Journal of Vascular Surgery最新文献

{"title":"Diabetes Status and Long-Term Mortality and Major Amputation Outcomes Following Revascularization in Chronic Limb Threatening Ischemia.","authors":"Santiago Callegari, Gaëlle Romain, Abhinav Aggarwal, Jacob Cleman, Kim G Smolderen, Carlos Mena-Hurtado","doi":"10.1016/j.jvs.2025.04.065","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.065","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus (DM) affects over 60% of patients with chronic limb-threatening ischemia (CLTI). The association between DM in outcomes after lower-extremity bypass (LEB) or peripheral vascular interventions (PVI) remains unclear. Our study aims to assess the association between DM and 5-year all-cause mortality and major amputation following LEB vs. PVI for CLTI.</p><p><strong>Methods: </strong>Patients with CLTI undergoing LEB or PVI between 2014-2019 were studied in the VQI registry and stratified according to DM status. Outcomes were derived from linked Medicare claims data. Propensity score 1:1 matching between PVI and LEB cohort was used. Cumulative incidence of mortality and hazard ratio were assessed with a Kaplan-Meier and Cox regression model, respectively. To account for the competing risk of death, major amputation was evaluated with Aalen-Johansen and Fine-Gray model for cumulative incidence and sub-hazard ratio (sHR), respectively. The interaction between DM and PVI vs LEB was tested.</p><p><strong>Results: </strong>Of 4,218 patients were included (70.7 ± 10.7 years old, 30.6% female), 62.3% had DM. . The 5-year cumulative incidence of death was lower in LEB vs PVI regardless of DM status (LEB vs. PVI without DM: P=0.005, and with DM: P = 0.004). The 5-year risk of death after LEB was 26% less than after PVI, regardless of DM status (P interaction = 0.490). There was no association between 5-year mortality risk and DM status (HR 1.16 95% CI 0.99-1.34, P = 0.060). The cumulative incidence of major amputation at 5 years did not differ in LEB vs. PVI regardless of DM status (LEB vs. PVI without DM cohort: P = 0.955, and with DM cohort: P=0.955). The 5-year risk of major amputation was not associated with the type of revascularization (sHR 0.79 95% CI 0.57-1.08, P=0.140). Major amputation was twice higher in patients with DM than in those without DM (sHR 1.98 95% CI 1.55-2.54, P< 0.001), regardless of treatment cohort (P interaction = 0.869). Similar results were seen regardless of insulin-dependent status.</p><p><strong>Conclusion: </strong>DM affects the majority of patients with CLTI. Regardless of DM status, mortality at 5 years was lower among patients undergoing LEB. There was no difference in major amputation in LEB vs PVI and mortality or major amputation at 5 years, but patients with DM vs. no DM had a higher risk of major amputation. Shared decision-making, team-based care, and integrated care offerings are needed within the context of a revascularization pathway for patients with DM.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024073","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 Aortic Visceral Branch Vessel Interventions On The Postoperative Outcomes Of Thoracic Endovascular Aortic Repair For Type B Aortic Dissection Complicated With Visceral Malperfusion.","authors":"Narek Veranyan, Dong-Jin E Kang Sim, Gregory A Magee, Jeffrey J Siracuse, Ann Gaffey, Mahmoud B Malas","doi":"10.1016/j.jvs.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.003","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thoracic endovascular aortic repair (TEVAR) is the standard of care for type B aortic dissection (TBAD) complicated with visceral malperfusion. TEVAR is considered efficient at relieving malperfusion caused by dynamic obstruction but not static obstruction, and as such, some patients also require adjunctive visceral branch vessel interventions (VBI). The role of VBI in patients undergoing TEVAR for TBAD complicated with visceral malperfusion is a subject of considerable debate. This study aims to compare the postoperative outcomes of TEVAR with VBI vs without for TBAD complicated with visceral malperfusion in a real-world multi-institutional setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) database was queried for patients who underwent TEVAR for TBAD complicated with hepatic, intestinal, or renal malperfusion. The cohort was divided into two groups based on the main exposure variable: TEVAR with adjunctive VBI vs without on either celiac artery (CA), superior mesenteric artery (SMA), right renal artery (RRA), or left renal artery (LRA), presenting with malperfusion. Baseline demographic, clinical, and perioperative characteristics, as well as outcomes such as overall 30-day mortality, malperfusion-related mortality, Major Adverse Cardiovascular Events (MACE: death, myocardial infarction, stroke), overall complications, reinterventions, and visceral branch reinterventions, were compared between the groups. Univariable and multivariable analyses were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of all reviewed patients, 477 were involved in the final analysis, 324 (67.9%) underwent TEVAR without a VBI, whereas 153 (32.1%) underwent TEVAR in association with an adjunctive intervention on at least one of the visceral branches (CA, SMA, RRA, LRA), presenting with malperfusion. Patients who underwent TEVAR with a VBI had significantly lower rates of overall 30-day mortality (9.8% vs 17.3%, p=0.032), malperfusion-related mortality (3.3% vs 9.6%, p=0.015), a tendency towards a lower rate of MACE (15.7% vs 22.8%, p=0.071), and a higher rate of visceral branch reinterventions (11.8% vs 6.2%, p=0.035). After adjustment for potential confounders, patients who underwent TEVAR with a VBI had 90% decreased odds of 30-day mortality (OR: 0.10, 95%CI: 0.03-0.40, p=0.001), 78% decreased odds of malperfusion-related mortality (OR: 0.22, 95%CI: 0.05-0.95, p=0.043), 50% decreased odds of MACE (OR: 0.50, 95%CI: 0.25-0.97, p=0.040) and increased odds of visceral branch reinterventions (OR: 2.36, 95%CI: 1.01-5.52, p=0.047).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;TEVAR with VBI is associated with significantly reduced odds of 30-day mortality, malperfusion-related mortality, and MACE, but increased odds of visceral branch reinterventions in TBAD patients presenting with visceral malperfusion. Based on these results, a lower threshold for performing VBI is recommended for patients ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971061","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 Associated with Type 2 Endoleaks After Infrarenal Endovascular Aneurysm Repair in the Vascular Quality Initiative Linked to Medicare Claims.","authors":"Venkata Vineeth Vaddavalli, Xinyan Zheng, Jialin Mao, Bernardo C Mendes, Salvatore T Scali, Randall R DeMartino","doi":"10.1016/j.jvs.2025.04.061","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.061","url":null,"abstract":"<p><strong>Objective: </strong>Type 2 endoleaks (T2EL) are commonly identified after endovascular aneurysm repair (EVAR) and may occur either at the completion of the procedure or during follow-up. However, the impact of T2EL on reintervention and survival remains poorly described. This study aims to evaluate the outcomes associated with T2EL in a real-world cohort using the Vascular Quality Initiative linked Medicare claims (VQI-Medicare) database.</p><p><strong>Methods: </strong>We retrospectively reviewed all elective EVARs in the VQI-Medicare (part of the Vascular Implant Surveillance and Interventional Outcomes [VISION] coordinated registry network) database from 2010-2018. Patients with Medicare fee-for-service entitlement at the time of the index procedure and continuous entitlement during follow-up were included. We excluded patients with endoleaks other than T2EL at completion or follow-up, those with missing T2EL status at completion, and subjects with no imaging follow-up. The primary outcomes were aneurysm-related reintervention, freedom from rupture, and overall survival. A time-dependent analysis based on the T2EL status, and Cox proportional hazards multivariable models were used to assess associations between T2EL and the outcomes.</p><p><strong>Results: </strong>A total of 8,195 patients were included in the final analysis, with 6,653 (81%) in the NO T2EL group and 1,542 (19%) in the T2EL group. Patients in the T2EL group were older (76 vs. 75 years, p=.006) and had lower rates of active smoking (21% vs. 26%, p<.001), COPD (28% vs. 32%, p=.003), congestive heart failure (9% vs. 12%, p=.004) and history of prior vascular intervention. At 5 years, the rate of aneurysm-related reintervention was significantly higher in the T2EL group (30.4% vs. 11%, p<.0001); however, there was no significant difference in freedom from rupture between the groups (95.6% vs. 98.2%, aHR 0.98, 95%CI 0.5-2). Unadjusted overall survival at 5 years was similar between the groups (74% vs. 71%). On multivariate regression analysis, presence of T2EL was not associated with an increased risk of mortality (aHR 0.83, 95% CI 0.69-1.01, p=.057). Subgroup analysis in patients with T2EL showed that reintervention was not significantly associated with overall survival at 5-years (aHR 0.45 95%CI 0.1-1.9, p=.27).</p><p><strong>Conclusions: </strong>T2EL occurred in nearly one-fifth of patients after EVAR and was associated with a higher rate of reintervention compared to subjects without T2EL. Yet, reinterventions were not linked to better survival. Thus, the overall benefit of reintervention for isolated T2EL in current practice remains to be defined.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989802","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 Ultrasonography-Based Comparative Analysis of Inner Branch Orientation for the Left Common Carotid Artery following Triple-Branch Arch Endovascular Repair.","authors":"Roberto G Aru, Jérémy Bendavid, Charles Lame, Reda Jerrari, Dominique Fabre, Stéphan Haulon","doi":"10.1016/j.jvs.2025.04.062","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.062","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to evaluate left common carotid artery (LCCA) perfusion using duplex ultrasonography (DUS) after endovascular repair of the aortic arch (endoarch) with a triple-branch arch device, featuring either an anterograde or retrograde inner branch configuration for the LCCA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent branched endoarch repair from May 2020 to February 2025 were identified using a prospectively maintained electronic database at a single, tertiary-care hospital. Inclusion criteria included implantation of the triple-branch arch device (Cook Medical) with an anterograde inner branch for the brachiocephalic trunk (BCT), an anterograde or retrograde inner branch for the LCCA, and a retrograde branch for the left subclavian artery (LSA). Exclusion criteria included no follow-up and postoperative DUS. Patient demographics, comorbidities, indication for the procedure, procedural details, and outcomes were recorded. The cohort was dichotomized based on LCCA branch orientation. The primary outcomes were to define postoperative DUS-based perfusion metrics of the bilateral carotid arteries and to compare them based on the orientation of the LCCA branch. The right common carotid artery (RCCA) served as a control, as it featured only an anterograde branch for the BCT. The secondary outcomes were to compare inner branch primary patency, stroke-related outcomes, reintervention, and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 74 patients underwent endoarch repair with the triple-branch arch device during the study period, of which 39 met the study inclusion criteria, with 18 (46%) anterograde and 21 (54%) retrograde inner branches of the LCCA. Most patients were male (74%) with a median age of 72 years. There was a high incidence of hypertension (90%) and dyslipidemia (59%). The indication for repair was a degenerative (51%) or chronic post-dissection (49%) aortic arch aneurysm. A totally percutaneous approach for procedural access occurred in 71% of the retrograde group (vs 17% anterograde). There was a decreased median operating time for LCCA retrograde branch of 160 min (vs 218 min anterograde). Thirty-day stroke was 5% (n=2, both anterograde), with no mortality. Postoperative DUS demonstrated similar perfusion metrics between the experimental LCCA and the control RCCA, regardless of the orientation of the LCCA inner branch. In the retrograde group, both the RCCA and LCCA featured predominantly monophasic (62%) and triphasic (31%) waveforms; the median peak systolic velocity (PSV), end diastolic velocity (EDV), and acceleration time (AcT) were 64-68 cm/s, 17-21 cm/s, and 56-65 ms, respectively. Midterm (median follow-up 11 months) outcomes were notable for 1 mortality, without events of stroke or target vessel-related reinterventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In endoarch repair with the triple branch device, inner branch orientation yields no significant diffe","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968959","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":"Peripheral arterial disease prevalence among sepsis hospitalizations and associated outcomes.","authors":"Stuthi Iyer, Marissa C Jarosinski, Jason N Kennedy, Kristina E Rudd, Christopher W Seymour, Edith Tzeng, Megan M Marron, Katherine M Reitz","doi":"10.1016/j.jvs.2025.04.058","DOIUrl":"10.1016/j.jvs.2025.04.058","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Sepsis is common, deadly, and exacerbated by comorbid conditions. Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease (CAD) and peripheral artery disease (PAD), are risk factors for sepsis with minimal data on the association between PAD and outcomes. We aimed to evaluate the prevalence of ASCVD and the association between ASCVD and in-patient mortality and limb outcomes among sepsis hospitalizations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We generated ASCVD prevalence estimates among survey-weighted adult sepsis hospitalizations within the National Inpatient Sample (2016-2020). We included hospitalizations with a primary diagnosis of sepsis and excluded nonadult patients (&lt;18 years), and those with missing outcome data (ie, in-hospital mortality) and demographic data (ie, age, sex, and race/ethnicity). Associations between ASCVD and in-hospital mortality and major or transmetatarsal amputation among sepsis hospitalizations were evaluated using Cox regression, adjusting for demographics (age, sex, race/ethnicity, and income) and comorbidities (diabetes mellitus, end-stage renal disease, cerebrovascular disease, and hypertension). Subgroup analyses were conducted to assess moderation of the association between ASCVD and outcomes by antithrombotic therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 174,776,160 estimated hospitalizations (age, mean ± standard error, 50 ± 0.2 years; 44% male; 65% White), 5.5% (5.5%-5.6%) had a primary diagnosis of sepsis (age 69 ± 0.1; 51% male; 70% White); of which, 9.5% (9.3%-9.6%) had a secondary diagnosis of PAD (age 73 ± 0.05; 58% male; 73% White). PAD was associated with 18% higher adjusted risk of in-hospital mortality (95% confidence interval [CI], 1.17-1.20) and 4.36 times the risk of major or transmetatarsal amputation (95% CI, 4.18-4.56). Sepsis hospitalizations with joint ASCVD had the highest risk of in-hospital mortality (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.31-1.36) compared with those with CAD alone (aHR, 1.25; 95% CI, 1.24-1.27) or PAD alone (aHR, 1.23; 95% CI, 1.21-1.26). Yet patients with PAD who were hospitalized for sepsis had a higher risk of in-hospital major or transmetatarsal amputation (aHR, 5.03; 95% CI, 4.76-5.32) compared with those with joint ASCVD (aHR, 3.89; 95% CI, 3.66-4.14); CAD was expectedly not associated with amputation (aHR, 1.05; 95% CI, 0.999-1.1). Subgroup analyses revealed significant interactions between ASCVD and antithrombotic therapy, such that, among those taking antithrombic therapy, the associations between ASCVD and in-hospital mortality (P &lt; .001) and amputation (P &lt; .05) were smaller when compared with the associations examined in the whole sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sepsis and ASCVD are common and associated with a higher risk of adverse outcomes. PAD diagnosis occurred among 9.5% of sepsis hospitalizations and, mirroring CAD, increased the risk of in-hospital mortality by approximately 25%. E","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975070","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":"International multicenter experience on early and late outcomes after endovascular repair of ruptured abdominal aortic aneurysms in patients with vs without type II endoleaks.","authors":"Mario D'Oria, Beatrice Grando, Anna-Leonie Menges, Abdulhakim Ibrahim, Sandro Lepidi, Alexander Oberhuber, Alexander Zimmermann, Benedikt Reutersberg, Alessia D'Andrea, Cristiano Calvagna, Clemens Zippel, Philip Dueppers","doi":"10.1016/j.jvs.2025.04.042","DOIUrl":"10.1016/j.jvs.2025.04.042","url":null,"abstract":"<p><strong>Background: </strong>Ruptured abdominal aortic aneurysms (rAAAs) remain as a great clinical challenge for vascular surgeons and endovascular aortic repair (EVAR), which is currently regarded as the first-line treatment for rAAA in patients with appropriate anatomy. While recommendations for management of type II endoleaks (T2ELs) are well-established in the elective setting, data after rAAAs are limited.</p><p><strong>Methods: </strong>Between January 2018 and December 2022, all patients who were treated with EVAR for rAAA in three tertiary referral centers from different countries (Germany, Italy, and Switzerland) were screened for inclusion in the study. The patients were divided into two groups based on the presence or absence of early T2EL (at completion angiography or at first postoperative computed tomography angiography). The primary end points for this study were 30-day mortality and long-term survival.</p><p><strong>Results: </strong>Overall, 123 patients were included in the final analysis. Of these, 73 were categorized as not having an early T2EL (group A) and 50 presented an early T2EL (group B). Except for a significantly lower proportion of males in group A as compared with group B (79.5% vs 92%; P = .05), no significant baseline differences were found. At 30 days, the overall mortality rate was not significantly different between study groups (22% vs 16%; P = .16). Using binary regression, the presence of a T2EL was not associated independently with 30-day mortality (odds ratio, 1.712; 95% confidence interval, 0.591-3.964; P = .54). Five-year survival estimates in the whole study cohort did not show any significant difference in patients without a T2EL as compared to those with a T2EL (53% vs 59%; log-rank P = .31). Using Cox proportional hazard regression, the presence of T2ELs was not independently associated with increased risk for long-term mortality (hazard ratio. 1.068; 95% confidence interval, 0.437-2.611; P = .079).</p><p><strong>Conclusions: </strong>Although the occurrence of a T2EL seems to be a relatively common scenario after EVAR for rAAA, their presence does not seem to be associated with worse outcomes in the immediate perioperative period or to decrease long-term survival. Therefore, careful observation may be warranted in the early phase, with selective treatment only in cases of ongoing hemodynamic decompensation. In the long run, it seems prudent to assume that the same indication for treatment as for standard EVAR could be recommended in the presence of T2EL.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026627","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 supporting the Society for Vascular Surgery guideline update on the management of intermittent claudication.","authors":"Samer Saadi, Tarek Nayfeh, Rami Rajjoub, Bashar Hasan, Mohammed Firwana, Tabinda Jawaid, Walid Hazem, Sahrish Shah, Yahya Alsawaf, Mohamed O Seisa, Larry J Prokop, Michael S Conte, M Hassan Murad","doi":"10.1016/j.jvs.2024.12.135","DOIUrl":"10.1016/j.jvs.2024.12.135","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review and meta-analysis evaluates the current evidence on the management of intermittent claudication (IC), a prevalent manifestation of peripheral arterial disease (PAD).</p><p><strong>Methods: </strong>We conducted comprehensive searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. We addressed six questions developed by a guideline committee from the Society for Vascular Surgery, addressing pharmacological treatments, exercise regimens, endovascular interventions, and predictors of major adverse cardiovascular, limb-related events, and mortality.</p><p><strong>Results: </strong>The search resulted in 5333 citations, from which we included 73 studies (46 randomized trials). In patients with PAD and IC who had one or more high-risk comorbidities, low-dose rivaroxaban and aspirin were associated with lower risk of major adverse limb events and major adverse cardiovascular events than aspirin alone. In patients who have undergone surgical or endovascular interventions for PAD, the addition of low-dose rivaroxaban to aspirin may improve limb outcomes. Of note, rivaroxaban trials excluded patients at high risk of bleeding. Single antiplatelet agents showed no significant efficacy differences head-to-head in ambulatory patients with IC and had a lower bleeding risk compared with combination therapy or anticoagulation. Home exercise programs were feasible and may be an alternative to supervised exercise in ambulatory patients with IC and in those who had revascularization. Several comorbidities increased the risk of adverse outcomes after revascularization for IC, such as advanced age, diabetes, coronary artery disease, chronic obstructive pulmonary disease, previous interventions, congestive heart failure, infrapopliteal artery involvement, and longer lesion lengths. In patients with IC undergoing endovascular intervention for superficial femoral artery disease, plain balloon angioplasty was associated with worse outcomes than drug elution or stent implantation for intermediate or longer lesions (ie, >5 cm).</p><p><strong>Conclusions: </strong>This systematic review summarizes the current evidence base for the management of IC, offering insights into the relative benefits and risks of various therapeutic strategies. The findings underscore the need for individualized patient care, considering both the potential benefits and risks associated with different interventions.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971102","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 Clinical Practice Guideline on the management of intermittent claudication: Focused update.","authors":"Michael S Conte, Bernadette Aulivola, Neal R Barshes, Daniel J Bertges, Matthew A Corriere, M Hassan Murad, Richard J Powell, Amy B Reed, William P Robinson, Jessica P Simons","doi":"10.1016/j.jvs.2025.04.041","DOIUrl":"10.1016/j.jvs.2025.04.041","url":null,"abstract":"<p><p>Intermittent claudication (IC) is the most common symptom of peripheral artery disease, which is a growing public health burden in the United States and globally. Patients with IC present with a broad spectrum of risk factors, comorbid conditions, range of disability, and treatment goals. Informed shared decision-making hinges on a comprehensive evaluation of these factors, patient education, and knowledge of the latest available evidence. In 2015, the Society for Vascular Surgery published a clinical practice guideline on the management of asymptomatic peripheral artery disease and IC. An expert writing group was commissioned to provide a focused update to this guideline on the management of IC. Based on the available evidence from published research conducted since the prior guideline, six specific key questions were formulated spanning the areas of antithrombotic management, exercise therapy, and revascularization for IC. A systematic review and evidence synthesis of each question was conducted by a dedicated methodology team. The GRADE approach was employed to describe the strength of each recommendation and level of certainty of evidence. The review identified major gaps in evidence particularly in the arena of comparative effectiveness for interventions (exercise, revascularization) across defined clinical subgroups and employing meaningful patient-centered outcomes. Twelve recommendations, among which are two best practice statements, are provided in this focused update. They address the use of dual pathway antithrombotic strategies, the role and type of exercise therapy, endovascular interventions for femoropopliteal and infrapopliteal disease, and the identification of specific risk factors that should be incorporated into shared decision-making around revascularization. A comprehensive and individualized approach to the management of patients with IC, relying first on education, risk factor control, optimal medical therapy, and exercise, is emphasized. A rubric for decision-making that includes a thorough assessment of risk, benefits, degree of impairment, and treatment durability, is considered fundamental to a patient-centered approach in IC. Significant unmet research needs in this field are also enumerated.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028536","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":"Cumulative risks for reoperation due to bleeding after carotid endarterectomy and the associated clinical impact of bleeding events.","authors":"Lorela Weise, Lily Darman, Elizabeth Yirga, Faeq Zaman, Kosmas I Paraskevas, David Stone, Salvatore Scali, Matthew Blecha","doi":"10.1016/j.jvs.2025.04.040","DOIUrl":"10.1016/j.jvs.2025.04.040","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to identify all preoperative and intraoperative variables in the Vascular Quality Initiative (VQI) carotid endarterectomy (CEA) module that have a statistically significant association with reoperation for bleeding. A weighted risk score was developed and validated to predict this event, with assessment of its impact on 30-day mortality and other adverse perioperative events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The VQI CEA module was queried between January 2003 and October 2023. Overall, 192,547 CEA procedures met study inclusion. An internal VQI validation cohort was created with the same exclusion criteria utilizing CEAs performed between November 2023 and October 2024, over which time period 17,449 procedures met inclusion criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The following variables had a statistically significant multivariable association (P &lt; .05) with reoperation for bleeding after CEA: Black race (adjusted odds ratio [aOR], 1.53); body mass index &lt;20 kg/m&lt;sup&gt;2&lt;/sup&gt; (aOR, 1.40); hypertension (aOR, 1.19); history of coronary artery disease revascularization (aOR, 1.16); congestive heart failure (CHF) (aOR, 1.37); chronic obstructive pulmonary disease (aOR, 1.19); dual antiplatelet at time of surgery (aOR, 1.51); on anticoagulation baseline (aOR, 1.23); preoperative Rankin score 2 or higher (aOR, 1.41); urgent/emergent CEA (aOR, 1.36); eversion CEA technique (aOR, 1.33); surgeon selection for drain placement (aOR, 1.17); and lack of protamine utilization intraoperatively (aOR, 2.08). The following variables had a significant (P &lt; .05) protective effect vs reoperation for bleeding after CEA: female sex (aOR, 0.84); body mass index &gt;35 kg/m&lt;sup&gt;2&lt;/sup&gt; (aOR, 0.85); and active smoking status (aOR, 0.85). Patients with risk scores of zero or less had an only 0.006% risk of return to the operating room for bleeding. There was significant elevation in risk for return to the operating room for bleeding with escalating risk sores. Patients with risk scores 11 and higher had an absolute reoperation for bleeding event rate of 3.6%, which was a total event rate 600 times higher than individuals with scores of 0 or less and 3.6 times as high as individuals with scores as high as 5. The internal VQI validation cohort experienced the event of return to the operating room for bleeding at very similar rates to the primary study source cohort with no statistically significant difference at any of the risk score points, indicating consistency for the risk score. Patients who experienced return to the operating room for bleeding after CEA experienced a statistically significant increased rate of 30-day mortality (OR, 1.59); cranial nerve injury (OR, 2.03); perioperative neurologic event (OR, 5.80); myocardial infarction (OR, 6.56); cardiac dysrhythmia (OR, 4.20); perioperative CHF (OR, 5.26); and skin-soft tissue infection postoperatively (OR, 12.61) with P &lt; .001 for all.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026626","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":"Extra-anatomic right lower extremity revascularization for patient with complex arterial occlusive disease.","authors":"Julianne E Bartz, Roberto G Aru, Michael Nooromid, Dawn Salvatore, Paul DiMuzio, Babak Abai","doi":"10.1016/j.jvs.2025.04.035","DOIUrl":"10.1016/j.jvs.2025.04.035","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002276","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}