Journal of Vascular Surgery最新文献

{"title":"Implementation of an acute care vascular surgery \"Surgeon of the Week\" model improves efficiency of inpatient care delivery.","authors":"Young Kim, Christina L Cui, E Hope Weissler, Brian F Gilmore, Kevin W Southerland, Zachary F Williams, Chandler A Long, Adam P Johnson, Dawn M Coleman","doi":"10.1016/j.jvs.2025.05.025","DOIUrl":"10.1016/j.jvs.2025.05.025","url":null,"abstract":"<p><strong>Objective: </strong>Acute care vascular surgery (ACVS) comprises a significant proportion of modern vascular surgery practice. Given the burden of ACVS at our institution, we have transitioned from a traditional \"on call\" model to a \"Surgeon of the Week\" (SOW) model, in which a single surgeon covers all daytime inpatient consults and resultant operations over the course of a week. The SOW surgeon has no overnight call, outpatient clinic, and minimizes elective operations during this week, enabling dedicated care to inpatient responsibilities. In this study, we report our 2-year experience with the SOW model for ACVS.</p><p><strong>Methods: </strong>Institutional medical records were retrospectively queried for all operations performed by the SOW surgeon at a single academic medical center from 2023 to 2024. The 1-year SOW period was then compared with the antecedent 5-year period from 2018 to 2023 (pre-SOW) to evaluate care delivery metrics.</p><p><strong>Results: </strong>A total of six vascular surgeons covered 51 weeks as the SOW over the study period. The SOW surgeon performed a total of 598 cases, averaging a median of 11.5 cases per week (interquartile range [IQR], 9-14 cases per week). The median weekly operative time was 28.6 hours (IQR, 21.0-33.5 hours). The most common indications for primary vascular operations included acute limb ischemia (n = 31), aortic disease (n = 44), carotid disease (n = 32), hemodialysis access (n = 71), major amputations (n = 112), mesenteric ischemia (n = 23), peripheral artery disease (n = 105), and wound complications (n = 87). Urgent and emergent procedures comprised 21.7% of all operations. An additional 61 intraoperative consultations were requested from 14 other surgical services over the study period. Compared with the pre-SOW period, preoperative length of stay for inpatient operations was shorter in the SOW period (2 days [IQR, 0-7 days] vs 3 days [IQR, 1-8 days]; P < .0001). Elective case cancellations (4.0% vs 3.7%; P = .55) and the proportion of weekend operations (8.3% vs 8.1%; P = .75) were similar between periods.</p><p><strong>Conclusions: </strong>In this study, we report our experience following implementation of the SOW model at a tertiary academic medical center. This alternative model for ACVS coverage enabled the SOW to perform a wide breadth of primary vascular operations and provide intraoperative assistance to many other surgical services, without being encumbered by competing responsibilities. Furthermore, the SOW model was associated with more efficient delivery of inpatient care, as reflected in a reduced time-to-operating room. Other medical centers with similar, high-volume ACVS responsibilities may also benefit from implementing a SOW model.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258364","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":"Longitudinal outcomes of forearm versus upper arm arteriovenous fistulas.","authors":"Mohit K Manchella, Abena Appah-Sampong, Mengyuan Ruan, James Fitzgibbon, Patrick Heindel, Eric Secemsky, Dirk M Hentschel, C Keith Ozaki, Mohamad A Hussain","doi":"10.1016/j.jvs.2025.05.021","DOIUrl":"10.1016/j.jvs.2025.05.021","url":null,"abstract":"<p><strong>Background: </strong>National guidelines recommend forearm arteriovenous fistulas (AVFs) over upper arm AVFs as the initial permanent vascular access for hemodialysis if consistent with the end-stage kidney disease (ESKD) Life-Plan, but comparative outcomes are underexplored. Our objective was to assess longitudinal outcomes of forearm vs upper arm AVFs in patients with advanced kidney disease.</p><p><strong>Methods: </strong>Using multicenter data from three prospective studies (Hemodialysis Fistula Maturation [HFM] Study, PATENCY-1 [A Study of PRT-201 Administered Immediately After Radiocephalic Arteriovenous Fistula (AVF) Creation in Patients With Chronic Kidney Disease], and PATENCY-2), we conducted a cohort study of 1516 patients who underwent upper extremity AVF creation (2014-2019). Demographic factors, comorbidities, procedural details, and 3 years of longitudinal follow-up were captured. Outcomes included primary, primary-assisted, and secondary patency at 3 years, successful AVF use, and access-related hand ischemia (ARHI) interventions. Forearm vs upper arm AVF outcomes were compared using Cox regression and logistic regression models. Subgroup analyses included outcomes stratified by site volume using model interaction terms.</p><p><strong>Results: </strong>The study population included 1059 forearm AVFs and 457 upper arm AVFs; mean age was 56.2 ± 13.4 years and 25.2% were female. The overall primary, primary-assisted, and secondary patency rates at 3 years was 26.2% (95% confidence interval [CI], 23.6%-29.1%), 57.6% (95% CI, 54.6%-60.9%), and 66.5% (95% CI, 63.6%-69.5%), respectively, with no significant differences between forearm and upper arm AVFs. Successful AVF use at 12 months was also similar between forearm (66.1%) and upper arm AVFs (70.0%) (odds ratio, 1.02; 95% CI, 0.71-1.48; P = .91). Forearm AVFs had lower risk of ARHI interventions (hazard ratio [HR], 0.36; 95% CI, 0.18-0.71; P = .003) compared with upper arm AVFs. Subgroup analyses showed that compared with upper arm AVFs, patients who received forearm AVFs at low volume sites (≤30 access creations per year) were at greater risk for loss of primary-assisted (HR, 2.03; 95% CI, 1.21-3.41; P < .001) and secondary patency (HR, 2.53; 95% CI, 1.33-4.83; P < .001). Patients receiving forearm AVFs at low volume sites also had lower AVF use at 12 months (odds ratio, 0.52; 95% CI, 0.21-1.31; P value of interaction = .03).</p><p><strong>Conclusions: </strong>Although forearm AVFs demonstrate similar long-term patency and usability as upper arm AVFs, they are associated with lower rates of ARHI. However, outcomes for forearm AVFs seem to have associations with institutional volume-significantly poorer results are seen at low-volume centers. System-level efforts are needed to improve outcomes for forearm AVFs, which serve as a critical lifeline for end-stage kidney disease patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258365","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":"Prediction model for safe contrast volume thresholds to prevent postcontrast acute kidney injury after endovascular abdominal aortic aneurysm repair.","authors":"Justin M Bader, Ying Li, Cecilia Lee, Judy Li, Shreef Said, Martin Slade, Yuan Huang, David P Kuwayama, Raul J Guzman, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.jvs.2025.05.041","DOIUrl":"10.1016/j.jvs.2025.05.041","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Post-contrast acute kidney injury (PC-AKI) is a serious complication of endovascular abdominal aortic aneurysm repair (EVAR) associated with development of chronic kidney disease, prolonged hospital stay, and perioperative mortality. Iodinated contrast is a known risk factor for PC-AKI but is a technical necessity for EVAR. The optimal volume of contrast necessary to minimize risk of PC-AKI in a patient undergoing elective EVAR is unknown. This study examines the incidence and significance of PC-AKI after EVAR and derives a patient-specific model to determine the optimal volume of contrast the surgeon should administer to mitigate the risk of PC-AKI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Vascular Quality Initiative database was queried for patients who underwent elective EVAR. Patients with history of dialysis, kidney transplant, intraoperative coverage of a renal artery or renal artery stenting, or open conversion were excluded. Patients were stratified by development of PC-AKI. Patient characteristics were compared using bivariate and then multivariable logistic regression analysis to select key significant variables. A prediction model was developed for PC-AKI using a split-sample approach with a model training dataset and a validation dataset. The 30-day postoperative mortality for this same patient cohort was evaluated using bivariate and multivariable logistic regression analysis. Kaplan-Meier curve analysis compared survival between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 49,417 patients undergoing elective EVAR, 2.6% (n = 1300) developed PC-AKI. Patients with PC-AKI were older with higher incidence of preoperative comorbidities and developed significantly more postoperative complications, including 30-day mortality (12% vs 0.5%; P &lt; .001), compared with patients without PC-AKI. Patients who developed PC-AKI also had lower survival on Kaplan-Meier analysis (2-year survival: 74.5% vs 82.8%; P &lt; .001). Regression analysis accounted for all other factors and showed that PC-AKI was independently associated with perioperative mortality (odds ratio [OR], 8.79; 95% confidence interval [CI], 6.60-11.64). On multivariable logistic regression, PC-AKI was independently associated with volume of contrast given (OR per mL, 1.005; 95% CI, 1.004-1.006) translating to a 5% increased PC-AKI risk for every 10 mL of contrast administered. The prediction model (area under the curve = 0.732; 95% CI, 0.706-0.759) provides surgeons with a recommended patient-specific safe volume of contrast that minimizes the risk of PC-AKI based on preoperative patient characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PC-AKI has significant impact on patient morbidity and mortality after elective EVAR. The model provided utilizes 13 simple, patient-specific variables to generate a recommended contrast volume to minimize PC-AKI risk. In the absence of established guidelines for optimal volume of contrast to administer during elective EVAR, t","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258366","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 correlation between obstructive sleep apnea-hypopnea syndrome and postoperative distal expansion of Type A aortic dissection.","authors":"Cong Cui, Yuxin Chen, Xia Gao, Jifang Wang, Kexiong Sun, Xianghui Zhang, Gang Wu, Yiqiang Yuan, Pingfan Wang, Guanghui Liu, Li Zhang","doi":"10.1016/j.jvs.2025.05.210","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.210","url":null,"abstract":"<p><strong>Background: </strong>Distal expansion of Type A aortic dissection is a severe complication following surgical intervention. Understanding the predictive factors of this condition can inform clinical practice and improve patient outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included 450 patients who underwent surgery for Stanford Type A aortic dissection at our hospital between 1 December 2021 and 31 December 2023. Patients were divided into expansion (n = 152) and non-expansion (n = 298) groups based on the occurrence of postoperative distal aortic expansion, defined as a distal aortic diameter >40 mm or an annual growth rate >5 mm/year. Data collected included demographic information, comorbidities, preoperative sleep status, intraoperative parameters, and postoperative examination results. The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed continuous variables were compared using independent t-tests and presented as mean ± standard deviation, while non-normally distributed variables were analyzed with Mann-Whitney U tests and presented as median (interquartile range). Categorical variables were compared using chi-square tests. Spearman correlation and logistic regression analyses with Firth's correction were used to assess associations between variables and distal aortic expansion.</p><p><strong>Results: </strong>Significant differences between groups were noted in preoperative sleep status and intraoperative parameters. Patients in the expansion group had higher severity of snoring (6.57 ± 2.9 vs 3.63 ± 1.23, P < 0.001) and a higher prevalence of sleep apnea syndrome (80.26% vs 3.02%, P < 0.001). Intraoperative endoleak requiring proximal stent placement was more frequent in the expansion group (14.47% vs 7.38%, P = 0.026). Multifactor logistic regression with Firth's correction identified the presence of sleep apnea syndrome (coefficient = 2.392, P = 0.006, OR = 10.939, 95% CI: 2.897-41.325) as a significant predictor of postoperative distal expansion. When categorized by severity, both moderate-to-severe AHI (≥15 events/hour) (OR = 2.83, 95% CI: 1.46-5.49, P = 0.002) and severe AI (≥10 events/hour) (OR = 3.12, 95% CI: 1.58-6.17, P < 0.001) were significant independent predictors of distal expansion.</p><p><strong>Conclusion: </strong>The presence and severity of sleep apnea syndrome, particularly indicated by the apnea-hypopnea index, are significant predictors of postoperative distal Type A aortic dissection expansion. These findings suggest that preoperative screening for sleep apnea may be essential in risk stratification and management of patients undergoing surgery for aortic dissection.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248481","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":"Factors Associated with Cancellation of Arteriovenous Access Creations.","authors":"Andrea Alonso, Jingtong Huang, Carlos Fairen Oro, Khuaten Maaneb de Macedo, Saran Lotfollahzadeh, Jeffrey Kalish, Alik Farber, Elizabeth King, Vipul C Chitalia, Jeffrey J Siracuse","doi":"10.1016/j.jvs.2025.05.211","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.211","url":null,"abstract":"<p><strong>Background: </strong>Cancellation of arteriovenous (AV) access creation delays establishing permanent hemodialysis (HD) access, potentially affecting patient outcomes and healthcare efficiency. Our goal was to assess the rate of AV access cancellations and identify contributing factors in a safety net hospital.</p><p><strong>Methods: </strong>All AV access creations at a single academic medical center (2018- 2024) were retrospectively reviewed. Reasons for outpatient and inpatient AV access creation cancellations on the planned day and week scheduled were analyzed using chart review. A multivariable analysis was performed to assess for predictors of same-day outpatient cancellations.</p><p><strong>Results: </strong>There were 584 patients who were scheduled for an AV access creation during the study period. 17.7% had same-day cancellations and 7.7% had week-before cancellations. The most common reasons for same-day cancellation were acute illness (21.4%), CKD-related complications (21.4%), logistical issues (11.7%), and inadequate pre-operative preparation (13.6%). The most common reasons for cancellations one week-before scheduled operation were patient choice (22.7%) acute illness (20.5%), inadequate pre-operative preparation (20.5), and logistical issues (11.4%). On multivariable analysis, same-day outpatient cancellations were significantly associated with an afternoon case start time (OR 3.09, 95% CI 0.75-2.37, P<.001). The median time to AV access creation following a cancellation was 32 days. However, among same-day cancellations, 14.3% of patients did not proceed with permanent HD access within 6 months, and 7% required an interval tunneled dialysis catheter (TDC). Among week-before cancellations, 16.7% did not proceed with permanent HD access within 6 months, and 4.7% required an interval TDC.</p><p><strong>Conclusion: </strong>Cancellations of AV access creations affected a quarter of scheduled cases with several patients not proceeding with permanent HD access by 6 months. Acute illness, poor control of CKD-related complications, and logistical factors were among the most common reasons for cancellations, highlighting potential areas for targeted improvement. Targeted efforts such as scheduling optimization and improved pre-operative preparation may help reduce surgical cancellations and prevent unnecessary catheter placements. These interventions are also likely to enhance the overall quality of hemodialysis care for patients.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248514","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":"Ten-Year Experience Using Cryopreserved Arterial Allografts for Vascular Reconstruction during Major Oncologic Surgery.","authors":"Sebastian Cifuentes, Armin Tabiei, Jill J Colglazier, Todd E Rasmussen, Bernardo C Mendes, Fahad Shuja, Manju Kalra, Melinda S Schaller, Jonathan J Morrison, Randall R DeMartino","doi":"10.1016/j.jvs.2025.05.212","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.212","url":null,"abstract":"<p><strong>Objective: </strong>Resection of vascular-encasing tumors has been associated with high morbidity and mortality. However, advances in surgical techniques and cancer treatments have improved outcomes for patients undergoing resection with vascular reconstruction. In specialized centers, cryopreserved arterial allografts (CAAs) are increasingly used when autologous conduits are unavailable, offering superior anatomical compliance and resistance to infection compared to prosthetic conduits. This study aimed to evaluate the outcomes of CAAs as a conduit for vascular reconstruction during major oncological surgery.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients without suitable autologous conduits who underwent tumor-related vascular reconstruction with CAAs between January 2014 and May 2024. Outcomes evaluated included conduit patency, freedom from CAA-related reintervention, CAA-related complications, and overall survival.</p><p><strong>Results: </strong>A total of 44 patients (mean age 57 ± 14 years; 61% female) underwent vascular reconstruction using commercially available femoral and aortoiliac CAAs during resection of abdominopelvic, peripheral, and neck tumors. Pancreatic ductal adenocarcinoma was the most common tumor type (73%, n=32). Single-vessel reconstruction was required in 27% of patients (n=12), while multivessel reconstruction was required in 73% (n=32). Ninety-three vessels were reconstructed, with a technical success rate of 100%. At 24 months, primary patency was 65% and 46% (p=0.19), primary-assisted patency was 75% and 68% (p=0.73), and secondary patency was 80% and 78% (p=0.95) for arterial and venous reconstructions, respectively. Freedom from CAA-related reintervention was 60%. Hemodynamically significant stenosis (>50% luminal narrowing) was observed in 57% (n=25) of patients; of these, 23% (n=10) progressed to occlusion. An additional 11% (n=5) experienced occlusion without prior stenosis. Structural CAA defects included pseudoaneurysm in 16% (n=7) of patients, all after pancreatic resection. Fistula formation in 4% (n=2), and anastomotic dehiscence in 2% (n=1) of patients. The 36-month survival rate was 50% for patients with non-pancreatic tumors and 23% for those with pancreatic tumors.</p><p><strong>Conclusions: </strong>CAAs are a technically feasible alternative for tumor-related vascular reconstruction, offering acceptable patency rates and freedom from reintervention. They provide a valuable conduit option in clean-contaminated fields and when autologous conduits are unavailable. However, the risk of pseudoaneurysm mandates diligent surveillance in specific settings.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248480","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":"Morphology and outcomes of endovascular repair of ruptured abdominal aortic aneurysms with hostile neck anatomy.","authors":"Grayson S Pitcher, Benjamin C Ford, Doran Mix, Karina S Newhall, Indrani Sen, Michael C Stoner, Bernardo C Mendes","doi":"10.1016/j.jvs.2025.05.209","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.209","url":null,"abstract":"<p><strong>Objective: </strong>Ruptured abdominal aortic aneurysms (rAAAs) have a high rate of hostile neck anatomy (HNA). The objective of this study was to evaluate the risk factors associated with intra-operative type Ia endoleak (T1EL) in endovascular repair (EVAR) for rAAAs with HNA, and to determine the association of intra-operative T1EL with long-term survival. The second objective was to delineate the visceral anatomy of rAAAs with HNA to determine the anatomic feasibility of the Cook p-Branch device.</p><p><strong>Methods: </strong>A multi-center retrospective review was performed to identify patients with rAAAs and HNA between 2004 and 2021. HNA was defined as infrarenal aortic neck diameter >28 mm, infrarenal neck length <15 mm or angulation >60 degrees. Clinical characteristics and morphology were reviewed for predictors of intra-operative T1EL. The Kaplan-Meier method was used to estimate survival. The anatomic feasibility of the Cook p-Branch was reviewed.</p><p><strong>Results: </strong>Eighty-five patients underwent standard EVAR for rAAAs with HNA. Mean age was 75 ± 10 years and 74% were male. Twenty-four (28%) patients required adjunctive procedures for an intra-operative T1EL. Large aneurysm size (OR 1.03, CI 1.00-1.05, P = .02), increased distance from the renal arteries to the aortic bifurcation (OR 1.02, CI 1.00-1.04, P = .04) and lower thrombus burden (OR 0.57, CI 0.34-0.96, P = .03) were associated with intra-operative T1EL and the need for adjunctive procedures on univariate analysis. Overall survival for patients who underwent standard EVAR at 30-days, 1-year and 5-years was 84%, 74% and 64%, respectively. There was no difference in 30-day (84% vs. 83%, P = .99), 1-year (75% vs. 71%, Log-rank P = .73) or 5-year survival (67% vs. 54%, Log-rank P = .34) in patients without an intra-operative T1EL versus patients with a T1EL who required an adjunctive procedure. There was also no difference in 1-year (98% vs. 96%, Log-rank P = .48) or 5-year (85% vs. 92%, Log-rank P = .51) aortic-related reintervention. No specific morphologic features within this population were predictive of aortic-related re-intervention at 5 years. The visceral vessel applicability of the Cook p-Branch was 65% and the overall applicability was only 56%.</p><p><strong>Conclusion: </strong>Despite a high rate of adjunctive intra-operative procedures for T1EL in patients who underwent EVAR for rAAAs with HNA, this was not associated with a significant difference in survival or aortic-related reintervention. The overall applicability of the Cook p-Branch device in patients with rAAAs and HNA is low, and standard EVAR is effective.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248517","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":"Glucagon-like peptide-1 receptor agonists are associated with fewer major adverse cardiovascular and limb events in patients with moderate peripheral arterial disease.","authors":"Catherine C Go, Frank Annie, Kerry Drabish, Mohammad H Eslami","doi":"10.1016/j.jvs.2025.05.037","DOIUrl":"10.1016/j.jvs.2025.05.037","url":null,"abstract":"<p><strong>Objective: </strong>Patients with peripheral arterial disease (PAD) and diabetes mellitus have significantly higher rates of cardiovascular mortality. Glucagon-like peptide-1 receptor agonists (GLP-1RA)-such as tirzepatide and semaglutide-have been shown to decrease rates of major adverse cardiac events (MACEs) and mortality in patients with diabetes mellitus. However, their effect on limb outcomes in patients with PAD has yet to be investigated. The aim of this study was to explore the impact of GLP-1RAs on cardiovascular outcomes in patients with moderate PAD.</p><p><strong>Methods: </strong>Data were sourced from the TriNetX research network, encompassing more than 1002 health care organizations. We used a one:one propensity-matched study to compare patients with an ankle-brachial index (ABI) of 0.4-0.9 who were started on GLP-1RA (group 1) with those patients who were not started on a GLP-1RA (group 2). Patients with chronic wounds or with an ABI outside of this range were excluded. MACEs were defined as myocardial infarction, stroke, acute ischemic heart disease, and heart failure. Major adverse limb events (MALEs) were defined as acute limb ischemia requiring thrombectomy or major amputation. Any inpatient admission, MACE, and MALE were identified using International Classification of Diseases, 10the edition, codes. Standard statistical methods were used as appropriate.</p><p><strong>Results: </strong>We identified 858,750 patients with moderate PAD between October 1, 2022, and December 31, 2023. After matching for age, sex, diabetes status, smoking history, and coronary artery disease, each group included 55,041 patients. Group 1 had a higher starting weight (216 ± 56.8 lb versus 188 ± 51.5 lb; P = .0001) and baseline hemoglobin A1C (7.2 ± 1.8 versus 6.7 ± 1.7; P = .01). The baseline ABI was 0.73 ± 0.29 in group 1 and 0.88 ± 0.26 in group 2 (P = .07). At 1 year, there were fewer mortalities (1.7% versus 4.4%; P < .01), MACEs (25.4% versus 29.3%; P < .01), MALEs (0.8% versus 1.5%; P < .01), and inpatient hospitalizations (17.9% versus 26.8%; P < .01) in group 1. On multivariate analysis, GLP-1RAs significantly reduced the risk of MACEs (hazard ratio, 0.87; 95% CI, 0.85-0.89; P = .01), MALEs (hazard ratio, 0.57; 95% confidence interval [CI], 0.51-0.64; P = .02), and inpatient admission (odds ratio, 0.64; 95% CI, 0.62-0.66; P = .01) and complications (odds ratio, 0.67; 95% CI, 0.65-0.68; P = .01).</p><p><strong>Conclusions: </strong>The use of GLP-1RAs in patients with moderate PAD is associated with a decreased rate of MACEs and MALEs. Patients on GLP-1RAs are at a decreased risk of mortality, inpatient hospitalizations, and inpatient complications.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248515","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 report of the safety of prophylactic spinal fluid drainage in open and endovascular thoracic and thoracoabdominal aortic aneurysm patients.","authors":"Lucas Skoda, Charles Acher, Jonathan Kay, Ashley Williamson, Jack Bontekoe, Leah Gober, Martha Wynn","doi":"10.1016/j.jvs.2025.05.020","DOIUrl":"10.1016/j.jvs.2025.05.020","url":null,"abstract":"<p><strong>Objectives: </strong>Spinal cord injury (SCI) is a complication of open and endovascular thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA) repair. Spinal fluid drainage (SFD) is used to reduce SCI risk in open surgery; however, many question the safety of SFD in endovascular repair. The objective of this retrospective study was to review the risks of prophylactic SFD in 1445 patients undergoing open and endovascular TAA and TAAA repair from 1987 to 2023.</p><p><strong>Methods: </strong>Spinal drains were placed in open TAAA repairs and endovascular repairs planning >12 cm aortic coverage. Cardiac anesthesiologists placed and managed all drains. From 2000 to 2023, spinal drains for elective surgery were placed using fluoroscopic guidance. SF was drained to <5 to 8 mm Hg depending on SCI risk. If bloody fluid appeared, drainage was stopped and a computed tomography (CT) can of the head was obtained. Drainage was stopped when patient demonstrated normal leg strength; drains were removed at 48 hours if leg strength was normal. A post-SFD headache was treated with a blood patch. We tracked intraoperative fluid drained, neurological complications from SFD (any neurological deficit from intracranial or spinal hematoma), bloody SF, intracranial blood on head CT without neurological deficit, headache requiring blood patch, transient SCI (paraparesis/paraplegia), and permanent SCI (paraparesis/paraplegia).</p><p><strong>Results: </strong>Of the 1445 patients (1029 open, 416 endovascular) undergoing TAA/TAAA repair, 1007 (777 open, 230 endovascular) had SFD. Before 2000, 263 open repairs done with smaller drains had an average of 125 mL of fluid drained intraoperatively to achieve pressure goals. From 2000 to 2023, intraoperative SFD to achieve pressure goals averaged 132 mL in open and 81 mL in endovascular repairs. Six patients (0.6%) had neurological complications from SFD; five of these (0.77%) occurred in open patients. Only one patient undergoing endovascular repair had a neurological complication from SFD (0.43%). From 2000 to 2023, other events not resulting in neurological deficit included bloody SF (20.7% open; 21.7% endovascular), intracranial blood on CT without neurological deficit (9.9% open; 6.1% endovascular), and headache requiring blood patch (7.6% open; 11.7% endovascular). From 2000 to 2023, 5.6% of open patients had transient SCI, 4.2% had permanent SCI. 3.6% of endovascular patients had transient SCI, and 1.2% had permanent SCI.</p><p><strong>Conclusions: </strong>Prophylactic SFD can be performed with acceptable risk in both endovascular and open TAAA repairs. We advocate that prophylactic SFD be used to reduce risk of SCI in both endovascular and open TAAA repairs.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248511","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":"Opioid Use Patterns and Persistent Use after Hemodialysis Access Surgery.","authors":"Timothy P Copeland, William J Nahm, Karen Woo, Lauren E Wisk, Jill Q Dworsky, Emily J Martin, Elaine Ku","doi":"10.1016/j.jvs.2025.05.207","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.207","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the risk of persistent opioid use related to opioid pain management for hemodialysis access creation and identify patterns of opioid dosage and use.</p><p><strong>Methods: </strong>This retrospective cohort study included Medicare-enrolled opioid naïve patients in the United States Renal Data System who initiated hemodialysis for end-stage kidney disease between April 2015 and June 2019. Persistent opioid use was defined as an opioid prescription 90 to 180 days post-surgery. The Cox proportional hazards model used censored patients at the time of hospitalization, subsequent hemodialysis access procedures, death, and end of Medicare enrollment. A mixed-effect logistic regression modeled opioid prescription, and a mixed-effect linear regression modeled opioid quantity in 5 milligrams (5 mg) hydrocodone equivalents.</p><p><strong>Results: </strong>A total of 28,404 patients (median age, 72 [25th, 75th Percentile; 66, 79] years; 15,322 men [53.9%]) underwent index access creation, of whom 14,265 patients filled an opioid prescription at access creation (50.2%), with 3,289 (23.1%) opioid prescriptions for ≥42 tablets of 5 mg hydrocodone equivalents (i.e., ≥2 weeks prescription). Patients receiving 42 or more tablets of 5 mg hydrocodone equivalents (≥2 weeks) had 1.28 times the risk of persistent opioid use (95% CI 1.08-1.52) relative to those who did not fill an opioid prescription. In contrast, receipt of 20 or fewer tablets of 5 mg hydrocodone equivalents was not associated with an increased risk of persistent opioid use (HR 1.00, 95% CI 0.85-1.18).</p><p><strong>Conclusions: </strong>Given the risk of persistent opioid use stemming from hemodialysis access procedures, the development of formal recommendations for conservative hemodialysis access pain management may be worth considering.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248477","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}