Journal of Vascular Surgery最新文献

{"title":"Healing by numbers: Reconsidering multiple infrapopliteal targets in endovascular management of chronic limb-threatening ischemia","authors":"Jeremy D. Darling MD, Allen D. Hamdan MD","doi":"10.1016/j.jvs.2025.07.002","DOIUrl":"10.1016/j.jvs.2025.07.002","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 5","pages":"Pages 1913-1914"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145326614","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":"Letter regarding \"Arteriovenous Fistula Surgeon Variability\"","authors":"Kenneth J. Woodside MD, Vahakn B. Shahinian MD","doi":"10.1016/j.jvs.2025.06.116","DOIUrl":"10.1016/j.jvs.2025.06.116","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 5","pages":"Pages 1919-1920"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145327241","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":"Non-Contrast Magnetic Resonance Angiography Outperforms Digital Subtraction Angiography in Detecting Hibernating Below-The-Knee Arteries and Downgrades TASC and GLASS Scores in CLTI Patients.","authors":"Alexander B Crichton, Enikő Pomozi, Madeline Drake, Judit Csőre, Bright Benfor, Janak Lamichhane, Paul Haddad, Trisha Roy","doi":"10.1016/j.jvs.2025.10.008","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.008","url":null,"abstract":"<p><strong>Introduction: </strong>Current imaging techniques are limited in their ability to accurately characterize below-the-knee diseased vessels. Digital subtraction angiography (DSA) remains the gold standard but may not visualize some vessels because it relies on nephrotoxic contrast that can fail to reach and opacify distal vessels. Quiescent-interval single shot (QISS) MRI images patients without exposure to nephrotoxic agents such as gadolinium or ionizing radiation and has been suggested to show \"hibernating vessels\" that are not visualized on DSA. The aim of this study is to evaluate whether QISS MRI would identify more patent vessels when compared to DSA, and whether this resulted in less severe Transatlantic Inter-Society Consensus (TASC) II and Global Limb Anatomic Staging System (GLASS) grades.</p><p><strong>Methods: </strong>Patients with CLTI undergoing QISS MRI and DSA were included. Two examiners reviewed the imaging of each patient on both modalities. The vessels assessed were the popliteal and infrapopliteal arteries. All vessels were split into three sections (e.g Anterior tibial artery [ATA]1=proximal, AT2=middle, AT3=distal) and scored as either patent or occluded as individual segments (except the tibioperoneal and dorsalis pedis arteries which were counted as one segment each). Following this, TASC II and infrapopliteal GLASS scoring was performed and compared between QISS MRI and DSA.</p><p><strong>Results: </strong>41 patients were evaluated. Overall, 570 vessel segments were analyzed, with a significantly higher number of patent vessel segments found on QISS MRI compared to DSA (66% vs 58%, p<0.001). On single vessel analysis, there was a higher level of patency seen on QISS MRI compared to DSA in the peroneal (72% vs 61%, p=0.001), posterior tibial (54% vs 42%, p=0.001, anterior tibial (60% vs 52%, p=0.01) and dorsalis pedis arteries (65% vs 38%). Overall TASC II and GLASS scoring did not significantly differ when comparing DSA and QISS MRI. Subgroup analysis of TASC D and infrapopliteal GLASS 4 lesions showed that vessels were significantly more likely to be downgraded to lower grade lesions when interpreting images using QISS MRI in comparison to DSA.</p><p><strong>Conclusion: </strong>QISS MRI can identify more patent vessel segments when compared to the current gold standard, DSA. This study also suggests that QISS MRI may result in lower grading on TASC II and GLASS scoring of the most severe spectrum of arterial disease. The improved visualization with QISS may expand the range of viable treatment options for patients with complex below-the-knee disease in CLTI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308617","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 Society for Vascular Surgery Vascular Quality Initiative Underestimates the Risk Associated with Mild Postoperative Acute Kidney Injury.","authors":"Amanda C Filiberto, Zdenek Novak, C Adam Banks, Angela D Sickels, Adam W Beck","doi":"10.1016/j.jvs.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.009","url":null,"abstract":"<p><strong>Objective: </strong>Recently the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) lowered the thresholds for acute kidney injury (AKI) to align with the Kidney Disease: Improving Global Outcomes (KDIGO) definition (>0.3 mg/dL change from the reference serum creatinine (sCr) within 48 hours of surgery or initiation of dialysis). The Vascular Quality Initiative (VQI) defines postoperative renal dysfunction as a rise in serum creatinine >0.5mg/dL from baseline or new postoperative temporary or permanent dialysis throughout the postoperative course. This definition does not align with guidelines outside of VQI and may not capture subtle changes in perioperative renal function that can impact patient outcomes.</p><p><strong>Methods: </strong>Single institution retrospective review of adult patients with no previous history of preoperative hemodialysis undergoing elective or nonelective major vascular surgery that were registered with the VQI. Patients undergoing endovascular abdominal or thoracic aortic repair, open abdominal aortic aneurysm repair, and suprainguinal or infrainguinal bypasses were included.</p><p><strong>Results: </strong>A total of 932 patients were included. AKI occurred in 6% of patients using the VQI definition (VQI-AKI), as compared to 18% of patients using a modified KDIGO definition (>0.3 mg/dL change from the reference serum creatinine (sCr) within 48 hours of surgery or initiation of dialysis (mKDIGO-AKI). Regardless of the definition used, patients with AKI had longer postoperative length of stay and higher morbidity and mortality. One-year survival was lower for VQI-AKI patients versus mKDIGO-AKI patients, 57% vs. 77%, respectively (log-rank p<.001). In a multivariable cox regression model adjusting for age, nonelective admission status, and history of congestive heart failure, patients with mKDIGO-AKI had 2.5x higher odds of postoperative mortality compared to patients without AKI.</p><p><strong>Conclusions: </strong>The current VQI definition underestimates the rate of clinically significant AKI when compared to mKDIGO, as patients with newly identified AKI using the mKDIGO definition are associated with increased postoperative complications and decreased survival as compared to those without AKI. Given the importance of AKI on short and long-term outcomes, the inclusion of preoperative and highest postoperative creatinine within 7 days of surgery among patients at high risk for postoperative AKI (open AAA, supra/infrainguinal bypass, TEVAR, and EVAR) may be warranted to facilitate appropriate benchmarking and quality improvement efforts.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308542","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":"Corrigendum.","authors":"","doi":"10.1016/j.jvs.2025.09.003","DOIUrl":"10.1016/j.jvs.2025.09.003","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225749","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":"Increased clinical frailty is associated with aortic-related mortality following fenestrated and branched endovascular repair for thoracoabdominal aortic aneurysm.","authors":"Silvia Chen, Elizabeth Ramirez, Blake E Murphy, Anjali Sribalaskandarajah, Martin Bunker, Joel Kruger, Karina A Newhall, Rebecca A Sorber, Sara L Zettervall, Matthew P Sweet","doi":"10.1016/j.jvs.2025.10.011","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Clinical frailty is associated with reduced long-term survival following fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for thoracoabdominal aortic aneurysm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent F/BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS) was used to determine phenotypic frailty. Patients with preoperative CFS&gt;4 (\"vulnerable\") and CFS&lt;4 were compared. Chi-squared and Fischer Exact tests were used to compare patient demographics, anatomic and operative characteristics, and perioperative outcomes. Fine-Gray analysis was used to compare cause of death between groups. Long-term survival and reintervention were assessed with Kaplan-Meier and Cox regression analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;233 patients were included; 60 (25.8%) had CFS&gt;4 and 173 (74.2%) had CFS&lt;4. Patients with CFS&gt;4 were more likely to have COPD (53% vs. 27%) and were treated for slightly larger aneurysms (72 mm vs 68 mm, p=0.04). There were no differences in symptomatic presentation, aneurysm extent, or operative complexity between patient groups. Additionally, there were no differences in perioperative complications including 30-day mortality, stroke, and spinal cord ischemia. Patients with CFS&gt;4 had an increased length of hospitalization (11.3 vs 6.9 days, p&lt;0.01) and were less likely to return to preoperative functional status (62.7% vs 86.1%, p&lt;0.01). Three-year all-cause and aortic-related mortality rates were 35.2% and 5.7%, respectively. Patients with CFS&gt;4 had reduced survival at 1-year (74% vs 89%), 3-years (39% vs 73%), and 5-years (25% vs 56%), compared to patients with CFS&lt;4 (p&lt;0.01). The most common causes of death among both groups were pulmonary comorbidities (14.0%), oncologic conditions (14.0%), cardiovascular comorbidities (11.2%), and procedure-related complications (11.2%). Patients with CFS&gt;4 were more likely to die from aortic-related mortality (10.3% vs 5.9%, p=0.02), pulmonary comorbidities (15.4 vs 13.2%, p=0.04), systemic decline (7.7% vs 1.5%, p=0.02), and infection (12.8% vs 7.4%, p=0.03). Aortic-related mortality for the entire patient cohort was 2.2% and 5.7% at 1-year and 3-years, respectively. Aortic-related deaths among clinically frail patients were often due to an inability to tolerate further aortic operations (e.g. arch repair), and secondary to follow-up non-adherence in patients with with CFS&lt;4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In an expanded cohort of patients, clinical frailty was associated with reduced long-term survival and increased risk for aortic-related mortality following F/BEVAR for treatment of thoracoabdominal aortic aneurysms. Chronic disease burden is a primary driver of overall mortality, while clinically frail patients are more likely to die from pulmonary comorbidities, infec","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308579","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 Effect of Aneurysm Diameter on Perioperative Outcomes Following Endovascular Thoracoabdominal Aortic Aneurysm Repair.","authors":"Isa F van Galen, Jeremy D Darling, Camila R Guetter, Elisa Caron, Jemin Park, Roger B Davis, Douglas W Jones, Thomas F X O'Donnell, Constantijn E V B Hazenberg, Joost A van Herwaarden, Marc L Schermerhorn","doi":"10.1016/j.jvs.2025.10.010","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.010","url":null,"abstract":"<p><strong>Introduction: </strong>Endovascular repair of large-diameter infrarenal and complex abdominal aortic aneurysms has been associated with worse outcomes. Whether these associations also apply to thoracoabdominal aortic aneurysms remains unclear.</p><p><strong>Methods: </strong>We identified all patients who underwent endovascular repair for intact thoracoabdominal aortic aneurysms between July 2010 and July 2024 in the Vascular Quality Initiative. A thoracoabdominal aortic aneurysm was defined as having a proximal aneurysm extent between zones 2 and 6, with at least one renal or visceral artery treated. Locally estimated scatterplot smoothing curves were used to visualize the relationship between preoperative aneurysm diameter and perioperative mortality, which informed the sex-specific definition of large aneurysms. Aneurysm size was categorized based on maximum diameter as follows (females/males): large (>60 mm/>65 mm), small (<50 mm/<55 mm), and medium (50-60 mm/55-65 mm). Perioperative outcomes were assessed using logistic regression models, and five-year mortality was evaluated using adjusted Kaplan-Meier methods and Cox regression. Both large and small aneurysms were compared with medium-sized aneurysms.</p><p><strong>Results: </strong>A total of 1,309 patients were included; of these, 54% underwent repair for medium-sized aneurysms, 37% for large aneurysms, and 9.1% for small aneurysms. Median follow-up was 345 days. After adjustment, compared to medium-sized aneurysms, large aneurysms were associated with 31% higher odds of any perioperative complication (adjusted odds ratio [aOR], 1.31; 95% confidence interval [CI], 1.00-1.72; P=.046) and nearly twice the hazard of five-year mortality (adjusted hazard ratio [aHR], 1.94; 95% CI, 1.43-2.62; P<.01). The odds of perioperative mortality and in-hospital reintervention were similar between medium-sized and large aneurysms. No significant differences in perioperative outcomes or five-year mortality were observed between patients with small and medium-sized aneurysms.</p><p><strong>Conclusions: </strong>Following endovascular repair for thoracoabdominal aortic aneurysms, compared with medium-sized aneurysms, large aneurysms (>60 mm in females, >65 mm in males) were associated with higher odds of any complication and higher five-year mortality. Patients with small aneurysms (<50 mm in females, <55 mm in males) demonstrated similar perioperative outcomes and five-year mortality compared to those with medium-sized aneurysms. These findings highlight the need to optimize management strategies for patients with large thoracoabdominal aortic aneurysms and emphasize the importance of improved screening programs to enable earlier detection.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Risk Score for Mortality Within Three Years of Non-Emergent TEVAR for Descending Thoracic Aortic Aneurysm.","authors":"Nabeeha Khan, Jericho Hallare, Lily Darman, Priya Rao, Amy Liu, Karan Chawla, Michael Soult, Matthew Blecha","doi":"10.1016/j.jvs.2025.09.057","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.09.057","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study is to create a validated risk score for mortality within three years of elective endovascular repair of descending thoracic aortic aneurysm (TEVAR) based on variables existing at the time of preoperative clinical presentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Vascular Quality Initiative was queried for non-emergent TEVAR for degenerative, non-dissection related descending thoracic aortic aneurysms limited to aortic landing zones 2 to 5. Inclusion criteria was met by 3750 patients. Patients were divided randomly into a 70% testing cohort for risk score model creation and a 30% internal validation cohort to verify the function of the risk score. Binary logistic regression analysis was performed for the outcome of three-year mortality utilizing variables which achieved a univariable P value &lt; .05. Using this regression, it was determined which variables have a multivariable association for the outcomes as defined by a regression P value of .05 or less. A risk score was then created for the primary outcome. Variables with a multivariable P-value &lt; .05 from the above-mentioned regression were included in the risk score and weighted based on their respective regression beta-coefficient in a point scale. Variables with a beta-coefficient of less than .25 were assigned 0 points, and then a point was added for each rise in beta-coefficient at .25 intervals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Significant (P&lt;.05) multivariable association with three-year mortality was noted for : advancing age decade (P&lt;.001); nursing home status (aOR 2.63, P=.029); BMI &lt;20 kg/m&lt;sup&gt;2&lt;/sup&gt; (aOR 1.74, P=.008); active smoking status (aOR 1.44, P=.023); 6-6.9 cm TAA diameter (aOR 1.40, P=.015 relative to &lt;6cm); 7 + cm TAA diameter (aOR 1.97, P&lt;.001 relative to &lt;6cm); COPD on medication (aOR 1.42, P=.029); COPD on oxygen (aOR 2.29, P&lt;.001); renal insufficiency (aOR 1.72, P&lt;.001); anemia (aOR 1.74, P=.001); and lack of statin medication preoperatively (aOR 1.54, P=.001). There is noted to be significantly upsloping mortality with statistically significant escalation between each risk score bundle. Patients with risk scores less than 3 experienced three-year mortality at just a 2.3% rate whereas patients with risk scores of 13 and higher had a mean 32.8% mortality at three years (OR 21.1, P&lt;.001). There was outstanding agreement between the testing and validation groups at all risk score bundles with near identical mortality rates and no statistically significant difference at each level. AUC analysis revealed 0.7 and 0.67 for the testing and validation cohorts respectively. Hosmer-Lemeshow goodness of fit for the source testing regression was 88.2% overall accuracy and for the validation cohort regression was 87.7%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A risk score for three-year mortality following TEVAR for non-dissection related descending thoracic aortic aneurysm has been created which has both good accuracy and outsta","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280629","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":"Periprocedural Outcomes of Embolic Protection Device Use in Carotid Artery Stenting.","authors":"Santiago Callegari, Gaëlle Romain, Odaly S Balasquide Odeh, Christiany Tapia, Daniel Pinto, Mufti Mushfiqur Rahman, Aseem Vashist, Kim G Smolderen, Carlos Mena-Hurtado","doi":"10.1016/j.jvs.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.004","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenting (CAS) is frequently used in the management of carotid artery stenosis. Although use of embolic protection devices (EPD) is common, the association with lower mortality has been questioned. We aimed to assess the association between CAS with and without EPD and periprocedural stroke and mortality.</p><p><strong>Method: </strong>We included patients from the nationwide Vascular Quality Initiative registry who underwent CAS between 2015-2019. Patients undergoing transcarotid artery revascularization were excluded. Outcomes following CAS with either no EPD attempted or failed vs. successful employment of any EPD (distal or proximal) were analyzed in propensity score 1:1 matching cohort. Logistic regression was used to assess in-hospital mortality and stroke and transient ischemia attack (TIA) outcomes (Odds Ratio [OR] with 95% Confidence Interval [CI]). Kaplan-Meier and Cox-proportional hazards regression were used to derive 30-day mortality cumulative incidence and risk. Analyses were replicated using inverse-propensity weighting as a sensitivity analysis.</p><p><strong>Results: </strong>A total of 19,451 patients were included, with 2,062 per EPD group after 1:1 PSM (aged 67.1±11.7 years, 41.4% female, 87.1% White). CAS without EPD was significantly associated with higher odds of in-hospital mortality (OR 2.40, 95%CI 1.50-3.85, p <0.001), but not stroke/TIA (OR 1.26, 95%CI 0.91-1.75, p = 0.160). The 30-day cumulative incidence and risk of death were twice as high in patients without vs. with EPD (4.3%, 95% CI 3.5%-5.3% vs. 2.0%, 95% CI 1.4%-2.7%; p<0.001; and HR: 2.21 95%CI 1.51-3.24; p<0.001). Sensitivity analysis revealed similar results.</p><p><strong>Conclusion: </strong>No EPD use was associated with higher in-hospital and 30-day mortality outcome in CAS when compared to EPD used. As the use of CAS increases, our real-world evidence highlights the risks of no EPD use and the potential for including this metric as part of national quality-improvement efforts for adequate CAS practices.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280700","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":"Predictors and Outcomes of Surgical Delay in Open Abdominal Aortic Aneurysm Repair.","authors":"Xheni Konci, Boaz Laor, Robert J Doonan, Jason Bayne, Elie Girsowicz, Daniel Obrand, Oren Steinmetz, Kent MacKenzie, Heather Gill","doi":"10.1016/j.jvs.2025.10.005","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.10.005","url":null,"abstract":"<p><strong>Introduction: </strong>The objectives of this study are to characterize surgical waiting times experienced by patients undergoing elective open abdominal aortic aneurysm (AAA) repair, as well as to identify predictors and adverse outcomes associated with surgical delay.</p><p><strong>Methods: </strong>A retrospective chart review of patients undergoing open AAA repair between 2015-2025 was carried out in two hospital centres. Patients were excluded from the study if they were not planned to undergo an elective operation. Demographic, preoperative, and postoperative data were collected, including the time course between the preoperative abdominal computed tomography (CT) scan, procedure consent, preoperative clinic evaluation and surgery date. Surgical delay was defined as a wait time of >8 weeks and assessed from both the preoperative CT scan and consent date to the day of surgery. Linear and logistic regression analyses were used to identify predictors and adverse postoperative outcomes of surgical delay.</p><p><strong>Results: </strong>Out of 468 charts reviewed, 298 patients were included in the study. The median time from the preoperative CT scan to surgery was 92 days [IQR 59-142, n=247], while the median time from the date of consent to surgery was 61 days [IQR 40-103, n=296]. Patients waited a median of 21 days [IQR 10-33, n=289] after seeing the vascular surgeon to be assessed by preoperative medicine. Multivariable logistic regression showed that predictors of surgical delay from the time of consent to surgery were cerebrovascular disease (OR 5.209, 95% CI 1.77, 19.26, p=0.006), juxtarenal aneurysms (OR 2.402, 95% CI 1.36, 4.35, p=0.003) and smaller AAA diameter (OR 0.915, 95% CI 0.88, 0.95, p=7.1e-6). Only smaller aneurysm diameter was a significant predictor of delay (OR 0.915, 95% CI 0.88, 0.95, p=9.22e-6) from the time of the CT scan to surgery. Prolonged time to surgery was associated with a small but significant increase in the comprehensive complication index in both univariable (β=0.426, 95% CI 0.17, 0.69, p=0.001) and multivariable linear regression (β=0.341, 95% CI 0.10, 0.58, p=0.006). The incidence of interval ruptures (n=1, 0.7%) and symptomatic AAAs (n=5, 1.7%) in the waiting period were low.</p><p><strong>Conclusions: </strong>In this review, patients with prolonged surgical delay well beyond 8 weeks are at risk of experiencing a higher postoperative complication burden and should be identified pre-emptively to ensure timely intervention.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280647","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}