Journal of Vascular Surgery最新文献

{"title":"Closed incisional Negative Pressure Wound Therapy versus Standard Surgical Dressing for groin incisions following arterial vascular surgery; a prospective multicenter randomized clinical trial.","authors":"Ellie Lenselink, Melissa Ruig, Diana Grootendorst, Abbey Schepers, Daniël Eefting","doi":"10.1016/j.jvs.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.017","url":null,"abstract":"<p><strong>Objective: </strong>Groin wound complications-including surgical site infections (SSIs), hematomas, seroma leakage, necrosis, and wound dehiscence-are frequently reported after arterial vascular surgery and significantly impact patient morbidity and mortality. This multicenter randomized controlled trial evaluated the effectiveness of closed incisional Negative Pressure Wound Therapy (ciNPWT) in reducing these complications.</p><p><strong>Methods: </strong>From April 2017 to January 2023, 290 patients with peripheral arterial disease scheduled for arterial vascular surgery requiring a longitudinal groin incision were enrolled in the Netherlands. Patients were randomized to receive either ciNPWT with PREVENA or standard surgical dressing (SSD). Wounds were assessed over a 30-day period at an outpatient wound clinic. The primary outcome was the occurrence of wound complications: infection, seroma, necrosis, and dehiscence, with infections graded according to CDC criteria.</p><p><strong>Results: </strong>A total of 275 patients were analyzed (132 in the ciNPWT group, 143 in the SSD group). Overall, 25.5% of patients experienced wound complications. There was no significant difference in the overall rate of wound complications between the ciNPWT and SSD groups (p = 0.37). Both groups had a median hospital stay of 4 days, and no significant difference was observed in time to complete wound healing (23.10 ± 20.78 days for ciNPWT vs. 22.81 ± 20.73 days for SSD; p = 0.99).</p><p><strong>Conclusion: </strong>CiNPWT did not reduce the overall rate of wound complications in patients undergoing groin incisions for peripheral arterial surgery. Routine use of ciNPWT in this context is not recommended.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817055","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":"Carotid-esophageal fistula from foreign body ingestion.","authors":"Georgette Vetanzo-Sánchez, Ricardo Jean Pool Cabello Barrón, Luz Rosadio Portilla, Gerardo Torres Ortiz, Juan Diego Cuipal-Alcalde","doi":"10.1016/j.jvs.2026.04.018","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.018","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816972","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":"Vessel-Level Comparative Analysis of Five-Year Renal Branch Performance Following Fenestrated-Branched Endovascular Aortic Repair Using Thoracoabdominal Multibranched Endoprostheses and Physician-Modified Endografts.","authors":"Clayton J Brinster, Zachary Rengel, Carrie Tackett, Armin Tabiei, Miju Bae, Kenneth Han, Randall DeMartino, Gustavo Oderich, Bernardo C Mendes, Sukgu M Han","doi":"10.1016/j.jvs.2026.03.793","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.03.793","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular repair options for pararenal (PRA) and thoracoabdominal aortic aneurysms(TAAA) include physician modified endografts (PMEG), and Thoracoabdominal MultiBranch Endoprosthesis (TAMBE). However, long term renal artery (RA) performance of TAMBE is unknown. Thus, we aimed to compare RA outcomes between TAMBE and PMEG.</p><p><strong>Methods: </strong>Patients who received TAMBE, and PMEG at 2 aortic centers from 2015 to 2025 were reviewed. Aneurysm extent, branch stent size, antiplatelet regimen, laterality, and relining stents were compared by vessel level analysis. Primary outcome was freedom from target vessel instability (FTVI). The secondary outcomes included primary patency (PP), freedom from branch reintervention (FBR) and branch endoleak (FBE). Cox proportional hazard regression was performed comparing PMEG and TAMBE RAs for TVI.</p><p><strong>Results: </strong>716 patients with 1339 RAs were included (633 patients/1180 RAs for PMEG, and 83 patients/159 RAs for TAMBE groups). RAs in PMEG had higher 5-year FTVI compared to TAMBE (89.5 vs 82.7%, P=.005), driven by higher FBR (90.8 vs 82.5%, P=.002), and PP (93.7vs 83.3%, P<.001), albeit similar FBE (93.9 vs 98.2%, P=0.3). This was likely due to the higher FTVI in the right (91.3 vs 77.9%, P=.002), but not left RA (87.6 vs 87.9%, P=.375). Subgroup analysis showed similar FTVI in the TAAA patients (P=.691), while PRA subgroup showed significantly lower FTVI in the TAMBE compared PMEG (P<.001). Cox regression, adjusting for aneurysm extent, branch stent size, relining, and dual antiplatelets, showed that the right RAs in TAMBE were more likely to develop TVI (HR: 4.2, P<.001) than PMEG.</p><p><strong>Conclusion: </strong>The right RA may be the principal site of failure for TAMBE, contributing to lower 5-year FTVI compared to PMEG. TAAA appears to confer protection against renal TVI in TAMBE, compared to PRA. These findings warrant revisiting anatomic criteria and further optimization of renal bridging stent design for TAMBE.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775377","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":"Quantifying Vascular Access-Associated Excess Mortality In Maintenance Hemodialysis Patients.","authors":"Amun Georg Hofmann, Maria Elisabeth Leinweber, Suman Lama, Afshin Assadian, Jeffrey Hymes, Peter Kotanko, Len Usvyat, Jochen G Raimann","doi":"10.1016/j.jvs.2026.03.790","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.03.790","url":null,"abstract":"<p><strong>Objective: </strong>Central venous catheters (CVCs) are commonly linked with higher mortality in hemodialysis (HD) patients compared to arteriovenous accesses (AVAs). However, patients with CVCs often have greater comorbidities, complicating causal interpretation. This study aimed to assess the association between vascular access type and survival adjusting for relevant confounders.</p><p><strong>Methods: </strong>In this retrospective cohort study, data from 146,967 incident HD patients treated between 2016 and 2019 at a large North American dialysis organization (Fresenius Medical Care North America) was analyzed. Multiple analytic strategies were conducted including inverse probability treatment weighted and time-dependent survival analyses.</p><p><strong>Results: </strong>Among 146,967 incident hemodialysis patients, median survival was 1,106 days for those initiating with a CVC compared to 1,290 days for patients with an AVA, corresponding to a 184-day difference and an 88% restricted mean survival time (RMST) ratio. In the sustained access analysis, median survival was 448 days for CVC-only versus 1,226 days for AVA-only patients (RMST difference = 778 days, RMST ratio = 52%). After inverse probability treatment weighting, AVA initiation was associated with a 25% lower mortality risk (HR 0.75, 95% CI 0.73-0.76), and sustained AVA use with a 62% lower risk (HR 0.38, 95% CI 0.36-0.40). Differences in infection-related deaths between groups were small (8.6 - 10.6% of deaths in all comparison groups).</p><p><strong>Conclusion: </strong>CVC use was associated with higher mortality compared to AVA. Although AVA use remained linked with better survival across analyses, the precise magnitude of any access-related benefit cannot be determined within the constraints of observational data. There are strong indications that the excess risk at least partially reflects differences in baseline health and patient selection rather than a direct causal effect.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775434","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":"Evaluation of sac volume regression after aortic aneurysm sac embolization with Shape Memory Polymer Plugs in patients undergoing EVAR.","authors":"Abhishek Rao, Andrew Holden, Michel M P J Reijnen, Marc L Schermerhorn, Paul D Bishop, Hasan H Dosluoglu, Petr Varejka, Patrick E Muck, Alexander Massmann, Giovanni Colacchio, Raghu L Motaganahalli, William P Shutze, Jozef Sivak, Sean P Lyden, Sidarth Ethiraj","doi":"10.1016/j.jvs.2026.03.792","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.03.792","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular aneurysm repair (EVAR) is widely used for infrarenal abdominal aortic aneurysm, offering improved short-term outcomes compared to open repair. However, long-term durability is limited by the need for surveillance and reintervention, often related to sac growth and endoleak. Prophylactic sac embolization using shape memory polymer (SMP) plugs-a porous, bioabsorbable polyurethane scaffold designed to promote thrombosis and tissue ingrowth-has been evaluated in early feasibility studies. This study represents the first global, multicenter real-world analysis of SMP use during EVAR.</p><p><strong>Methods: </strong>A multicenter, retrospective, two-arm CTA-based sac regression analysis was performed in 97 highly selected patients meeting prespecified eligibility criteria. Fifty-six patients underwent EVAR with prophylactic sac management (EVAR-PSM) using SMP between 2019 and 2023, including 31 treated prospectively in the AAA-SHAPE early feasibility studies and 25 treated in real-world practice. Forty-one patients underwent standard EVAR between 2014 and 2019 at a single center and met identical inclusion/exclusion criteria, including aneurysm size thresholds, sac volume parameters, infrarenal stent grafts use within IFU, serial CTA availability, and exclusion of adjunctive branch vessel embolization. Sac regression (>10% volume reduction between 30-day and 1-year CTA) was assessed. Thrombus burden and patent accessory vessels were analyzed in all patients; packing density and plug proximity to accessory vessels were analyzed in the EVAR-PSM group.</p><p><strong>Results: </strong>Hypertension was more prevalent in controls (98% vs 77%, p=.01), whereas prior myocardial infarction was less common (0% vs 17%, p=.01). In the treatment group, a mean of 59 plugs per patient were implanted, yielding a mean packing density of 129%. Sac regression >10% at one year occurred more frequently in the EVAR-PSM group (79% vs 51%, p<.01). Type II endoleak occurred in 40% vs 49% (p=0.4), and secondary reintervention rates were similar (2.4% vs 1.8%, p<.90). No aneurysm ruptures occurred. One-year survival was similar between groups (100% vs 96%, p=.50). On multivariable analysis, SMP treatment was independently associated with sac regression (OR 4.13 [1.5-12.0], p<.01). Within the treatment group, shorter plug distance to patent branch vessels was independently associated with sac regression (OR 0.54 [0.30-0.71], p<.01), while packing density and thrombus burden were not.</p><p><strong>Conclusions: </strong>In this multicenter analysis of controlled and real-world data, prophylactic sac embolization with SMP was associated with significantly greater sac regression compared with standard EVAR. Effective sac remodeling appears influenced by plug proximity to branch vessels.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775445","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 Value of the Mini-Cuff Technique in FB-EVAR: Efficacy Validation Based on the Composite Endpoint of Target Vessel Instability.","authors":"Dong-Sheng Fu, Zhao-Hui Pan, Yu-Zhu Wang, Zi-He Zhao, Zhao Liu","doi":"10.1016/j.jvs.2026.03.791","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.03.791","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether adjunctive mini-cuff use is associated with a reduced risk of postoperative target vessel instability (TVI) after physician-modified endograft-based (PMEG-based) fenestrated/branched endovascular aortic repair (FB-EVAR).</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 216 patients with complex aortic diseases treated with PMEG-based FB-EVAR between January 2018 and June 2024. Patients were divided into two groups based on the use of the mini-cuff technique: the FB-EVAR with mini-cuff group (FM group, n=79) and the FB-EVAR without mini-cuff group (FB group, n=137). A total of 666 target vessels were analyzed at the branch level, including 193 reconstructed with adjunctive mini-cuff and 473 without mini-cuff. The primary endpoint was TVI, a composite of target vessel occlusion, >70% stenosis, re-intervention, or type Ic/target vessel-related type III endoleak. Time-to-event data were analyzed using Cox proportional hazards regression with robust standard errors to account for within-patient clustering of vessels. Key covariates were prespecified and forced into the multivariable model, including pathology (degenerative vs post-dissection), prior aortic endovascular surgery, aneurysm neck-to-sac β-angle>60°, adverse target-vessel condition, and age.</p><p><strong>Results: </strong>The FM group had a higher prevalence of prior aortic endovascular surgery (48.1% vs 16.1%) and post-dissection pathology (65.8% vs 27.7%); at the branch level, adverse anatomic conditions were also more frequent in the FM group (26.4% vs 19.2%). In the unadjusted branch-level analysis, TVI occurred less often with mini-cuffs (10.9% vs 16.3%), although this difference did not reach statistical significance (P=0.074). Because mini-cuffs were selectively used in higher-risk anatomy, multivariable adjusted analyses were performed. In the multivariable Cox model with robust standard errors, mini-cuff use was independently associated with a lower hazard of TVI (aHR 0.882, 95% CI 0.802-0.969; P=0.009). At 24 months, the Kaplan-Meier-estimated branch-level TVI risk was approximately 20% with mini-cuffs versus 25% without, corresponding to an absolute risk reduction of approximately 5% and an estimated number needed to treat of approximately 21. Perioperative outcomes were similar between groups.</p><p><strong>Conclusion: </strong>In this retrospective PMEG-based FB-EVAR cohort, adjunctive mini-cuff use was independently associated with improved mid-term target-vessel stability without increased perioperative risk. However, given the nonrandomized design and selective use in higher-risk anatomy, residual confounding and selection bias cannot be excluded.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775415","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":"Rising hospital costs outpace reimbursement for common vascular procedures.","authors":"Clayton J Brinster, Christopher Antunez, G Thomas Escousse, Samuel Money","doi":"10.1016/j.jvs.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.015","url":null,"abstract":"<p><p>Hospitals across the United States have faced sharply rising operating costs since the onset of the COVID-19 pandemic, driven by increased labor expenses, supply chain disruptions, and inflation, while reimbursement growth has remained comparatively modest. This study analyzed institutional financial data from 2019 to 2022 for five commonly performed vascular procedures-arteriovenous fistula creation, arteriovenous graft placement, carotid endarterectomy, endovascular aortic repair, and lower extremity angiography with percutaneous intervention-within a large tertiary health system. Direct hospital costs, reimbursement, and contribution to indirect were evaluated and standardized per case. Direct hospital costs increased by approximately 32% over the study period, while reimbursement rose by only 21%, resulting in an 11% decline in procedural margins. Contribution to indirect decreased from $1,470 per case in 2019 to $1,177 in the 2020-2022 period, representing a 20% reduction. These declines were consistent across both inpatient and outpatient procedures. Notably, procedural volumes, length of stay, and payer mix remained stable, indicating that worsening financial performance was driven primarily by rising costs rather than changes in utilization. Overall, hospital margins for vascular procedures have eroded substantially, underscoring increasing financial strain and the urgent need for reimbursement models that more accurately reflect the true cost of delivering complex vascular care.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775428","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":"Cervical Massage-Induced Bilateral Internal Carotid Artery Dissection.","authors":"Jihui Sun, Xianzhong Wu","doi":"10.1016/j.jvs.2026.04.008","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.04.008","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Antifibrinolytics Association with Reduced Blood Transfusions After Vascular Surgery Procedures.","authors":"Mikayla N Lowenkamp, Sharon E Kim, Hasan Nassereldine, Samantha N Machinski, Alexas Iams, Edith Tzeng, Katherine M Reitz","doi":"10.1016/j.jvs.2026.04.011","DOIUrl":"10.1016/j.jvs.2026.04.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Major vascular surgery interventions are critical to treat peripheral artery disease but have high risks of intraoperative blood loss with resultant coagulopathy. Blood product transfusions are limited, costly, and associated with an increased risk of myocardial infarction and death. Planned preoperative antifibrinolytic agent (AFA) administration, for the purpose of inhibiting intra-operative plasmin-mediated lysis, has becomes standard practice for orthopedic, trauma, obstetrics, and cardiac surgical interventions effectively reduce perioperative bleeding and need for transfusions. However, there is little data supporting AFA use in vascular surgery interventions. We hypothesize that preoperative AFA administration in elective, major vascular surgical interventions will be associated with reduced receipt of blood products.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We included elective, index major abdominal revascularization procedures (open abdominal aortic aneurysm repair, mesenteric revascularization, aortoiliac revascularization) and lower extremity revascularization procedures (open bypass) in adult patients across a multi-hospital healthcare system (January 2017-June 2024). Preoperative receipt of AFA (tranexamic acid [TXA] or epsilon-aminocaproic acid [EACA]) was defined as administration within 60-minutes of the operative start time recorded in anesthesia-logs. The primary outcome was total blood product transfusions received (packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate) within 5-postoperative days. Safety outcomes included in-hospital seizures, venous thromboembolism events (VTE; deep venous thrombosis, pulmonary embolism), arterial thrombosis (stroke, bypass thrombosis), and bleeding complications. Multivariable negative binomial regression analyzed the association between preoperative AFA and number of postoperative blood transfusions with clinically significant covariates chosen a priori with variance clustering by surgeon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 674 cases (age 68.6±10.8 years, male 67.4%, White 88.1%), 213 (31.6%) received preoperative AFAs. Among treated patients, 36 (16.9%) received blood transfusion by postoperative day 5 at a median of 2 [IQR 1-2] products per person. After covariate adjustment, preoperative AFA was significantly associated with fewer blood products transfused by 5-postoperative days (aIRR 0.57, 95% CI [0.34-0.98], p-value=.04). Seizures were only observed among patients who did not receive preoperative AFA (N=2). Rates of VTE, bleeding complication, and bypass thrombosis were similar with and without AFA exposure (VTE: N=2 [0.9%] vs N=5 [1.1%]; p-value=.86; bleeding: N=3 [1.4%] vs N=6 [1.3%]; p-value&gt;.9; bypass thrombosis: N=7 [3.3%] vs N=11 [2.4%]; p-value=.7). There were no in-hospital strokes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Overall, preoperative administration of AFA was associated with decreased number of transfusions at 5-postoperative","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775404","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":"Midterm outcomes of off-the-shelf multibranched versus physician-modified endografts for endovascular repair of complex and thoracoabdominal aortic aneurysms: A systematic review and meta-analysis.","authors":"Kenneth Han, Hyejin Mo, Shreya Guha, Miju Bae, Carrie Tackett, Sukgu M Han","doi":"10.1016/j.jvs.2026.03.616","DOIUrl":"10.1016/j.jvs.2026.03.616","url":null,"abstract":"<p><strong>Background: </strong>Custom-manufactured fenestrated-branched endovascular aortic repair devices have demonstrated excellent outcomes for elective repair of complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). However, for symptomatic or ruptured aneurysms, the manufacturing and shipping time render this option impractical for urgent or emergent repair. To address this clinical need, alternative technologies have been developed, including physician-modified endografts (PMEGs) and off-the-shelf multibranched devices (OTSDs). In this systematic review and meta-analysis, we compare midterm outcomes between OTSDs and PMEGs.</p><p><strong>Design/method: </strong>A systematic search was conducted using the MEDLINE, Embase, Scopus, and ClinicalTrials.gov databases through January 1, 2025. Studies with 10 or more patients reporting 1- or 2-year mortality or reintervention after PMEG or OTSD repair of CAAAs or TAAAs were included. Primary outcomes included midterm reintervention and mortality. Secondary outcomes included 30-day mortality, spinal cord ischemia (SCI), and technical success. Subgroup analyses by presentation and aneurysm extent were also performed.</p><p><strong>Results: </strong>Eighteen studies (11 PMEG, 7 OTSD), including 994 patients (538 PMEGs, 456 OTSDs), were included in the review. One-year reintervention was 11% for PMEG and 12% for OTSD (P = .966), and 2-year reintervention was 15% for PMEG and 13% for OTSD (P = .820). One-year mortality was 9% for PMEG and 8% for OTSD (P = .714), and 2-year mortality was 11% for PMEG and 12% for OTSD (P = .758). Technical success was slightly higher with OTSD (98% vs 96%, P = .03), and SCI occurred more frequently with OTSD (6% vs 0%, P < .0001). Thirty-day mortality was 1% for PMEG and 2% for OTSD (P = .836). Subgroup analyses by presentation and aneurysm extent revealed no differences in primary outcomes.</p><p><strong>Conclusions: </strong>PMEGs and OTSDs demonstrate acceptable midterm outcomes. However, interpretation of comparative results is limited by substantial differences in aneurysm extent, symptomatic or ruptured presentation, and follow-up duration between the cohorts. Both remain viable strategies, with device selection guided by individual anatomy, urgency, and institutional expertise.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674432","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}