Journal of Vascular Surgery最新文献

{"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":"https://doi.org/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 is 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 pre- and postoperative computed tomography angiography (CTA) ≥ two years after treatment were included. Data were collected using medical charts, radiologic institutional databases, and a deep learning based method called Augmented Reality for Vascular Aneurysm (ARVA). Volume and diameter assessments were automatically performed on CTAs using ARVA. 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 t-test, and categorical data were tested using chi-square 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 amongst these patients: 51 (57%) had volume shrinkage, only 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 (20%) patients with stable sac diameters and simultaneous volume growth, 13 (72%) had ELs (T2ELs: n=9, T1ELs, n=2, T3EL: 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":"Duplex-ultrasound as a single imaging test for Global Limb Anatomic Staging System (GLASS) 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":"https://doi.org/10.1016/j.jvs.2024.10.076","url":null,"abstract":"<p><strong>Introduction: </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 (TAP) and estimated limb-based patency (LBP), crucial for determining the best arterial route to restore blood flow.</p><p><strong>Materials and methods: </strong>A prospective study conducted from May to December 2022 involved 66 patients undergoing revascularization surgery for Critical Limb-Threatening Ischemia (CLTI). Preoperative arterial mapping (PAM) using duplex ultrasonography was the sole imaging modality. The TAP was defined in each patient, and GLASS staging was determined. Intraoperative arteriography (IA) was used on the day of surgery for comparison. Agreement between PAM and IA was assessed using Cohen's kappa coefficient, and diagnostic metrics were compared using ROC curves.</p><p><strong>Results: </strong>Doppler ultrasound demonstrated a sensitivity of 98%, specificity and PPV of 100%, and NPV of 94.7% in the femoropopliteal sector, with a Kappa coefficient of 0.98. For the infrapopliteal sector, sensitivity was 95%, specificity 96.5%, PPV 97.3%, and NPV 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. ROC curves revealed no significant differences between ultrasound and arteriography in terms of staging.</p><p><strong>Conclusion: </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":"2024-11-08","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":"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":"https://doi.org/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":"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":"https://doi.org/10.1016/j.jvs.2024.10.073","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-08","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":"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":"https://doi.org/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 Intra-Operative Positioning System (IOPS) - an FDA-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, Flagstaff, AZ USA) deployed into a 3D printed abdominal aortic aneurysm (AAA) model connected to a 7000 MDX flow pump (Sarns Inc/3M, Ann Arbor, MI USA) 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 minutes 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 versus fluoroscopy (4.3 ±4.4 min vs 7.1±4.9 min; P=.04), but not statistically different when comparing IOPS-FS and fluoroscopy (6.3±4.5 min vs 7.1±4.9 min; 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 amongst the three different endovascular approaches, there was a trend towards shorter cannulation times with IOPS-FS or IOPS-AR as compared to fluoroscopy (mean time of 2.5±0.9, 4.4±4.0 and 5.2±4.5 min, 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 to 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 ability to adapt to different en","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 PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States.","authors":"Ahsan Zil E Ali, Billal Alamarie, Leana Dogbe, Alpha Tall, Abdul Wasay Paracha, Faisal Aziz","doi":"10.1016/j.jvs.2024.09.040","DOIUrl":"https://doi.org/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 arterial disease (PAD), carotid artery disease, and aortic aneurysms in the United States. The review also aims to report the diverse tools utilized to compute SES within the vascular surgery literature.</p><p><strong>Methods: </strong>A systematic review of English literature was conducted based on the English literature review using literature databases PubMed and Scopus from inception till November 2023. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (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 (ROBINS-I) tool. 1,133 studies were initially selected and 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 2018-2023 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, 3 analyzed the impact of these factors in patients with Carotid Artery Disease, and 6 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 following 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>Conclusion: </strong>Multiple metrics are utilized 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 highlights the need to consider SES in improving surgical outcomes and reducing healthcare disparities.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","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":"https://doi.org/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 revascularizations. Luminor, nanotechnology-based paclitaxel coated balloon, has demonstrated efficacy and safety in the Effpac trial. The LUMIFOLLOW registry, a large-scale, prospective, multicenter study, aims to assess the real-world performance of Luminor in femoropopliteal 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 endpoints 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 (f-TLR) and/or binary restenosis); secondary endpoints 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 age was 71.2 years, with 67.2% male patients. Prevalent comorbidities included diabetes (42.6% n=231/542), hypertension (72.1%, n=391/542), hyperlipidemia (56.3%, n=305/542) and current smoking (27.2%, n=147/540); 23.8% were classified as Rutherford classification (RC) 2 (n=129/542), 43.2% as RC 3 (n=234/542), 16.8% as RC 4 (n=91/542) and 16.2% as RC 5 (n=88/542). Lesions were located in the superficial femoral artery (57.5%, n=329/572) and could extend to the popliteal artery (42.5%, n=243/572), with 43.6% classified TASC II C-D; 24.2% were restenosis (n=139/575) with a 44.3% rate of total occlusions (n=255/576). Mean lesion length was 140.55±99.42mm. Provisional stenting was required in 43.1% (n=249/580) with a mean stent length shorter than the initial lesion length at 87.21±42.30mm. The acute procedural success rate was 99.4% (n=536/539), with 2 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 endpoint was 82.7% (5.7% all-cause mortality, 0.7% index limb major amputation) and estimated primary patency was 87.4% (95%CI: 84.1;90.1%), with f-TLR 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% enhanced usual activities. Walking Impairment Questionnaire scores increased significantly in walking distance, speed, and stair-climbing ability (from 31.4±24.7 to 62.5±31.0, p&lt;.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The LUMIFOLLOW registry demonstrates that Luminor DCBs are effective and safe for femoropopliteal interventions. The significant improvement in quality of life and walking ability, along with high primary patency and low complication rates, underscore the benefits of Luminor DCBs ","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":"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":"https://doi.org/10.1016/j.jvs.2024.10.069","url":null,"abstract":"<p><strong>Objectives: </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 (AV), prosthetic grafts (PG) or biologic grafts (BG). 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 post-operative 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: arm vein (cephalic, basilic), prosthetic grafts [Dacron, polytetrafluoroethylene (PTFE)], and biologic grafts (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 (MACE), graft occlusion, prolonged length of stay >7days (PLOS), packed red blood cell (pRBC) transfusion >2 units, and infection. Cox Regression was used to report one-year outcomes: mortality, major amputation (above-ankle), and major adverse limb events (MALE 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%); BG 1228 (13.40%). Compared to AV, patients receiving PG had higher odds of infection (aOR 2.89, p=0.045) and higher hazard of one-year mortality (aHR 1.51, p=0.035). On the other hand, patients receiving BG had higher risk of graft occlusion (aOR 4.55, p=0.040) and infection (aOR 2.78, p=0.046) as well higher hazard of one-year mortality (aHR 1.53, p=0.040), amputation (aHR 1.72, p=0.019) and amputation or death (aHR 1.52, p=0.005) compared to AV. After stratifying by bypass configuration, AV 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, AV are found to be the most resistant to infections and are associated with the best overall survival and limb salvage outcomes compared to PG and BG particularly in below-knee distal targets. In cases where no GSV is available, AV and PG are acceptable alternatives with comparable one-year amputation-free survival and MALE-free survival rates. On the other hand, BG are associated with higher risk of graft occlusion and lower freedom from major amputation and death compared to AV.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","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}

{"title":"Whole aorta imaging shows increased risk for thoracic aortic aneurysms and dilatations in relatives of abdominal aortic aneurysm patients.","authors":"Heng Liu, Arne S IJpma, Jorg L de Bruin, Hence J M Verhagen, Jolien W Roos-Hesselink, Jos A Bekkers, Hennie T Brüggenwirth, Heleen M M van Beusekom, Danielle Majoor-Krakauer","doi":"10.1016/j.jvs.2024.10.067","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.067","url":null,"abstract":"<p><strong>Objective: </strong>For relatives of abdominal aortic aneurysm (AAA) patients, guidelines recommend abdominal imaging aimed at early detection and management of AAA, and do not include screening for thoracic aortic aneurysms (TAA). We aimed to investigate if TAA occur in undiagnosed relatives of AAA patients without a known genetic susceptibility for aneurysms, similar to families with identified genetic susceptibilities for aneurysms like in Marfan and Loeys-Dietz syndrome, where both AAA and TAA occur.</p><p><strong>Methods: </strong>Relatives of AAA patients were invited for non-contrast whole aorta CT screening. Systematic measurements of the CT scans were used to detect aneurysms and dilatations. Classification into familial and non-familial was based on reported family histories. In addition, aneurysm gene panel testing of AAA index cases was used for the classification of high vs unknown genetic risk (high genetic risk: familial aneurysm or a (likely) pathogenic variant (P/LP) in an aneurysm gene; unknown genetic risk: no family history or P/LP).</p><p><strong>Results: </strong>Whole aorta imaging of 301 relatives of 115 abdominal aortic aneurysm index-patients with non-contrast CT scans showed a 28-fold increase in thoracic aortic aneurysms in relatives (1.7%, p<0.001 versus the age adjusted population) and a high frequency of thoracic dilatations in 18% of the relatives. Thoracic aneurysms and dilatations in relatives occurred even when index patients were unaware of familial aneurysms. AAA was increased in the relatives compared to the age adjusted population (8%, p<0.001).</p><p><strong>Conclusions: </strong>An increased risk for thoracic aneurysms and dilatations was detected by whole aorta imaging of relatives of AAA index patients, even when index patients were unaware of familial aneurysms. These results indicate -still unknown- shared genetic susceptibilities for thoracic and abdominal aneurysms. Therefore, imaging of the whole aorta of relatives of all abdominal aneurysm patients, will improve early detection of aortic aneurysms in relatives of all AAA patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569044","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":"Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database.","authors":"Keyuree Satam, Anand Brahmandam, Xinyan Zheng, Jialin Mao, Philip Goodney, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.jvs.2024.10.026","url":null,"abstract":"<p><strong>Introduction: </strong>The best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single center studies suggest open popliteal aneurysm repair (OPAR) is more durable than endovascular (EPAR), but large randomized multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the VQI-VISION database.</p><p><strong>Methods: </strong>Vascular Quality Initiative (VQI) Medicare-linked VISION database (2010-2019) for peripheral vascular interventions and infrainguinal bypass were reviewed for elective PAR. Patients undergoing OPAR and EPAR were propensity-matched to compare outcomes.</p><p><strong>Results: </strong>There were 1,159 PAA repairs (65.1% open). EPAR patients were older (77 vs 73 years, p<0.001) and more likely to be on P2Y12 inhibitors (26.5% vs 17.0%, p<0.001). After matching, there were 396 patients in each group with similar baseline characteristics. EPAR patients were more likely to be discharged home (87.6% vs 48.5%, p<0.001) and have shorter hospital length-of-stay (1 vs 3 days, p<0.001). Kaplan-Meier curves showed no difference in mortality, reintervention, or major amputation at 1, 3, and 5 years. Cox proportional hazards regression showed no significant association between revascularization strategy and mortality, reintervention, or major amputation. Subgroup analysis of patients undergoing OPAR with great saphenous vein (GSV) bypass compared to EPAR showed that OPAR with GSV bypass was associated with lower mortality without difference in reintervention or major amputation.</p><p><strong>Conclusion: </strong>Elective EPAR is durable and comparable to OPAR in terms of limb outcomes, even when GSV is used as conduit. However, bypass with GSV was associated with increased survival after open popliteal aneurysm repair compared to endovascular therapy.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502948","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}