Journal of Vascular Surgery最新文献

{"title":"Dual pathway inhibition versus dual antiplatelet therapy in patients with acute or nonacute limb ischemia: A propensity score-matched analysis from the RESOLVE study.","authors":"Yuli Wang, Yang Liu, Chunshui He, Qiang Li, Zhengyu Shi, Zibo Feng, Ziheng Wu, Lianrui Guo, Lan Zhang, Meng Ye","doi":"10.1016/j.jvs.2026.08.031","DOIUrl":"10.1016/j.jvs.2026.08.031","url":null,"abstract":"<p><strong>Objective: </strong>Real-world evidence comparing dual-pathway inhibition (DPI) with dual antiplatelet therapy (DAPT) after endovascular revascularization for acute or nonacute limb ischemia is limited. This study aims to compare the 24-month effectiveness and safety outcomes of DPI vs DAPT in this setting.</p><p><strong>Methods: </strong>This prospective, multicenter observational study, drawing data from the RESOLVE registry, used propensity score matching (PSM) to compare outcomes in patients receiving either DPI or DAPT after endovascular revascularization. The primary end point was 24-month major adverse events (MAE), defined as recurrent acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, or cardiovascular death. Secondary end points included major adverse limb events (MALE), major adverse cardiovascular events (MACE), and all-cause death.</p><p><strong>Results: </strong>After PSM, 109 matched pairs were analyzed. The DPI group had a significantly lower 24-month MAE incidence than the DAPT group (11.47% vs 28.45%; hazard ratio [HR] = 2.83; P < .01). The DPI group also showed lower rates of MALE (16.83% vs 28.40%; HR = 1.83; P = .04) and all-cause death (2.94% vs 11.65%; HR = 4.28; P = .02). MACE showed a trend toward lower incidence with DPI (2.00% vs 7.77%; HR = 4.22; P = .07). No major bleeding events were observed in either group. A modified Society for Vascular Surgery runoff score >10 and chronic limb-threatening ischemia predicted greater benefit from DPI (P for interaction = .020 and .031, respectively).</p><p><strong>Conclusions: </strong>In this PSM analysis, DPI was associated with significantly lower 24-month rates of MAE, MALE, and all-cause death compared with DAPT. No major bleeding events were observed in either group. These findings suggest a potentially favorable efficacy profile for DPI but warrant confirmation in further randomized controlled trials.</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":"148906462","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":"Outcomes from the real-world multicenter laser in situ fenestrated endovascular repair (LIFE) registry for complex thoracoabdominal and pararenovisceral aortic pathology.","authors":"Jonathan Bath, Fanny Alie-Cusson, Sukgu M Han, Gregory A Magee, Andrew Barleben, Robert Allen, Mark Fugate, Frank R Arko, Jordan R Stern, Kenneth Tran, Jason T Lee, Jeromy S Brink, Chase Schlesselman, Brant Ullery","doi":"10.1016/j.jvs.2026.07.083","DOIUrl":"10.1016/j.jvs.2026.07.083","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Laser in situ fenestrated endovascular (LIFE) repair enables fenestrated endovascular aortic repair in complex and challenging cases, including urgent and emergency presentations and patients with prior aortic repairs. From the real-world multicenter LIFE registry, the results are reported for this unique approach for thoracoabdominal and pararenovisceral aortic aneurysm (TAAA/PAA) pathologies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients (2017-2022) undergoing LIFE for thoracoabdominal and pararenovisceral aortic aneurysms were identified at nine high-volume institutions and were included in a retrospective multicenter registry database. Descriptive statistics and Kaplan-Meier analysis were used. The primary outcomes were technical success and target vessel instability. The secondary outcomes included mortality, stroke, paraplegia, and reintervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included 210 patients undergoing LIFE (mean age, 72.3, 27% female, 83% White). The notable demographics included previous stroke in 14%, chronic obstructive pulmonary disease in 26%, renal insufficiency in 27% (dialysis in 3%), and previous aortic repair in 55% of patients. Indications for repair included fusiform aneurysm in 69%, type Ia endoleak in 21%, saccular aneurysm in 10%, and aortic dissection in 7%. Repair was performed for symptomatic/ruptured pathologies in 39% of patients. Overall, 30-day deaths occurred in 17 patients (8%), with 15 deaths in patients with symptomatic/ruptured pathologies and 2 deaths in asymptomatic patients (P &lt; .0001). Proximal seals were achieved in Zone 2 (1%), Zone 3 (5%), Zone 4 (10%), Zone 5 (34%), Zone 6 (14%), Zone 7 (16%), and Zone 8 (17%). A total of 529 target vessels were incorporated (one vessel in 18%, two vessel in 26%, three vessel in 29%, four vessel in 24%, and NR in 3% of patients), with a mean of 2.5 target vessels per patient. The technical success rate for LIFE repair was 95%. Fifteen deaths occurred in 77 patients (19%) with symptomatic/ruptured pathologies. The results revealed stroke in six (2.9%) and permanent paraplegia in four patients (2%). At the mean follow-up of 9 months (range, 1-35), 12 additional deaths (5.7%) occurred, four of which were aneurysm-related (2%). Kaplan-Meier survival for the overall cohort at 36 months was 70%, with 80% freedom from bridging stent reintervention at 24 months (both standard error &lt;10%). By group, asymptomatic patients had higher overall survival (82% vs 63%; P = .0007) at 20 months and freedom from bridging stent reintervention (88% vs 77%; P = .0005) at 21 months than patients with symptomatic/ruptured pathologies (standard error &lt;10%). Overall reinterventions were performed in 64 patients (21%), with additional aortic stent graft in 21 patients (10%), bridging stent reintervention to 24 target vessels (4.5%), coil embolization in 4 patients for type II endoleak and to the false lumen of a dissection (2%), and other surgical pr","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":"148906429","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 echocardiographic trajectories after high-flow vascular access creation.","authors":"Abdullah Khan, Enrico Prajiante Bertolino, Ahmed A Sorour, J Emanuel Finet, Tushar J Vachharajani, Heba Wassif, Jon G Quatromoni, Francis J Caputo, Sean P Lyden, Lee Kirksey","doi":"10.1016/j.jvs.2026.08.018","DOIUrl":"10.1016/j.jvs.2026.08.018","url":null,"abstract":"<p><strong>Objective: </strong>The provision of renal replacement therapy for patient with end-stage kidney disease is lifesaving therapy. Surgically created arteriovenous access (SAA) is the most used modality. Positive remodeling may occur following SAA leading to high-flow vascular access (HFVA). The impact of long-term exposure to HFVA on cardiovascular structural remodeling is not well understood. Accordingly, this study describes the echocardiographic changes observed in HFVA following SAA creation.</p><p><strong>Methods: </strong>This single-center retrospective study included all patients with HFVA, defined as volume flow > 2000 mL/min, over a 10-year period. Electronic medical records were reviewed to extract demographic, clinical, and echocardiographic data before and after SAA creation at serial intervals. Changes in echocardiographic parameters were compared using paired analyses. Univariable and multivariable Cox regression models assessed mortality, ventricular dilatation, and dysfunction.</p><p><strong>Results: </strong>A total of 201 patients were included, with an average age of 57 years and a median volume flow of 2338 mL/min (interquartile range, 2189-2787 mL/min). The cohort comprised of 31% females and 68% Black American patients. SAA were predominantly in the upper arm (87%), brachial-basilic (42%), and autogenous (89%). Significant echocardiographic changes were observed over time: left atrial volume and left ventricular (LV) end-diastolic volume worsened after 6 months. At 1 to 3 years, most remaining parameters worsened significantly, and notably right ventricular (RV) systolic pressure. LV ejection fraction significantly decreased after 5 years (P < .01), and LV mass index did not change significantly (P = .34). RV and LV dilation and dysfunction were significant at 1 to 3 years. Most importantly, any degree of RV dilatation (hazard ratio, 2.83; P = .007) or RV systolic dysfunction (hazard ratio, 2.36; P = .017) was independently associated with early mortality.</p><p><strong>Conclusions: </strong>In patients with HFVA, cardiac remodeling was observed as early as 6 months. After 1 to 3 years of HFVA exposure, progressive decline in key echocardiographic parameters related to heart failure was observed. These findings underscore the importance of routine surveillance of the vascular access circuit and cardiac structures to detect early remodeling. Close monitoring of worsening RV parameters is essential, as it independently correlates with early mortality risk.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829589","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":"Sex differences in peripheral artery disease detection during community-based screening in underserved populations through the CHAMPIONS program.","authors":"Guistinna Tun, Maria Denalene Tiu, Jade S Hiramoto, Clara M Gomez-Sanchez, Maria D Gonzalez Hinojosa, Manreet Dosanjh, Isabel Bjork, Molly McCabe, Leigh Ann O'Banion","doi":"10.1016/j.jvs.2026.08.020","DOIUrl":"10.1016/j.jvs.2026.08.020","url":null,"abstract":"<p><strong>Objective: </strong>Females with peripheral artery disease (PAD) often present with atypical or advanced symptoms and experience worse outcomes compared with males. The Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks delivers free cardiovascular screenings in vascular deserts, reaching underserved communities with limited access to care. This study evaluated sex-based disparities in PAD risk classification and PAD detection among the Comprehensive Heart and Multidisciplinary Limb Preservation Outreach Networks participants in California.</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of 736 participants screened between 2022 and 2025. Screening included a demographic/health questionnaire, nonfasting lipid panel, hemoglobin A1c, and blood pressure measurement. At-risk status was determined using the European Society for Vascular Surgery guidelines for asymptomatic PAD. At-risk participants underwent toe-brachial index (TBI) measurements. PAD was defined as TBI < 0.7. Primary outcomes were at-risk classification and TBI-defined PAD. Logistic regression was used to evaluate the association between sex and the outcomes.</p><p><strong>Results: </strong>Female participants comprised 54.3% (n = 400) of participants, with a mean age of 53.1 ± 15.7 years. Comorbidities were similar between sexes, although smoking was more prevalent among male participants (27.4% vs 10.5%; P < .001). Overall, 43% of participants were Hispanic, 51% unemployed, and 26% reported grade school as the highest education. There was no significant difference in at-risk status by sex (odds ratio, 0.78; 95% confidence interval, 0.58-1.05; P = .10). Among at-risk participants, PAD prevalence was significantly higher in female vs male participants (10.9% vs 2.8%; P < .001). Female sex was associated with increased odds of meeting TBI criteria for PAD (odds ratio, 4.21; 95% confidence interval, 1.80-11.52; P < .001), persisting after multivariable adjustment.</p><p><strong>Conclusions: </strong>Despite similar risk classification, female participants were significantly more likely to meet TBI criteria for PAD at screening. These findings suggest that sex-based disparities in PAD may already exist at the point of detection, highlighting the importance of improved screening strategies and increased awareness in females, particularly in underserved populations.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818828","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":"Having class II/III obesity significantly increases risks of wound complications following lower extremity bypass by twofold.","authors":"Grace Djapri, Constantinos Constantinou, Andris Kazmers, Jeremy Albright, Jenna Bernson, Yetunde Balogun, Pavan Chanamolu, Tal Avraham Chamdi, Frank Davis, Jacob Frisbie, Abdul R Halabi, Peter Henke, Eugene Laveroni, Hue Thai, Yash Varma","doi":"10.1016/j.jvs.2026.08.011","DOIUrl":"10.1016/j.jvs.2026.08.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Although lower extremity bypass (LEB) may be the only viable option for limb salvage in selected patients with chronic limb-threatening ischemia, it carries significant postprocedural risks. Previous studies on the impact of body mass index (BMI) and LEB typically extrapolated data from national databases, which may be skewed by data abstracted from hospitals with vascular residency or fellowship training programs. The scarcity of data from nonteaching hospitals does not permit a comprehensive picture of outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We queried the Blue Cross Blue Shield Michigan Cardiovascular Consortium (BMC2) registry data to identify patients who underwent elective LEB. Cases with patients younger than 18 years, in-hospital death, missing data, emergent procedures, or LEB for popliteal artery entrapment syndrome or trauma were excluded. Patient demographic characteristics are classified into five BMI categories: underweight (BMI &lt; 18.5), healthy weight (BMI ≥ 18.5 and &lt;25), overweight (BMI ≥ 25 and &lt;30), class I obesity (BMI ≥ 30 and &lt;35), and class II or III obesity (BMI ≥ 35). Primary outcomes included 30-day and 1-year wound complications and amputation. Secondary outcomes included major adverse cardiac events and their constituent elements (mortality, myocardial infarction, and stroke). Unadjusted differences were tested using F-tests from one-way analyses of variance, Kruskal-Wallis tests, or χ&lt;sup&gt;2&lt;/sup&gt; tests, depending on the variable type and distribution. These tests, when significant, were followed by Bayesian mixed-effects logistic regression models to control for site, demographic, and comorbidity differences between exposure groups. Bayesian models are interpreted as significant if the 95% credible intervals (CIs) around the odds ratios (ORs) do not include 1.00.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between January 2016 and December 2024, a total of 7676 patients underwent elective LEB, with a mean age of 67 years. The study cohort was divided into five different BMI categories as follows: underweight (n = 297; 3.9%), healthy weight (n = 2325; 30.3%), overweight (n = 2639; 34.4%), class I obesity (n = 1528; 19.9%), class II or III obesity (n = 887; 11.5%). Using healthy weight patients as reference, adjusted analysis of primary outcomes demonstrated that patients with class II/III obesity had significantly higher odds of 30-day and 1-year wound complications (30-day: OR, 1.728; 95% CI, 1.31-2.279; 1-year: OR, 1.881; 95% CI, 1.457-2.431). Interestingly, obese patients demonstrated lower odds of 1-year major amputations (class I obesity: OR, 0.74; 95% CI, 0.55-1.00; class II/III obesity: OR, 0.58; 95% CI, 0.39-0.86). For secondary outcomes, patients with overweight and class I obesity had lower odds of 30-day mortality (overweight: OR, 0.356; 95% CI, 0.167-0.725; class I obesity: OR, 0.38; 95% CI, 0.147-0.829). Patients with class I obesity also had lower odds of 1-year mortality (OR, 0.727; ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794736","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":"Synchronous carotid body and glomus jugulare paragangliomas.","authors":"Hong Yang, Xiaodong Zhang","doi":"10.1016/j.jvs.2026.08.009","DOIUrl":"10.1016/j.jvs.2026.08.009","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762199","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":"Quantification of hemodynamic changes and wound healing following transcatheter arterialization of the deep veins in no-option chronic limb-threatening ischemia.","authors":"Peter A Schneider, Anahita Dua, Richard J Powell, Daniel G Clair, Steven A Abramowitz, Michael C Siah, Mehdi H Shishehbor, Roberto Ferraresi","doi":"10.1016/j.jvs.2026.08.008","DOIUrl":"10.1016/j.jvs.2026.08.008","url":null,"abstract":"<p><strong>Objective: </strong>Transcatheter arterialization of the deep veins (TADV) is a novel therapy for no-option chronic limb-threatening ischemia (CLTI) that delivers oxygenated blood to the foot via the venous system and has demonstrated favorable limb salvage outcomes in several studies, including the Pivotal Revascularization or Limb Restoration in Patients With Chronic Limb-Threatening Ischemia (PROMISE) II trial. The present study characterizes circuit maturation in the PROMISE II cohort by examining its longitudinal hemodynamic development and associated wound healing, with the goal of better defining the mechanism of action of TADV.</p><p><strong>Methods: </strong>PROMISE II (NCT03970538) was a prospective, multicenter study on TADV in patients with no-option CLTI due to \"desert foot\" arterial anatomy. The objective was to evaluate longitudinal changes following TADV including hemodynamics from duplex ultrasound, distal perfusion, and wound healing over time. Clinical outcomes, perfusion metrics, and serial duplex ultrasound data were collected through 1 year using standardized protocols. Duplex studies evaluated volume flow and spectral Doppler parameters across the TADV circuit. Distal perfusion was assessed using toe-brachial index and toe pressures. Duplex-derived waveforms were categorized as low resistance or high resistance, and longitudinal hemodynamic changes were analyzed. Circuit maturation was assessed using characteristics such as waveform achieving high-resistance configuration and decreased acceleration time indicating vascular remodeling.</p><p><strong>Results: </strong>A total of 105 patients from PROMISE II were included in the analysis. Limb salvage was 68.7% at 1 year. Among patients with adjudicated wound data, 75.5% were healed/healing at 1 year; patients with worsening status decreased from 52.6% to 14.3%, whereas complete healing increased to 46.9%. Circuits transitioned from low- to high-resistance waveforms (7.9% at baseline; 24.6% at 3 months; 37.7% at 6 months; 81.1% at 1 year; P < .0001). At 1 year, in patients with high-resistance circuits, healed/healing wound status was 86.7%, toe-brachial index ≥ 0.3 was 57.1%, and toe pressure ≥40 mmHg was 78.3% indicating greater distal perfusion.</p><p><strong>Conclusions: </strong>TADV promotes limb salvage through staged hemodynamic maturation demonstrated by duplex ultrasound, microvascular remodeling, sustaining perfusion, and supporting its durable benefit in no-option CLTI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760210","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":"Medication nonadherence is associated with higher morbidity after lower extremity revascularization in patients with peripheral arterial disease.","authors":"Michelle C Zhang, Alexandra A Sansosti, Yanling Zhao, Beatrix Choi, Madeleine D Hunter, Ian M Kronish, Virendra I Patel, Nicholas J Morrissey, Danielle Bajakian, Thomas Fx O'Donnell","doi":"10.1016/j.jvs.2026.08.001","DOIUrl":"10.1016/j.jvs.2026.08.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Medical management of peripheral artery disease (PAD) consists of antiplatelet therapy, cholesterol reduction, blood pressure control, and anticoagulation. These medications lead to lower mortality, improved quality of life, and fewer adverse limb events in patients with PAD. However, few studies have examined medication adherence rates, the factors that influence them, and the subsequent effect on outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We identified all patients who underwent lower extremity endovascular revascularization for PAD between May 2022 and November 2024. Pharmacy dispensing reports were utilized to calculate the proportion of days covered for 90 days postoperatively for antiplatelet agents, anticoagulants, statins, antihypertensives, insulin, and other antihyperglycemic agents. We evaluated the factors associated with nonadherence (defined as composite proportion of days covered of &lt;80%) and the association between nonadherence and reintervention, minor and major amputation, and 90-day mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our study population included 405 patients, of which 45% were female, 39% Hispanic, 18% current smokers, 22% had claudication, and 78% had chronic limb-threatening ischemia (CLTI). Nonadherence rates ranged from 21.7% for sulfonylureas to 54.1% for short-acting insulin. In our sample, 62% met the criteria for composite adherence. Patients with CLTI had 45% lower composite medication adherence compared with that for claudicants (87.7% vs 78.1%; P = .046). Moreover, 97 patients underwent reintervention (24%), 68 (17%) underwent minor amputation, 39 (10%) underwent major amputation, 149 (37%) were readmitted within 90 days, and 16 (4%) died within 90 days. While no difference was noted in mortality (P = .90) between adherent and nonadherent patients, medication adherence was associated with a 61% lower risk of death-censored reintervention (subdistribution hazard ratio [sHR], 0.39; 95% confidence interval [CI], 0.27-0.58, P &lt; .001), 56% lower risk of death-censored major amputation (sHR, 0.44; 95% CI, 0.23-0.84; P = .01), and 45% lower risk of death-censored minor amputation (sHR, 0.55; 95% CI, 0.34-0.90; P = .02). Patients on dialysis had a higher risk of minor amputation (P = .007), and patients with CLTI had higher risks of reintervention (P = .017) and minor amputation (P = .032). Insurance status and area deprivation index were not associated with composite adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Medication nonadherence significantly increases the risks of reintervention and major/minor amputation following lower extremity endovascular revascularization. A significant proportion of patients are nonadherent to their medications following revascularization. Patients with CLTI comprise a high-risk group for nonadherence, with high rates of reintervention and amputation. Notably, traditionally accepted risk factors such as area deprivation index and insurance were not asso","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706986","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 reversed, in situ, and nonreversed great saphenous vein conduits for chronic limb-threatening ischemia: An analysis of the Vascular Quality Initiative-Medicare-linked database.","authors":"Shima Rahgozar, Sina Zarrintan, Mohammed Hamouda, Mitali Doshi, Sophie X Wang, Mahmoud B Malas","doi":"10.1016/j.jvs.2026.07.082","DOIUrl":"10.1016/j.jvs.2026.07.082","url":null,"abstract":"<p><strong>Background: </strong>Single-segment great saphenous vein (GSV) grafts are the conduits of choice for infrainguinal bypass (IIB) performed for chronic limb-threatening ischemia. GSV has been used in three configurations: reversed, in situ, and nonreversed. In this large multi-institutional study, we aimed to compare the outcomes of IIB performed utilizing different GSV configurations in a real-world experience.</p><p><strong>Methods: </strong>We queried the Vascular Quality Initiative-Medicare-linked database for all IIB procedures performed for chronic limb-threatening ischemia due to occlusive disease between 2011 and 2019. All bypass procedures were performed with single-segment GSV. The primary outcome was amputation-free survival. The secondary outcomes included overall survival, limb salvage, and freedom from reintervention. Limb salvage was defined as freedom from major amputation. All the outcomes were analyzed at 1 and 5 years. Kaplan-Meier survival estimates and Cox regression were used for analyses.</p><p><strong>Results: </strong>This study included three cohorts of IIB, namely reversed (N = 3003, 53.0%), in situ (N = 1344, 23.7%), and nonreversed (N = 1322, 23.3%) GSV configurations. The 5-year amputation-free survival rates were 39.8%, 39.5%, and 42.4% in the reversed, in situ, and nonreversed cohorts, respectively (P = .126). After adjustment for potential confounders, the analysis revealed that the in situ and nonreversed configurations were not associated with increased hazard of major amputation/death at 1 year compared with the reversed configuration (adjusted hazard ratio [aHR], 0.96; 95% confidence interval [CI], 0.83-1.13; P = .652 and aHR, 0.94; 95% CI, 0.81-1.08; P = .375, respectively). Additionally, the in situ and nonreversed configurations were not associated with increased hazards of major amputation/death at 5 years compared with the reversed configuration (aHR, 1.06; 95% CI, 0.96-1.17; P = .255 and aHR, 0.93; 95% CI, 0.84-1.02; P = .129, respectively). The nonreversed configuration was associated with decreased hazards of death (aHR, 0.82; 95% CI, 0.73-0.93; P = .002) and major amputation/death (aHR, 0.87; 95% CI, 0.78-0.97; P = .016) at 5 years compared with the in situ configuration. GSV configurations were not associated with reintervention.</p><p><strong>Conclusions: </strong>In this large multi-institutional study comparing three GSV configurations for lower extremity bypass, long-term limb-related outcomes were mainly comparable across the configurations. Although the nonreversed configuration was associated with lower hazards of death and major amputation/death at 5 years compared with the in situ configuration, this difference was primarily due to mortality and may reflect differences in patient selection. Overall, all three GSV configurations represent acceptable and durable options for IIB, with conduit selection guided by surgeon preference, conduit availability, and patient anatomy.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712978","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 ≤50% carotid artery stenosis is associated with higher rates of vulnerable plaque features and acceptable revascularization outcomes: A three-stroke-center cohort study.","authors":"Camilo Polania-Sandoval, James F Meschia, Gyanendra Kumar, Robert D Brown, Bernard R Bendok, Kevin M Barrett, Diego Sanchez-Calderin, Ekin Inal, Camila Esquetini-Vernon, David A Miller, W Christopher Fox, Christopher Jacobs, Sukhwinder J S Sandhu, Richard D Beegle, Houssam Farres, Giuseppe Lanzino, Young Erben","doi":"10.1016/j.jvs.2026.08.002","DOIUrl":"10.1016/j.jvs.2026.08.002","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Current carotid revascularization paradigms are primarily stenosis-based, with optimized medical therapy alone generally recommended for symptomatic patients with (≤50%) mild-to-moderate degree of stenosis (MMDS) and no routine recommendation for revascularization, despite evidence of potentially high-risk plaque features beyond stenosis. We aimed to contrast clinical presentation, prevalence of vulnerable plaque features, and postrevascularization outcomes among symptomatic patients with MMDS and high-degree stenosis (HDS &gt; 50%) across three stroke centers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective multicenter case-control study of symptomatic patients with MMDS vs HDS who underwent carotid revascularization from January 2016 to February 2026. Carotid revascularization procedures included were endarterectomy, transfemoral stenting, and transcarotid revascularization. MMDS was defined as ≤50% stenosis on all available preoperative cross-sectional imaging using North American Symptomatic Carotid Endarterectomy Trial criteria and the European Society for Vascular Surgery 2023 Clinical Practice Guidelines. Patients with any imaging study showing &gt;50% stenosis were classified as HDS. Baseline characteristics, symptom phenotype, preoperative medications, imaging findings, vulnerable plaque features on magnetic resonance angiography with vessel wall imaging, and 30-day and long-term outcomes were compared. Composite outcomes included ipsilateral stroke, transient ischemic attack, myocardial infarction, and death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 800 symptomatic patients, 87 (10.9%) had MMDS and 713 (89.1%) had HDS. Patients with MMDS were more frequently male (MMDS: 85.1% vs HDS: 68.0%; P &lt; .01) and more commonly presented with cerebral infarction (MMDS: 59.8% vs HDS: 48.4%; P = .04), whereas transient ischemic attack were trending more frequently in patients with HDS (MMDS: 23.0% vs HDS: 33.5%; P = .05). Neurologic severity was similar by the National Institutes of Health Stroke Scale at admission (MMDS: 3.00 ± 3.54 vs HDS: 4.34 ± 5.78; P = .27), National Institutes of Health Stroke Scale at discharge (MMDS: 1.60 ± 2.20 vs HDS: 2.02 ± 3.64; P = .80), modified Rankin Scale at discharge (MMDS: 0.87 ± 1.25 vs HDS: 0.81 ± 1.09; P = .43), and Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes score (MMDS: 3.83 ± 1.53 vs HDS: 3.47 ± 1.43; P = .31). Patients with MMDS had higher rates of intraplaque hemorrhage (MMDS: 64.0% vs HDS: 29.4%; P &lt; .01), ulceration (MMDS: 30.0% vs HDS: 13.0%; P &lt; .01), and overall vulnerable plaque features other than stenosis (MMDS: 80.0% vs HDS: 39.4%; P &lt; .01). Thirty-day composite outcomes were similar (MMDS: 5.7% vs HDS: 3.7%; P = .39), as were long-term (3.3 ± 2.6 years) composite outcomes (MMDS: 17.2% vs HDS: 25.0%; P = .11). In a sensitivity analysis excluding patients with 50% stenosis, the &lt;50% stenosis subgroup (n = 44) demonstrated findings c","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701649","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}