Journal of Vascular Surgery最新文献

{"title":"A Systematic Review Supporting the Development of the Society for Vascular Surgery Clinical Practice Guidelines on the Management of Blunt Thoracic Aortic Injury.","authors":"Mohammed Firwana, Mohamed Seisa, Magdoleen Farah, Reem Alsibai, April Christensen, Yahya Alsawaf, Alzhraa Abbas, Bashar Hasan, Samer Saadi, Larry J Prokop, Ali Azizzadeh, M Hassan Murad","doi":"10.1016/j.jvs.2025.05.208","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.208","url":null,"abstract":"<p><strong>Background: </strong>The writing committee (WC) from the Society for Vascular Surgery (SVS) has commissioned this systematic review to support the development of clinical practice guidelines (CPG) on the management of patients with blunt thoracic aortic injury (BTAI).</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Pairs of independent reviewers selected and appraised studies addressing seven key questions identified by the SVS committee regarding the evaluation and management of BTAI patients. The certainty of evidence was assessed using the GRADE approach.</p><p><strong>Results: </strong>We included 23 studies across seven key clinical questions. For Grade 1 and 2 injuries, TEVAR was associated with higher aortic-related mortality compared to non-operative management (RR 4.73, 95% CI: 1.19-18.68). Early (<24 hours) TEVAR was associated with higher mortality compared to delayed (>24 hours) intervention (RR 2.04, 95% CI: 1.45-2.86) with moderate certainty of evidence. There may be an increase in ischemic events when the left subclavian artery is covered and not revascularized, with low certainty of evidence. Intraoperative heparin use during TEVAR was associated with lower mortality (RR 0.41, 95% CI: 0.23-0.71) with low certainty of evidence. In patients with concurrent traumatic brain injury, early TEVAR (< 9 hours) was associated with higher mortality (12.9% vs 6.5%, p = 0.003) compared to delayed repair with low certainty of evidence. Analysis of imaging surveillance protocols suggested potential benefits of systematic follow-up. For Grade 2 injuries managed non-operatively, studies demonstrated favorable intermediate-term outcomes with most injuries resolving within 8 weeks.</p><p><strong>Conclusion: </strong>This systematic review demonstrates a limited evidence base with high uncertainty for numerous patient-important outcomes. The evidence suggests benefits of delayed intervention when feasible, particularly for patients with concurrent injuries. Non-operative management may be appropriate for lower-grade injuries, while the timing of intervention and use of intraoperative anticoagulation may be important factors associated with outcomes in TEVAR. These findings of this evidence synthesis, along with individual patient factors and local expertise will inform the development of clinical practice guidelines.</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":"144248512","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":"Natural Course and Mid-to-Long-term Outcomes of Conservatively Managed Spontaneous Isolated Celiac Artery Dissections.","authors":"Ethan Chervonski, Moira A McGevna, Molly Ratner, Karan Garg, Thomas S Maldonado, Mikel Sadek, Todd L Berland, Katherine A Teter, Caron B Rockman","doi":"10.1016/j.jvs.2025.05.206","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.206","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Spontaneous isolated celiac artery dissection (SICAD) is a rare condition with an unclear natural history and no management consensus. This study evaluated mid-to-long-term outcomes of conservatively managed SICAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center, retrospective cohort study identified patients with SICAD from January 2011-December 2022 in the institutional electronic health record. Demographics, comorbidities, radiographic features, management, and outcomes were reviewed. Clinical endpoints were symptomatic remission, significant organ malperfusion, rupture, and secondary intervention. Radiographic endpoints included dissection remodeling (i.e., shortened dissection length or increased true lumen diameter), celiac aneurysm incidence, and aneurysm diameter growth among &lt;1.5 cm, 1.5-1.9 cm, and ≥2.0 cm size categories. Endpoints were stratified by symptomatic vs. incidental presentation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-nine patients with SICAD were identified. Eighty percent were male, and 57% had hypertension. Extra-celiac aneurysms were present in 25%, including 12% with aortic aneurysms. Forty-nine percent of SICADs were symptomatic on presentation, while 51% were incidentally discovered. Patients with incidental SICAD were older than symptomatic patients (62 ± 15 years vs. 54 ± 8 years, p=0.02) but had similar comorbidities. Ninety-two percent of symptomatic patients experienced complete symptom resolution without operative intervention by the earliest follow-up (182 ± 386 days). No incidental cases developed symptoms over a mean of 3.9 ± 3.5 years. No significant organ malperfusion, rupture, or secondary intervention occurred in this series. Symptomatic SICAD was more likely to undergo remodeling than incidental SICAD (p=0.02) over an average of 3.3 ± 3.7 years. Thirty-two percent of symptomatic cases had partial remodeling, and 37% had no residual dissection. Seventy-one percent of incidental dissections remained stable without remodeling. Celiac thrombus on initial imaging predicted remodeling (p=0.003). Baseline antihypertensive (p=0.006) and antiplatelet use (p=0.047) were associated with remodeling in symptomatic patients only. Aneurysmal degeneration was noted in 46% of all presenting lesions; none were ≥2.0 cm in maximal diameter. Incidental cases presented with more aneurysmal dilatation than symptomatic cases (59% vs. 32%, p&lt;0.001). No celiac aneurysms at presentation grew over an average of 4.8 ± 4.0 years. Forty percent and 13% of incidental and symptomatic cases without initial celiac aneurysms, respectively, developed incident aneurysms by a mean follow-up of 2.0 ± 3.0 years (p=0.3).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Conservative management of uncomplicated SICAD yielded excellent clinical outcomes, even with incomplete remodeling and aneurysmal degeneration, which were common, albeit largely benign. Patients may warrant screening for aneurysms beyond the celiac axis. Antih","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":"144248518","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 aortic and arterial vulnerability spectrum: A conceptual biological framework for risk stratification and precision surgical decision-making in aortopathy and arteriopathy.","authors":"Sherene Shalhub","doi":"10.1016/j.jvs.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.028","url":null,"abstract":"<p><strong>Objective: </strong>To introduce the Aortic and Arterial Vulnerability Spectrum (AAVS), a biologically grounded conceptual framework designed to improve risk stratification and surgical decision-making in aortopathy and arteriopathy by incorporating substrate-level insights.</p><p><strong>Methods: </strong>The framework was developed using a structured, hypothesis-driven process that integrates high-reliability systems theory, extracellular matrix biology, and clinical outcome patterns. A novel application of skin biopsy is introduced as a tissue-level surrogate for aortic wall integrity. Histological and transmission electron microscopy analyses were used to identify gradable ultrastructural features of collagen and elastin organization. The AAVS framework defines three biological risk domains, substrate vulnerability, clinical fragility, and mechanisms of failure, each linked to a proposed scoring system under development. Clinical case illustrations demonstrate conceptual utility.</p><p><strong>Results: </strong>The three domains of biological risk are (1) substrate vulnerability, assessed through the AAVS Score of histological; and ultrastructural analysis of skin biopsy as a surrogate for aortic tissue integrity; (2) clinical fragility, captured by the Vascular Fragility Score, which quantifies phenotypic indicators of vascular fragility from clinical history, physical findings, and imaging; and (3) mechanisms of failure, modeled by substrate vulnerability progression, a longitudinal, dynamic modeling system that tracks substrate vulnerability progression over time toward aortic failure and includes vascular health modifiers that alter mismatch progression over time.</p><p><strong>Conclusions: </strong>AAVS introduces a structured clinical reasoning framework and skin biopsy-based scoring approach for risk stratification in aortopathy and arteriopathy. It reframes failure as a progressive biological process shaped by substrate integrity, not just anatomy or procedural success. Although the scoring systems remain under development, the cognitive framework offers immediate utility for case interpretation, biologically matched surgical planning, and future longitudinal modeling. Ongoing work aims to validate the scoring systems and refine biological risk assessment across diverse clinical cohorts.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234463","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":"Validation of BASIL-2 among patients undergoing primary bypass or angioplasty with or without stenting for chronic limb-threatening ischemia.","authors":"Jeremy D Darling, Camila R Guetter, Elisa Caron, Isa van Galen, Jemin Park, Christina Marcaccio, Patric Liang, Andy Lee, Mark C Wyers, Allen D Hamdan, Marc L Schermerhorn, Lars Stangenberg","doi":"10.1016/j.jvs.2025.05.009","DOIUrl":"10.1016/j.jvs.2025.05.009","url":null,"abstract":"<p><strong>Objective: </strong>BASIL-2 demonstrated the superiority of an endovascular-first approach in patients with chronic limb-threatening ischemia (CLTI) for the primary endpoint of amputation-free survival (AFS); however, the generalizability of these data are unknown. Thus, we aimed to externally validate these findings by comparing open surgical bypass (BPG) to angioplasty ± stenting (PTA/S), using the BASIL-2 inclusion and randomization criteria.</p><p><strong>Methods: </strong>All patients undergoing a first-time lower extremity infrapopliteal revascularization for CLTI at our institution from 2005 to 2022 were retrospectively reviewed. To approximate BASIL-2, one-to-one propensity matching was performed. The primary outcome was AFS; secondary outcomes included perioperative complications, major reintervention, major amputation, and major adverse limb events (MALE). A sensitivity analysis was performed assessing the same PTA/S cohort vs BPG with only single-segment great saphenous vein (ssGSV) conduits. Outcomes in the matched cohorts were evaluated using χ², Kaplan-Meier, and Cox regression analyses.</p><p><strong>Results: </strong>Of 1184 limbs undergoing a first-time infrapopliteal intervention for CLTI between 2005 and 2022, 490 underwent BPG, and 694 underwent PTA/S. After matching, 620 patients (310 BPG and 310 PTA/S) fit our criteria, with no baseline differences noted between groups. Between BPG and PTA/S, the mean age was 71.0 years in both groups, with similar rates of male sex (64% vs 66%), White race (74% vs 75%), coronary artery disease (49% vs 52%), diabetes (75% vs 77%), chronic kidney disease (27% vs 34%), dialysis dependence (17% vs 19%), and smoking history (65% vs 66%). There were no differences in perioperative mortality (4.5% vs 3.9%), stroke (1.0% vs 0.0%), myocardial infarction (2.9% vs 1.3%), or acute kidney injury (12% vs 16%) (all P > .05). BPG, as compared with PTA/S, did not demonstrate any difference in AFS (at 5 years, 36% vs 39%), major reintervention (15% vs 19%), major amputation (24% vs 22%), or MALE (32% vs 36%) (all P > .05). When limiting the BPG group to only ssGSV conduits (n = 267), despite no difference seen in AFS (32% vs 36%), we noted significantly lower rates of major reintervention (12% vs 19%) and MALE (29% vs 36%), demonstrating a 48% and 30% risk reduction, respectively (hazard ratio, 0.52; 95% confidence interval, 0.30-0.89 and 0.69; 95% confidence interval, 0.49-0.98).</p><p><strong>Conclusions: </strong>Among patients undergoing infrapopliteal revascularization for CLTI, BPG and PTA/S do not differ in regard to AFS, raising concerns regarding the generalizability of BASIL-2. Importantly, infrapopliteal interventions following ssGSV BPG, as compared with PTA/S, do demonstrate significantly lower rates of major reintervention and MALE, reinforcing the benefits of this conduit in patients with CLTI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248482","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":"Evolution of practice patterns and learning curve of aortic repair using the E-nside off-the-shelf inner branch thoracoabdominal endograft.","authors":"Francesco Squizzato, Michele Piazza, Gabriele Piffaretti, Emanuele Gatta, Yamume Tshomba, Matteo Orrico, Sonia Ronchey, Antonio Bozzani, Giovanni Pratesi, Andrea Gaggiano, Gioele Simonte, Wassim Mansour, Michele Antonello","doi":"10.1016/j.jvs.2025.05.036","DOIUrl":"10.1016/j.jvs.2025.05.036","url":null,"abstract":"<p><strong>Objective: </strong>To report the impact of the learning curve on the outcomes of branched endovascular aortic repair using an off-the-shelf preloaded inner branch device (E-nside).</p><p><strong>Methods: </strong>Data from a physician-initiated national multicenter registry, including patients treated with E-nside endograft (INBREED [ItaliaN Branch Registry of E-nside EnDograft]) were collected prospectively (2020-2024). End points were early (30-day) technical success, mortality, major adverse events (MAEs), and 2-year freedom from endograft instability and target vessel instability. Patients were divided into early and late cohorts based on the median date of the procedure in each center.</p><p><strong>Results: </strong>There were 215 patients treated with the E-nside, 108 (393 target vessels) in the early and 107 (395 target vessels) in the late cohort. Most patients had a degenerative aneurysm (early, 82%; late, 75%; P = .326) or a chronic dissection (early, 6%; late, 15%; P = .025). Aneurysm extent was thoracoabdominal in 53% of patients and complex abdominal in 47%; and 23% were ruptured or symptomatic and 26% had an aneurysm size of more than 70 mm, without differences between groups. A narrow paravisceral aortic lumen of less than 25 mm was more frequent in the late cohort (late, 30%; early, 18%; P = .037). From the early to the late groups, there was an increase in the use of a total transfemoral approach (late, 29% vs early, 18%; P = .042), balloon-expandable bridging stents (late, 82% vs early, 76%; P = .032), and reinforcement bridging stents (late, 26%; early, 11%; P < .001). Operating time (late, 267 ± 131 minutes; early, 244 ± 130 minutes; P = .230), iodinated contrast volume (late, 181 ± 81 mL; early, 210 ± 141 mL; P = 108; P = .302), and dose area product (late, 272 ± 110 Gycm² early, 291 ± 118 Gycm²; P = .277) were similar in the two groups. Intraprocedural complications decreased in the later stage of the learning curve (late, 11%; early, 23%; P = .030), whereas overall 30-day mortality (late, 8%; early, 6%; P = .346), technical success (late, 99%; early, 98%; P = .286), and MAEs (late, 27%; early, 29%; P = .879) remained substantially stable. There were no differences in 2-year freedom from endograft instability (late, 100 ± 0%; early, 96 ± 5%; P = 1.00), freedom from target vessel instability (late, 98 ± 3%; early, 94 ± 2%; P = .090), and target vessel primary patency (late, 97 ± 2%; early, 97 ± 2%; P = .321).</p><p><strong>Conclusions: </strong>The increased experience with the E-nside endograft was associated with a more frequent use of a total transfemoral approach and use of balloon-expandable and reinforced bridging stents. From the early to the late stages, there was a significant decrease in intraoperative complications, although most centers were learning independent and achieved a consistent mortality, MAE, procedural metrics, and mid-term results from the start.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248513","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":"Long-term outcomes of radiocephalic arteriovenous fistulas created in anatomical snuffbox or with VasQ external support device","authors":"Robert Shahverdyan MD ,&nbsp;Mohamad A. Hussain MD, PhD","doi":"10.1016/j.jvs.2025.03.166","DOIUrl":"10.1016/j.jvs.2025.03.166","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the long-term outcomes of radiocephalic arteriovenous fistulas (RCAVFs) created in the anatomical snuffbox (SB-AVF) or with the VasQ external support device (ES-RCAVF).</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective analysis including 394 primary AVFs created for hemodialysis access in patients with advanced kidney disease between November 2017 and October 2024. Outcomes examined included rates of access maturation, successful cannulation, patency (primary, assisted primary, and secondary), reintervention rates, and rates of juxta-anastomotic stenosis. Multivariate analyses were used to study the associations between baseline characteristics and clinical outcomes, aiming to identify variables that could inform algorithmic decision-making for optimal distal RCAVF configuration selection.</div></div><div><h3>Results</h3><div>The cohort consisted of 148 SB-AVFs and 246 ES-RCAVFs. ES-RCAVFs had significantly higher rates of 4-week maturation (81.9% vs 69.7%; <em>P</em> = .009), successful cannulation (82.6% vs 71.6%; <em>P</em> = .044), and tunneled dialysis catheter (TDC) removal (62.9% vs 56.9%; <em>P</em> = .28) at 6 months as compared with SB-AVFs. There was no significant difference in juxta-anastomotic stenosis rates (34% in the SB-group and 32% in the ES-group; <em>P</em> = .734) or 5-year patency rates between the two groups (26.1% vs 26.6% for primary [<em>P</em> = .531]; 51.2% vs 52.4% for assisted primary [<em>P</em> = .778]; and 56.5% vs 57.8% for secondary [<em>P</em> = .1278] patency rates) for the SB-AVF vs ES-RCAVFs, respectively. The number of interventions per patient year was 0.46 for SB-AVFs and 0.57 for ES-RCAVFs (<em>P</em> = .998). In the multivariate analysis, the VasQ significantly (<em>P</em> = .001) increased the probability of maturation, and female gender (<em>P</em> = .007) and diabetes (<em>P</em> = .026) significantly reduced that probability at 4 weeks. The VasQ also significantly increased the probability of overall maturation (<em>P</em> = .002). Female gender (<em>P</em> = .003) and older age (<em>P</em> = .028) negatively contributed to the probability of overall maturation. Moreover, VasQ significantly increased the probability of cannulation success (<em>P</em> = .034) and was the only significant factor for increased likelihood of TDC removal by 6 months (<em>P</em> = .031). Female gender (<em>P</em> = .002) and older age (<em>P</em> = .006) were associated with a significantly decreased likelihood of TDC removal.</div></div><div><h3>Conclusions</h3><div>Our findings indicated that, although ES-RCAVFs achieve superior short-term and long-term outcomes, SB-AVFs remain a valuable option for select patients—particularly younger and nondiabetic individuals—to preserve distal access sites for future use.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"82 1","pages":"Pages 229-239"},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year outcomes from the pivotal trial of a four-branch off-the-shelf solution to treat pararenal and extent IV thoracoabdominal aortic aneurysms.","authors":"Mark A Farber, Sukgu Han, Michel S Makaroun, Jon S Matsumura, Bernardo C Mendes, Gustavo S Oderich, Luis A Sanchez, Bjoern D Suckow, Carlos H Timaran","doi":"10.1016/j.jvs.2025.05.016","DOIUrl":"10.1016/j.jvs.2025.05.016","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To report 1-year primary-arm outcomes of the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis pivotal trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The multicenter, nonrandomized, prospective study included patients with extent IV thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs). All-cause and adjudicated lesion-related mortality were assessed at 12 months. Core-lab-reported, imaging-dependent outcomes included aneurysm size, endoleaks assessed through 1-year follow-up window, and target vessel instability (defined as occlusion, stenosis, type Ic/IIIc endoleak, or reintervention) at 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred two patients were treated; 59 patients had an extent IV TAAA and 43 had a PRAA. The mean maximum aneurysm diameter was 59.4 ± 7.8 mm. At 1 year, eight patients were lost to follow-up and six patients died (1 device-related, 1 procedure-related, and 4 unrelated causes). No lesion-related mortality occurred. Freedom from all-cause mortality was 94.1% ± 2.3%. The 1-year combined freedom from \"clinically significant reintervention\" and lesion-related mortality was achieved in 78.7% and 60.5% of patients with extent IV TAAAs and PRAAs, respectively (P = .09). At least one target vessel branch occlusion occurred in 14.7% of patients through 1 year of follow-up. At the vessel level, freedom from target vessel instability at 1 year was 94.2% ± 1.2% (celiac 99.0% ± 1.0%, superior mesenteric 97.1% ± 1.7%, right renal 90.8% ± 2.9%, and left renal 89.8% ± 3.1%). Acute kidney injury requiring dialysis occurred in three patients (n = 2 permanent, n = 1 temporary) through 1 year. Renal artery occlusion occurred more often in arteries with diameters &lt;5 mm (odds ratio = 3.04; 95% confidence interval: 1.08, 8.54) and in patients with pararenal aneurysms (odds ratio = 2.85; 95% confidence interval: 0.88, 9.25, statistically insignificant). Of the 22 reinterventions in 15 patients, 16 (73%) reinterventions were classified as minor: 13 (81%) for target vessel complications and 3 (19%) for type II endoleaks. Device- or procedure-related major reinterventions in six patients included thrombectomy or thrombolysis for target vessel occlusion (n = 5) and one exploratory laparotomy after procedural aortic rupture. No type I/III endoleaks were identified (Core Lab) through 1 year. Aortic enlargement (&gt;5 mm) occurred in 5 patients (6.0%). Aneurysm shrinkage (&gt;5 mm) occurred in 20 patients (23.8%). Aortic component fractures identified in 3 patients (3.6%) were clinically insignificant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although mortality remains low 1 year after treatment with the GORE EXCLUDER Thoracoabdominal Branch Endoprosthesis device for extent IV and pararenal aneurysms, renal artery occlusion was the predominant adverse event and was primarily associated with PRAAs and smaller renal vessel diameters. During extended follow-up, attention should be focused on renal branch assess","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248510","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":"Long-term Comparison of Physician-Modified Endografts With and Without Low-Profile Fabric Designs for Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms.","authors":"Armin Tabiei, Jesse Chait, Randall R DeMartino, Gustavo S Oderich, Sukgu M Han, Bernardo C Mendes","doi":"10.1016/j.jvs.2025.05.204","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.204","url":null,"abstract":"<p><strong>Objective: </strong>Following commercial approval, our institution began utilizing the Cook Zenith Alpha low-profile stent graft (LPSG) for physician-modified endograft (PMEG) repair of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA) due to its smaller sheath size and wider apex-to-apex stent distances, allowing for better accommodation of modifications. We aimed to compare outcomes of PMEGs using LPSGs and the standard-profile stent graft (SPSG), Zenith TX2.</p><p><strong>Methods: </strong>We reviewed clinical data and outcomes of patients treated using PMEGs for CAAAs (short-neck infrarenal, juxtarenal, and pararenal AAAs) and TAAAs between 2007-2024. Endpoints included 30-day mortality and major adverse events (MAEs), patient survival, freedom from reintervention, freedom from target artery (TA) instability and freedom from type III endoleak.</p><p><strong>Results: </strong>Of 317 patients treated with PMEGs, 228 (72%) were men with a mean age of 74 ± 9 years. SPSGs were utilized in 174 (55%) patients and LPSGs were utilized in 143 (45%) patients. Patients treated with LPSGs were mostly treated for TAAAs (69% vs 48%) and subsequently had more incorporated TAs per patient (3.7 ± 0.6 vs 3.1 ± 1.0) compared to the SPSG cohort (p=<.001). LPSGs had been used more frequently with percutaneous femoral access (91% vs 36%, p=<.001) and less frequently with upper extremity access (41% vs 75%, p=<.001), and iliofemoral conduits (6% vs 21%, p=<.001). Technical success rates were similar between the two groups (89%; LPSG vs 93%; SPSG, p=<.001), with shorter operating time (257 ± 89 minutes vs 296 ± 107 minutes), and lower estimated blood loss (383 ± 464 mL vs 1063 ± 1221 mL) compared to the SPSG cohort (p=<.001). Early (30-day) mortality (5%; SPSG vs 4% LPSG) and any MAE rates (30; SPSG vs 23; LPSG) were similar between two groups, however, patients in the SPSG cohort were more likely to undergo early aortic or side-branch related reintervention (13% vs 6%, p=<.035). There were no significant differences in four-year overall survival, freedom from TA instability, freedom from reintervention and freedom from type III endoleak rates between the two groups.</p><p><strong>Conclusion: </strong>Repair of CAAAs and TAAAs with PMEGs utilizing devices with low-profile fabric has similar perioperative and long-term outcomes compared to standard-profile endografts including no difference in endoleak or issues with device integrity. Confounding factors in this comparison include learning curve, improved surveillance, and treatment of more complex aneurysms.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234421","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-White Race Is Associated With Higher Risk Of Amputation In Patients With Lower WIfI Scores.","authors":"Caroline E Minnick, Gloria Sanin, Ashlee Stutsrim, Timothy Williams, Gabriela Velazquez, Cody Blazek, Matthew Edwards, Timothy Craven, Matthew Goldman","doi":"10.1016/j.jvs.2025.05.202","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chronic wounds represent a significant source of debilitation and morbidity. Disparate outcomes based upon racial, socioeconomic, and patient-specific factors have been routinely demonstrated in literature. This retrospective cohort study evaluated inpatients with lower extremity wounds who were assessed by a limb preservation service, with an aim to examine differences in amputation rates between White and non-White groups across varying levels of disease severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of prospectively collected data was performed evaluating patients seen by the inpatient limb preservation service at a large academic medical center between 2018 and 2023. Wound, Ischemia, foot infection (WIfI) scores, demographics, and outcomes were collected on the cohort. Patients were categorized into two racial/ethnic groups: HNW (Hispanic and non-White) and NHW (non-Hispanic Whites). Associations between race/ethnicity and amputation outcomes were examined after using a propensity score (PS) model to estimate inverse probability of treatment weights (IPTW) for non-White group membership. IPTW weighting was applied to \"balance\" race groups on observed covariates when examining differences using 2-way contingency tables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;696 patients were evaluated, with a primary endpoint of major or minor amputation. 37% of patients were female, and 36% were Hispanic/non-White (HNW). Minor amputations occurred in 20% of patients, and 18% underwent major limb amputations. HNW patients experienced higher rates of both minor (27% vs. 17%; OR 1.8, 95% CL 1.2-2.6) and major amputations (27% vs. 13%; OR 2.4, 95% CL 1.5-3.7). Intervention/revascularization rates did not differ between HNW and NHW patients. In analyses adjusted for confounding using IPTW weighting, differential risk of amputation across WIfI levels was observed in non-White versus White patients (Breslow-Day chi-square P-value: 0.002). However, after Bonferroni adjustment for multiple comparisons, only one of the stratified confidence intervals was significantly associated with risk of any amputation (OR 6.2, 98.75% CL 0.6-65 at WIfI=1; OR 9.2, 98.75% CL 1.7-50 at WIfI=2; OR 2.1, 98.75% CL 0.8-5.2 at WIfI=3; OR 0.9, 98.75% CL 0.5-1.8 at WIfI=4).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Non-White race was significantly associated with lower extremity amputation events even after stratification by WIfI amputation risk score, which is consistent with previous research. However, our findings suggest non-White patients appear to be at higher risk for minor/major limb amputation at lower WIfI scores when controlling for common risk factors. The underlying reasons for this disparity remain unclear, emphasizing the need for further investigation and highlighting the potential impact of WIfI scores in risk stratification and clinical decision-making. Future research is needed to elucidate the underlying mechanisms contributing to t","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234461","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":"Centers with Vascular Surgery Training Programs Are More Likely to Utilize Vein Mapping and Autologous Vein for Infrainguinal Bypass.","authors":"Hassan Chamseddine, Mouhammad Halabi, Loay Kabbani, Timothy Nypaver, Mitchell Weaver, Tamer Boules, Yasaman Kavousi, Kevin Onofrey, Andi Peshkepija, Alexander Shepard","doi":"10.1016/j.jvs.2025.04.072","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.072","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The Society for Vascular Surgery (SVS) recommends preoperative vein mapping (PVM) and the use of autologous vein (AV) conduits when available for infrainguinal bypass (IIB). This study aims to evaluate the association between the presence of a vascular surgery (VS) training program at a medical center and the utilization of PVM and AV conduits in IIB procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients undergoing an elective IIB for peripheral artery disease (PAD) between 2016 and 2022 were identified in a prospective, statewide, multicenter observational registry. Hospital rates of PVM and AV utilization were calculated. Patients were then classified based on whether the medical center in which they were treated had an Accreditation Council for Graduate Medical Education (ACGME) certified VS training program or not. Both integrated vascular surgery residencies (0+5) and vascular surgery fellowships (5+2) were considered as VS training programs. Bayesian mixed effects logistic regressions were performed to study the independent association of VS training programs with the primary outcomes of PVM and AV utilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 37 centers performing IIB were included, of which 24% (9/37) had a VS training program and 76% (28/37) did not. Hospital rates of PVM ranged from 10.2% to 81.7% with a median rate of 40.5% (IQR, 24.4%-61.9%), whereas that of AV utilization as an IIB conduit varied between 16.5% and 88.1% with a median rate of 43.8% (IQR, 33.3%-56.0%). A strong linear correlation between hospital rates of PVM and hospital rates of AV utilization was observed (R&lt;sup&gt;2&lt;/sup&gt; = 0.956). A total of 5,951 patients met the inclusion criteria, of whom 36.9% (2,196/5,951) underwent IIB at centers with a VS training program and 63.1% (3,755/5,951) underwent IIB at centers without a VS training program. Patients treated at centers with a VS training program were less likely to undergo an IIB for claudication (47.0% vs 63.5%, p&lt;0.001) and more likely to undergo preoperative ABI testing (68.9% vs 55.2%, p&lt;0.001). Moreover, centers with a VS training program were more likely to perform PVM (57.7% vs 39.0%, p&lt;0.001) and utilize an AV conduit (60.0% vs 45.3%, p&lt;0.001) in IIB. On multivariate logistic regression analysis, centers with a VS training program were more than twice as likely to utilize PVM (OR 2.23, 95% CI 1.04-4.88) and nearly twice as likely to utilize AV as a conduit (OR 1.84, 95% CI 1.07-3.17) in patients undergoing IIB compared to centers without a VS training program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The overall utilization of PVM and AV conduits in IIB remains below 50%, highlighting a significant concern in the national effort to improve PAD care. Centers with a VS training program demonstrate higher rates of PVM and AV utilization in IIB, reflecting greater adherence to SVS guidelines for the management of PAD. Future strategies and quality improvement initiatives should aim","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234418","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}