Journal of Vascular Surgery最新文献

{"title":"Radiographic evaluation of the psoas and iliopsoas muscle as predictors for spinal cord ischemia after fenestrated and branched endovascular aortic repair.","authors":"Kaj O Kappe, Jorn P Meekel, Tilo Kölbel, Petroula Nana, Giuseppe Panuccio, Jacco Engel, Jelmer M Wolterink, Vincent Jongkind, Kak Khee Yeung","doi":"10.1016/j.jvs.2026.03.628","DOIUrl":"10.1016/j.jvs.2026.03.628","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the association between sarcopenia and spinal cord ischemia (SCI) after fenestrated and branched endovascular aortic repair (F/B-EVAR) using two- and three-dimensional measurements of the psoas and iliopsoas muscles on preoperative computed tomography angiography (CTA).</p><p><strong>Methods: </strong>A retrospective, two-center study was conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Data were collected from patients with Crawford type I-IV thoracoabdominal aortic aneurysms (TAAA) and pararenal abdominal aortic aneurysms treated with F/B-EVAR between December 2010 and January 2024. One center included all consecutive patients, whereas from the other center, patients with SCI were actively selected together with non-SCI patients in a 1:1 fashion based on patient and procedural characteristics. Preoperative CTAs were analyzed for surrogate markers of sarcopenia, including the psoas muscle area (cm<sup>2</sup>), lean psoas muscle area (cm<sup>2</sup> HU [Hounsfield units]), iliopsoas muscle volume (cm<sup>3</sup>), and lean iliopsoas muscle volume (cm<sup>3</sup> HU). Area measurements were performed manually, whereas volume measurements were performed using an artificial intelligence-based segmentation tool. The primary outcome was to evaluate the predictive value of the measured sarcopenia surrogate markers for SCI occurrence.</p><p><strong>Results: </strong>A total of 138 patients (35.5% female; median age 72 years, interquartile range [IQR]: 68-75 years), with 16 Crawford type I (11.6%), 45 type II (32.6%), 30 type III (21.7%), and 47 type IV/pararenal (34.1%) aneurysms, were included. Fifty-one patients had postoperative SCI (all severities), and 87 had no SCI symptoms. Compared with non-SCI patients, patients with SCI had higher American Society of Anesthesiologists classification (P = .005), more commonly type II TAAA (P < .001), and symptomatic presentation (P = .016). Other patient characteristics were similar between the groups. Psoas muscle area (6.97 cm<sup>2</sup> [IQR: 5.22-8.73 cm<sup>2</sup>] vs 8.47 cm<sup>2</sup> [IQR: 6.39-10.03 cm<sup>2</sup>], P = .003), lean psoas muscle area (253.3 cm<sup>2</sup> HU [IQR: 204.9-333.8 cm<sup>2</sup> HU] vs 335.6 cm<sup>2</sup> HU [IQR: 256.3-409.7 cm<sup>2</sup> HU], P = .002), iliopsoas muscle volume (247.6 cm<sup>3</sup> [IQR: 184.0-303.8 cm<sup>3</sup>] vs 277.7 cm<sup>3</sup> [IQR: 234.1-331.5 cm<sup>3</sup>], P = .018), and lean iliopsoas muscle volume (10,879 cm<sup>3</sup> HU [IQR: 8589-14,497 cm<sup>3</sup> HU] vs 13,445 cm<sup>3</sup> HU [IQR: 10,777-16,396 cm<sup>3</sup> HU], P = .004) were lower in patients with SCI in the unadjusted analyses. On multivariable analysis, only psoas muscle area was independently associated with SCI (odds ratio: 0.815; 95% confidence interval: 0.680-0.977, P = .027).</p><p><strong>Conclusions: </strong>","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":"147674491","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":"Staged embolization of a complex pelvic arteriovenous malformation with bilateral ovarian artery supply.","authors":"Qingping Zhong, Binglin Lai","doi":"10.1016/j.jvs.2026.03.622","DOIUrl":"10.1016/j.jvs.2026.03.622","url":null,"abstract":"","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":"147674556","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":"Cost-effectiveness of antithrombotic therapies for peripheral arterial disease.","authors":"Uday Dhanda, Dana Alameddine, Kurt S Schultz, Lydia Tran, David Silva, Martin D Slade, Loay Kabbani, Raul J Guzman, Ira L Leeds, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2026.03.629","DOIUrl":"10.1016/j.jvs.2026.03.629","url":null,"abstract":"<p><strong>Objectives: </strong>Antithrombotic treatment plays a critical role in managing peripheral arterial disease and reducing the risk of major adverse limb events and major adverse cardiovascular events after revascularization. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the most commonly used regimen following lower extremity revascularization (LER), but emerging studies suggest that dual antithrombotic pathway inhibition (DPI), which combines a factor Xa inhibitor with an antiplatelet agent, may offer enhanced protection. This study evaluates the clinical outcomes and cost-effectiveness of DPI compared with DAPT in patients undergoing LER.</p><p><strong>Methods: </strong>A retrospective analysis compared the characteristics of patients treated with DAPT and DPI after LER at Yale New Haven Hospital. After applying a 4:1 propensity score matching to adjust for differences in baseline characteristics, the outcomes of the two groups were compared. Cost-effectiveness was evaluated over a 5-year horizon using modeled costs and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio was calculated. The willingness-to-pay (WTP) threshold was set at $150,000 per QALY, which aligns with the average U.S. WTP for health interventions.</p><p><strong>Results: </strong>A total of 986 patients undergoing LER were reviewed, with 5.6% on DPI. After propensity matching (N = 275), Kaplan-Meier analysis showed significantly improved major adverse limb event-free survival in the DPI group, with no difference in adverse cardiovascular event-free survival between the two groups. Although the DPI strategy incurred higher costs ($73,826 vs $39,548), it yielded greater health benefits (4.64 vs 3.51 QALYs). The incremental cost-effectiveness ratio was $30,331 per QALY, well below the U.S. WTP threshold of $150,000 per QALY, indicating that DPI is a cost-effective alternative compared with DAPT.</p><p><strong>Conclusions: </strong>DPI is associated with improved limb-related outcomes and represents a cost-effective alternative to DAPT for antithrombotic therapy after LER.</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":"147674416","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":"Associations of antidiabetic medications with abdominal aortic aneurysm growth and clinical outcomes: A systematic review and meta-analysis.","authors":"Yoonjung Park, Soyoung Kang, Hyun Woo Lee, Jaekyu Shin, Wonseok Seol, Jiseok Lee, Yun Mi Yu, Young-Mi Ah","doi":"10.1016/j.jvs.2026.03.617","DOIUrl":"10.1016/j.jvs.2026.03.617","url":null,"abstract":"<p><strong>Objective: </strong>This review aimed to evaluate the association between different antidiabetic agents, abdominal aortic aneurysm (AAA) growth, and related events.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PROSPERO CRD420251115799), MEDLINE, Embase, and CENTRAL were searched through January 2026. Eligible studies evaluated antidiabetic drugs compared with not using the medication of interest and reported AAA growth and/or AAA-related events. The risk of bias was assessed using Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) and RoB 2 for nonrandomized and randomized trials, respectively. Pooled estimates (mean difference [MD], odds ratio [OR], and hazard ratio [HR]) were calculated using inverse variance random-effects models.</p><p><strong>Results: </strong>Thirteen studies (15 distinct cohorts; 150,630 participants) were included. Metformin was associated with slower AAA growth (MD, -0.65 mm/year; 95% confidence interval [CI], -0.97 to -0.33) and lower AAA-related events (OR, 0.63; 95% CI, 0.41-0.95). Moreover, sulfonylureas reduced AAA growth (MD, -0.35 mm/year; 95% CI, -0.52 to -0.18) and AAA-related events (OR, 0.63; 95% CI, 0.52-0.77). Findings for dipeptidyl peptidase-4 inhibitors were not statistically significant in relation to AAA growth (MD, -0.32 mm/year; 95% CI, -0.71 to 0.08). Metformin was not significantly associated with postoperative mortality (HR, 0.86; 95% CI, 0.65-1.13). Most studies were observational, with a moderate risk of bias, which limited causal inference.</p><p><strong>Conclusions: </strong>Metformin and sulfonylurea were associated with reduced AAA progression, although potential confounding necessitates cautious interpretation. Evidence for other glucose-lowering therapies remains limited. Randomized trials are required to evaluate drug-specific associations and outcomes across stratified patient groups.</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":"147674440","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":"Wound healing, wound-free period and amputation-free survival in patients with Wound, Ischemia, and foot Infection (WIfI) stage 3 and 4 disease.","authors":"Cuneyt Koksoy, Sydney Browder, Ilse Torrez-Ruiz, Sai Prasada Rao K Manikonda, Moussa Shahoud, Joseph L Mills, Zachary S Pallister, Katherine L McGinigle, Jayer Chung","doi":"10.1016/j.jvs.2026.03.625","DOIUrl":"10.1016/j.jvs.2026.03.625","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent publications in low-risk Wound, Ischemia, and foot Infection (WIfI) stage 1 to 2 chronic limb-threatening ischemia (CLTI) suggest wound care-first strategies are safe. Although revascularization is widely accepted as beneficial in high-risk WIfI stage 3 to 4 patients, its impact on wound-centered outcomes such as wound healing time (WHT) and wound-free period (WFP) has not been well-characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A two-center, retrospective analysis was performed. Baseline data included demographics, comorbidities, perfusion indices, WIfI, and treatment modality (endovascular, open, hybrid, wound care only). Outcomes were WHT, WFP, and amputation-free survival. WHT was defined as the interval from initial presentation to complete epithelialization, regardless of interim reinterventions; major amputation or death prior to healing were classified as unhealed episodes. WFP was defined as the healed interval until recurrence or censoring.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over 9 years, 1483 patients were managed with CLTI, of whom 920 (1091 limbs) were WIfI stage 3 and 4 disease. These contributed 1158 wounds episodes (median follow-up, 29.0 months; interquartile range [IQR], 10.0-45.0 months). Most limbs underwent revascularization (n = 945; 81.6%), including endovascular (n = 713; 62%), open (n = 196; 17%), and hybrid (n = 36; 3%) approaches, whereas 18.4% were managed with wound care only. Overall, 550 wound episodes (47.6%) healed, with a median WHT of 248 days (IQR, 120-441 days). The median WHT did not differ meaningfully by revascularization strategy. Successful revascularization was independently associated with a higher likelihood of healing (adjusted odds ratio, 2.45; 95% confidence interval [CI], 1.71-3.50). Independent predictors of healing included successful revascularization (hazard ratio [HR], 2.45; 95% CI, 1.71-3.50; P &lt; .001), obesity (HR, 1.52; P = .003), and hyperlipidemia (HR, 1.55; P = .044), whereas WIfI stage 4 predicted decreased healing (HR, 0.61; P &lt; .001). Among 550 healed episodes, 79 (14.4%) developed recurrence or underwent major amputation at a median of 502 days (IQR, 163-1084 days). The median WFP was 502 days (95% CI, 350-654 days) and did not differ by treatment strategy on Kaplan-Meier analysis (P = .41). At last follow-up, 720 patients (62.2%) experienced major amputation/death. One-year limb salvage, survival, and amputation-free survival were consistently lower in the wound care-only group, whereas revascularized patients demonstrated more favorable early outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In high-risk CLTI (WIfI 3-4), wound healing is prolonged (&gt;6 months), and fewer than one-half of wound episodes heal. Revascularization was strongly associated with wound healing. Once healing occurred, durability (WFP) was similar across strategies. These findings highlight the value of wound-centered metrics (WHT and WFP) to complement traditional survival-base","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":"147674475","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":"Conduit choice in open repair of iliac artery injuries: a comparative analysis of in-hospital outcomes from the National Trauma Data Bank.","authors":"Michael J Fassler, Dan Neal, David H Stone, Erica L Mitchell, Divya Kewalramani, Mayur Narayan, Gabriel Brat, Christopher Tignanelli, Gilbert R Upchurch, Salvatore T Scali, Tyler J Loftus","doi":"10.1016/j.jvs.2026.03.624","DOIUrl":"10.1016/j.jvs.2026.03.624","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Iliac artery trauma is associated with substantial morbidity and mortality. Although open bypass or patch arterioplasty remain common even in the endovascular era, associations between conduit choice and outcomes remain unclear. This study compares short-term outcomes among conduit types for iliac artery injuries in a national cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients undergoing open patch or bypass repair of an iliac artery injury were identified from the National Trauma Data Bank (2017-2023) via deterministic, fully supervised natural language processing techniques and stratified by repair material. Reconstructions performed with entirely autogenous (vein patch or autogenous vein bypass) or cadaveric (nonautogenous tissue substitute patch or bypass used with or without autogenous vein) material were classified as such. Repairs that included any synthetic material (prosthetic patch or conduit) were classified as synthetic. The primary endpoint was the composite of in-hospital, amputation-free survival. Secondary endpoints included sepsis, surgical site infection, and reintervention rates. Cox proportional hazard modeling was used to adjust differences between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1014 patients were analyzed. Patients across cohorts presented with class II hemorrhagic shock and substantial injury burden, with the synthetic cohort having the highest vascular abbreviated injury scores (6.0; interquartile range [IQR],4.0-8.0 vs autogenous 5.5; IQR, 3.0-7.2; P = .04 and cadaveric 4.0; IQR, 3.0-7.0; P &lt; .001) and rates of prehospital traumatic arrests (9% vs autogenous 3%; P = .003 and cadaveric 8%; P = .6). Compared with synthetic, autogenous reconstructions were more often performed at level 1 centers (75% vs 65%; P = .008). High rates of concomitant hollow viscous injuries occurred across cohorts, particularly with synthetic reconstructions vs autogenous (stomach/small bowel injury: 44% vs 36%; P = .03 and colon/rectal: 31% vs 24%; P = .04). In-hospital mortality rates were highest in the synthetic cohort (31% vs autogenous: 17%; P &lt; .001; and cadaveric: 18%; P &lt; .001). Rates of sepsis and surgical site infection were suspiciously low (consistent with prior NTDB analyses) and similar. No differences were observed in reintervention rates (median number of vascular interventions, 1; IQR, 1-2). Cox proportional hazard modeling with autogenous reconstruction as the reference cohort revealed lower rates of risk-adjusted in-hospital amputation-free survival in the synthetic cohort (hazard ratio, 1.76; 95% confidence interval, 1.26-2.46; P &lt; .001) but not the cadaveric cohort (hazard ratio, 1.02; 95% confidence interval, 0.68-1.54; P = .913).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Synthetic reconstruction for iliac artery trauma demonstrated lower risk-adjusted in-hospital amputation-free survival compared with autogenous or cadaveric reconstructions. In the context of frequent hollow viscou","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":"147674380","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 of lifestyle factors and genetic risk with incident abdominal aortic aneurysm.","authors":"Jingyi Ren, Zhenao Zhang, Xiaoya Sun, Huanting Pei, Yadong Zhang, Chongyue Zhang, Xiaolong Zhang, Simeng Qiao, Siqi Zhu, Bowen Yin, Yuxia Ma","doi":"10.1016/j.jvs.2026.03.619","DOIUrl":"10.1016/j.jvs.2026.03.619","url":null,"abstract":"<p><strong>Objective: </strong>Although lifestyle factors are associated with the risk of abdominal aortic aneurysm (AAA), its relationship with genetic susceptibility in determining AAA remains unclear. We aim to investigate the association of lifestyle factors and genetic risk with the incidence of AAAs.</p><p><strong>Methods: </strong>A prospective cohort study, including 274,755 adult participants with White European ancestry and no AAA at baseline, was recruited between 2006 and 2010. A polygenic risk score was calculated to quantify genetic susceptibility to AAA in participants, and a comprehensive healthy lifestyle score was derived based on factors including sleep, diet, alcohol consumption, physical activity, waist-to-hip ratio, and smoking. Incident AAAs were determined by linking medical history with hospital admission and death registries.</p><p><strong>Results: </strong>Participants at high genetic risk had an 89% higher risk of AAAs compared with those at low genetic risk. A poor lifestyle was associated with a 165% increased risk of developing AAAs compared with a healthy lifestyle. Participants with both a poor lifestyle and high genetic risk exhibited the highest risk, with a hazard ratio for incident AAAs of 4.64 (95% confidence interval, 2.59-8.31) compared with those at low genetic risk and a healthy lifestyle. Moreover, there was a significant positive additive interaction between poor lifestyle and high genetic risk (relative excess risk due to interaction: 1.81; 95% confidence interval, 0.69-2.92).</p><p><strong>Conclusions: </strong>High genetic risk and poor lifestyle were both independently and jointly associated with an increased risk of AAAs. Moreover, following a healthy lifestyle can reduce the risk of AAAs for individuals, particularly among those with high genetic risk.</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":"147674418","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 multi-institutional study comparing antegrade and retrograde open mesenteric bypass for chronic mesenteric ischemia.","authors":"Brian J Fazzone, Salvatore T Scali, Peter Albrecht, Erik M Anderson, Dan Neal, Thomas S Huber, Eric D Endean","doi":"10.1016/j.jvs.2026.03.613","DOIUrl":"10.1016/j.jvs.2026.03.613","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Contemporary clinical practice guidelines recommend an endovascular-first approach for chronic mesenteric ischemia (CMI), reserving open mesenteric bypass (OMB) for flush ostial vessel occlusion, long-segment disease, heavily calcified lesions, or failed stents. However, guidelines are equivocal regarding bypass configuration, leaving the optimal strategy debated. The antegrade (AG) approach may carry higher perioperative risk due to supramesenteric aortic cross-clamping, whereas the retrograde (RG) approach from the infrarenal aorta or iliac vessels raises concerns about long-term patency. Therefore, we compared perioperative and midterm outcomes of AG and RG bypass in a multi-institutional cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed consecutive patients undergoing OMB for CMI at two high-volume centers (2000-2024). The primary end point was 30-day mortality; secondary end points included complications, survival, and patency. Adjusted comparisons were performed using multivariable logistic regression, Cox models, and propensity-matched cohorts. Kaplan-Meier methods estimated survival and patency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 209 patients underwent OMB: 130 AG (all from center A) and 79 RG (36 from center A, 43 from center B). Compared with AG, RG patients had higher rates of cardiopulmonary comorbidity, including chronic obstructive pulmonary disease (57% vs 44%; P = .08) and congestive heart failure (26% vs 12%; P = .01), were more frequently hospital transfers (29% vs 15%; P = .02), and more often received autogenous vein conduit (55% vs 1%; P &lt; .0001). Unadjusted complication rates (22% vs 22%; P = 1), 30-day mortality (4.4% vs 8.7%; P = .3), and 90-day mortality (10% vs 15%; P = .5) were similar between groups. Primary patency was excellent and comparable (1-year: 97% ± 2% AG vs 98 ± 2% RG; 3-year: 90% ± 8% vs 90% ± 9%; P = NS). On multivariable analysis, bypass configuration was not independently associated with mortality (hazard ratio, 1.4; 95% confidence interval [CI], 0.7-2.7; P = .3) or perioperative complications (odds ratio, 0.93; 95% CI, 0.3-2.5; P = .9). In the propensity-matched cohort (65 AG vs 65 RG), early outcomes and patency remained similar; however, 1-year mortality was higher after RG bypass (36.8% vs 16.3%; odds ratio, 3.0; 95% CI, 1.2-8; P = .02). Overall survival in the full cohort did not differ significantly by Kaplan-Meier analysis (log-rank P = .5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this multi-institutional analysis of patients with CMI undergoing OMB, AG and RG configurations demonstrated similar perioperative morbidity and excellent graft patency. Bypass configuration was not independently associated with early or midterm outcomes in adjusted analyses, although higher 1-year mortality was observed after RG bypass in a propensity-matched cohort. These findings support individualized selection of bypass configuration based on anatomic consid","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":"147674242","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":"Analysis of complex endovascular aneurysm repair in patients with median arcuate ligament compression.","authors":"Daria Anokhina, Lukas Fuchs, Anna Sotir, Johannes Klopf, Lina El-Kilany, Florian Wolf, Christoph Neumayer, Wolf Eilenberg","doi":"10.1016/j.jvs.2026.03.618","DOIUrl":"10.1016/j.jvs.2026.03.618","url":null,"abstract":"<p><strong>Objective: </strong>Treating abdominal aortic aneurysms with fenestrated or branched endovascular aneurysm repair in the presence of a median arcuate ligament (MAL) compression of the celiac trunk presents special challenges. This study aimed to investigate whether compressed celiac trunks can be safely stented or left unstented. It also aimed to assess the durability of bridging stent grafts (BSGs) of new generation in patients with compression of the celiac trunk.</p><p><strong>Methods: </strong>A single-center retrospective analysis of 187 consecutive patients treated with fenestrated or branched endovascular aneurysm repair was performed. The study population was divided into three groups: patients whose MAL compression was stented with a BSG (MAL+ stented), patients whose MAL compression was not stented (MAL+ unstented), and patients without MAL compression (MAL-). Celiac trunk compression was evaluated in consecutive computed tomography angiography (CTA) scans.</p><p><strong>Results: </strong>Of 187 patients, 76 patients (41%) had a MAL compression in the preoperative CTA scan. Of those, 46 patients (25%) were in the MAL+ stented group, and 30 patients (16%) were in the MAL+ unstented group. Six of 30 patients (20%) from the MAL+ unstented group developed mesenteric ischemia compared with zero of 46 patients (0%) from the MAL+ stented group (P ≤ .001). One of MAL+ stented patients (2%) developed target vessel instabilities, compared with one of MAL- patients (3%) and three of MAL- patients (3%) (P=.960). No BSG fracture was observed.</p><p><strong>Conclusions: </strong>BSGs of new generation are capable of withholding the pressure of MAL compression of the celiac trunk. Patients with unstented celiac trunk compression are significantly more likely to develop mesenteric ischemia. In accordance with present data, BSG deployment, including cases with high-grade stenosis, should be considered for maintenance of celiac blood flow.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674410","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":"Manuscript Title: Sex differences in patients hospitalized for repair of intact abdominal aortic aneurysms in eleven high-income countries: A cross-sectional cohort study.","authors":"Seohyun Woo, Sun Jung Kim, Soo-Hee Hwang, Saeed Al-Azazi, Amitava Banerjee, Pieter Bakx, Nitzan Burrack, Yu-Chin Chen, Johannes Cordier, Adam G Elshaug, Jonas Cuzulan Hirani, David Ehlig, Christina Fu, Asa R Hartman, Carlos Godoy Junior, Daniel Griffiths, Laura A Hatfield, Huai-Hsuan Huang, Nicole Huang, Peter Jones, Manar Khashram, Dennis T Ko, Serkan Korkmaz, Lisa M Lix, Dominik Moser, Victor Novack, Laura Pasea, Feng Qiu, Marc Schermerhorn, Therese A Stukel, Carin Uyl-de Groot, Bruce Landon, Peter Cram","doi":"10.1016/j.jvs.2026.03.623","DOIUrl":"https://doi.org/10.1016/j.jvs.2026.03.623","url":null,"abstract":"<p><strong>Objective: </strong>Sex differences in the treatment and outcomes of males and females undergoing intact abdominal aortic aneurysm (AAA) repair have been documented in single-country studies, with females tending to have worse outcomes. However, international comparisons of sex differences across countries using patient-level data and harmonized analytical methods are lacking.</p><p><strong>Methods: </strong>We conducted a retrospective serial cross sectional cohort study using population-representative administrative data from eleven countries participating in the International Health Systems Research Collaborative (IHSRC) to identify adults aged 66+ hospitalized for intact AAA repair between 2011 and 2019. We compared females and males within each country with respect to age- and comorbidity-adjusted AAA population-adjusted incidence of surgeries, 30-day and 1-year mortality, 30-day readmission, and hospital length of stay (LOS).</p><p><strong>Results: </strong>Our intact AAA repair cohort sizes differed widely across our 11 countries, ranging from 200,151 in the US (178,777 [78%] EVAR; 21,374 [22%] open repair) to 1,290 in Israel (1,199 [89%] EVAR, 91[11%] open repair). Overall AAA population-adjusted incidence of surgeries (EVAR plus open repairs per 100,000 population per year) were significantly lower for females than males in all countries but the male to female repair ratio within countries differed widely. For example, in the US there were approximately 4.5 male repairs per 1.0 female repair; in Israel the ratio was 10:1. 30-day and 1-year age- and comorbidity-adjusted mortality was higher for females than males in most countries (Switzerland, 1-year mortality: 8.5 female, 5.4 male). Females experienced longer hospital overall (EVAR plus open) LOS (e.g., South Korea, male 17.9 days vs female 23.5 days) and higher rates of hospital readmission (e.g., Israel, male 21.0% vs female 33.6%) than males. These disparities persisted across years and repair subtype.</p><p><strong>Conclusions: </strong>Compared to males, females had lower AAA population-adjusted incidence of surgeries, higher mortality, higher readmission rates, and longer hospital LOS across 11 diverse high-income countries. However, the magnitude of the female-male differences were surprisingly variable. These findings raise important questions about whether these differences are manifestations of true clinical differences across countries or differences in how males and females are treated in each country. We suggest that countries with larger \"gaps\" explore the underlying drivers of these differences while simultaneously exploring opportunities to redesign care.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674438","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}