Journal of Vascular Surgery最新文献

{"title":"Vascular Diagnosis in the Pediatric Patient.","authors":"Bethany J Slater, Sean Pfaff, Manish N Shah, Joseph Cao","doi":"10.1016/j.jvs.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.031","url":null,"abstract":"<p><p>Imaging is an important component for vascular diagnoses in pediatric patients, however, it is important to minimize radiation exposure in children. The pediatric population is up to 10 times more sensitive to the effects of radiation than adults due to increased tissue radiosensitivity of their developing organs and tissues, and they have a longer lifespan in which the effects can manifest. In general, the choice of imaging modality for vascular diseases depends on individual patient needs, balancing diagnostic accuracy with potential risks and limitations. A thorough understanding of the advantages and disadvantages of each technique is essential for clinicians to make informed decisions regarding diagnosis and monitoring. This manuscript will discuss some important aspects regarding imaging of vascular diagnoses in pediatric patients including preoperative imaging for access and vascular lesions, vascular malformations, the role of angiography, and diagnosis and monitoring of pediatric brain vascular diseases.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct comparison of frailty scores and their association with post-operative outcomes in patients undergoing lower extremity revascularization.","authors":"Brandon T Gaston, Tiffany R Bellomo, Brett Salomon, Bianca Mulaney-Topkar, Falen Demsas, Aderike Anjorin, Micah Thornton, Austin Gregg, Mohit Manchella, Felita Zhang, Mansi Totwani, Anahita Dua, Abhishek Mohapatra, Sunita D Srivastava, Matthew J Eagleton, Nikolaos Zacharias","doi":"10.1016/j.jvs.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.033","url":null,"abstract":"<p><strong>Background: </strong>Frailty is increasingly recognized as a key driver of postoperative risk in vascular surgery. Yet the relative accuracy of the major frailty indices in a purely vascular cohort remains unclear.</p><p><strong>Objective: </strong>To compare the predictive accuracy of the Modified Frailty Index (mFI), Risk Analysis Index (RAI), Vascular Quality Initiative Frailty Index (VQI-FI), and VQI Procedure-Based Index (VQI-PBI) in predicting adverse postoperative outcomes in patients undergoing lower extremity revascularization.</p><p><strong>Methods: </strong>In this retrospective single-center cohort study, 193 patients who underwent open or endovascular lower extremity revascularization between January 1 and December 31, 2023, were included. Frailty scores were retrospectively calculated based on data available at the time of the preoperative evaluation. Primary outcomes were 30-day and one-year mortality and 30- and 60-day hospital readmission. Secondary outcomes included new dialysis within 30 days, and myocardial infarction. Statistical associations were evaluated using logistic regression models.</p><p><strong>Results: </strong>The cohort's mean age was 69.4 years, 32 % were female, and 74 % presented with critical limb ischemia. All four indices predicted 1-year mortality and initiation of dialysis within 30 days. The mFI, VQI-FI, and VQI-PBI also predicted 30-day readmission, but only the VQI scores were associated with 60-day readmission. The RAI was the only score associated with in-hospital mortality. The VQI-FI demonstrated the greatest number of statistical associations with good discriminatory ability.</p><p><strong>Conclusions: </strong>Vascular specific frailty indices (VQI-FI and VQI-PBI) provide superior risk stratification compared to generic measures. Incorporating these tools into preoperative evaluation may improve patient selection and shared decision-making.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BALLOON ANGIOPLASTY PLUS STENTING OR ATHERECTOMY PLUS DRUG-COATED BALLOON ANGIOPLASTY IN ENDOVASCULAR REPAIR OF THE COMMON FEMORAL ARTERY.","authors":"Camil-Cassien Bamdé, Yann Goueffic, Comlan Blitti, Aline Laubriet, Jean-Michel Davaine, Eric Steinmetz","doi":"10.1016/j.jvs.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.027","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment of common femoral artery (CFA) lesions has emerged as an alternative to surgical endarterectomy, with two main strategies: balloon angioplasty and stenting versus atherectomy plus drug-coated balloon (DCB) angioplasty. However, the optimal endovascular approach for CFA lesions remains to be defined.</p><p><strong>Methods: </strong>This single-center retrospective study analyzed consecutive patients with symptomatic atheromatous CFA stenosis requiring endovascular treatment between January 2016 and January 2024. Patients were stratified by approach. The primary endpoint was twelve-month primary patency, defined as duplex ultrasound peak systolic velocity ratios ≤2.4 without clinically driven target-lesion revascularization. Secondary endpoints included freedom from target-lesion revascularization, technical success and primary sustained clinical improvement.</p><p><strong>Results: </strong>A total of 134 limbs of 138 patients were included in the final analysis, 39 in the atherectomy plus DCB group and 95 in the plain old balloon angioplasty (POBA) plus stenting group. Baseline demographic and clinical characteristics were comparable between the groups, with mean ages of 74 ± 8 years for atherectomy plus DCB angioplasty and 72 ± 8 years for stenting (p=0.14). Technical success was achieved in 89.2% of atherectomy plus DCB angioplasty cases compared with 92.3% of stenting procedures (p=0.52). The twelve-month primary patency rates were similar between the groups: 79.5% for atherectomy plus DCB angioplasty versus 78.7% for stenting (p=0.71). Freedom from target-lesion revascularization was 92.3% and 85.3%, respectively (p=0.56). Bailout stenting was required in 10% of atherectomy cases, while stent fractures occurred in 5.3% of the stenting cohort.</p><p><strong>Conclusions: </strong>Atherectomy plus DCB angioplasty and stenting demonstrated similar twelve-month outcomes for CFA lesions. Both strategies represent viable endovascular options. Multicenter randomized trials are warranted to establish optimal treatment strategies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102933","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 Access Site on Carotid Artery Stenting in Patients with Challenging Aortic Arch Anatomy.","authors":"Christopher Y Chow, Naixin Kang, Stefan Kenel-Pierre, Kathy Gonzalez, Matthew Sussman, Jorge Rey, Omaida C Velazquez, Arash Bornak","doi":"10.1016/j.jvs.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.028","url":null,"abstract":"<p><strong>Background: </strong>Aortic arch anatomy can pose challenges during carotid artery stenting (CAS). Transradial carotid artery stenting (TRCAS) offers an alternative to transfemoral carotid artery stenting (TFCAS). This study reports on the impact of access site on CAS outcomes across different aortic arch anatomies.</p><p><strong>Methods: </strong>The Vascular Quality Initiative (VQI) database was queried for patients who underwent TRCAS or TFCAS between 2017-2024. Exclusion criteria included patients with transcarotid artery revascularizations, intracranial revascularizations, dissections, aneurysms, trauma, and fibromuscular dysplasia. Patients were categorized by aortic arch type (type I, II, or III) and presence of a bovine arch. Symptomatic and asymptomatic patients were separately analyzed. Primary outcomes included postoperative stroke, transient ischemic attack (TIA), myocardial infarction (MI), in-hospital mortality, and access site complications. Secondary outcomes included procedure time, fluoroscopy time, contrast volume, and length of hospital stay.</p><p><strong>Results: </strong>14,351 patients (5.78% TRCAS; 94.21% TFCAS) were included in the analysis. TRCAS was used more frequently in bovine (18.92% of TRCAS; 11.33% of TFCAS), type II (43.98% of TRCAS; 35.90% of TFCAS), and type III (19.28% of TRCAS; 11.70% of TFCAS) arches, as well as symptomatic (70.84% of TRCAS; 58.42% of TFCAS) and right sided (59.40% of TRCAS; 49.62% of TFCAS) lesions (p<0.001). TRCAS showed no significant difference in primary outcomes after multivariate analysis except in symptomatic patients with right sided carotid lesions, where a type III arch increased the risk of postoperative stroke/TIA by over threefold (aOR: 3.52; 95% CI: 1.42 - 8.75; p = 0.007). In bovine arches, TRCAS did not impact primary outcomes. Access site complications were similar between the two cohorts and occurred in fewer than 4%. For secondary outcomes, multivariate analysis showed no difference between TRCAS and TFCAS, except for increased fluoroscopy time in patients with type I arches undergoing TRCAS (coefficient: 6.20 mins, 95% CI: 2.91 - 9.49). When stratified by lesion laterality and symptom status, asymptomatic patients with right-sided lesions and type II arches had shorter procedure times with TRCAS (coefficient: -7.16 mins, 95% CI: -13.66 - -0.66, p = 0.031) and required less contrast (coefficient: -11.39 mL, 95% CI: -22.38 - -0.41, p=0.042).</p><p><strong>Conclusions: </strong>TRCAS and TFCAS offer similar risk of postoperative stroke/TIA, and access site complications in patients with type I, II, and bovine arch, regardless of lesion laterality or symptom status. However, in symptomatic patients with right sided lesions and type III aortic arch, TRCAS is associated with higher risk of postoperative cerebrovascular events, contrary to previous suggestions of safety benefits.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103085","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":"Surgical wound complications after major lower limb amputations for chronic limb-threatening ischemia.","authors":"Mirva Virolainen, Eszter Bako, Milla Kallio, Henrik Nuutinen, Jari Halonen, Jari Karjalainen, Jussi M Kärkkäinen","doi":"10.1016/j.jvs.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.030","url":null,"abstract":"<p><strong>Objective: </strong>To investigate rates, risk factors and the impact of surgical wound complications (SWCs) on healthcare resources after below-the-knee (BKA) and above-the-knee amputation (AKA) for chronic limb-threatening ischemia (CLTI).</p><p><strong>Methods: </strong>This single-center retrospective study included consecutive patients undergoing major amputation for CLTI between 2011-2020. Primary endpoint was surgical wound complication (SWC) defined as surgical revision, higher amputation or non-healing wound at one year. Risk factors for SWCs were studied in multivariable analyses and expressed as odds ratios (ORs) with 95% confidence intervals. Secondary aim was to estimate hospital resources consumed by SWCs.</p><p><strong>Results: </strong>One-hundred-twenty patients (27%) with CLTI underwent 132 BKAs and 322 patients (73%) underwent 362 AKAs. One-year mortality was 32% in BKA and 52% in AKA group (p<.001). SWC rates were 47% and 11%, respectively (p<.001). AKA patients were older, more often female and memory disorders were more common compared to BKA patients. BKA patients had more often diabetes, chronic kidney disease and dialysis. None of these factors were associated with SWCs. Nineteen patients (14%) in the BKA group had no continuous arterial line to the amputation level; this did not increase the risk of SWC. Nineteen (14%) BKA patients had undergone guillotine ankle amputation before BKA, which was independently protective of SWC (OR 0.16 [0.04-0.60], p=.006). Long-term corticosteroid use increased the risk of SWC after BKA (OR 2.93 [1.19-7.23], p=.020) and AKA (OR 2.25 [1.07-4.73], p=.032). BKA was a major independent risk factor for SWC with more than four times higher risk compared to AKA (OR 4.13 [2.32-7.35], p<0.001). BKAs required more hospital resources than AKAs. SWCs more than doubled median hospital and healthcare center stay and multiplied mean number of readmissions and outpatient clinic visits.</p><p><strong>Conclusion: </strong>Nearly half of patients with CLTI developed SWC after BKA. Corticosteroid use increases the risk whereas guillotine amputation was associated with lower SWC rate after BKA. SWCs increase the need for healthcare resources significantly. SWCs are difficult to predict and the decision between BKA versus AKA remains a challenge for the vascular surgeon.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103052","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":"Association Between Serum Testosterone and Related Hormones and Risk of Symptomatic Abdominal Aortic Aneurysm in Male Participants from UK Biobank.","authors":"Yijun Liu, Hongbin Guo, Hongji Pu, Cammie Tran, Jiazhen Zheng, Zhijue Xu, Zhaoyu Wu, Guang Liu, Ruihua Wang, Kaichuang Ye, Pin Sun, Xinrui Yang, Fengshi Li, Peng Qiu, Xinwu Lu, Zhen Zhou","doi":"10.1016/j.jvs.2025.08.051","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.08.051","url":null,"abstract":"<p><strong>Background: </strong>Ruptured abdominal aortic aneurysm (AAA) is associated with high mortality risk. Few studies found a relationship between testosterone levels and AAA development but were limited by small event numbers and single-center design.</p><p><strong>Objective: </strong>To assess the associations of serum testosterone and sex hormone-binding globulin (SHBG) levels with symptomatic AAA risk in male participants from the UK biobank.</p><p><strong>Methods: </strong>Study exposures included baseline serum total testosterone (TT), free testosterone (cFT and FTZ), bioavailable testosterone (BioT), and SHBG. Multivariable Cox proportional-hazards regression models were employed for outcome analyses. The joint association of male hormones and AAA polygenetic risk score (PRS) was further investigated with AAA risk.</p><p><strong>Results: </strong>This study followed 190,627 males over 15 years, with 1,903 symptomatic AAA cases identified. Compared to those in higher quartiles, individuals in the lowest quartile of TT, FTZ, cFT and BioT had a 19% (95%CI, 1.07-1.33), 16% (1.05-1.28), 8% (0.98-1.19), and 13% (1.03-1.25) higher risk of AAA, respectively. For SHBG, individuals in the highest quartile had a 20% (1.07-1.34) greater risk of AAA compared to those in lower quartiles. Stratified analysis by AAA PRS found that individuals with higher PRS and either lower testosterone levels or higher SHBG levels, had a greater risk of developing AAA.</p><p><strong>Conclusion: </strong>This large population-based cohort study found that higher PRS and either lower testosterone or highest SHBG were associated with a greater risk of symptomatic AAA among male individuals. Due to the observational nature of this study, further research is warranted to establish whether or not a causal relationship exists between lower testosterone and development or growth of AAA, and whether testosterone treatment might reduce the risk of AAA.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102913","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":"Risk Factors for Restenosis Following Carotid Endarterectomy in Patients with Full Collapse Carotid Near-Occlusion.","authors":"Linfeng Zhang, Yiming Chai, Zhouyang Jiao, Peng Xu, Hui Cao, Shirui Liu, Zhiling Ma, Zhaohui Hua, Zhen Li","doi":"10.1016/j.jvs.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.025","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the postoperative efficacy of carotid endarterectomy for the treatment of near-total occlusion lesions at the bifurcation of the carotid artery and/or origin of the internal carotid artery, accompanied by distal vascular collapse, and factors influencing postoperative restenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cohort study enrolled 380 patients diagnosed with severe carotid artery stenosis. All patients underwent carotid endarterectomy at the First Affiliated Hospital of Zhengzhou University from March 2015 to 2023. Clinical data from these patients-296 males and 84 females, median age 66 years-were obtained. Patients were stratified into three groups based on carotid artery stenosis: severe stenosis (n=234), near-occlusion without collapse (n=70), and near-total occlusion (n=76). A comparative analysis was conducted regarding general characteristics, surgical data, and postoperative complications. Transcranial Doppler ultrasound data were obtained from 65 patients with near-total occlusion. They were divided into two groups based on the occurrence of restenosis postoperatively: restenosis (n=7) and no-restenosis (n=58). A comparative analysis was conducted to determine the disparities in systolic peak-flow and diastolic end-flow velocities between these two groups before and after surgical intervention. A 2-year follow-up study was conducted for 366 patients. Cox univariate and multivariate regression analyses were performed to identify factors associated with postoperative restenosis in patients with near-total occlusion. Kaplan-Meier survival curves were plotted for patients without restenosis and stroke, and Log-rank tests were used to compare survival curves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Surgical intervention was completed in all patients. During the perioperative period, 29 cerebral infarctions, seven high perfusion syndrome, four cerebral hemorrhage, 17 postoperative restenosis, and 14 deaths occurred. Among the patients who completed the 2-year follow-up, no new cases of cerebral infarction or postoperative restenosis were observed. Statistically significant differences were observed in preoperative cerebral infarction (χ&lt;sup&gt;2&lt;/sup&gt;=8.953, P=0.011) and postoperative restenosis (P=0.005). Subgroup analysis revealed that the presence of middle cerebral artery disease (hazard ratio=13.393, 95% confidence interval: 1.321-135.772, P=0.028) was an independent risk factor for restenosis in patients with near-total occlusion lesions. Survival analysis demonstrated that the cumulative incidence of restenosis and stroke did not exhibit a significant difference (Log rank χ&lt;sup&gt;2&lt;/sup&gt;=7.950, P=0.019; Log rank χ&lt;sup&gt;2&lt;/sup&gt;=0.453, P=0.797, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In comparison with patients diagnosed with severe carotid artery stenosis and near-occlusion without collapse, those with carotid near-total occlusion lesions demonstrated an increased propensity ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103083","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":"Aortic Luminal Contrast Attenuation Varies with Dissection Morphology and is Associated with Need for Intervention.","authors":"Zach M Feldman, Brandon J Sumpio, Sujin Lee, Marlena Sabatino, Charles S DeCarlo, Thomas Fedrigoni, Eric M Isselbacher, Farhad R Nezami, Arminder S Jassar, Sunita D Srivastava, Matthew J Eagleton, Jahan Mohebali","doi":"10.1016/j.jvs.2025.09.024","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.024","url":null,"abstract":"<p><strong>Objective: </strong>Prognostication after acute Type B aortic dissection (aTBAD) may be limited when relying upon static computed tomographic angiography (CTA) images to evaluate a dynamic process. We performed an exploratory study to characterize variations in luminal contrast attenuation on CTA, as a surrogate for blood flow in dissection, and to determine whether the resulting parameters held prognostic value.</p><p><strong>Methods: </strong>Retrospective, single-institution data for patients with aTBAD were gathered from 1999-2020. Patients with prior dissection repairs were excluded. Dissection morphology was classified by the joint Society for Vascular Surgery / Society of Thoracic Surgeons (SVS/STS) scheme and location/number of fenestrations. Hounsfield unit ratios (HUR) comparing lumina, phases, and aortic zone were calculated. Aortic growth, false lumen thrombosis, and need for intervention were evaluated with logistic regression.</p><p><strong>Results: </strong>After exclusions, 74 patients were identified (Figure 1). Most fenestrations were in Zone 4/5 (56.5%) and associated with more equilibrated HUR (0.93) compared to dissections without fenestration (0.65, p = 0.04). Intervention occurred in 68.9%. Increased arterial phase false-to-true HUR was strongly associated with eventual need for intervention (odds ratio [OR] 25.3 [95% CI 4.15-188.4], p = 0.001) while increased delayed-to-arterial phase false lumen HUR was associated with decreased intervention (OR 0.49 [95% CI 0.25-0.89], p = 0.02).</p><p><strong>Conclusion: </strong>In patients with aTBAD, calculated permutations of HUR across lumina and between CTA phases may give insight into blood flow dynamics, which in turn likely impact need for intervention. Future prospective studies of time-resolved CTA are likely to hold significant prognostic value and alter management.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102935","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":"Eversion versus conventional carotid endarterectomy with patch angioplasty: Population-based cohort study.","authors":"Arnar B Ingason, Venkatesa P Muruganandam, Sean Liebscher, Daniel J Bertges, Georg Steinthorsson","doi":"10.1016/j.jvs.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.029","url":null,"abstract":"<p><strong>Objective: </strong>To compare in-hospital and long-term outcomes between conventional carotid endarterectomy with patch angioplasty (cCEA) and eversion carotid endarterecomy (eCEA).</p><p><strong>Methods: </strong>Patients undergoing eCEA or cCEA from 1 Jan 2012 to 31 December 2024 were identified using the Vascular Quality Initiative database and included in the study. Inverse probability weighting was used to yield balanced study groups. Propensity-weighted logistic regression was used to compare binary outcomes and propensity-weighted Cox regression to compare all-cause mortality.</p><p><strong>Results: </strong>Overall, 157,729 patients undergoing cCEA and 22,296 patients undergoing eCEA were included in the study. eCEA was associated with lower odds of cranial nerve injury (adjusted odds ratio [aOR] 0.69, 95% confidence interval [CI] 0.66-0.73). This was consistent for injuries to cranial nerves VII, IX, X, XII, and other cranial nerves. Similarly, eCEA had lower odds of in-hospital myocardial infarction (aOR 0.71, 95% CI 0.65-0.78) and long-term myocardial infarction (aOR 0.92, 95% CI 0.87-0.98) compared to cCEA. The odds of in-hospital stroke or transient ischemic attack (aOR 1.06, 95% CI 0.99-1.12) and long-term stroke or transient ischemic attack (aOR 1.03, 95% CI 0.98-1.07) were similar in both groups. However, odds of in-hospital stroke (aOR 0.89, 95% CI 0.81-0.99) and long-term stroke (aOR 0.93, 95% CI 0.85-0.98) was lower for eCEA. All-cause mortality was similar in both groups (aOR 1.05, 95% CI 0.99-1.11). Patients that were younger, had higher BMI, underwent general anesthesia, and underwent surgery later in the study period were found to experience greater benefit from undergoing eCEA.</p><p><strong>Conclusion: </strong>eCEA was associated with lower odds of stroke, cranial nerve injury, and myocardial infarction, but similar all-cause mortality rates compared to cCEA. Given its superior effectiveness and safety, eCEA may be a better alternative to cCEA for treatment of flow-limiting carotid disease.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102954","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":"Management of Renal Artery Aneurysms: A Decision and Cost-Effectiveness Analysis","authors":"Aravind Ponukumati ,&nbsp;Mark Eid ,&nbsp;Anna Tosteson ,&nbsp;James Stahl ,&nbsp;Bjoern Suckow ,&nbsp;Caitlin Hicks ,&nbsp;Salvatore Scali ,&nbsp;David Stone ,&nbsp;Jesse Columbo","doi":"10.1016/j.jvs.2025.06.108","DOIUrl":"10.1016/j.jvs.2025.06.108","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 4","pages":"Pages e112-e113"},"PeriodicalIF":3.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104490","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}