Journal of Vascular Surgery最新文献

{"title":"Patient-reported outcome measures after revascularization for intermittent claudication from the GermanVasc prospective cohort study.","authors":"Frederik Peters, Mette Søgaard, Jenny Lübcke, Joakim Nordanstig, Ulrich Rother, Christian-Alexander Behrendt","doi":"10.1016/j.jvs.2026.08.034","DOIUrl":"10.1016/j.jvs.2026.08.034","url":null,"abstract":"<p><strong>Objective: </strong>This prospective multicenter cohort study investigated patient-reported outcome measures in patients undergoing invasive revascularization for intermittent claudication at 35 centers in Germany.</p><p><strong>Methods: </strong>Patients were enrolled between May 1, 2018, and March 31, 2021, and followed for up to 12 months (NCT03098290). The Physical Component Summary score (PCS-12) of the SF-12 questionnaire, maximum pain-free walking distance, and frequency of leg pain at rest were collected as outcomes.</p><p><strong>Results: </strong>A total of 963 (64% male; median age, 68 years) provided sufficient data at follow-up (median, 352 days). At index admission physical quality of life was substantially impaired at a median PCS-12 score of 35 (Q1: 28; Q3: 43). At follow-up, median PCS-12 improved to 45 (Q1: 39; Q3: 52) along with substantial improvement in maximum walking distance (+20 minutes) and lower leg pain (-10 points). Not working, retired job, and obesity were associated with lack of improvements in PCS-12 during follow-up, whereas obesity and retired job seemed to particularly prevent improvements in maximum walking distance and reductions in leg pain.</p><p><strong>Conclusions: </strong>Invasive revascularization with either technical approach markedly improved patient-reported outcome measures. Gains were smaller in obese and retired patients, with similar trends in those not working and those with a high comorbidity burden.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912808","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":"Rupture prevention after endovascular aneurysm repair focused on sealing zone integrity.","authors":"Fukashi Serizawa, Daijirou Akamatsu, Ken Tsuchida, Michihisa Umetsu, Shinichiro Horii, Shunya Suzuki, Hitoshi Goto, Takashi Kamei","doi":"10.1016/j.jvs.2026.08.038","DOIUrl":"10.1016/j.jvs.2026.08.038","url":null,"abstract":"<p><strong>Objective: </strong>The optimal criteria for reintervention after endovascular aneurysm repair (EVAR) remain controversial, particularly for type II endoleak (T2EL)-associated sac enlargement. This study evaluated a post-EVAR rupture prevention strategy prioritizing sealing zone integrity rather than diameter-based thresholds.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study included 658 patients who underwent EVAR for abdominal aortic aneurysm. Reintervention was not routinely performed for isolated T2EL; instead, decisions were based on compromised sealing zone (CSZ), defined as deterioration of proximal or distal sealing integrity. The primary end point was aneurysm rupture. Secondary outcomes included reintervention and aneurysm-related death.</p><p><strong>Results: </strong>During a median follow-up of 4.1 years, overall survival was 83.3% at 3 years and 68.5% at 5 years. A total of 83 reinterventions were performed, of which 60 were for sealing-related complications, with a median time to reintervention of 3.9 years (interquartile range, 2.1-6.4). No reintervention was performed for isolated T2EL. Freedom from reintervention was 92.9% at 3 years and 86.7% at 5 years. Twelve ruptures occurred; most were associated with type I endoleaks, whereas no rupture was attributed to isolated T2EL. Among rupture cases, CSZ was identified before rupture in seven patients, with a median interval of 3.1 months from detection to rupture. Three ruptures occurred in patients who were lost to follow-up. Aneurysm-related death occurred in nine patients.</p><p><strong>Conclusions: </strong>A follow-up strategy prioritizing sealing zone integrity was associated with low rupture rates and limited reintervention. Rupture after EVAR appeared to be more closely associated with sealing failure than with isolated T2EL, supporting surveillance focused on early detection of CSZs while recognizing sac enlargement as an important warning sign rather than a sole trigger for reintervention.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920151","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":"Assessment of potentially preventable hospital readmissions after vascular surgery.","authors":"Courtney M Rentas, Grace E Kennedy, Sonali M Reddy, Zhaohui Fan, Justin B Dimick, John W Scott, Craig S Brown","doi":"10.1016/j.jvs.2026.08.039","DOIUrl":"10.1016/j.jvs.2026.08.039","url":null,"abstract":"<p><strong>Objective: </strong>Postsurgical readmissions are common, costly, and widely used as a marker of health care quality, with particularly high rates following vascular surgery. Despite this burden, the proportion of readmissions that are potentially preventable remains unclear, especially in this high-risk population. The objective of this study was to quantify the burden of potentially preventable readmissions (PPRs) after major vascular surgery and identify patient- and procedure-level factors associated with their occurrence.</p><p><strong>Methods: </strong>This retrospective cohort study used the 2016 to 2022 National Readmissions Database to evaluate a weighted sample of 544,404 adult inpatient hospitalizations for four common major vascular surgical procedures: carotid endarterectomy, open abdominal aortic aneurysm repair, lower-extremity peripheral arterial bypass, and endovascular abdominal aortic aneurysm repair. Ninety-day readmission rates were assessed, including PPRs defined by the Agency for Healthcare Research and Quality as ambulatory care-sensitive conditions, as well as superficial surgical site infection, acute kidney injury, and aspiration pneumonitis. Multivariable logistic regression was used to identify factors associated with PPRs.</p><p><strong>Results: </strong>Among an estimated 544,404 patients undergoing major vascular surgery, 20.4% (110,965/544,404) experienced a 90-day readmission, 17% (19,013/110,965) of which were classified as a PPR. PPR rates varied by procedure, ranging from 2.4% after carotid endarterectomy to 6.2% after lower-extremity bypass, and were higher among lower-income and publicly insured patients. On multivariable analysis, older age [odds ratio (OR), 1.22 per decade], female sex (OR, 1.23), complicated diabetes (OR, 2.40), chronic kidney disease (OR, 1.70), and congestive heart failure (OR, 2.14) were independently associated with increased odds of PPR, whereas higher household income was associated with lower odds.</p><p><strong>Conclusions: </strong>This study suggests that nearly one in five readmissions after vascular surgery are potentially preventable. Alongside optimization of inpatient care, improved access to ambulatory and transitional care may represent an important opportunity to reduce avoidable readmissions in this population.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920102","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":"Collateral vessels supplying blood to the brain and the entire upper body in a patient with Takayasu arteritis.","authors":"Naohiko Oki, Naritaka Kimura, Hideyuki Shimizu","doi":"10.1016/j.jvs.2026.09.004","DOIUrl":"10.1016/j.jvs.2026.09.004","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912802","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":"Textbook outcomes as a composite quality metric following fenestrated-branched endovascular aortic repair.","authors":"Hannah V Oden-Brunson, Ying Huang, Bruno Pagnin Schmid, Zemia C Ferreira, Steven Maximus, Jorge A Miranda, Erin Greenleaf, Naveed U Saqib, Thanila A Macedo, Manju Kalra, Gustavo S Oderich","doi":"10.1016/j.jvs.2026.08.036","DOIUrl":"10.1016/j.jvs.2026.08.036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Fenestrated-branched endovascular aortic repair (FB-EVAR) has been increasingly utilized to treat complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). Textbook Outcome (TO) is a composite quality metric designed to reflect the ideal postoperative course. This study aimed to evaluate the incidence of TO following FB-EVAR and to identify the predictors of TO failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study reviewed the data of consecutive patients enrolled in a prospective nonrandomized sponsor-initiated investigational device exemption study to assess FB-EVAR for CAAAs and TAAAs between 2013 and 2025. TO was defined as the absence of major complications, early reintervention, prolonged hospital length of stay (LOS; based on the 75th percentile of the cohort), non-home discharge, and early mortality (death within 30 days or during the index hospitalization). The primary end point was the incidence of TO. The secondary end points included the identification of the predictors of TO achievement, individual TO component contributions, early morbidity and mortality, and overall survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 609 patients (422 [69%] males, median age, 74 years [interquartile range, 68-79]) were analyzed. The aneurysm extent included CAAA in 164 (27%) and TAAA in 445 patients (73%). The early mortality rate was 1.3% (n = 8), and the 30-day major adverse event rate was 10.2% (n = 62). TO was achieved in 64.2% of patients (n = 391). The most common components of TO failure were prolonged LOS (23.6%) and major complications (17.9%), and failure occurred due to a single component in 48.2% of non-TO patients. According to multivariable analysis, the independent predictors of failure to achieve TO were female sex (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.35-0.77; P = .001), increased age (OR, 0.97; 95% CI, 0.95-0.99; P = .013), chronic obstructive pulmonary disease (OR, 0.58; 95% CI, 0.39-0.85; P = .006), chronic kidney disease stage 3-5 (OR, 0.63; 95% CI, 0.44-0.92; P = .015), chronic post-dissection aneurysms (OR, 0.53; 95% CI, 0.29-0.97; P = .041), larger aneurysm diameter (OR, 0.97; 95% CI, 0.96-0.99; P = .001), and extent I-III TAAA (OR, 0.51; 95% CI, 0.29-0.89; P = .019). TO achievement was independently associated with improved overall survival (adjusted hazard ratio, 0.58; 95% CI, 0.43-0.78; P &lt; .001), with an unadjusted 1-year survival rate of 96% in TO vs 83% in non-TO patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FB-EVAR was performed with low early mortality, and TO was achieved in nearly two-thirds of patients. The primary components of TO failure were major complications and prolonged LOS. Several independent predictors of TO failure were identified, and TO achievement was associated with improved overall survival. These findings establish TO after FB-EVAR as a benchmark and a practical framework to guide risk stratification, patient counseli","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912880","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":"Pre-emptive embolization of aneurysm sac side branches in endovascular aneurysm repair: A systematic review and meta-analysis.","authors":"Denise Filippini, Mariana Kondo Obara, Enrico Prajiante Bertolino, Miguel Godeiro Fernandez, Dilson Pimentel-Junior, Milena Monteiro Mastra, Carlos B Melo, Hence J M Verhagen, Grace Carvajal Mulatti","doi":"10.1016/j.jvs.2026.08.027","DOIUrl":"10.1016/j.jvs.2026.08.027","url":null,"abstract":"<p><strong>Background: </strong>Pre-emptive side branch embolization (PBE), typically targeting the inferior mesenteric artery (IMA) or lumbar artery during endovascular aneurysm repair, usually aims to prevent type II endoleaks (T2ELs), but its true role remains unclear. This study evaluates the impact of PBE on sac dynamics, aneurysm-related reinterventions, T2EL incidence, rupture, and mortality.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies assessing the effect of PBE during endovascular aneurysm repair. PubMed, EMBASE, and Cochrane were searched up to February 2026. Outcomes included T2EL and type I endoleak incidence, aneurysm-related reinterventions, sac growth and shrinkage, rupture, and mortality. Temporal subgroups were analyzed at 6 months and 3 years. Subgroup analysis was conducted on studies that restricted embolization to IMAs ≥ 2.5 mm. Data were analyzed using RevMan Web. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.</p><p><strong>Results: </strong>Twenty-two studies including 19,433 patients and two randomized controlled trials were analyzed (18% female, 80% current or former smokers, and 19% diabetic). Among these, 1950 (10%) underwent PBE, which was associated with reduced T2EL incidence at last follow-up [risk ratio (RR), 0.62; 95% confidence interval (CI), 0.46-0.84; P = .003], and aneurysm-related reinterventions (RR, 0.58; 95% CI, 0.38-0.89; P = .02). It was also associated with reduced sac enlargement ≥ 5 mm (RR, 0.49; 95% CI, = 0.31-0.77; P = .005), and increased sac shrinkage ≥ 5 mm (RR, 1.31; 95% CI, 1.02-1.68; P = .04; I² = 62%), but did not significantly impact type I endoleak (RR, 0.81; 95% CI, 0.46-1.40; P = .36). Procedural and fluoroscopy times, as well as contrast volume, were higher with PBE (+28 and +16 min; +28 mL). Time-stratified analysis showed no effect on 6-month T2EL incidence (RR, 0.61; 95% CI, 0.27-1.36; P = .18), but a significant reduction with ≥3-year follow-up (RR, 0.43; 95% CI, 0.24-0.80; P = .02). In the subgroup of studies restricting embolization to IMAs ≥ 2.5 mm, the analyses revealed an association with reduced T2ELs (RR, 0.50; 95% CI, 0.26-0.95; P = .04), but no effect on sac growth ≥ 5 mm (RR, 0.38; 95% CI, 0.13-1.12; P = .06). No difference in rupture rates (RR, 0.77; 95% CI, 0.15-3.96; P = .56) or mortality (RR, 0.58; 95% CI, 0.31-1.07; P = .07) was observed.</p><p><strong>Conclusions: </strong>PBE may be associated with reduced long-term T2EL incidence, sac expansion, and reinterventions, while possibly improving sac shrinkage. However, current evidence does not support a benefit on hard clinical outcomes, including aneurysm rupture or mortality. Its routine use cannot be recommended, and future randomized trials with follow-up beyond 5 years and standardized reporting are essential to clarify its clinical utility.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912836","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":"Symptomatic carotid artery disease differentially affects outcomes after carotid endarterectomy, transcarotid revascularization, and transfemoral carotid artery stenting.","authors":"Aidin Baghbani, Daniel G Miles, Taylor Hicks, Arash Keyhani, Kourosh Keyhani, Gordon H Martin, Naveed U Saqib, S Keisin Wang","doi":"10.1016/j.jvs.2026.08.035","DOIUrl":"10.1016/j.jvs.2026.08.035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Symptomatic carotid artery stenosis is associated with a greater risk of stroke than asymptomatic disease. However, the influence of symptom status on outcomes across contemporary carotid revascularization strategies remains incompletely understood. We compared perioperative and long-term outcomes following carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), and transfemoral carotid artery stenting (TF-CAS) according to symptom status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of a prospectively maintained institutional carotid revascularization database was performed, including patients undergoing CEA, TCAR, or TF-CAS between March 2003 and August 2025. Patients were stratified by symptomatic vs asymptomatic presentation. The primary outcome was 30-day stroke/death. Secondary outcomes included myocardial infarction, cranial nerve injury, thrombosis, reintervention, and long-term stroke-free survival. Multivariable logistic regression was used to evaluate procedure-specific outcomes and the independent association between symptom status and 30-day stroke/death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 2657 patients had symptom status available, including 1830 asymptomatic (68.9%) and 827 symptomatic (31.1%). Among asymptomatic patients, 30-day stroke/death did not differ significantly among CEA, TCAR, and TF-CAS (1.8%, 1.6%, and 2.3%, respectively; P = .843). In symptomatic patients, stroke/death differed significantly across procedures (4.8%, 4.2%, and 14.5%, respectively; P = .005). After adjustment, no differences in stroke/death were observed among procedures in the asymptomatic cohort. In symptomatic patients, TF-CAS was associated with higher odds of 30-day stroke/death compared with both CEA [odds ratio (OR), 3.38; 95% confidence interval (CI), 1.27-9.02; P = .015] and TCAR (OR, 4.32; 95% CI, 1.56-11.95; P = .005). Compared with CEA, TCAR demonstrated comparable adjusted odds of stroke/death (OR, 0.78; 95% CI, 0.38-1.62; P = .510) and stroke (OR, 0.69; 95% CI, 0.31-1.53; P = .361) in the symptomatic cohort. Symptomatic presentation independently increased the risk of 30-day stroke/death following CEA (OR, 3.68; 95% CI, 1.77-7.64; P &lt; .001) and TF-CAS (OR, 9.12; 95% CI, 1.46-56.97; P = .018). A similar association was observed following TCAR, although statistical significance was not reached (OR, 2.49; 95% CI, 0.89-6.94; P = .082). The long-term stroke-free survival was significantly lower among symptomatic patients across all revascularization modalities (all log-rank P &lt; .01).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among symptomatic patients, TF-CAS was associated with higher 30-day stroke/death rates compared with both CEA and TCAR. In contrast, CEA and TCAR demonstrated comparable perioperative outcomes across symptomatic and asymptomatic cohorts. These findings support symptom-stratified procedure selection and reinforce CEA and TCAR as preferred revascularization strat","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912805","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":"Bridging the gap: Digital and disease-specific literacy in vascular surgery patients at an urban safety-net hospital.","authors":"Arnav Mahajan, Pooja Podugu, Daria Moody, Pierangelo Nitzkowski, Priyash Hafiz, Megan Long, Ali Mansoor Kara, Ariadna Marrero, Tien Nguyen, Ramiro Cadena Semanate, Garietta Falls-Beddies","doi":"10.1016/j.jvs.2026.09.003","DOIUrl":"10.1016/j.jvs.2026.09.003","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing vascular surgery have disproportionately high rates of limited health literacy, yet vascular disease-specific knowledge and digital health literacy remain poorly characterized in this population, particularly in a safety-net setting. We assessed both forms of literacy among patients undergoing vascular surgery at an urban safety-net hospital and examined the relationship between them.</p><p><strong>Methods: </strong>We conducted a prospective, cross-sectional study of adult patients undergoing vascular surgery across three outpatient clinic sites within a single urban safety-net institution over an 8-week period. Participants completed the Vascular Surgery Literacy Assessment Tool, a 24-item assessment, and the eHealth Literacy Scale (eHEALS), an eight-item measure of perceived digital health proficiency. Demographic and clinical data were collected. Bivariate analyses and multivariable linear regression were used to identify factors associated with each literacy domain and assess the relationship between them.</p><p><strong>Results: </strong>Among 84 patients (mean age, 64 years; 57.1% female; 48.8% White; 35.7% Black), the mean Vascular Surgery Literacy Assessment Tool score was 11.3 of 24 (47.1%), with 62.9% scoring at or below 50%. The mean eHEALS score was 24.7 of 40, with fewer than half of patients (43.5%) expressing confidence in using online health information. Black patients scored significantly lower on both vascular literacy (8.8 vs 13.4; P < .001) and eHEALS (18.0 vs 28.6; P < .001) compared with their White counterparts. Low household income was independently associated with lower eHEALS scores (β = -7.9; P < .001). Vascular and digital literacy were moderately correlated (r = 0.541; P < .001). After adjusting for eHEALS in the regression model, Black race was no longer associated with a lower vascular literacy score (β = -.4; P = .71), suggesting that digital health literacy influences the observed racial disparity in vascular knowledge.</p><p><strong>Conclusions: </strong>Patients undergoing vascular surgery at a safety-net hospital demonstrated significant deficits in both disease-specific knowledge and digital health literacy, with disparities linked to race and socioeconomic status. Digital literacy impacted the relationship between race and vascular disease knowledge, highlighting the compounding effect of the digital divide on health inequity. These findings highlight the need for multimodal, literacy-adapted educational interventions tailored to address these barriers in vulnerable patient populations.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912743","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":"Dual pathway inhibition versus dual antiplatelet therapy following isolated tibial balloon angioplasty for chronic limb-threatening ischemia.","authors":"Mina Abdelmalak, Ibrahim Abdelaziz, Usama Abdulaal, Hussein Rabee, Abdulaziz Algaby","doi":"10.1016/j.jvs.2026.08.033","DOIUrl":"10.1016/j.jvs.2026.08.033","url":null,"abstract":"<p><strong>Background: </strong>Optimal antithrombotic therapy following infrapopliteal angioplasty for chronic limb-threatening ischemia (CLTI) remains uncertain. Dual pathway inhibition (DPI) with low-dose rivaroxaban plus aspirin has demonstrated benefit in broader peripheral arterial disease populations, including after lower-extremity revascularization; however, evidence specific to isolated crural interventions is limited. Currently, patients receive either DPI or dual antiplatelet therapy (DAPT) based on surgeons' choice, and this study will compare the outcomes of the two regimens in a retrospective cohort analysis based on the hypothesis that DPI provides superior prevention of thromboembolic events after angioplasty.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including patients undergoing isolated tibial balloon angioplasty for CLTI between January 2022 and July 2024. Patients receiving DAPT (aspirin plus clopidogrel) were compared with those receiving DPI (rivaroxaban 2.5 mg twice daily plus aspirin) lifelong. Patients undergoing multilevel interventions, stenting, drug-coated balloon angioplasty, thrombolysis, or treatment for claudication were excluded. Primary outcomes included major limb amputation and all-cause mortality. Secondary outcomes included target lesion revascularization (TLR), acute limb ischemia, and bleeding complications.</p><p><strong>Results: </strong>A total of 199 patients met the inclusion criteria, including 102 treated with DAPT and 97 treated with DPI. Baseline demographic and clinical characteristics were broadly comparable between groups. At 12 months, major limb amputation occurred in 27 patients (26.5%) receiving DAPT and 17 patients (17.5%) receiving DPI (P = .04), corresponding to an absolute risk reduction of 9.0% and a number needed to treat of 11. TLR was required in 14 patients (13.7%) in the DAPT group and five patients (5.2%) in the DPI group (P = .04), corresponding to an absolute risk reduction of 8.5% and a number needed to treat of 12. Acute limb ischemia occurred in four patients (3.9%) receiving DAPT and one patient (1.0%) receiving DPI (P = .40). One-year mortality was similar between groups (3.9% vs 3.1%; P = .79). No major bleeding events occurred in either group, whereas minor bleeding rates were low and comparable.</p><p><strong>Conclusions: </strong>Among patients undergoing isolated tibial angioplasty for CLTI, DPI with low-dose rivaroxaban plus aspirin was associated with reduced major limb amputation and TLR compared with DAPT, without an increase in major bleeding. Larger prospective studies are warranted to confirm these findings and define the optimal antithrombotic strategy following infrapopliteal intervention.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912795","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":"Veterans Affairs community care vascular surgery procedural costs from 2020 to 2025 dominated by infrainguinal endovascular interventions.","authors":"Gloria Y Kim, Daniel J Koh, Michael Costanza, Gale L Tang","doi":"10.1016/j.jvs.2026.08.032","DOIUrl":"10.1016/j.jvs.2026.08.032","url":null,"abstract":"<p><strong>Objective: </strong>The 2018 MISSION Act for expanding access for Veterans to receive care outside the Veterans Affairs (VA) health care system has resulted in a significant increase in Vascular Surgery Community Care referrals and cost, especially for endovascular procedures, over time. We hypothesized that more endovascular procedures would be performed over time and that this would contribute to increasing costs over the study period.</p><p><strong>Methods: </strong>A retrospective analysis of the VA Community Care Referral Dashboard and Integrated Informatics and Analytics was conducted for fiscal year (FY) 2020 to FY 2025. Referral volume and justification for vascular surgery consultation and Vascular Laboratory, and total paid claims were obtained for 40 vascular surgery-related current procedural terminology codes from all VA centers nationwide across four categories: endovascular arterial, open arterial, dialysis access, and vein procedures. All costs were inflation-adjusted to 2025 U.S. dollars using the Consumer Price Index.</p><p><strong>Results: </strong>Total Vascular Surgery Community Care paid claims increased from $72.7 million in FY 2020 to $288.2 million in FY 2025 (+296%). Number of referrals rose from 34,196 in FY 2021 to 62,487 in FY 2025 (+83%). Distance from a VA facility accounted for more than 70% of referral justifications. Endovascular arterial procedures represented the largest cost annually. Femoral-popliteal atherectomy (current procedural terminology 37225) was the highest-cost procedure in all years except 2022, with increasing cost from $2.2 million to $9.9 million (+348%). Infrainguinal endovascular paid claims increased from $8.8 million to $40.2 million, with atherectomy codes consistently comprising 60% to 67% of these charges. No open bypass or groin-level reconstruction appeared in the top 30 paid codes in any study year. Carotid endarterectomy was the highest-cost open procedure (increased from $611,984 to $1,151,122; +88%). Dialysis access costs increased substantially (+252%), led by fistulagram with percutaneous transluminal angioplasty. Vein procedures had the largest percentage increase (+445%).</p><p><strong>Conclusions: </strong>VA Community Care Vascular Surgery paid claims increased nearly threefold from FY 2020 to FY2025. Infrainguinal endovascular procedures, particularly atherectomy, represented the largest cost category. All procedural groups demonstrated consistent growth, with vein procedures exhibiting the greatest relative increase. Open bypass procedures were absent from the highest-cost claims throughout the study. These findings characterize the trajectory of VA Community Care vascular surgery expenditures and may inform future resource allocation and policy decisions.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906483","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}