Journal of Vascular Surgery最新文献

{"title":"Advanced Wound, Ischemia, and foot Infection stage is associated with poor outcomes in the BEST-CLI trial.","authors":"Jeffrey J Siracuse, Alik Farber, Matthew T Menard, Kenneth Rosenfield, Michael S Conte, Andres Schanzer, Gheorghe Doros, Raghu Motaganahalli, Igor J Laskowski, Neal R Barshes, Elizabeth A Genovese, Michael B Strong, Joseph L Mills","doi":"10.1016/j.jvs.2024.11.027","DOIUrl":"10.1016/j.jvs.2024.11.027","url":null,"abstract":"<p><strong>Objective: </strong>Wound, Ischemia, and foot Infection (WIfI) staging was established to provide objective classification in patients with chronic limb-threatening ischemia (CLTI) and to predict 1-year major amputation risk. Our goal was to validate WIfI staging using data from the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.</p><p><strong>Methods: </strong>Data from the BEST-CLI Trial, a prospective randomized trial comparing surgical revascularization (OPEN) and endovascular revascularization (ENDO), were used to assess the association of WIfI stage on long-term outcomes in an intention-to-treat analysis. Patients were prospectively allocated to two cohorts, which included patients with and without adequate single-segment greater saphenous vein, respectively. The primary outcome of this analysis was major amputation.</p><p><strong>Results: </strong>There were 1568 patients analyzed, representing 86% of the entire trial population; of these 35.5%, 29.6%, and 34.9% were categorized as WIfI stage 4, WIfI stage 3, and WIfI stage 1/2, respectively. There were 1223 patients (606 OPEN, 617 ENDO) and 345 patients (OPEN 172, ENDO 173) in cohorts 1 and 2, respectively. On unadjusted Kaplan-Meier analysis, WIfI clinical stages 4 and 3, compared with WIfI stage 1/2, were associated with higher rates of major amputation (21.4%, 16.2% vs 10.7%), death (33.5%, 35.7% vs 24.6%), amputation/death (44.9%, 44.5% vs 31.3%), major adverse limb events (MALEs)/death (34.4%, 33.9% vs 29.5%), and reintervention/amputation/death (69.9% vs 69% vs 60.4%) (P < .05 for all) at 3 years. On risk-adjusted analysis, compared with WIfI stage 1/2, major amputation was associated with WIfI stage 4 (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.44-2.96; P < .001) and WIfI stage 3 (HR, 1.62; 95% CI, 1.1-2.37; P = .013) stages. Death was associated with WIfI stage 4 (HR, 1.3; 95% CI, 1.03-1.63; P = .027) and WIfI stage 3 (HR, 1.42; 95% CI, 1.13-1.79; P = .003). MALE/death was associated with WIfI stage 4 (HR, 1.29; 95% CI, 1.02-1.63; P = .036. Reintervention amputation/death was associated with WIfI stage 4 (HR, 1.28; 95% CI, 1.09-1.50; P = .03) and WIfI stage 3 (HR, 1.22, 99% CI 1.03-1.43) ; P = .018). When examining OPEN vs ENDO revascularization by each WIfI stage, OPEN intervention was favored in cohort 1 for MALE/death for each stage.</p><p><strong>Conclusions: </strong>In BEST-CLI, WIfI stage was strongly associated with major amputations, death, and MALEs/death after revascularization for CLTI. Cohort 1 patients, with an adequate preoperative single segment greater saphenous vein, had lower MALE/death with OPEN intervention across all WIfI stages. This validation of WIfI score in a prospective multicenter trial reinforces its importance in shared-decision making, informed consent, and prognostication.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786019","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":"Predicting high-flow arteriovenous fistulas and cardiac outcomes in hemodialysis patients.","authors":"Nasir A Shah, Pauline Byrne, Zoltan H Endre, Blake J Cochran, Tracie J Barber, Jonathan H Erlich","doi":"10.1016/j.jvs.2024.11.028","DOIUrl":"10.1016/j.jvs.2024.11.028","url":null,"abstract":"<p><strong>Background: </strong>Heart failure is common in patients receiving hemodialysis. A high-flow arteriovenous fistula (AVF) may represent a modifiable risk factor for heart failure and death. Currently, no tools exist to assess the risk of developing a high-flow AVF (>2000 mL/min). The aim of this study was to use machine learning to develop a predictive model identifying patients at risk of developing a high-flow AVF and to examine the relationship between blood flow, heart failure, and death.</p><p><strong>Methods: </strong>Between 2011 and 2020, serial AVF blood flows were measured in 366 prevalent hemodialysis patients at two tertiary hospitals in Australia. Four prediction models (deep neural network and three separate tree-based algorithms) using age, first AVF flow, diabetes, and dyslipidemia were compared to predict high-flow AVF development. Logistic regression was used to assess the relationship between AVF blood flow, heart failure, and death.</p><p><strong>Results: </strong>High-flow AVFs were present in 31.4% of patients. The bootstrap forest predictive model performed best in identifying those at risk of a high-flow AVF (under the curve, 0.94; sensitivity 86%; specificity 83%). Heart failure before vascular access creation was identified in 10.2% of patients with an additional 24.9% of patients developing heart failure after AVF creation. Long-term mortality after access formation was 27%, with an average time to death after AVF creation of 307.5 ± 185.6 weeks. No univariable relationship using logistic regression was noted between AVF flow and incident heart failure after AVF creation or death. Age, flow at first measurement of >1000 mL/min, time to highest AVF flow, and heart failure predicted death after AVF creation using a general linear model.</p><p><strong>Conclusions: </strong>Predictive modelling techniques can identify patients at risk of developing high-flow AVF. No association was seen between AVF blood flow rate and incident heart failure after AVF creation. In those patients who died, time to highest AVF flow was the most important predictor of death after AVF creation.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780440","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":"Thoracic endovascular aortic repair in connective tissue disease patients is not a definitive option.","authors":"Bryan Cass, Courtney Hanak, Ryan Ellis, Ahmed Sorour, Jon Quatromoni, Ali Khalifeh, Ravi Ambani, Levester Kirksey, Patrick Vargo, Eric Roselli, Sean Lyden, Francis Caputo","doi":"10.1016/j.jvs.2024.11.029","DOIUrl":"10.1016/j.jvs.2024.11.029","url":null,"abstract":"<p><strong>Objective: </strong>Open surgery is the gold standard for patients a connective tissue disorder (CTD). Thoracic endovascular aortic repair (TEVAR) is used in emergencies and patient-specific situations. Limited data on durability of TEVAR in patients with CTD exist. The purpose of this study was to investigate the durability, complications, and outcomes of TEVAR in patients with CTD.</p><p><strong>Methods: </strong>This single-center retrospective study included 40 patients with CTD who underwent TEVAR for thoracoabdominal aortic aneurysm or aortic dissection from February 2014 to April 2021. CTDs included Marfan syndrome, Loey-Dietz syndrome, and nonspecific CTD-related diagnoses. Primary outcomes included aortic-related morbidities, time to and type of postoperative reinterventions, and time to open/hybrid conversion. Time to conversion and reintervention was calculated using Kaplan-Meier estimation. Predictors of reintervention and open/hybrid conversion were evaluated using Cox proportional hazards models.</p><p><strong>Results: </strong>The median age was 53 years with 52.5% of the patients being female. Marfan syndrome was diagnosed in 57.5%, Loey-Dietz syndrome in 2.5%, and 40% had a diagnosed nonspecific or other CTD. Thirty-two (80%) had prior aortic interventions. Thoracic aneurysm existed in 52.5% and dissection in 82.5%. The average maximum thoracic aortic diameter was 55.2 mm. There were two mortalities within the first month. Of the remaining 38 patients, 71.1% had aneurysm-related morbidities, including 81.5% with aneurysmal degeneration and 33.3% with endoleak. Overall, 62.5% required reintervention. Of those, median time to reintervention was 9.1 months, including redo-TEVAR/extension in 32%, ascending/arch repair in 24%, open thoracoabdominal aortic repair in 56%, and false lumen embolization in 16%. Open conversions and reintervention were most likely to occur within the first year, with freedom of open conversion of 67.2% at 1 year, and 59.7% at 2 and 3 years, and freedom of reintervention of 49.8%, 36.0%, and 30.0% at 1, 2, and 3 years, respectively.</p><p><strong>Conclusions: </strong>This study suggests that TEVAR for patients with CTD can be performed safely; however, patients are at high risk for aortic-related morbidities and reintervention. Reinterventions and open conversion are common and more likely to occur within 1 year. TEVAR should remain limited in this population until more durable outcomes are possible.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of preoperative smoking status on carotid endarterectomy outcomes in asymptomatic patients.","authors":"Sabrina Straus, Nishita Vootukuru, Daniel Willie-Permor, Nadin Elsayed, Elsie Ross, Mahmoud Malas","doi":"10.1016/j.jvs.2024.11.031","DOIUrl":"10.1016/j.jvs.2024.11.031","url":null,"abstract":"<p><strong>Objective: </strong>The current medical landscape lacks comprehensive data regarding the impact of preoperative smoking status on both short and long-term outcomes for patients undergoing carotid endarterectomy (CEA). This study seeks to elucidate the influence of smoking cessation on in-hospital and long-term outcomes in this patient population.</p><p><strong>Methods: </strong>Data were collected from the Vascular Quality Initiative for all asymptomatic patients who underwent CEA from 2016 to 2023. Outcomes were compared across three different smoking status groups: never smoke (NS), current smoker (CS), and quit >30 days ago. Our primary outcomes included in-hospital stroke, death, and myocardial infarction. Secondary outcomes included 1-year and 3-year death. We used inverse probability of treatment weighting to balance the following preoperative factors: age, gender, race, ethnicity, body mass index, diabetes, coronary artery disease, prior congestive heart failure, renal dysfunction, chronic obstructive pulmonary disease, hypertension, prior coronary artery bypass grafting/percutaneous coronary intervention, prior CEA/carotid artery stenting, degree of stenosis, urgency, anesthesia type, and medications.</p><p><strong>Results: </strong>The final analysis included 85,237 CEA cases with 22,343 NS (26.2%), 41,731 who quit >30 days ago (49.0%) , and 21,163 CS (24.8%). Notably, NS tended to be older and more likely to be female. In contrast, patients who quit >30 days ago were more likely to have comorbidities, including obesity, coronary artery disease, prior congestive heart failure, and CKD, as well as prior procedures. Patients who are CS were more likely to have chronic obstructive pulmonary disease and stenosis of >80%. After inverse probability of treatment weighting, we found no statistical difference for in-hospital stroke, death, myocardial infarction outcomes across the three groups. However, the long-term outcomes revealed quit >30 days ago and CS compared with NS had higher odds of 1-year death (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.5; P < .001; OR, 1.4; 95% CI, 1.2-1.6; P < .001) and 3-year death (OR, 1.5; 95% CI, 1.3-1.6; P < .001; OR, 1.5; 95% CI, 1.4-1.7; P < .001), respectively. There was no significant difference in midterm mortality outcomes between those who quit >30 days ago and CS.</p><p><strong>Conclusions: </strong>In this large national study, we found that smoking status did not emerge as a substantial determinant of adverse short-term outcomes for asymptomatic patients undergoing CEA. However, smoking did adversely affect midterm mortality in these patients. In light of these findings, our study suggests that delaying CEA for smokers may not be warranted. It is crucial to recognize that the complex relationship between smoking and surgical outcomes requires further exploration and validation through additional prospective studies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769960","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":"Uncontrolled hypertension is associated with higher perioperative mortality, prolonged intensive care unit stay, and increased cardiac complications vs controlled hypertension after endovascular aneurysm repair.","authors":"Sabrina Straus, Marc Farah, Kathryn Pillai, Jeffrey Siracuse, Tom Alsaigh, Mahmoud Malas","doi":"10.1016/j.jvs.2024.11.030","DOIUrl":"10.1016/j.jvs.2024.11.030","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Hypertension (HTN) has been well-documented as a strong predictive factor for worse outcomes in patients undergoing various cardiovascular procedures. However, limited research has investigated the effect of controlled vs uncontrolled HTN (uHTN) preoperatively in patients undergoing elective endovascular aneurysm repair (EVAR). Using a national database, we aimed to determine whether there are significant differences in outcomes between these two groups to improve quality of care and preoperative management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We studied patients undergoing EVAR in the Vascular Quality Initiative from 2020 to 2023. Patients were categorized into three groups: no history of HTN, controlled HTN (cHTN), and uHTN. The definition of HTN in this study was based on documented history of HTN or recorded blood pressures on three or more occasions before the procedure. Patients with cHTN included patients treated with medication and having a blood pressure of &lt;130/80. Patients with uHTN had a blood pressure of &gt;130/80. Our primary outcome was perioperative death. Secondary outcomes included myocardial infarction and other cardiac complications, pulmonary complications, bowel and leg ischemia, acute kidney injury, and prolonged intensive care unit (ICU) length of stay (LOS) (&gt;1 day). We used logistic regression models for a multivariate analysis, controlling for confounding variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 11,938 patients without HTN (34.6%) , 17,926 patients with cHTN (52.0%) , and 4598 patients with uHTN (13.3%) were analyzed. Patients with cHTN and uHTN had higher rates of comorbidities, including prior coronary artery disease, diabetes, and congestive heart failure and were more likely receiving aspirin and statin compared with patients with no HTN. In the multivariate analysis, patients with uHTN had higher risk of perioperative death (adjusted odd ratio [aOR], 2.64; 95% confidence interval [CI], 1.44-4.88; P = .002), and prolonged ICU LOS (aOR, 1.52; 95% CI, 1.25-1.83; P &lt; .001) compared with patients without HTN. Patients with patients with cHTN had a significantly lower rate of perioperative death (aOR, 0.60; 95% CI, 0.38-0.96; P = .029), cardiac complications (aOR, 0.60; 95% CI, 0.38-0.99; P = .036), and prolonged ICU LOS (aOR, 0.55; 95% CI, 0.46-0.66; P &lt; .001) compared with patients with uHTN. Notably, there was no significant difference in perioperative mortality or in-hospital complications between patients with cHTN and those with no history of HTN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with uHTN are more likely to experience worse outcomes-including perioperative death, cardiac complications, and prolonged ICU stay-compared with patients with no HTN and those with cHTN. Patients with cHTN had similar outcomes to patients with no HTN. These results highlight the importance of regulating blood pressures before undergoing elective EVAR to improve patients' overall outcomes. ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769980","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":"Transitions of frailty after lower extremity interventions for chronic limb-threatening ischemia.","authors":"Joseph P Hart, Mark G Davies","doi":"10.1016/j.jvs.2024.11.025","DOIUrl":"10.1016/j.jvs.2024.11.025","url":null,"abstract":"<p><strong>Background: </strong>Frailty is common among surgical patients and predicts poor surgical outcomes. This study aimed to analyze transitions in frailty state among patients undergoing lower extremity care for chronic limb-threatening ischemia (CLTI).</p><p><strong>Methods: </strong>Between 2018 and 2022, all patients undergoing a primary intervention for CLTI (endovascular intervention [EV], bypass [BYP], major amputation [AMP]) or wound care were analyzed. Frailty was assessed by Vascular Quality Initiative-derived Risk Analysis Index. Frailty was defined as a Vascular Quality Initiative-derived Risk Analysis Index score of ≥35. Transition in frailty state between preoperative and follow-up measurement at 1 month and 1 year were analyzed. Patient characteristics leading to a transition in frailty state were analyzed using multivariable Cox regression analysis. Amputation-free survival (survival without AMP) and freedom from major adverse limb events (above-ankle amputation of the index limb or major re-intervention (new BYP graft, jump/interposition graft revision) were evaluated.</p><p><strong>Results: </strong>We included 1859 patients (56% male; mean age, 65 ± 11 years) who underwent either EV (52%), a BYP (29%), AMP (13%), or wound care (6%). Amon them, 25% were considered frail on initial evaluation (28%, 16%, 32%, and 30% EV, BYP, AMP, and wound care, respectively). At 30 days, overall frailty increased to 34%: 13% of patients moved from nonfrail to frail (9%, 18%, 22%, and 5% for EV, BYP, AMP, and wound care, respectively), and 4% of patients moved from frail to nonfrail (6%, 2%, 1%, and 0% for EV, BYP, AMP, and wound care, respectively). At 1 year, overall frailty increased to 40%: an additional 13% of patients shifted from nonfrail to frail (15%, 6%, 23%, and 8% for EV, BYP, AMP, and wound care, respectively), and 5% of patients shifted from frail to nonfrail (4%, 8%, 2%, and 0% for EV, BYP, AMP, and wound care, respectively). At 1 year, frailty increased by 28% in EV, 16% for BYP, 32% in AMP, and 43% in wound care. Frailty at baseline, 30 days, and 1 year was associated with a high Charlson's Comorbidity Index. Shifting to a frail state postoperatively was associated with decreased survival and a lower amputation-free survival at 1 year.</p><p><strong>Conclusions: </strong>After major interventions for CLTI at 1 year, 27% of patients shift from a nonfrail to a frail state, and 9% of patients shift from a frail to a nonfrail state with differences across modalities in comparison to wound care, where 13% of patients moved from a nonfrail to a frail state, and none shifted from a frail to a nonfrail state. Shifting to a frail state after intervention is associated with poor outcomes and should be considered when evaluating and intervention in a patient with CLTI.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755317","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":"Impact of skin closure with staples vs sutures on perioperative outcomes following lower extremity bypass surgery.","authors":"Mohammed Hamouda, Umu-Hawa Rogers, Alik Farber, Vincent L Rowe, Michael S Conte, Mahmoud B Malas","doi":"10.1016/j.jvs.2024.11.023","DOIUrl":"10.1016/j.jvs.2024.11.023","url":null,"abstract":"<p><strong>Objective: </strong>Wound complications are one of the major sources of morbidity after open vascular procedures, especially lower extremity bypass (LEB). The preferred skin closure method is based on surgeon preference. Because no data clearly demonstrates the superiority of one method over the other, we aimed to compare outcomes of staples vs sutures for skin closure after LEB.</p><p><strong>Methods: </strong>The Vascular Quality Initiative database was queried for patients who underwent LEB from August 2014 to March 2024. Patients were stratified according to skin closure method: staples vs sutures (which included either absorbable subcuticular or nonabsorbable interrupted sutures). The primary outcome was surgical site infection (SSI). Secondary outcomes were return to operating room (RTOR), prolonged length of stay >7 days (PLOS), and 30-day mortality. After adjusting to baseline and clinically relevant variables, multivariate logistic regression modeling analyzed primary and secondary outcomes.</p><p><strong>Results: </strong>A total of 18,268 LEB procedures were included (staples, n = 5676; 31.07%); sutures (n = 12,592; 68.93%). Compared with suture closure, staples utilization was associated with 57% higher odds of SSI (196 [3.46%] vs 259 [2.06%]; odds ratio [OR], 1.57; 95% confidence interval [CI], 1.21-2.04; P = .001) and 30% higher odds of RTOR (860 [15.17%] vs 1449 [11.53%]; OR, 1.30; 95% CI, 1.12-1.50; P = .001) and PLOS (1630 [28.72%] vs 2835 [22.51%]; OR, 1.30; 95% CI, 1.16-1.45; P < .001). However, there was no significant difference in 30-day mortality among both closure methods (P > .05).</p><p><strong>Conclusions: </strong>In this large multi-institutional study, our analysis demonstrates increased risk of SSI, RTOR, and PLOS after wound closure with staples compared with sutures in patients who underwent LEB. Although staple closure might be easier and more time efficient, meticulous wound closure with sutures should be the preferred closure method for LEB.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751183","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":"Gastrointestinal complications and visceral circulation changes after intentional celiac artery embolization during complex endovascular aortic repair.","authors":"Arash Fereydooni, Claudia Trogolo Franca, Sabina M Sorondo, Shernaz S Dossabhoy, Elizabeth L George, A Claire Watkins, Shipra Arya, Jason T Lee","doi":"10.1016/j.jvs.2024.11.021","DOIUrl":"10.1016/j.jvs.2024.11.021","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Intentional celiac artery embolization (CAE) is an oft-used strategy to extend proximal or distal seal during complex endovascular aortic repair. Prior reports document a wide range of gastointestinal-related complications. However, associated changes in collateral circulation are poorly defined. We sought to report the long-term outcomes and adaptive changes in collateral visceral circulation following CAE during complex endovascular aortic repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients undergoing complex endovascular aortic procedures (endovascular aortic repair [EVAR] and thoracic EVAR) with CAE at a single institution over a 12-year period were included. Pre- and postoperative clinical, radiologic, and laboratory data were reviewed to identify mesenteric complications related to CAE and to assess long-term survival and radiologic changes in collateral anatomy. Multivariable logistic regression was used to determine the association between collateral vessel diameter change and mesenteric complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From 2011 to 2023, 70 patients underwent planned CAE during complex EVAR. With regards to mesenteric complications not attributable to the superior mesenteric artery (SMA) stent, 11.4% had 30-day mesenteric complications, including upper gastrointestinal bleed or perforated ulcer (n = 3), cholecystitis (n = 2), pancreatitis (n = 2), and ischemic hepatitis (n = 1). During 31 to 90 days after CAE, two additional patients (2.9%) had upper gastrointestinal bleed. With regards to 90-day mesenteric complications related to the SMA stent, four additional patients (5.7%) had SMA stent complications leading to mesenteric ischemia. On Kaplan-Meier analysis, patients with any 90-day mesenteric complication had significantly lower overall 2-year survival (42.5% vs 75.0%; P = .002). On preoperative imaging, 20% of patients had variant SMA anatomy with the gastroduodenal artery as the dominant SMA-celiac collateral pathway in 68.6%. Postoperatively, patients without mesenteric complications had a greater increase in the collateral diameter at both SMA and celiac junctions at 1, 3 to 6, 12, and 24 months, with a statistically significant difference in diameter at 1 month compared with patients with complications (median: 16.2% vs -2.1% at celiac; P = .006 and 20.8% vs 7.7% at SMA; P = .021). On adjusted multivariate regression, increase in collateral diameter at the SMA junction on first postoperative computed tomography was significantly protective of 90-day mesenteric complications (odds ratio, 0.93; 95% confidence interval, 0.87-0.96; P = .046).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CAE during complex EVAR is a useful adjunct to increase seal zone in select patients; however, mesenteric complications occur in 14% of the patients over a 90-day postoperative period, and patients with mesenteric complications have a higher long-term all-cause mortality. CAE should be a technique within the tool","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751181","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":"Comparison of EndoSuture vs fenestrated aortic aneurysm repair in treatment of abdominal aortic aneurysms with unfavorable neck anatomy.","authors":"Arash Fereydooni, Keyuree Satam, Shernaz Dossabhoy, Claudia Trogolo-Franco, Sabina Sorondo, Shipra Arya, Brant W Ullery, Jason T Lee","doi":"10.1016/j.jvs.2024.11.020","DOIUrl":"10.1016/j.jvs.2024.11.020","url":null,"abstract":"<p><strong>Background: </strong>Hostile aortic neck anatomy is associated with loss of proximal seal and increased late reinterventions. Although both EndoSuture aneurysm repair (ESAR) and fenestrated endovascular aortic repair (FEVAR) are commercially available options for treatment of short neck aneurysms, branch vessel patency is a potential tradeoff for improved seal with FEVAR owing to the incorporation of renovisceral vessels. This study compares the performance of ESAR vs FEVAR in hostile aortic necks.</p><p><strong>Methods: </strong>Patients who underwent elective ESAR or FEVAR for hostile neck AAAs at a single center from 2012 to 2024 were reviewed retrospectively. Exclusion criteria included pararenal or thoracoabdominal aortic aneurysm, off-label modifications, and nonstandard FEVAR configurations. Propensity matching weights were generated based on age, year of operation, preoperative estimated glomerular filtration rate, neck length, neck diameter, and infrarenal angulation. Rates of survival, reintervention, dialysis, chronic kidney disease stage progression, type IA endoleak (EL), and sac regression (>5 mm) were assessed at latest follow-up.</p><p><strong>Results: </strong>Of 391 patients, 60 with ESAR and 207 with FEVAR were included. FEVAR patients were younger (74.4 years vs 79.8 years; P < .001) with larger neck diameters (25.0 mm vs 23.6 mm; P = .016), shorter neck length (5.0 mm vs 9.8 mm; P < .001), and decreased infrarenal angulation (20° vs 40°; P < .001). After propensity score-adjusted regression (58 ESAR, 169 FEVAR), FEVAR, compared with ESAR, was associated with decreased IA EL (hazard ratio, 0.341; 95% confidence interval [CI], 0.061-0.72; P = .031) and increased sac regression (hazard ratio, 3.92; 95% CI, 1.25-5.14; P = .02). Notably, FEVAR was associated with increased 1-year aneurysm-related reintervention (odds ratio, 4.33; 95% CI, 1.12-10.54; P = .046). On Kaplan-Meier analysis, FEVAR was associated with reduced freedom from reinterventions at 3 years (71.8% [95% CI, 0.63-0.78] vs 93.5% [95% CI, 0.80-0.97]; log-rank P = .019) but a trend toward improved survival at 3 years (79.15% [95% CI, 0.70-0.85] vs 61.5% [95% CI, 0.44-0.74]; log-rank P = .095). There was no significant difference in new-onset chronic dialysis between ESAR and FEVAR at 3 years (94.2% [95% CI, 0.82-0.98] vs 97.4% [95% CI, 0.93-0.99]; log-rank P = .124).</p><p><strong>Conclusions: </strong>In the treatment of abdominal aortic aneurysms with hostile neck anatomy in this propensity-matched cohort, FEVAR was associated with fewer type IA ELs and greater sac regression compared with ESAR, with no detrimental impact on long-term renal function. There were more reinterventions, mostly branch related, in the FEVAR group. We await the results of the current randomized prospective trial comparing these strategies to further determine the impact of these clinical differences on aneurysm-related mortality.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative smoking cessation improves carotid endarterectomy outcomes in asymptomatic carotid stenosis patients.","authors":"Hassan Chamseddine, Alexander Shepard, Constantinos Constantinou, Timothy Nypaver, Mitchell Weaver, Tamer Boules, Yasaman Kavousi, Kevin Onofrey, Andi Peshkepija, Mouhammad Halabi, Loay Kabbani","doi":"10.1016/j.jvs.2024.11.022","DOIUrl":"10.1016/j.jvs.2024.11.022","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Smoking cessation has been suggested as having the potential to improve the outcomes of carotid endarterectomy (CEA) and mitigate the risk of long-term stroke in patients with asymptomatic carotid stenosis (ACS). This study aims to compare the perioperative and long-term outcomes of CEA in patients with ACS across different smoking status groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;All patients receiving an elective CEA for ACS between 2013 and 2023 were identified in the Vascular Quality Initiative (VQI). Patients with an ipsilateral carotid stenosis &lt;70% and those receiving a concomitant coronary artery bypass graft were excluded. Patients were then classified according to their smoking status: never smokers, former smokers (defined as those who have stopped smoking more than 30 days prior to their operation), and current smokers. Patient characteristics and outcomes were compared using the χ&lt;sup&gt;2&lt;/sup&gt; or Fischer exact test as appropriate for categorical variables and the analysis of variance or Kruskal-Wallis test as appropriate for continuous variables. Cox regression analysis was used to study the association between smoking status and the primary outcomes of long-term stroke and major adverse cardiac events (MACE) defined as the composite outcome of stroke, myocardial infarction, and/or mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 77,664 patients received a CEA for ACS, of which 19,416 patients (25%) were never smokers, 39,374 patients (51%) were former smokers, and 18,874 patients (24%) were current smokers. Patients in the three groups had similar rates of perioperative stroke (P = .79), myocardial infarction (P = .07), mortality (P = .23), and MACE (P = .17). At 18-month follow-up, former and never smokers had similar rates of stroke (former 0.9% vs never 0.8%; P = .92), with former smokers exhibiting a lower stroke risk than current smokers (former 0.9% vs current 1.5%; P = .001). At 18 months, former smokers had a significantly lower rate of MACE compared with current smokers (former 11.8% vs current 13.2%; P = .03), but a higher rate compared with never smokers (former 11.8% vs never 8.7%; P &lt; .001). On multivariate Cox regression analysis, compared with current smokers, former smokers were independently associated with a lower risk of stroke (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.53-0.87; P = .002), mortality (HR, 0.79; 95% CI, 0.74-0.84; P &lt; .001), and MACE (HR, 0.77; 95% CI, 0.70-0.83; P &lt; .001). No difference in long-term stroke risk was observed between former and never smokers (HR, 1.06; 95% CI, 0.82-1.38; P = .65).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study demonstrates that preoperative smoking cessation in patients with ACS significantly reduces the risk of stroke, mortality, and MACE following CEA compared with continued smoking, aligning their outcomes more closely with those of never smokers. Optimizing patients with ACS prior to surgery should include smoking ce","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751185","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}