Journal of Vascular Surgery最新文献

{"title":"Sex-specific association between preoperative foot infection and vein graft stenosis after distal bypass for chronic limb-threatening ischemia.","authors":"Hiroko Okuda, Shinsuke Kikuchi, Atsuhiro Koya, Keisuke Miyake, Nobuyoshi Azuma","doi":"10.1016/j.jvs.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.10.002","url":null,"abstract":"<p><strong>Objective: </strong>Sex differences in lower-extremity bypass outcomes remain controversial, and the mechanism is unclear. We examined whether female sex is associated with vein graft stenosis, predominantly due to intimal hyperplasia, after distal bypass for chronic limb-threatening ischemia, and whether preoperative foot infection contributes.</p><p><strong>Methods: </strong>We studied 318 limbs with chronic limb-threatening ischemia undergoing para- or inframalleolar autogenous vein bypass at a single center (2000-2014; 74 women, 23%). All analyses were restricted to single-vein grafts; after excluding grafts occluding within 30 days, 232 formed the analytic cohort (182 men, 50 women). Female versus male outcomes were compared by 1:1 optimal matching (Mahalanobis distance within a propensity-score caliper on six covariates) and by inverse-probability-of-treatment weighting, which was the primary inference; death was treated as a competing risk. Stenosis was diagnosed by duplex surveillance, with histologic examination of excised segments. Wound, ischemia, and foot infection grades and preoperative C-reactive protein and fibrinogen were analyzed by sex with sex-by-exposure interaction terms; wound cultures were reviewed.</p><p><strong>Results: </strong>After matching (48 pairs), the 5-year cumulative incidence of vein graft stenosis remained higher in women (44% vs 9%; log-rank P=.004), and primary patency was lower (52% vs 88%; P=.003); secondary patency (85% vs 98%; P=.06) and limb salvage (P=.60) did not differ significantly. Weighting confirmed the excess (adjusted hazard ratio 2.13; 95% confidence interval 1.13-4.02; P=.019). Five-year mortality was 55% in men vs 35% in women; with death as a competing risk, stenosis incidence remained higher in women (34% vs 16%). Preoperative high-grade foot infection was associated with stenosis in women (hazard ratio 4.27; 95% confidence interval 1.56-11.70; P=.005) but not men (hazard ratio 0.87; P=.74), with a significant sex-by-infection interaction (P=.026); wound and ischemia grades showed no sex difference. C-reactive protein and fibrinogen showed the same direction without a significant interaction. All 25 excised stenotic segments showed intimal hyperplasia without active inflammation, and organism type was unrelated to stenosis. In women, foot infection, poor vein quality, and run-off resistance were independent correlates.</p><p><strong>Conclusions: </strong>Women undergoing single-vein distal bypass for chronic limb-threatening ischemia have a higher incidence of vein graft stenosis despite balanced baseline risk, with the excess concentrated in those with preoperative foot infection. The findings suggest a sex-specific vein-wall response to infection-related inflammation and support intensified, infection-aware graft surveillance in women.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147828","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":"Multicenter Outcomes of Peripheral Vascular Interventions in Patients with Active Cancer.","authors":"Elisa Caron, Shreef Said, Hind Anan, Yashashwini Sudina, Dana Alameddine, Rabih Chaer, Marc Schermerhorn, Cassius Iyad Ochoa Chaar, Lars Stangenberg","doi":"10.1016/j.jvs.2026.09.037","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.037","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer is typically associated with venous thrombosis, but its impact on patients undergoing peripheral vascular interventions (PVI) for concomitant peripheral arterial disease (PAD) remains unclear. This multicenter study examines the characteristics of patients with active cancer and their outcomes after PVI.</p><p><strong>Methods: </strong>Institutional vascular quality initiative (VQI) PVI data from 3 tertiary care centers (2019-2023) were combined and expanded through a retrospective chart review to include the presence and types of cancer. All adult patients undergoing endovascular intervention for PAD, including those with claudication, chronic limb-threatening ischemia (CLTI), and acute limb ischemia (ALI), were included. The primary outcome was the composite of major amputation or mortality at 4 years in patients with cancer compared to those without. Additional long-term outcomes included reintervention, mortality, and major amputation at both 1 and 4 years. Secondary outcomes included perioperative outcomes.</p><p><strong>Results: </strong>A total of 3,072 patients were included. The incidence of active cancer was 2.2% (N=68). Lung cancer was the most common, affecting 30.9% (N=21) of patients. 53% (N=36) presented with advanced stages (3/4) irrespective of cancer type. Patients with cancer were less likely to have diabetes. There was no significant difference in indication, but patients with cancer were more likely to get treated for aortoiliac disease and undergo stenting. Patients with cancer had a higher incidence of distal embolization (4.4% vs 0.6%, P=0.012) and perioperative major amputation (4.4% vs 1.3%, P=0.046). Kaplan-Meier analysis showed significantly higher mortality or amputation in patients with cancer up to 4 years (63% vs 35.1%, P<0.001). Late outcomes in patients with cancer were driven by significantly higher mortality (52.2% vs. 28.3%, p<.001) rather than adverse limb events (amputation: 14.7% vs. 11.4%, p=.50; reintervention:47.8% vs. 48.3%, p=.80). Regression analysis demonstrated independent association of cancer with the composite outcome of mortality or major amputation (aHR=2.24 [1.61-3.10]).</p><p><strong>Conclusion: </strong>Active cancer affects a small proportion of patients undergoing PVI but has a significant impact on perioperative limb outcomes and long-term survival. This multicenter collaboration, combining registry data and EMR review, can shed light on less common risk factors affecting lower extremity revascularization.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147682","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":"Faculty Narrative Feedback in the Vascular Surgery Entrustable Professional Activity (EPA) Pilot is Disproportionately Focused on Patient Care and Medical Knowledge Competencies.","authors":"Oraya Vesvoranan, Cesar Delgado, Ting Sun, Katie Glasgow, Courtney Morgan, Paul DiMusto, M Libby Weaver, Brigitte K Smith","doi":"10.1016/j.jvs.2026.09.039","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.039","url":null,"abstract":"<p><strong>Objectives: </strong>Performance feedback is critical to guide vascular surgery trainees' skill development across competency domains. Workplace-based assessment of Entrustable Professional Activities (EPA) allows faculty frequent opportunities to provide and document clinical performance feedback. ACGME Milestones were previously mapped to each EPA and accompanying behavioral anchors reflect the range of competencies required to execute each clinical activity. It is unclear how faculty use this information to guide and focus the content of their feedback. We sought to identify the core competencies reflected in narrative feedback in a multi-institutional study of EPA assessments.</p><p><strong>Methods: </strong>EPA assessments were collected during a 3-month national Vascular Surgery EPA Pilot in 2024. Trainees were rated on their performance of EPAs on a 4-point Likert scale and faculty had the opportunity to provide feedback. Narrative feedback was qualitatively analyzed using focused coding guided by the Vascular Surgery Milestones 2.0 framework. Feedback was coded using the six ACGME Core Competencies-patient care (PC), medical knowledge (MK), professionalism (PROF), interpersonal and communication skills (ICS), practice-based learning and improvement (PBLI), and systems-based practice (SBP)-to characterize the domains emphasized in feedback. Quality assessment scores were assigned to all narrative feedback using the Quality of Assessment of Learning (QuAL) framework. Descriptive analysis was completed using R.</p><p><strong>Results: </strong>Faculty completed 983 EPA assessments of 78 trainees across 17 institutions (n=16 integrated residencies, n=12 fellowships). Narrative feedback was included in 760 (77%) assessments. Feedback most frequently addressed PC (n=662, 82%), followed by MK (n=418, 55%), while feedback about PBLI (n=42, 6%), ICS (n =42,6%), PROF (n=20, 3%), and SBP (n=26, 3%) were less common. Most assessments were completed for PGY-3 (29%) and PGY-4 trainees (22%). Most assessments occurred during the intra-operative phase of care (88%), with relatively few occurring in pre-operative (7%) or post-operative (5%) phases. Additionally, feedback referencing PC was associated with higher odds of high-quality feedback in comparison to feedback about the other competencies (OR = 25.56, 95% CI: 6.13-106.55).</p><p><strong>Conclusion: </strong>In this multi-institutional study of vascular surgery EPA assessments, faculty most frequently provided trainees with feedback on their performance of PC and MK competencies. Feedback on performance related to SBP was infrequently provided and, when provided, was of generally low quality. This has important implications for the use of EPAs to inform ACGME Milestones ratings and suggests alternative assessment tools will continue to be needed to capture performance across all competency domains required of a physician.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148006","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":"Visceral to Systemic: The Inferior Mesenteric Artery as a Silent Saviour in Asymptomatic Aortoiliac Occlusion.","authors":"Dr Devender Singh, Dr Shalini Aryala","doi":"10.1016/j.jvs.2026.09.029","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.029","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111390","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":"Selective Endovascular Aortic Repair in Connective Tissue Disease Patients Within a Multidisciplinary Program Achieves Comparable Outcomes in High-Risk Patients.","authors":"Walker R Ueland, Pavel Mazirka, Michael J Fassler, Dan Neal, Zain Shahid, Michol A Cooper, Gilbert R Upchurch, John Spratt, Eric Jeng, Thomas Beaver, Tomas Martin, Salvatore T Scali, Martin R Back","doi":"10.1016/j.jvs.2026.08.044","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.08.044","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular aortic repair (ENDO) in connective tissue disease (CTD) patients has historically been discouraged in societal guidelines because of durability concerns. However, high-volume aortic centers increasingly employ ENDO strategies in carefully selected high-risk scenarios such as rupture, dissection-related pathology, or hostile anatomy. Herein, we describe temporal ENDO adoption at our multidisciplinary CTD aortic program.</p><p><strong>Methods: </strong>Ninety-two CTD patients undergoing aortic intervention at a single high-volume aortic center between 2005 and 2023 were analyzed. Patients were stratified by ENDO (n=50) versus open repair (OPEN; n=42). The primary outcome was freedom from aortic-related mortality (ARM). Secondary outcomes included technical success, complications, secondary aortic intervention (SAI), and overall survival. A prespecified contemporary analysis (2018-2023) evaluated outcomes following establishment of a multidisciplinary CTD aortic program. Kaplan-Meier methods estimated survival and freedom from SAI.</p><p><strong>Results: </strong>Mean age was 48±16 years and 34% (n=31) were female. Diagnoses included Marfan syndrome (69%), Loeys-Dietz syndrome (15%), familial aortopathy (11%), and vascular Ehlers-Danlos syndrome (5%). ENDO patients more frequently had prior sternotomy/open cardiac surgery (68% vs. 19%; p<.0001), prior aortic surgery (70% vs. 33%; p=.0007), and urgent presentation (50% vs. 14%; p=.0004). Overall, 60% of ENDO patients were deemed unfit for open repair by the multidisciplinary aortic team because of physiologic risk, anatomic complexity, or urgent presentation. Technical success was lower after ENDO (82% vs. 98%; p=.02), and 30-day reintervention was higher (16% vs. 0%; p=.01). Median follow-up was 2.3 years [IQR 1.1-4.7]. SAI occurred more frequently following ENDO (56% vs. 12%; p=.0001), including planned staged procedures (ENDO 28.6% vs. OPEN 20%; p=1) and unplanned reinterventions (ENDO 71.4% vs. OPEN 80%; p=1) among those requiring SAI. In the full cohort, ENDO patients had lower 3-year survival (71±7% vs. 92±4%; log-rank p=.03). In the contemporary cohort, survival at 2 years following ENDO (n=17) was poorer than after OPEN repair (n=42), although the difference did not reach significance (71±14% vs. 92±4%; log-rank p=.1). Similarly, freedom from ARM was lower but not significantly different (88±12% vs. 98±2%; log-rank p=.4).</p><p><strong>Conclusions: </strong>Open repair remains the gold standard for CTD-associated aortic disease. In carefully selected high-risk patients, ENDO serves as a complementary strategy with acceptable contemporary survival and comparable freedom from ARM. Higher secondary intervention rates reflect both planned staged repair and unplanned surveillance-detected failure modes, underscoring the need for lifelong follow-up within multidisciplinary programs.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111403","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":"One year outcomes of Percutaneous Deep Vein Arterialization in the Dutch LimFlow Registry.","authors":"Dieder J Stolk, Michael J Nugteren, Daniel van den Heuvel, Jan-Willem H C Daemen, Bram Fioole, Çağdaş Ünlü, Gert Jan de Borst, Michiel A Schreve","doi":"10.1016/j.jvs.2026.09.026","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.026","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous deep venous arterialization (pDVA) offers an endovascular potential alternative to reduce the risk of major amputation in patients with chronic limb threatening ischemia (CLTI) with no standard revascularization options (NO-CLTI).</p><p><strong>Methods: </strong>In this prospective, multicenter registry conducted in the Netherlands between May 2020 and June 2024, NO-CLTI patients underwent pDVA using the LimFlow™ system. The primary endpoint was amputation-free survival (AFS) at 12 months. Secondary outcomes included limb salvage, overall survival, patency, pain scores, wound healing, transcutaneous oxygen pressure (TcPO₂), and quality of life (QoL).</p><p><strong>Results: </strong>A total of 26 limbs of 23 NO-CLTI patients (mean age 64 ± 12 years; 20 men) were included, all classified as Rutherford category 5 and 17 (77.3%) as Wound Ischemia and foot Infection (WIfI) stage 4. Thirteen (53.8%) patients suffered from diabetes mellitus and six (21.7%) from renal insufficiency. Technical success was 100%. AFS was 69.2%, limb salvage 80.8% and overall survival 88.5% at 12 months. Primary patency, primary assisted patency and secondary patency rates at 12 months were 6.6%, 27.3% and 35.7% respectively. Reinterventions were performed to maintain patency in 85% of the limbs and in 58% for maturation of the pDVA. Median time to wound healing was 6.9 months, with 73.4% healed at 12 months. Pain scores decreased significantly (p <.001) in 12 months. QoL improved from a mean of 37% to 68% on the VascuQoL-25, though these analyses were based on limited available data.</p><p><strong>Conclusion: </strong>pDVA in NO-CLTI patients is safe and effective at 12 months, preventing major amputation and mortality in the majority of patients. QoL also appeared to improve following pDVA. These observations warrant confirmation in larger studies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081149","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":"Real-world outcomes of endoanchors in the prevention and treatment of proximal endograft failure in a multicenter registry.","authors":"Michele Antonello, Simona Marrocco, Giovanni Pratesi, Umberto M Bracale, Raffaele Pulli, Diego Moniaci, Stefano Bonvini, Gianfranco Veraldi, Gabriele Piffaretti, Fabio Verzini, Domenico Milite, Sandro Irsara, Sandro Lepidi, Santi Trimarchi, Paolo Frigatti, Alessandro Medeot, Alberto Sacco, Alberto Dall'Antonia, Davide Esposito, Giulio Accarino, Rossella Di Domenico, Alberto Buonavita, Nicola Spadoni, Luca Mezzetto, Marco Franchin, Lorenzo Gibello, Andrea Xodo, Cristina Rocchi, Mario D'Oria, Paola Scrivere, Elena Guerrieri, Luca Porcellato, Viviana Grassi, Franco Grego, Michele Piazza, Francesco Squizzato","doi":"10.1016/j.jvs.2026.09.025","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.025","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the outcomes of the Heli-FX EndoAnchor system (ESAR) in the prevention and treatment of proximal endograft failure after endovascular aneurysm repair (EVAR).</p><p><strong>Methods: </strong>We conducted a retrospective data analysis from a multicenter registry of patients treated by ESAR (2017-2025). In the Prevention group (PG), endoanchors were used to prevent proximal endograft failure during primary endovascular repair (EVAR). In the treatment group (TG), endoanchors were used to treat a type Ia endoleak and/or migration after a prior EVAR. Endpoints were technical success, procedural success, and freedom from proximal endograft failure (new-onset type Ia endoleak, related reintervention, endograft migration).</p><p><strong>Results: </strong>There were 325 patients, 234 (72%) in the PG and 91 (28%) in the TG. Technical success was 100% in the PG and 97% in TG (P=.043), with a procedural success of 100% vs 88% (P<.001). After 5 years of follow-up (median 42 months), freedom from proximal endograft failure was 90.2% (95%CI 85-95) in the PG and 74.9% (95%CI 64-87) in the TG (P=.001). Neck length <7 mm (HR 2.11, 95%CI 1.18-4.56; P<.001) and use of endoanchors as a treatment (HR 3.48, 95%CI 1.61-7.51; P<.001) had a higher risk of proximal endograft failure. In the TG, the use of endoanchors alone (without a proximal aortic extension) (HR 4.00, 95%CI 1.19-8.65; P<.001) and the persistence of a type Ia endoleak at the completion angiography (HR 15.9, 95%CI 10.5-23.0; P<.001) were associated with a higher risk of proximal failure.</p><p><strong>Conclusions: </strong>In this real-world registry, ESAR was used as an adjunct during primary EVAR in patients with a hostile proximal neck and as a salvage treatment of proximal endograft failure after a previous EVAR, with favorable success rates in both settings. In the preventive setting, outcomes were less favorable when the anatomical proximal neck length was <7 mm. In the treatment of type Ia endoleak, favorable results were obtained in up to 80% of cases, with a higher success rate when endoanchors were combined with a proximal aortic extension, and the persistence of a type Ia endoleak on the completion angiogram was a negative prognostic factor. Future comparative studies are necessary to better clarify the clinical efficacy of ESAR in a prevention and treatment setting.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081188","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 TEVAR for uncomplicated subacute type B aortic dissection in the IRAD registry.","authors":"Brendan Gontarz, Bradley Leshnower, George Arnaoutakis, Arminder Jassar, Derek Brinster, Thomas Gleason, Ibrahim Sultan, Eric Isselbacher, Nimesh Desai, Alan Braverman, Kim Eagle, Marc Schermerhorn, Firas F Mussa, Santi Trimarchi, Himanshu Patel, Chih-Wen Pai, Owen Glotzer","doi":"10.1016/j.jvs.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.09.022","url":null,"abstract":"<p><strong>Background: </strong>Thoracic endovascular aortic repair (TEVAR) in uncomplicated type B acute aortic dissection (TBAAD) remains controversial. Compared to best medical therapy (BMT), TEVAR has demonstrated benefits in aortic remodeling; however, this intervention does include procedural related risks.</p><p><strong>Methods: </strong>The International Registry of Acute Aortic Dissection (IRAD) database was queried from January 1996 to September 2023 for all uncomplicated TBAAD. Patients receiving subacute (15-90 days) TEVAR (sTEVAR) and BMT were included. Baseline comorbidities were recorded. The primary outcome was survival at 4 years. Secondary outcomes included delayed aortic interventions, progression of aortic disease, new dissection, re-hospitalization, rupture, and stroke.</p><p><strong>Results: </strong>During the study period, 1373 uncomplicated TBAAD patients were entered into the registry and had follow-up data available. Sixty-three patients (4.6%) underwent sTEVAR and 1310 (95.4%) received BMT. Four-year survival was similar between the groups (sTEVAR 87% vs BMT 84%, p=0.925). At three years, the sTEVAR group had higher rates of new dissection (13.9% vs 4.8%, p=0.002), all within 1 year of TEVAR. Progression of dissection, aneurysmal degeneration, reintervention, rupture, stroke, and re-hospitalization were comparable between groups.</p><p><strong>Conclusion: </strong>As compared to BMT, sTEVAR had similar rates of survival. New dissection was higher in the sTEVAR group. TEVAR may have a role in subacute uncomplicated TBAAD, and ongoing randomized trials are essential to understand which patients benefit from intervention.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075089","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 association of rural residence with aneurysm presentation and loss to follow-up after endovascular aneurysm repair in the Vascular Quality Initiative.","authors":"Sashi Inkollu, Abraham Hussain, Erika Beidelman, Paul Rothenberg, Corey Kalbaugh, Samantha D Minc","doi":"10.1016/j.jvs.2026.09.021","DOIUrl":"10.1016/j.jvs.2026.09.021","url":null,"abstract":"<p><strong>Objective: </strong>Early recognition, timely access to care, and diligent follow-up are essential components of care for patients with aortic aneurysms. Rural patients have significant barriers to care and may present for surgery with larger aneurysms and be more likely to be lost to follow-up (LTFU). The purpose of this study was to assess the effects of rurality on clinical presentation of abdominal aortic aneurysms (AAA) and follow-up after endovascular aortic aneurysm repair.</p><p><strong>Methods: </strong>The Vascular Quality Initiative's U.S. endovascular aortic aneurysm repair module (2003-2021) was used for analyses (n = 62,503). Patients were categorized as residing in an urban or rural area using rural-urban commuting area codes. Univariate analyses were performed to describe differences in sociodemographic, intraoperative, and follow-up factors. We fit unadjusted and adjusted logistic regression models to assess the association between rurality and aneurysm size, symptomatic presentation, adverse cardiovascular events, death, loss to follow-up, and follow-up type.</p><p><strong>Results: </strong>A total of 79% (n = 49,372) of patients were classified as urban and 21% (n = 13,131) as rural with several significantly different demographic variables. On multivariable analyses, residing in a rural compared with urban area was significantly associated with 9% higher odds of undergoing repair with an aneurysm diameter of >6.5 cm [adjusted odds ratio (aOR), 1.09; 95% confidence interval (CI), 1.03-1.15], an 18% increase in the odds of presenting with an urgent AAA compared with elective (aOR, 1.18; 95% CI, 1.11-1.24) and a 14% increase in the odds of being LTFU (aOR, 1.14; 95% CI, 1.05-1.23). Finally, of the patients who did follow-up, rural compared with urban residence was associated with a 10% lower odds of having in-person follow-up (aOR, 0.90; 95% CI, 0.86-0.95), but was associated with 13% higher odds of having any follow-up imaging (aOR, 1.13; 95% CI, 1.04-1.23).</p><p><strong>Conclusions: </strong>This study found that rural patients had higher odds of large aneurysms at time of repair, higher odds of requiring urgent repair, and being LTFU. When they did have follow-up, it was less likely to be in person. This suggests geographic disparities in quality of and access to appropriate AAA screening, repair and follow-up. Addressing this disparity will require coordinated multidisciplinary efforts, efficient referral pipelines, and reliable surveillance mechanisms postoperatively. Future efforts should aim to develop and implement evidence-based care delivery strategies for AAA care for patients in rural settings, such as primary care clinician education, telehealth platforms and travel assistance.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030915","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 Vascular Quality Initiative contemporary benchmarks: Carotid artery stenting.","authors":"Mahmoud Malas, Pooria Nakhaei, Cassius Iyad Ochoa Chaar, Faisal Aziz, Jens Eldrup-Jorgensen","doi":"10.1016/j.jvs.2026.09.013","DOIUrl":"10.1016/j.jvs.2026.09.013","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Carotid artery stenting (CAS) utilization and indications have evolved substantially with the introduction of transcarotid artery revascularization (TCAR), recent regulatory expansion, and renewed attention following contemporary trial data. We sought to establish contemporary real-world benchmark outcome rates for CAS and characterize temporal trends and modality adoption within the Vascular Quality Initiative (VQI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed all CAS procedures recorded in the VQI from 2011 to 2024. Contemporary benchmark analyses were restricted to procedures performed from 2021 to 2024, selected to reflect recent practice following the coronavirus disease 2019 pandemic and the maturation of TCAR adoption, and stratified by symptomatic status and modality [TCAR vs transfemoral CAS (TFCAS)]. Primary outcomes included in-hospital stroke, death, myocardial infarction, and major adverse cardiovascular events. One-year ipsilateral stroke and mortality were assessed among patients with available long-term follow-up data. Temporal trends in utilization were evaluated across the full study period and in relation to regulatory milestones, outcomes were compared by operator volume and physician-level TCAR adoption patterns were examined among Physicians with an established pre-2016 TFCAS practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 119,240 CAS procedures were identified across 821 centers and 3991 physicians, including 78,997 performed during the 2021 to 2024 benchmark period. TCAR comprised 73.6% of procedures performed during 2021 to 2024. In-hospital stroke rates were lower with TCAR than TFCAS in both asymptomatic (0.9% vs 1.4%) and symptomatic patients (1.8% vs 2.8%), as were death (0.3% vs 0.7% asymptomatic; 0.5% vs 1.8% symptomatic) and major adverse cardiovascular events (1.5% vs 2.1% asymptomatic; 2.5% vs 4.4% symptomatic; all P &lt; .05). One-year ipsilateral stroke was lower after TCAR in symptomatic patients (5.6% vs 8.5%; P &lt; .001) but did not differ significantly in asymptomatic patients (2.8% vs 3.4%; P = .054); 1-year mortality was lower after TCAR in both strata (3.0% vs 4.5% asymptomatic; 5.0% vs 7.6% symptomatic; both P &lt; .001). In 2016, TCAR accounted for 7% of CAS procedures and TFCAS 93%, shifting to 76% and 24% respectively by 2023; annual TFCAS volume remained relatively stable through 2020 before increasing thereafter. Following the October 2023 Centers for Medicare and Medicaid Services National Coverage Determination extending standard-risk coverage to both modalities, TCAR volume fell 11.5% (P = .008) and then declined 0.6% per month through December 2024, whereas TFCAS volume rose 11.2% (P = .026). Among 97 physicians with established pre-2016 TFCAS practice who subsequently adopted TCAR and remained active through 2022 to 2024, TCAR accounted for 85% of CAS volume by 2024, with lower pre-existing TFCAS volume associated with faster TCAR adoption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025336","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}