequently normotensive at presentation and had higher rates of prior aortic dissection and prior cardiac or aortic surgery.Patent false lumen was more frequent in FTBAD (60.0%) and MFS (66.7%) compared to sporadic TBAD (49.8%) and FTBAD patients had more extensive dissections despite a similar aortic diameter at the time of dissection compared to sporadic TBAD. The indication for endovascular intervention was more frequently visceral ischemia in FTBAD compared to sporadic TBAD (23.5 vs. 10.9%, p<0.05). TEVAR was less frequently performed in FTBAD compared to sporadic TBAD (23.8% vs. 29.7%, p=0.081), and least common in MFS (15.6%). Post-discharge data were available for 56.9% of those discharged. Three-year incidence of late surgical intervention was 23.78% for FTBAD patients, higher than sporadic TBAD (15.7%, p=0.023). One-year survival exceeded 93% in all groups; four-year survival exceeded 83%.</p><p><strong>Conclusions: </strong>Non-syndromic familial TBAD is present in a meaningful proportion of patients and is associated with distinct clinical features consistent with increased underlying aortic vulnerability compared with sporadic TBAD. Systematic assessment of family history may improve risk stratification, longitudinal surveillance, and patient shared decision-making in the management of TBAD.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839631","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":"Impact of Renin-Angiotensin-Aldosterone System Antagonists on Recovery and Survival After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection.","authors":"Pooria Nakhaei, Shima Rahgozar, Ivan Yun-Kuen Luu, Sophie X Wang, Mahmoud B Malas","doi":"10.1016/j.jvs.2026.04.019","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.019","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Discontinuation of renin-angiotensin-aldosterone system (RAAS) antagonists prior to specific surgeries has been recommended due to their potential association with hypotension-related postoperative complications. However, research on their impact in vascular surgery is limited. This study investigates the association between angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and postoperative outcomes following Thoracic Endovascular Aortic Repair (TEVAR) in patients with type B aortic dissection (TBAD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Vascular Quality Initiative (VQI) database was utilized to identify all patients who underwent TEVAR for TBAD between January 2014 and March 2025. Patients below the age of 18 and those with connective tissue disorders were excluded. Patients with rupture presentation, type A aortic dissection, and those who required further open thoracotomy were also excluded from the analysis. Our primary outcomes were postoperative myocardial infarction (MI), 30-day, and one-year mortality. Our secondary outcomes were stroke, spinal cord ischemia (SCI), postoperative acute kidney injury, hospital and ICU length of stay, intubation period, and packed red blood cell transfusion. Multivariable logistic regression was used to analyze short-term outcomes while one-year survival was evaluated using Kaplan-Meier estimates with log-rank testing and multivariable Cox proportional hazards modeling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 5,283 patients who underwent TEVAR for TBAD, 40.2% received preoperative ACE inhibitors or ARBs. These patients were older, had higher rates of hypertension, diabetes, coronary artery disease, congestive heart failure, and cerebrovascular disease, and were more likely to undergo elective procedures. Multivariable analysis showed that preoperative ACEI/ARB use was independently associated with lower SCI risk (aOR 0.72; 95% CI: 0.54-0.96; p=0.024), a reduced need for packed red blood cell transfusions (aOR 0.81, 95% CI 0.69-0.96; p = 0.013), higher odds of same-day extubation (aOR 1.51, 95% CI 1.20-1.91; p &lt; 0.001), and lower odds of prolonged ICU stay (aOR 0.81, 95% CI 0.68-0.97; p = 0.025). ACEI/ARB use was associated with a reduced risk of prolonged hospital stay (aOR 0.84, 95% CI 0.72-0.98; p = 0.027). No significant differences were observed in postoperative MI, postoperative renal dysfunction, or stroke. At one year, ACEI/ARB use was associated with improved survival (adjusted HR 0.84, 95% CI 0.73-0.97; p = 0.022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This multi-institutional study found that preoperative ACEI/ARB use was associated with reduced spinal cord ischemia risk, transfusion requirements, higher likelihood of same-day extubation, and shorter ICU stays, contributing to improved early postoperative recovery and discharge. Additionally, a significant survival benefit at one year was observed, suggesting a potential role for continui","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817042","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}