Journal of Vascular Surgery最新文献

{"title":"Prognostic impact of juxtarenal inner vessel diameter and vertical distance in renal artery outcomes after fenestrated endovascular repair.","authors":"Luca Mezzetto, Nikolaos Tsilimparis, Mario G D'Oria, Sandro Lepidi, Rocco Giudice, Ciro Ferrer, Giulia Bravo, Michelle Antonello, Michelle Piazza, Gian Franco Veraldi","doi":"10.1016/j.jvs.2024.10.071","DOIUrl":"10.1016/j.jvs.2024.10.071","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this retrospective multicenter study is to evaluate the impact of juxtarenal inner vessel diameter (JR-IVD) and vertical distance between renal arteries (RA-VerDi) on RA instability (RAI) and associated complications in patients undergoing fenestrated endovascular aortic repair for complex aortic pathology.</p><p><strong>Methods: </strong>Patients undergoing fenestrated endovascular aortic repair with custom-made stent grafts at six referral hospitals between 2017 and 2023 were included. Data on patient demographics, anatomical characteristics, stent configurations, and outcomes were collected. Patients were divided into tertiles and categorized into three groups: JR-IVD <20 mm, JR-IVD 20 to 24 mm, and JR-IVD >24 mm. RA-VerDi was determined by measuring the distance between the center of the lowest RA and the highest RA, based on the planning specifications for each custom-made graft. The primary outcome was freedom from RAI, with secondary outcomes including RA stenosis/occlusion, endoleak, and reintervention. Statistical analyses were performed using MedCalc software, with logistic regression and Kaplan-Meier survival curves used to assess outcomes.</p><p><strong>Results: </strong>In total, 520 RAs among 260 patients were analyzed. The technical success rate was 98.7%, with a 30-day mortality rate of 2.3%. After a mean follow-up of 26.9 ± 28.1 months (range, 1-154 months), RAI was observed in 5.6% of cases, including stenosis/occlusion (3.2%) and endoleak (2.2%). Freedom from RAI at 12, 24, and 48 months was 95.8% (standard error [SE], 0.01), 93.5% (SE, 0.01), and 90.7% (SE, 0.01), respectively. JR-IVD of <20 mm was identified as a significant risk factor for RA stenosis/occlusion (P = .01), although it did not increase the risk of RAI or reintervention compared with larger JR-IVDs. A correlation was found between RA-VerDi and RAI, with smaller vertical distances associated with higher RAI risk (odds ratio, 0.89; 95% confidence interval, 0.82-0.99; P = .05), but no significant cutoff was determined. Severe RA stenosis was an independent predictor of RAI (odds ratio, 13.28; 95% confidence interval, 3.1-55.86; P = .004).</p><p><strong>Conclusions: </strong>The use of fenestrated custom-made grafts in patients with a JR-IVD of <20 mm may increase the risk of RA complications, particularly stenosis/occlusion. Although a correlation between RA-VerDi and RAI was observed, a definitive predictive cutoff could not be established. Attention should be given to patients with severe RA stenosis, because this condition seems to be an independent predictor of RAI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623141","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":"Duplex ultrasound as a single imaging test for Global Limb Anatomic Staging System assignment stage and comparison with intraoperative arteriography.","authors":"Carlos Martínez-Rico, Xavier Martí-Mestre, Dorelly Martínez-Del Carmen, Elena Iborra-Ortega","doi":"10.1016/j.jvs.2024.10.076","DOIUrl":"10.1016/j.jvs.2024.10.076","url":null,"abstract":"<p><strong>Objective: </strong>Obtaining a prognostic and predictive classification based on the risk of amputation is crucial in ischemic pathology of the lower limbs. Accurate anatomical characterization of arterial lesions is essential for optimal clinical decision-making. The Global Limb Anatomic Staging System (GLASS) provides a comprehensive anatomy assessment of the femoropopliteal and infrapopliteal arterial system. GLASS introduces concepts such as the target arterial path and estimated limb-based patency, crucial for determining the best arterial route to restore blood flow.</p><p><strong>Methods: </strong>A prospective study conducted from May to December 2022 involved 66 patients undergoing revascularization surgery for critical limb-threatening ischemia. Preoperative arterial mapping using duplex ultrasonography was the sole imaging modality. The target arterial path was defined in each patient, and GLASS staging was determined. Intraoperative arteriography was used on the day of surgery for comparison. Agreement between preoperative arterial mapping and intraoperative arteriography was assessed using Cohen's kappa coefficient, and diagnostic metrics were compared using receiver operating characteristic curves.</p><p><strong>Results: </strong>Doppler ultrasound demonstrated a sensitivity of 98%, specificity and positive predictive value of 100%, and negative predictive value of 94.7% in the femoropopliteal sector, with a Kappa coefficient of 0.98. For the infrapopliteal sector, sensitivity was 95%, specificity 96.5%, positive predictive value 97.3%, and negative predictive value 93.3%, with a Kappa coefficient of 0.89. Combining both sectors, the overall GLASS stage showed a 93.9% concordance with a Kappa coefficient of 0.91. Receiver operating characteristic curves revealed no significant differences between ultrasound and arteriography in terms of staging.</p><p><strong>Conclusions: </strong>This study demonstrates that Doppler ultrasound can serve as the exclusive imaging modality for determining the preoperative GLASS stage.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623121","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":"Interval repair of traumatic innominate artery pseudoaneurysm in a polytrauma patient.","authors":"Christopher Noty, Abdulrhman Elnaggar, Faisal Aziz, Maria Camila Castello-Ramirez","doi":"10.1016/j.jvs.2024.10.073","DOIUrl":"10.1016/j.jvs.2024.10.073","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623129","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 percutaneous closure devices for large bore arterial access in patients with genetic aortopathy does not result in increased rates of access site complications.","authors":"Rebecca Sorber, Sasha Smerekanych, Haley J Pang, Blake E Murphy, Kirsten Dansey, Matthew P Sweet, Sara L Zettervall","doi":"10.1016/j.jvs.2024.11.001","DOIUrl":"10.1016/j.jvs.2024.11.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Percutaneous closure devices for arterial sheaths of sufficient caliber to deliver aortic endografts have a published success rate of 90% to 95%. Despite this, they are frequently avoided in patients with genetic aortopathy due to concern for high failure rates and increased complications in the setting of compromised tissue integrity. This study aims to compare rates of access site complications after large bore percutaneous access among patients with and without confirmed genetic aortopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients undergoing endovascular aortic procedures requiring large bore (≥9F) femoral sheath access between 2019 and 2023 were identified. The specific mutation, demographics, comorbidities, and operative details including maximum sheath size were recorded. Outcomes including unplanned femoral cutdown, access site complications, and reinterventions were evaluated. These factors were then compared between patients with and without a laboratory-confirmed mutation associated with genetic aortopathy. A supplemental analysis was then performed on all patients with genetic aortopathy from 2014 to 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 404 patients identified, 33 (8%) had confirmed genetic aortopathy. Among these, 7 patients (21%) had Marfan syndrome, 7 (21%) had Loeys-Dietz syndrome, and 3 (9%) had vascular Ehlers-Danlos. Also represented were ACTA2, PRKG1, FOXE3, and LOX mutations. The genetic aortopathy group was significantly younger (median genetic aortopathy: median 52 years; nongenetic aortopathy: 71 years; P &lt; .001). Thoracic endovascular aortic repair was most frequent in the genetic aortopathy group (52%), followed by zone II arch replacement with frozen elephant trunk (21%); the most frequent operation among the nongenetic aortopathy group was fenestrated/branched endovascular aortic repair (43%), followed by thoracic endovascular aortic repair (25%). Both groups had a median sheath size of 20F; the patients with genetic aortopathy had higher rates of both prior open (genetic aortopathy: 27%; nongenetic aortopathy: 12%; P = .015) and prior percutaneous ipsilateral access (genetic aortopathy: 58%; nongenetic aortopathy: 39%; P = .041). Rates of unplanned cutdowns (genetic aortopathy: 0%; nongenetic aortopathy: 6%) and access site complications (genetic aortopathy: 0%; nongenetic aortopathy: 8%) did not significantly differ between groups (P = .160 and P = .096, respectively). In supplementary analysis, there was one patient with genetic aortopathy who required unplanned cutdown, yielding an overall technical success rate of 97% for percutaneous closure over a 10-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Percutaneous access is safe and effective in patients with confirmed genetic aortopathy with similar rates of unplanned cutdown as those in patients without genetic aortopathy. Given the high rates of staged, repeat aortic procedures in this patient population, percutaneous","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623145","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 benefit of automated sac volume measurements in postoperative endovascular aortic repair surveillance.","authors":"Magdalena Broda, Alexandre Rossillon, Thomas Le Houérou, Camille Ruppli, Erol Lorisson, Emad Al Osail, Dominique Fabre, Michel Bartoli, Stéphan Haulon","doi":"10.1016/j.jvs.2024.10.070","DOIUrl":"10.1016/j.jvs.2024.10.070","url":null,"abstract":"<p><strong>Objective: </strong>Abdominal aortic aneurysm (AAA) shrinkage is considered a marker for success following endovascular aortic repair (EVAR). Although maximum diameter is widely used to assess sac behavior, research indicates that changes in AAA morphology do not always affect the maximum diameter. The aim of this study was to investigate if automated AAA sac volume measurements after EVAR can add more nuanced information on sac behavior compared with maximum diameter evaluation alone.</p><p><strong>Methods: </strong>A retrospective review of all patients treated for AAA with a standard or fenestrated EVAR at two tertiary referral centers was performed. Patients with a preoperative and postoperative computed tomography angiography ≥2 years after treatment were included. Data were collected using medical charts, radiological institutional databases, and a deep learning based method called Augmented Reality for Vascular Aneurysm. Volume and diameter assessments were automatically performed on computed tomography angiography using Augmented Reality for Vascular Aneurysm. Preoperative sac volumes and diameters were compared with those obtained at least two years after repair. Information on endoleaks (ELs) was collected. Continuous data were tested using the t test, and categorical data were tested using the χ² or Fishers test, depending on sample size.</p><p><strong>Results: </strong>A total of 89 patients (standard EVAR n = 46; fenestrated EVAR n = 43) were included in this study. Of the 89 patients, 41 (46%) had sac diameter shrinkage, 38 (43%) had stable sac diameters, and 10 (11%) had diameter sac growth during follow-up. The distribution of sac volume behavior was different among these patients: 51 (57%) had volume shrinkage, 9 (10%) had stable volumes, and 29 (33%) had volume growth. Significantly more patients had sac growth and fewer had sac stability, when assessed with volume compared with diameter (P = .003 and P < .001, respectively). The increase in patients with volume-assessed sac shrinkage (57% vs 46%) was not statistically significant. Of the 18 patients (20%) with stable sac diameters and simultaneous volume growth, 13 (72%) had ELs (type 2 ELs, n = 9; type 1 ELs, n = 2, type 3EL, n = 1, and EL of undefined origin, n = 1).</p><p><strong>Conclusions: </strong>This study found that volume-assessed sac behavior identifies more sac shrinkage or growth, and less sac stability than diameter does. If confirmed by larger studies, sac volume assessment should be performed routinely after endovascular repair.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623143","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":"Society for Vascular Surgery appropriate use criteria methodology and rating Terminology.","authors":"Adam W Beck, Thomas L Forbes, Larry W Kraiss, Gary W Lemmon, Daniel T McDevitt, Robert G Molnar, William P Shutze, Jessica P Simons, Jeffery J Siracuse, Britt H Tonnessen, M Libby Weaver, Reva Bhushan","doi":"10.1016/j.jvs.2024.10.072","DOIUrl":"10.1016/j.jvs.2024.10.072","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623142","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":"Intraoperative position system guided with augmented reality improves the learning curve of endovascular navigation in endovascular-naïve operators.","authors":"Joshua Wong, Thomas Mesnard, Andrea Vacirca, Mitchell George, Vikash Goel, Titia A L Sulzer, Ying Huang, Emanuel R Tenorio, Max Skibber, Steve Maximus, Gustavo S Oderich","doi":"10.1016/j.jvs.2024.10.074","DOIUrl":"10.1016/j.jvs.2024.10.074","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to compare the completion of gate cannulation task performed by participants of varying experience using fluoroscopy, the Intraoperative Positioning System (IOPS)-a United States Food and Drug Administration-cleared endovascular navigation system that has been developed to reduce dependence on fluoroscopy-or an investigational augmented reality electromagnetic navigation technology based on IOPS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The task consisted in the cannulation of the gate of a GORE Excluder AAA endoprosthesis bifurcated aortic stent graft (W.L. GORE & Associates) deployed into a three-dimensional printed abdominal aortic aneurysm model connected to a 7000 MDX flow pump (Sarns Inc/3M) reproducing physiological conditions. The procedure was performed in a hybrid operating room (GE Allia IGS 7). Each participant performed the cannulation task with fluoroscopy, standard IOPS guidance with flat screen display (IOPS-FS), and the investigational IOPS with augmented reality headset (IOPS-AR), in a randomly assigned order. All participants used the same sensorized guidewire and steerable 6Fr catheter during their three cannulation tasks. A total of 26 participants were classified in three groups of experience: Group 1 (endovascular naïve; n = 13), Group 2 (surgeon in training; n = 12) and Group 3 (one expert surgeon). Primary endpoints included cannulation time and technical success, which was defined as the advancement of the catheter over the guidewire within the main body of the aortic stent graft within a maximum 15-minute cutoff time for each trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In group 1, the mean cannulation time was shorter using IOPS-AR vs fluoroscopy (4.3 ± 4.4 vs 7.1 ± 4.9 minutes; P = .04), but not statistically different when comparing IOPS-FS and fluoroscopy (6.3 ± 4.5 vs 7.1 ± 4.9 minutes; P = .63). In group 1, technical success was 77% with fluoroscopy and 92% with both IOPS-FS and IOPS-AR (P = .59). In group 2, although there was no significant difference between cannulation time among the three different endovascular approaches, there was a trend towards shorter cannulation times with IOPS-FS or IOPS-AR as compared with fluoroscopy (mean time of 2.5 ± 0.9, 4.4 ± 4.0, and 5.2 ± 4.5 minutes, respectively). In group 2, technical success was 92% with fluoroscopy and 100% with both IOPS-FS and IOPS-AR (P &gt; .99). The expert vascular surgeon repeated the cannulation task four times for each endovascular approach, with 100% technical success and no difference in mean cannulation time between the imaging modalities (P = .89).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Augmented reality allows for reducing the gate cannulation time as compared with fluoroscopy in participants with no previous exposure to any endovascular procedure. This suggests that augmented reality can be beneficial for individuals early in their career and can mitigate the learning curve. As individuals become experts, their abi","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623076","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":"A systematic review to examine the impact of socioeconomic status on revascularization for piripheral arterial disease, carotid artery surgery, and aortic aneurysm repair outcomes in the United States.","authors":"Ahsan Zil-E-Ali, Billal Alamarie, Leana Dogbe, Alpha Ahamadou Tall, Abdul Wasay Paracha, Faisal Aziz","doi":"10.1016/j.jvs.2024.09.040","DOIUrl":"10.1016/j.jvs.2024.09.040","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aims to study the available literature on the impact of SES on the surgical outcomes of peripheral artery disease (PAD), carotid artery disease, and aortic aneurysms in the United States. The review also aims to report the diverse tools used to compute SES within the vascular surgery literature.</p><p><strong>Methods: </strong>A systematic review of English literature was conducted using the PubMed and Scopus literature databases from inception to November 2023. The review was designed on the PRISMA guidelines. It included studies reporting socioeconomic factors, income, social determinants of health, social class, and health status disparities in patients undergoing vascular surgical procedures. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions tool. There were 1133 studies initially selected; only 19 passed the complete inclusion criteria for final assessment and reporting.</p><p><strong>Results: </strong>A total of 19 studies were examined that assessed the relationship between socioeconomic status and vascular surgery outcomes. All analyses were published between 2018 and 2023 and included a broad spectrum of patients undergoing multiple vascular procedures. A total of 10 publications addressed the role of these factors in patients with PAD, three analyzed the impact of these factors in patients with carotid artery disease, and six explored the role of these factors in patients with aortic repairs. No high risk of bias was reported for any selected study, and most studies (15/19) were based on national or large registries. The results of these studies showed widespread reporting measures of SES. The findings reported describe that lower SES is associated with a higher risk of amputation and stroke after revascularization for PAD and carotid artery surgery. Among the patients undergoing aortic repair, lower SES was more likely to present with ruptured aneurysms or symptomatic at the time of surgery.</p><p><strong>Conclusions: </strong>Multiple metrics are used to assess SES in the vascular surgery literature. All studies associated lower SES with poorer outcomes or higher acuity of symptoms at the time of revascularization for PAD, carotid artery disease, and aortic repair. This finding highlights the need to consider SES in improving surgical outcomes and decreasing health care disparities.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French multicentric registry on LUMINOR drug-eluting balloon for superficial femoral and popliteal arteries.","authors":"Caroline Caradu, Claire Webster, Bahaa Nasr, Jonathan Sobocinski, Nicolas Louis, Benjamin Thévenin, Gilles Goyault, Yann Goueffic, Eric Ducasse","doi":"10.1016/j.jvs.2024.10.068","DOIUrl":"10.1016/j.jvs.2024.10.068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Endovascular interventions using drug-coated balloons (DCBs) have shown promise in improving outcomes for femoropopliteal (FP) revascularizations. Luminor, a nanotechnology-based paclitaxel coated balloon, has demonstrated efficacy and safety in Effpac (Effectiveness of Paclitaxel-coated Luminor Balloon Catheter Versus Uncoated Balloon Catheter in the Arteria Femoralis Superficialis). The LUMIFOLLOW (European All-comers' Multicentric Prospective REGISTRY on LUMINOR Drug Eluting Balloon in the Superficial Femoral Artery and Popliteal Artery With 5 Years Follow-up) registry, a large-scale, prospective, multicenter study, aims to assess the real-world performance of Luminor in FP lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;LUMIFOLLOW enrolled 542 patients with 580 lesions across 15 French centers. It included both de novo and restenotic lesions, with calcified and/or long occlusions. Primary end points were medical safety (defined as freedom from peri-procedural death, index limb amputation, and/or all-cause mortality) and efficacy (primary patency defined as freedom from target lesion revascularization and/or binary restenosis); secondary end points included acute device success, procedural and clinical success, major adverse events, and functional assessments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean patient age was 71.2 years, with 67.2% male patients. Prevalent comorbidities included diabetes (n = 231/542 [42.6%]), hypertension (n = 391/542 [72.1%]), hyperlipidemia (n = 305/542 [56.3%]), and current smoking (n = 147/540 [27.2%]); 23.8% were classified as Rutherford category 2 (n = 129/542), 43.2% as Rutherford category 3 (n = 234/542), 16.8% as Rutherford category 4 (n = 91/542), and 16.2% as Rutherford category 5 (n = 88/542). Lesions were located in the superficial femoral artery (n = 329/572 [57.5%]) and could extend to the popliteal artery (n = 243/572 [42.5%]), with 43.6% classified as Trans-Atlantic Inter-Society Consensus II C or D; 24.2% were restenosis (n = 139/575) with a 44.3% rate of total occlusions (n = 255/576). The mean lesion length was 140.55 ± 99.42 mm. Provisional stenting was required in 43.1% of patients (n = 249/580), with a mean stent length shorter than the initial lesion length at 87.21 ± 42.30 mm. The acute procedural success rate was 99.4% (n = 536/539), with two in-hospital deaths and one thrombosis of target lesion. Acute clinical success was achieved in 93.5% (n = 504/539). The 12-month composite safety end point was 82.7% (5.7% all-cause mortality, 0.7% index limb major amputation) and the estimated primary patency was 87.4% (95% confidence interval [CI], 84.1%-90.1%), with freedom from target lesion revascularization at 96.2% (95% CI, 93.9%-97.6%) and from target vessel revascularization at 94.9% (95% CI, 92.5%-96.6%). The EQ-5D-5L questionnaire indicated significant improvements in quality of life at 12 months, with 67.4% improved mobility, 63.5% reduced pain and discomfort, and 47.8","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of prosthetic and biological grafts compared to arm vein grafts in patients with chronic limb-threatening ischemia.","authors":"Mohammed Hamouda, Sina Zarrintan, Nishita Vootukuru, Sneha Thandra, Jon G Quatromoni, Mahmoud B Malas, Ann C Gaffey","doi":"10.1016/j.jvs.2024.10.069","DOIUrl":"10.1016/j.jvs.2024.10.069","url":null,"abstract":"<p><strong>Objective: </strong>The optimal conduit for infrainguinal bypass (IIB) is single-segment great saphenous vein (GSV). Unfortunately, GSV is not always available in patients with chronic limb-threatening ischemia (CLTI). Other graft choices include arm vein grafts (AVs), prosthetic grafts (PGs), or biologic grafts (BGs). Current data regarding the durability and limb salvage rates of those options is scarce; hence, we aimed to investigate the impact of alternative graft types on postoperative and long-term outcomes on IIB in patients with CLTI.</p><p><strong>Methods: </strong>The Vascular Quality Initiative (VQI) database was queried for patients undergoing IIB from January 2003 to April 2024. Patients were stratified into three groups: AVs (cephalic, basilic), PGs (Dacron, polytetrafluoroethylene [PTFE]), and BGs (cadaveric, homograft, or xenograft). Saphenous vein grafts (greater and lesser saphenous) were excluded. Multivariate logistic regression analyzed postoperative outcomes: 30-day mortality, major adverse cardiovascular events, graft occlusion, prolonged length of stay >7 days, packed red blood cell transfusion >2 units, and infection. Cox regression was used to report 1-year outcomes: mortality, major amputation (above-ankle), and major adverse limb events (defined as major amputation, thrombectomy, or reintervention).</p><p><strong>Results: </strong>A total of 9165 IIB procedures have been analyzed: AV, 417 (4.55%); PG, 7520 (82.05%); and BG, 1228 (13.40%). Compared with AVs, patients receiving PGs had higher odds of infection (adjusted odds ratio [aOR], 2.89; P = .045) and higher hazard of 1-year mortality (adjusted hazard ratio [aHR], 1.51; P = .035). On the other hand, patients receiving BGs had higher risk of graft occlusion (aOR, 4.55; P = .040) and infection (aOR, 2.78; P = .046), as well as higher hazard of 1-year mortality (aHR, 1.53; P = .040), amputation (aHR, 1.72; P = .019), and amputation or death (aHR, 1.52; P = .005) compared with patients receiving AVs. After stratifying by bypass configuration, patients with AVs had the highest overall survival and amputation-free survival among the three alternative conduits in below-knee popliteal and tibial bypass targets.</p><p><strong>Conclusions: </strong>In this large multi-institutional study investigating alternative conduits to GSV, AVs are found to be the most resistant to infections and are associated with the best overall survival and limb salvage outcomes compared with PGs and BGs, particularly in below-knee distal targets. In cases where no GSV is available, AVs and PGs are acceptable alternatives with comparable 1-year amputation-free survival and major adverse limb events-free survival rates. On the other hand, BGs are associated with higher risk of graft occlusion and lower freedom from major amputation and death compared with AVs.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}