Journal of Vascular Surgery最新文献

{"title":"Racial and Ethnic Minority Groups, Female Sex, and Tissue Loss are Associated with Increased Risk for Hospital Readmission Following Revascularization for Chronic Limb-Threatening Ischemia.","authors":"Walker R Ueland, Muhammad J Javed, Michael Spinosa, Tam Nguyen, Amin Mirzaie, Udochukwu Amanamba, Dan Neal, Salvatore T Scali, Martin R Back, Thomas S Huber, Gilbert R Upchurch, Samir K Shah","doi":"10.1016/j.jvs.2025.05.203","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.203","url":null,"abstract":"<p><strong>Introduction: </strong>Unplanned hospital readmission following surgery for peripheral arterial disease (PAD) is among the highest in all diagnosis-related groups. While previous studies have examined readmissions in certain subgroups, such as for patients undergoing lower extremity bypass, few have examined longer term readmissions for those with the most severe form of PAD, chronic limb-threatening ischemia (CLTI). Among patients with CLTI undergoing revascularization, we sought to outline rates of readmission beyond 30 days up to 1 year and identify patient and procedural characteristics associated with readmission.</p><p><strong>Methods: </strong>We identified patients by CPT codes from 1/6/2020 to 5/25/2022, and collected demographic, operative, and one-year outcomes data. We used univariate and multivariable modeling to assess factors associated with hospital readmission.</p><p><strong>Results: </strong>Of the 247 patients who underwent intervention for CLTI, 130 patients (53%) were readmitted within one year, primarily for revascularization-related problems. 130 patients (53%) were readmitted within one year. The most common indications for readmission within 30 days and one year were wound infection and tissue breakdown (48.3%, 37.7%) and new rest pain or tissue loss (13.8%, 20.8%). The only cause of readmission considered non-modifiable was staged procedure. Overall, 96.6% and 96.9% of readmissions within 30 days and 1 year were potentially modifiable (i.e., wound infection and tissue breakdown, new rest pain or tissue loss, graft thrombosis, sepsis, myocardial infarction, etc.). After multivariable adjustment, racial and ethnic minority groups (OR 2.6, p=.009), female sex (OR 2.1, p=.031), and tissue loss as an indication (OR 4.1, p=.0002) were associated with readmission within 30 days. At one-year, only racial and ethnic minority (OR 2.6, p=.007) and a tissue loss indication (OR 2.1, p=.011) were associated with readmissions. Patient age, comorbidity burden, area deprivation index, and intervention type (endovascular vs open) were not significantly associated with 30-day and 1-year readmissions. Racial and ethnic minority groups (p=0.014), female sex (p=0.05), AKI (p=0.014), and index hospital LOS (p=0.009) were associated with multiple readmissions. Number of readmissions was not associated with risk of major limb amputation.</p><p><strong>Conclusions: </strong>Postoperative readmission among patients with CLTI is high and occurs primarily for wound infections and new rest pain or tissue loss. Overall, the majority of readmissions were for potentially modifiable reasons. Racial and ethnic minority groups and female patients undergoing revascularization for tissue loss are at highest risk for readmissions. These data support the investigation of interventions targeting these high-risk populations.</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":"144234462","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":"Fenestrated/Branched endovascular repair after failed endovascular aortic repair has similar perioperative outcomes to primary repairs.","authors":"Mouhammad Halabi, Hassan Chamseddine, Alexander Shepard, Timothy Nypaver, Mitchell Weaver, Andi Peshkepija, Tamer Boules, Yasaman Kavousi, Kevin Onofrey, Loay Kabbani","doi":"10.1016/j.jvs.2025.05.205","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.205","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) in patients undergoing reintervention for failed endovascular aneurysm repair (EVAR) compared to those undergoing primary FB-EVAR.</p><p><strong>Methods: </strong>Patients undergoing FB-EVAR between 2014 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were then divided into two groups, those undergoing FB-EVAR after failed EVAR and those undergoing primary FB-EVAR. Baseline characteristics, operative details, and outcomes were compared between groups. Primary outcomes included mortality, reintervention, and endoleak (Type I/III) rates. Secondary outcomes included perioperative complications. Kaplan-Meier survival analysis and Cox regression were used to evaluate 1-year outcomes.</p><p><strong>Results: </strong>A total of 2067 patients were included in this study, 386 (18.6%) underwent F/BEVAR after failed EVAR, while 1,681 (81.4%) underwent primary FB-EVAR. In the failed EVAR group, perioperative mortality (3.1% vs. 4%, p=0.934) and rates of Type I/III endoleaks (6.5% vs 8.6%, p=0.164) were comparable to that of no prior EVAR. At 12-month follow-up, mortality rates remained similar (17.2% vs. 15.8%, p=0.265), However, patients with prior EVAR had a significantly higher reintervention rates (HR 1.60, 95% CI 1.10-2.35, p=0.015), despite similar mortality and endoleak rates.</p><p><strong>Conclusion: </strong>FB-EVAR is a safe and effective reintervention strategy following failed EVAR, achieving similar mortality and endoleak outcomes compared to primary FB-EVAR. However, the significantly higher reintervention rates in patients with prior EVAR may be related to the increased complexity this population.</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":"144234420","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":"Exploring Socioeconomic Disparities in Outcomes and Follow-up After Endovascular Treatment of Abdominal Aortic Aneurysms among Medicare Beneficiaries.","authors":"Elisa Caron, Christina L Marcaccio, Emily St John, Siling Li, Yang Song, Robert W Yeh, Marc L Schermerhorn, Eric A Secemsky","doi":"10.1016/j.jvs.2025.05.051","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.051","url":null,"abstract":"<p><strong>Objective: </strong>Socioeconomic disparities are known to contribute to adverse outcomes after surgery; however, the role of individual wealth and neighborhood environment on both follow-up and outcomes following EVAR are not well understood.</p><p><strong>Methods: </strong>We included all fee-for-service Medicare beneficiaries ≥66 years who underwent infrarenal EVAR with a bifurcated endograft for intact AAA from 2011-2019. Patients were divided into cohorts using dual enrollment in Medicare/Medicaid (vs. Medicare only) as a measure of individual wealth and residence in a distressed community (vs. non-distressed community) as a measure of regional wealth (as defined by the Distressed Community Index, DCI). The primary outcome was the composite of late aneurysm rupture, aortic reintervention, conversion to open repair, or all-cause mortality at 9 years. The cumulative incidence of the primary composite outcome was determined using Kaplan Meier methods and compared across groups using log-rank tests.</p><p><strong>Results: </strong>Of 111,381 patients who underwent EVAR, 9,991 (9.0%) were dual-enrolled in Medicare/Medicaid, and 22,902 (21%) lived in distressed communities. A higher incidence of the primary outcome was observed in dual-enrolled vs. Medicare-only patients (83% vs 72%, hazard ratio (HR) 1.42[95% Confidence interval (CI) 1.38, 1.47] p<.01) and in those living in distressed vs. non-distressed communities (75% vs 72%, HR 1.09[1.06,1.11] p<.01). After adjustment for comorbidities and other disparity measures, the association between dual enrollment or DCI and the primary outcome was attenuated but remained significant (aHR 1.19 [95%CI 1.15, 1.23], aHR 1.03 [95%CI 1.00,1.05], respectively). When mortality was removed from the primary outcome, the relationships between dual enrollment or DCI and the composite outcome were no longer significant after adjustment (aHR 1.02, [0.93, 1.13], aHR 0.95, [0.89, 1.05]). Among EVAR-specific secondary outcomes, rates of 9-year all-cause mortality and late rupture were higher in dual-enrolled vs. Medicare-only patients, and mortality rates were higher in distressed vs. non-distressed patients. In addition, both dual-enrolled and residents of distressed communities had lower rates of EVAR-related office visits and AAA-related imaging in follow-up and higher rates of emergency department visits.</p><p><strong>Conclusion: </strong>Among Medicare beneficiaries who underwent EVAR for AAA, socioeconomically disadvantaged beneficiaries had a higher incidence of the primary composite outcome, driven primarily by higher all-cause mortality. This study highlights the need for interventions targeted at improving access to appropriate disease surveillance and management of comorbidities for patients who are most vulnerable.</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":"144234419","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":"Principles and Practice in Pediatric Vascular Trauma: Part 2: Fundamental Vascular Principles, Pediatric Nuance, and Follow-up Strategies.","authors":"Matthew T Harting, Natalie A Drucker, Wendy Chen, Bryan A Cotton, S Keisin Wang, Joseph J DuBose, Charles S Cox","doi":"10.1016/j.jvs.2024.12.121","DOIUrl":"10.1016/j.jvs.2024.12.121","url":null,"abstract":"<p><p>As of 2020, penetrating injuries became the leading cause of death among children and adolescents ages 1-19 in the United States. For those patients who survive and receive advanced medical care, vascular injuries are a significant cause of morbidity and trigger notable trauma team angst. Moreover, penetrating injuries can lead to life-threatening hemorrhage and/or limb-threatening ischemia if not addressed promptly. Vascular injury management demands timely and unique expertise, particularly for pediatric patients. In part 1 of this review, we discussed the scope and extent of the epidemic of traumatic vascular injuries in pediatric patients, reviewed current evidence and outcomes, discussed various challenges and advantages of a myriad of existing team structures, and outlined potential outcome targets and solutions. However, in order to optimize care for pediatric vascular trauma, we must also understand the fundamental best practice principles, surgical options and approaches, medical management, and recommendations for ongoing, outpatient follow-up. In part 2, we will address the best evidence, combined with expert consensus, regarding strategies for diagnosing, managing, and ongoing follow-up of vascular trauma, with particular focus on the nuances that define the unique approaches to pediatric patients. LEVEL OF EVIDENCE: n/a.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199520","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 of carotid artery stenting for nonatherosclerotic disease.","authors":"Mouhammad Halabi, Hassan Chamseddine, Alexander Shepard, Timothy Nypaver, Mitchell Weaver, Tamer Boules, Loay Kabbani","doi":"10.1016/j.jvs.2025.04.043","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.043","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate and compare the outcomes of transcarotid artery revascularization (TCAR) and transfemoral carotid artery stenting (tfCAS) in patients with nonatherosclerotic carotid diseases, including dissection, trauma, and fibromuscular dysplasia.</p><p><strong>Methods: </strong>Patients who underwent TCAR and tfCAS for nonatherosclerotic carotid diseases between 2016 and 2024 were identified in the Vascular Quality Initiative (VQI) database. Patients were classified into TCAR or tfCAS based on the procedure performed. Baseline characteristics, demographics, and operative details were collected. Primary outcomes included stroke, death, and major adverse cardiovascular events (MACE), which was defined as the composite of stroke, myocardial infarction, and death. Secondary outcomes included perioperative complications. Descriptive statistics, univariable comparisons, and multivariable logistic regression analyses were performed to evaluate the association between procedure type and outcomes. A two-tailed P value of <.05 was considered statistically significant.</p><p><strong>Results: </strong>Six hundred seventy six patients were identified (tfCAS, n = 503; TCAR, n = 173). TCAR patients were older (64 ± 14 years vs 56 ± 16 years; P < .001), and had higher rates of hypertension (74% vs 60.4%; P = .001) and coronary artery disease (34.1% vs 22.2%; P = .002). Dissection was the most common etiology (TCAR, 77.5%; tfCAS, 77.9%), followed by fibromuscular dysplasia (TCAR, 14.5%; tfCAS, 10.5%) then trauma (TCAR, 8.1%; tfCAS, 11.5%). Intraoperatively, TCAR patients had shorter fluoroscopy times (5 minutes vs 18.25 minutes; P < .001) and required less radiocontrast (30 mL vs 95 mL; P < .001), but had slightly longer procedure times (75.5 minutes vs 69 minutes; P = .055). When analyzed by procedure type, TCAR was associated with significantly lower rates of MACE (1.2% vs 7%; P = .004) and stroke/death (1.2% vs 6.4%; P = .007) compared with tfCAS. Furthermore, when stratified by symptomatic status, TCAR consistently had lower rates of MACE and stroke/death. On multivariate analysis, TCAR was independently associated with a significantly lower risk of MACE (odds ratio, 0.09; 95% confidence interval, 0.01-0.74; P = .025) and stroke/death (odds ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .045).</p><p><strong>Conclusions: </strong>TCAR was associated with superior perioperative outcomes compared with tfCAS in the treatment of nonatherosclerotic carotid diseases. These findings highlight TCAR's potential to be a safer and more effective treatment option for this challenging patient population.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248478","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":"Understanding the Risks of Abdominal Aortic Endograft Explantation with Early Outcomes from Two Decades of Experience.","authors":"Andrew Huang, Craig Brown, Shipra Arya, Katherine Gallagher, Jonathan Eliason","doi":"10.1016/j.jvs.2025.05.048","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.048","url":null,"abstract":"<p><strong>Objectives: </strong>Endovascular aneurysm repair (EVAR) currently comprises more than two thirds of all AAA repairs in the United States. However, data show that patients are at higher risk for late mortality after EVAR compared to open repair. As the number of aging EVARs grow, so, too, does the number requiring explant. The objective of this work is to highlight perioperative details and outcomes of EVAR explantation to allow physicians to better counsel patients regarding the perioperative risks.</p><p><strong>Methods: </strong>We abstracted all open aortic procedures performed at the University of Michigan from January of 2002 to January of 2024, from which cases of late aortic endograft explants (>30 days) were identified. We then collected and compared data regarding pre-operative demographics & aneurysm related history, peri-operative characteristics, and post-operative course including explant indication and endograft type using t-test, χ2, or their non-parametric counterpart when appropriate. Multivariable logistic regression models were developed to evaluate postoperative complications and 30-day mortality rates. Survival was compared using Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>142 EVAR explants were evaluated, 100 for endoleak and 42 for infection from 2002-2024. Patients with infected endografts were more likely than those with endoleaks to have any complications (57.1% vs 32.0%, p=0.006) and serious complications (54.8% vs 30.0%, p=0.005). Real world complications were reflected in NSQIP estimated risks, with infected endograft patients at a higher predicted NSQIP risk than endoleak patients for any complication (44.9% vs 35.6%, p<0.001), serious complication (35.7% vs 29.2%, p <0.001), and 30-day mortality (19.0% vs 7.0%, p=0.03). No differences were seen based on endograft type. Infected endografts were at higher risk for mortality at 30 days (28.6% vs 14.0%, p=0.03). That trend persisted to 2 years (38.1% vs 15.0%, p=0.007). Most mortality occurred by post-op day 45.</p><p><strong>Conclusions: </strong>EVAR explantation regardless of indication places patients at high risk for mortality, with infection conferring early mortality risk in this cohort. This work underscores the need for a candid discussion regarding operative risk with patients facing explantation.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199521","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":"Aneurysm sac regression after fenestrated or branched endovascular aortic repair is associated with superior long-term survival.","authors":"Kiera Zehner, Jeremy Zack, Andres Schanzer, Adam W Beck, Matthew P Sweet, Gustavo Oderich, Carlos H Timaran, Mark A Farber, Warren J Gasper, W Anthony Lee, Matthew J Eagleton, Xingsheng Li, Ryan Cantor, Grace J Wang, Darren B Schneider","doi":"10.1016/j.jvs.2025.05.047","DOIUrl":"10.1016/j.jvs.2025.05.047","url":null,"abstract":"<p><strong>Objective: </strong>Aneurysm sac behavior after fenestrated or branched endovascular repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAAs) remains a key knowledge gap. The purpose of this study was to identify independent predictors of sac behavior after FB-EVAR and assess the relationship between sac behavior and long-term survival.</p><p><strong>Methods: </strong>Patients undergoing FB-EVAR between 2005 and 2023, in 10 physician-sponsored investigational device exemption studies in the United States, were analyzed. Patients who underwent elective FB-EVAR for juxtarenal, suprarenal, or extent 1 to 5 TAAAs and had 30-day and 1-year computed tomography follow-up imaging were included. Patients with chronic aortic dissections were excluded. Sac regression or expansion (≥5 mm) was defined using the Society for Vascular Surgery guidelines. Independent predictors of sac growth were identified using multivariable logistic regression analysis and survival rates were compared using Kaplan-Meier curves.</p><p><strong>Results: </strong>Of 3057 patients who underwent FB-EVAR, 1497 were eligible for analysis. Median follow-up was 2.9 years (interquartile range, 1.3-4.0 years). At 1 year, 103 (6.9%) patients experienced sac expansion, 694 (46.4%) experienced sac regression, and 700 (46.7%) had a stable sac. Variables independently associated with sac expansion were age (odds ratio [OR] 1.04; 95% confidence interval [CI], 1.01-1.07; P = .0057), prior aortic surgery (OR, 2.22; 95% CI, 1.32-3.40; P = .0026), prior EVAR (OR, 1.84; 95% CI, 1.07-3.14; P = .0264), larger aneurysm diameter (OR, 1.03; 95% CI, 1.01-1.04; P = .0014), type II endoleak observed on 30-day follow-up computed tomography (OR, 2.15; 95% CI, 1.36-3.41; P = .0011), and any secondary intervention during the first year (OR, 2.19; 95% CI, 1.35-3.55; P = .0016). Overall survival at 1 year was significantly lower in the expansion group compared with the stable and regression groups (85.6% vs 90.9% vs 93.1%, respectively). This effect persisted on 5-year evaluation (48.1% vs 63.0% vs 67.7%, respectively). Both expansion and stability at 1 year were both associated with increased long-term mortality in unadjusted cox model (expansion, hazard ratio, 2.083; 95% CI, 1.47-2.95; P < .0001; stability, hazard ratio, 1.26; 95% CI, 1.02-1.56; P = .0298) vs regression.</p><p><strong>Conclusions: </strong>Both aneurysm sac expansion and stability (lack of regression) one year after FB-EVAR are associated with decreased long-term survival compared with sac regression. These outcomes underscore the need for vigilant monitoring of patients without sac regression and to better understand if interventions to address factors associated with unfavorable aneurysm sac behavior can improve long-term survival.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191938","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":"Five-year pivotal trial outcomes of the Gore Excluder conformable endoprosthesis implanted in abdominal aortic aneurysms with short non-angulated infrarenal seal zones.","authors":"Bjoern D Suckow, Gustavo S Oderich, Mahmoud W Almadani, Dai Yamanouchi, Alyssa J Pyun, Erin Moore, Patrick E Muck, Robert Y Rhee","doi":"10.1016/j.jvs.2025.04.038","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.038","url":null,"abstract":"<p><strong>Objective: </strong>The GORE EXCLUDER Conformable Abdominal Aortic Aneurysm Endoprosthesis with Active Control System (EXCC) is approved in the United States (U.S.) for treatment of AAAs and highly angulated (≤90°) and short (≥10 mm) infrarenal aortic proximal seal zones (necks). Reported here are the 5-year outcomes of the EXCC U.S. pivotal clinical trial in the short, non-angulated cohort (SNA).</p><p><strong>Methods: </strong>The EXCC investigational device exemption prospective pivotal trial short neck sub-study across 31 sites included patients with infrarenal necks measuring ≥10 mm length and ≤60° angulation. Five-year outcomes assessed by Core lab and adjudicated by independent review committee included patient safety (mortality, reintervention, rupture, conversion to open repair), device effectiveness (freedom from endoleak, migration, fracture, erosion, occlusion), and freedom from aneurysm sac expansion in the SNA cohort and subpopulations of patients with neck length of ≥10 mm to <15 mm and ≥15 mm.</p><p><strong>Results: </strong>The EXCC device was implanted in 80 SNA patients, of which 23 (29%) had <15 mm neck length and 57 (71%) had ≥15 mm. Patients were a mean age of 73.5 ± 8.1 years, 93.8% White, and had a mean body mass index of 29.5 ± 5.1 kg/m². At 5 years, 15 patients died, 12 were lost to follow-up, and for 47 of the 53 remaining patients, 5-year follow-up data was available. The mean maximum abdominal aortic aneurysm (AAA) diameter was 57.7 mm (range, 42.5-82.7 mm), and the mean infrarenal aortic angle was 35.7° (range, 3°-59°). Through 5 years, no aneurysm-related mortality, conversion to open repair, obstruction, occlusion, erosion, migration, or type I or type III endoleaks were reported. AAA expansion ≥5 mm occurred in eight patients (10.3%). Nine patients (11.3%) underwent reintervention, predominantly embolization for type II endoleak. One patient (1.3%) experienced an AAA rupture. In patients with a ≥10 mm to <15 mm seal zone vs a ≥15 mm seal zone, differences in AAA expansion (9.5% vs 10.5%) or reinterventions (8.7% vs 12.3%) were not significant (P = 1.0).</p><p><strong>Conclusions: </strong>The 5-year outcomes of the EXCC U.S. pivotal trial demonstrate excellent patient safety and device effectiveness endpoints. There is complete absence of aneurysm-related mortality, conversion to open repair, significant endoleak, or device occlusion/migration. Reinterventions and AAA sac expansion are infrequent and do not differ between short or standard infrarenal seal zone lengths. The EXCC device is safe and effective through 5 years for AAA necks measuring ≥10 mm length and ≤60° angulation.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216220","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":"Isolated middle cerebral artery significantly increases risk of postoperative stroke after transcarotid revascularization in asymptomatic patients.","authors":"Natalie G Ray, Fanny S Alie-Cusson, Halim Yammine, Charles S Briggs, Jeremy Hackworth, Sarah G Burnash, Conall T Monahan, Joe Bernard, Frank R Arko","doi":"10.1016/j.jvs.2025.05.046","DOIUrl":"10.1016/j.jvs.2025.05.046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Limited research has been conducted to demonstrate the safety and efficacy of flow reversal in transcarotid revascularization (TCAR) patients with an ipsilateral isolated middle cerebral artery (iMCA). We hypothesize that an iMCA decreases tolerance to flow reversal and increases the risk of ipsilateral ischemic stroke after TCAR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Clinical data and outcomes for TCAR were collected prospectively through our multihospital single-institution Vascular Quality Initiative study between January 2019 and April 2024. Patient characteristics, imaging, and outcomes were reviewed retrospectively. Symptomatic patients and patients with inadequate intracranial imaging for appropriate circle of Willis (CoW) assessment were excluded. All anatomical segments of the CoW were evaluated by the same research assistant and radiologist and classified as normal, hypoplastic, or absent. The anterior semicircle and both the ipsilateral and contralateral posterior semicircles were further classified as complete, incomplete, and hypoplastic accordingly. The ipsilateral MCA was defined as isolated (iMCA) if there were incomplete segments in both the anterior semicircle and the ipsilateral posterior semicircle. Patients were then divided into iMCA and non-iMCA groups for comparison. Primary outcome was immediate neurological event (INE), defined as any transient ischemic attack or stroke diagnosed within 24 hours of the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 230 TCARs (218 patients) performed for asymptomatic severe carotid artery stenosis were included in our analysis. Baseline characteristics did not differ significantly between groups. The median treated lesion length was significantly longer in the nonisolated MCA group at 24 mm compared with 19 mm. After imaging analysis, no patient was found to have a complete CoW. An ipsilateral iMCA was found in 27 cases (11.7% of 230 cases, 12.4% of 218 patients). A total of four patients (1.7%) suffered an INE. Cases complicated by INE had significantly longer flow reversal times (13.5 minutes vs 9 minutes; P = .0142), but did not differ between the iMCA and non-iMCA groups. INE occurred in three cases (11.1%) in the iMCA group vs one (0.5%) in the non-iMCA group (P = .005). iMCA was significantly associated with risk of INE on univariable logistic regression (odds ratio, 25.3; 95% confidence interval, 2.5-252.4; P = .006).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this retrospective, single-center study of 230 patients with asymptomatic carotid artery stenosis undergoing TCAR, an iMCA significantly increases the risk of postoperative stroke. Our results suggest that comprehensive intracranial imaging should be considered for all patients to assess the CoW anatomy optimally before flow reversal. We recommend avoiding flow reversal in this patient population and considering alternative treatment methods such as carotid endarterectomy with shunting or transf","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191939","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":"Hospital setting of endovascular repair influences procedural outcomes in blunt traumatic aortic injury.","authors":"John H Cabot, Micaella Zubkov, Lisa M Knowlton, Anna Romagnoli, David S Kauvar","doi":"10.1016/j.jvs.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.04.021","url":null,"abstract":"<p><strong>Background: </strong>Thoracic endovascular aortic repair (TEVAR) has become the mainstay of treatment for blunt thoracic aortic injuries (BTAI) over open repair. Since the arrival of TEVAR, hybrid operating rooms have emerged as highly specialized environments equipped to streamline endovascular and open cases. Procedure characteristics and outcomes may vary when TEVAR is performed in the setting of a standard operating room with a portable C-Arm vs in a hybrid operating room or interventional radiology (IR) suite with a fixed imaging system. The purpose of this study was to compare clinical characteristics and outcomes of TEVAR for BTAI across these settings. We hypothesize that cases performed with a C-Arm would lead to higher rates of complications.</p><p><strong>Methods: </strong>The PROOVIT registry (PROspective Observational Vascular Injury Treatment) captures trauma-specific outcomes related to vascular injury across 14 trauma centers in the United States. The registry was queried for BTAI undergoing TEVAR from 2012 to 2021. Cases were categorized as having been performed in a standard operating room with portable C-Arm imaging (C-Arm), or in a fixed imaging suite (hybrid room [Hybrid] or IR). Procedural characteristics and complications (arterial access, reintervention, stroke) were collected and compared using univariate analyses.</p><p><strong>Results: </strong>PROOVIT contained 199 TEVAR for BTAI: 82 C-Arm, 75 Hybrid, and 42 IR cases. There was no clear temporal trend in the setting TEVAR was performed. Demographics and mechanism of injury were similar between groups; Hybrid room procedures had higher median Injury Severity Score (ISS) (38; interquartile range [IQR], 14) than C-Arm (33; IQR, 15) and IR (29; IQR, 25; P = .02) and a higher proportion of cases with an Abbreviated Injury Scale head score of >3 (44% vs 28% C-Arm vs 24% IR; P = .06). Hybrid cases were most often delayed >6 hours from arrival (78% vs 48% vs 41%; P < .001), but C-Arm cases most frequently lasted >3 hours (34% vs 12% Hybrid vs 15% IR; P = .002). Use of C-Arm (P = .03) and time to TEVAR of <6 hours (P = .04) were predictors of complications. All strokes (n = 3) occurred in C-Arm cases (P = .04).</p><p><strong>Conclusions: </strong>Despite technological advances, TEVAR for BTAI is still performed frequently in a standard operating room with C-Arm imaging, rather than with a fixed imaging system in a hybrid operating room or IR suite. C-Arm procedures take longer and have higher complication rates, including stroke. TEVAR for BTAI is conducted most safely using a fixed imaging system in a hybrid operating room setting.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216221","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}