Journal of Vascular Surgery最新文献

{"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":"<p><strong>Objective: </strong>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 > 50%) across three stroke centers.</p><p><strong>Methods: </strong>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 >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.</p><p><strong>Results: </strong>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 < .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 < .01), ulceration (MMDS: 30.0% vs HDS: 13.0%; P < .01), and overall vulnerable plaque features other than stenosis (MMDS: 80.0% vs HDS: 39.4%; P < .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 <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}

{"title":"A systematic review and meta-analysis of prognosis and revascularization strategies in chronic limb-threatening ischemia according to the global limb anatomical staging system.","authors":"Carlos B Melo, Dilson Pimentel-Junior, Mariana K Obara, Denise Filippini, Enrico P Bertolino, Miguel Godeiro Fernandez, Milena Monteiro Mastra, Katharine L McGinigle, Michael S Conte, Grace Carvajal Mulatti","doi":"10.1016/j.jvs.2026.07.079","DOIUrl":"10.1016/j.jvs.2026.07.079","url":null,"abstract":"<p><strong>Objective: </strong>To perform a systematic review and meta-analysis evaluating the prognostic utility of the Global Limb Anatomical Staging System (GLASS) classification in patients with chronic limb-threatening ischemia, and to determine which intervention, endovascular or open bypass, is associated with superior outcomes in patients classified as GLASS III.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis using PubMed, Scopus, and Cochrane Central from inception through October 2025. Outcomes compared across GLASS stages included immediate technical success (ITS) of endovascular procedures, overall survival, amputation-free survival, limb salvage, freedom from major adverse limb events (MALE), and limb-based patency (LBP). For patients with GLASS III disease, we directly compared endovascular vs surgical bypass revascularization for overall survival, freedom from MALE, and limb salvage.</p><p><strong>Results: </strong>We included 17 studies in the meta-analysis, comprising 5290 patients and 5492 limbs: 945 (17.2%) GLASS I, 1431 (26.1%) GLASS II, and 3116 (56.7%) GLASS III. Compared with GLASS I, GLASS II presented a significantly higher hazard for LBP failure [hazard ratio (HR), 1.53; 95% confidence interval (CI), 1.06-2.20; P = .032] and major amputation (endovascular only; HR, 1.45; 95% CI, 1.13-1.86). When comparing GLASS III with GLASS I, GLASS III had significantly higher hazard for mortality (HR, 1.28; 95% CI, 1.06-1.56; P = .021), MALE (HR, 1.36; 95% CI, 1.02-1.83; P = .042), and LBP failure (HR, 2.23; 95% CI, 1.56-3.19; P = .003). GLASS I presented a significantly higher ITS rate compared with GLASS II [risk ratio (RR), 1.03; 95% CI, 1.01-1.05; P = .016] and GLASS III (RR, 1.24; 95% CI, 1.09-1.41; P = .005). GLASS II also showed a significantly higher ITS rate compared with GLASS III (RR, 1.20; 95% CI, 1.04-1.38; P = .017). No other comparisons across GLASS stages were statistically significant. Among patients classified as GLASS III, we found an increased hazard of MALE in the endovascular group compared with open bypass surgery (HR, 1.88; 95% CI, 1.35-2.61; P = .015). No significant differences were identified between endovascular and surgical bypass revascularization for other outcomes.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates that increasing GLASS anatomical severity is associated with progressively lower ITS following endovascular intervention and increased hazard of LBP failure across all revascularization strategies in patients with chronic limb-threatening ischemia. Patients classified as GLASS I, with low complexity anatomies, had a lower mortality and MALE hazard compared with those with high-complexity disease (GLASS III). Among patients classified as GLASS III, endovascular therapy is associated with an increased hazard for MALE compared with bypass surgery.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669924","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":"Intravascular ultrasound versus angiography for lower-extremity peripheral artery disease endovascular revascularization: A systematic review and meta-analysis.","authors":"Marc-André d'Entremont, Graham R McClure, Krzysztof Kowalik, Eric A Secemsky, Samuel Lemaire-Paquette, Laura M Drudi, Andrew D Brown, Elisa Greco, Andrew Benko, Anirudh Mirakhur, Elie Girsowicz, Jane Newman, Jonathan Misskey, Simon Bérubé, Julien Barrière-Groppi, Pierre-Nicholas Perron, Zain Badar, John Harlock, Sanjit S Jolly","doi":"10.1016/j.jvs.2026.06.180","DOIUrl":"10.1016/j.jvs.2026.06.180","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to conduct a systematic review and study-level meta-analysis of randomized controlled trials and observational studies comparing intravascular ultrasound (IVUS) guidance with angiography guidance for peripheral artery disease (PAD) endovascular revascularization, as current evidence is lacking.</p><p><strong>Methods: </strong>We searched Medline, Embase, and CENTRAL from inception until November 22, 2025. Trials and observational studies were analyzed separately. We used random-effects as our primary analysis and assessed the certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation. Key outcomes included restenosis, reintervention, major amputation, and mortality.</p><p><strong>Results: </strong>We included two randomized trials (n = 387), and 19 observational studies (n = 1,164,329). According to randomized data, IVUS-guidance likely reduces restenosis compared with angiography-guidance [risk ratio (RR), 0.59; 95% confidence interval (CI), 0.42-0.83; moderate certainty]. However, IVUS may not reduce reintervention (RR, 0.68; 95% CI, 0.44-1.08; low certainty), or mortality (RR, 1.13; 95% CI, 0.37-3.42; low certainty), whereas its effect on major amputation is very uncertain (RR, 0.97; 95% CI, 0.14-6.73; very low certainty). However, based on observational data, IVUS may reduce restenosis (RR, 0.70; 95% CI, 0.54-0.90; low certainty), reintervention (RR, 0.66; 95% CI, 0.48-0.90; low certainty), major amputation (RR, 0.83; 95% CI, 0.72-0.96; low certainty), and mortality (RR, 0.88; 95% CI, 0.84-0.93; low certainty).</p><p><strong>Conclusions: </strong>IVUS guidance likely reduces restenosis based on limited randomized evidence. Observational studies suggest potential benefits across several outcomes, although the certainty of evidence is low. Larger randomized trials are required to clarify the potential benefits of IVUS guidance.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670020","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":"Dual antiplatelet therapy is not associated with target vessel occlusion or bleeding complications following fenestrated and branched aortic repair.","authors":"Blake E Murphy, Gerald Anderson, Matthew P Sweet, Sara L Zettervall","doi":"10.1016/j.jvs.2026.07.080","DOIUrl":"10.1016/j.jvs.2026.07.080","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Delphi consensus guidelines recommend utilization of dual antiplatelet therapy (DAPT) following fenestrated and branched endovascular aortic repair (F/BEVAR) for target vessel (TV) patency. Limited data supports this recommendation with little known about the impact on bleeding events and optimal treatment duration. This study assesses TV occlusion and bleeding complications based on antithrombotic regimens following F/BEVAR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent F/BEVAR for treatment of thoracoabdominal aortic aneurysms at a single institution from 2012 to 2024 were assessed. Discharge regimens were maintained for 3-months, long-term regimens were assessed at 6-months and included single antiplatelet therapy (SAPT), DAPT, and anticoagulation (AC) plus SAPT. TV occlusion and bleeding events within 3-months were assessed with univariate analysis. Long-term outcomes including TV occlusion, bleeding events, reintervention, and survival were compared with Kaplan-Meier analysis. Multivariate Cox regression analysis was performed for TV occlusion, bleeding events, and survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 235 patients were included; 53% were discharged on SAPT, 28% on DAPT, and 19% on AC plus SAPT. During the study period, there were 35 TV occlusions (3.8%)-including 31 branches (6.1%), four fenestrations (1.0%), 29 renal (6.4%), and five mesenteric targets (1.1%). In total, nine TV occlusions (26%) occurred in the setting of documented cessation and/or noncompliance with prescribed antiplatelet medication regimens. TV occlusion within 3-months did not differ by discharge regimen. In time-to-event analysis, TV occlusions were similar based on discharge (P = .30) and long-term regimens (P = .62). At 1-year, 3.4%, 2.5%, and 0% of patients discharged on SAPT, DAPT, and AC plus SAPT had TV occlusions. In subgroup analysis, there were differences in TV occlusion by type of SAPT prescribed at discharge; 1-year (Aspirin, 2.1% vs Plavix, 17.1%; P &lt; .001). In adjusted analysis, renal targets [hazard ratio (HR), 7.5; 95% confidence interval (CI), 2.9-19.3] and branch configurations (HR, 8.3; 95% CI, 2.9-23.9) were associated with increased risk for TV occlusion, but medication regimens were not. In total, 41 patients (17%) experienced 51 bleeding events. The majority of bleeding events were minor (73%) and gastrointestinal bleeds (57%). Bleeding events by long-term regimen did not differ in time-to-event analysis (P = .07). However, in adjusted analysis, long-term AC plus SAPT was associated with increased risk of bleeding complications (HR, 3.1; 95% CI, 1.3-7.6) and decreased long-term survival (HR, 2.2; 95% CI, 1.1-4.3) compared with SAPT, whereas DAPT was not.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;DAPT was not associated with a significant reduction in TV occlusion following F/BEVAR. However, complete cessation of antithrombotic medications increases risk for TV occlusion, highlighting the critical ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670015","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":"Systematic review of pediatric abdominal aortic aneurysms.","authors":"Donia Ballan, Ahmad Aljobeh, Rahnuma Beheshti, Apostolos Tassiopoulos","doi":"10.1016/j.jvs.2026.06.178","DOIUrl":"10.1016/j.jvs.2026.06.178","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric abdominal aortic aneurysms (AAAs) are rare and differ fundamentally from adult degenerative disease in terms of etiology, presentation, and management. We performed a systematic review to characterize the causes, clinical features, treatment strategies, and outcomes of pediatric AAAs.</p><p><strong>Methods: </strong>This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted using PubMed/MEDLINE, Embase, and Web of Science from inception through March 2025. Studies reporting AAAs in patients aged ≤18 years were included. Case reports and case series were eligible. The data extracted included demographics, aneurysm characteristics, etiology, presentation, management approach, complications, and outcomes.</p><p><strong>Results: </strong>A total of 77 studies encompassing 87 pediatric patients met the inclusion criteria. The median age at presentation was 13 months [interquartile range (IQR): 1-96 months], with some cases identified during the prenatal period. Etiologies were idiopathic congenital (50.6%), mycotic (26.4%), genetic disorders (17.2%), and vasculitis (5.7%). Nearly half of aneurysms were detected incidentally, including eight cases identified prenatally. Thirteen patients (15%) presented with rupture. Most aneurysms were infrarenal (81.6%), with a mean diameter of 4.6 cm. Open surgical repair was the predominant treatment (n = 74), most commonly using prosthetic grafts. The overall mortality rate was 17.2%, with deaths primarily associated with rupture or postoperative complications. Survival was favorable in patients without rupture undergoing repair.</p><p><strong>Conclusions: </strong>Pediatric AAAs represent a heterogeneous and clinically significant entity distinct from adult disease. Early recognition in high-risk populations and timely surgical intervention are critical. Given the absence of pediatric-specific guidelines, multicenter collaboration and long-term surveillance data are needed to inform evidence-based management strategies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620681","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":"Comparing major adverse limb events in claudicants with complete, partial, and nonadherence to preoperative guideline-directed care.","authors":"Richard Shi, Nicholas Bulatao, Rupak Mukherjee, Jean Marie Ruddy, Adam Tanious","doi":"10.1016/j.jvs.2026.06.164","DOIUrl":"10.1016/j.jvs.2026.06.164","url":null,"abstract":"<p><strong>Objective: </strong>The Society for Vascular Surgery recommends surgery be reserved for claudicants with severe lifestyle-limiting symptoms despite optimal medical therapy and supervised exercise therapy-the sum of these known as guideline-directed care (GDC). However, most claudicants do not receive the full spectrum of GDC prior to open surgery or endovascular intervention. We investigate the impact of complete vs partial vs nonadherence to preoperative GDC in claudicants and assess its impact on 2-year major adverse limb events (MALEs).</p><p><strong>Methods: </strong>A retrospective analysis was performed on claudicants with open surgery or endovascular intervention at a tertiary care institution between 2016 and 2023. GDC was measured prior to surgery and defined as (1) severe lifestyle limitation documentation, (2) optimal medical therapy adherence (composite of single antiplatelet agent, lipid-lowering therapy, smoking cessation), and (3) exercise therapy completion. Partial adherence was defined by meeting one or two of these components, and nonadherence was defined by meeting none of the components. The primary outcome was 2-year MALE, defined as a composite of major amputation or major open/endovascular reintervention of the target limb. Statistical analysis included one-way analysis of variance, Pearson χ² tests, Kaplan-Meier, and univariable and multivariable Cox regression modeling.</p><p><strong>Results: </strong>Of the 258 claudicants receiving open surgery or endovascular intervention, 13.9% demonstrated nonadherence to GDC, 73.3% demonstrated partial adherence, and 12.8% demonstrated complete adherence. MALE was seen in 23.3% of claudicants at 2 years, primarily because of reinterventions. On Kaplan-Meier analysis, claudicants with nonadherence to GDC demonstrated a 2-year MALE-free survival of 66.6%, partial adherence with 76.7%, and complete adherence with 87.9% (P < .01). On multivariable Cox regression modeling, patients with complete guideline adherence demonstrated a decreased risk of MALE (hazard ratio, 0.24 [0.09, 0.69]) when compared with nonadherence, whereas partial adherence did not (hazard ratio, 0.99 [0.56, 1.74]).</p><p><strong>Conclusions: </strong>Complete adherence to preoperative GDC is protective against MALE in claudicants undergoing intervention out to 2 years postintervention, whereas partial adherence may not offer a similar benefit. Future studies must prioritize improving adherence rates prior to surgery in claudicants to ensure long-term risk mitigation and prevent complications.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562274","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":"Terminal aortic arborization with bilateral hypoplastic iliac arteries: A rare distal aortoiliac developmental variant.","authors":"Devender Singh, Shalini Aryala, E Shashidhar Reddy","doi":"10.1016/j.jvs.2026.07.015","DOIUrl":"10.1016/j.jvs.2026.07.015","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549470","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 open thoracoabdominal aortic repair in connective tissue disease patients.","authors":"Abdul Kader Natour, Bernardo C Mendes, Alberto Pochettino, Manju Kalra, Randall R DeMartino, Thomas C Bower, Jill J Colglazier","doi":"10.1016/j.jvs.2026.06.163","DOIUrl":"10.1016/j.jvs.2026.06.163","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the short- and long-term outcomes of open thoracoabdominal aortic repair in patients with connective tissue disease (CTD).</p><p><strong>Methods: </strong>Retrospective single-institutional review of patients with clinically or genetically diagnosed CTD who underwent extent I-V open thoracoabdominal aortic repair between 2013 and 2025. The primary outcomes were 30-day and 1-year mortality. Secondary outcomes included neurologic, renal, cardiac, and pulmonary complications, visceral ischemia, long-term branch-graft patency, graft-related complications, and survival.</p><p><strong>Results: </strong>During the study period, 146 patients underwent open thoracoabdominal aortic repair, 56 patients with CTD were included in the analysis. Average age was 42 ± 12 years, and 68% patients (n = 38) were male. Most of the patients were diagnosed with Marfan syndrome (68%, n = 38), followed by Loeys-Dietz syndrome (14%, n = 8). Ninety-one percent of repairs were done electively for postdissection aneurysms (n = 51) requiring extent II thoracoabdominal aortic repair (68%, n = 38). Visceral and/or renal artery reconstructions were performed in nearly all patients (96%, n = 54). Most patients had previous aortic surgery performed (89%, n = 50). The 30-day mortality was 2% (n = 1), with one patient dying intraoperatively secondary to failure to wean from cardiopulmonary bypass. The 1-year mortality was 5% (n = 3). Prolonged ventilator support >48 hours occurred in four patients (7%), with two (4%) requiring tracheostomy placement. Visceral ischemia occurred in four patients (7%). One patient (2%) had spinal cord ischemia with transient paraparesis, and two (4%) had renal failure requiring dialysis at discharge. At a mean imaging follow-up time of 59 ± 48 months, the primary patency of the celiac, superior mesenteric, left renal and right renal arteries were 98%, 100%, 100%, and 94%, respectively. Graft-related complications were mainly secondary to intercostal patch aneurysms, which occurred in eight patients (15%), five of whom necessitated endovascular repair. At a mean follow-up of 68 ± 47 months, the survival of operated cohort was 89%.</p><p><strong>Conclusions: </strong>Open thoracoabdominal aortic repair in CTD patients can be performed safely with good short- and long-term outcomes, and durable visceral and renal branch-graft patency. However, ongoing surveillance is critical in detecting graft related complications, especially intercostal patch aneurysms, which may require intervention.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536454","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":"Early real-world experience with thoracoabdominal branch endoprosthesis from a physician-initiated multicenter postmarket registry.","authors":"Carrie Tackett, Pouria Parsa, Jonathan Bath, Jason T Lee, Carlos Timaran, Mark A Farber, Bernardo Mendes, William Yoon, Mitri K Khoury, Nathan Droz, Ali Rana, Sukgu M Han","doi":"10.1016/j.jvs.2026.06.161","DOIUrl":"10.1016/j.jvs.2026.06.161","url":null,"abstract":"<p><strong>Objective: </strong>Recent commercial approval of the thoracoabdominal multibranch endoprosthesis (TAMBE) has enabled wide dissemination of four-vessel multibranched endovascular aortic repairs in the United States. However, the real-world performance benchmarks remain incompletely characterized. This study evaluated 30-day clinical outcomes of patients receiving TAMBE across diverse practice settings.</p><p><strong>Methods: </strong>We performed a retrospective study of commercial TAMBE implants across multiple US centers between May 2024 and November 2025. The primary outcomes were 30-day mortality and technical success. Secondary outcomes included overall adverse events (AE) and major adverse events (MAE). Intraoperative metrics and clinical outcomes were compared between centers with previous investigational access to TAMBE (PRE) and those adopting the device after commercial approval (POST).</p><p><strong>Results: </strong>A total of 182 patients from 11 centers were included. The mean age was 73.8 ± 9.01 years. Most patients were the American Society of Anesthesiologists class III (51.6%) or IV (36.3%), with a high prevalence of previous aortic repairs (20.1% open; 40.5% endovascular repair). Aneurysm extent included complex abdominal aneurysms (68.3%) and thoracoabdominal aneurysms (31.7%). Technical success was achieved in 95% of cases. Thirty-day mortality was 3.3%, and 20.3% of patients experienced AE, among which MAE occurred in 13.7%. Technical success, 30-day mortality, and MAE did not differ between the PRE and POST centers. POST centers had longer operative, fluoroscopy times, and higher 30-day AE (33.3% vs 11.8%, P <.001). Thoracoabdominal aortic aneurysms were more frequently repaired in the PRE centers (69% vs 54.5%), whereas pararenal aneurysms were more commonly treated at the POST centers (34.9% vs 27.1%). The overall incidence of spinal cord ischemia (SCI) did not differ significantly between PRE and POST centers (9.1% vs 5.6%; P = .43). At PRE centers, most SCI events resolved with minimal residual deficit (60%), whereas at POST centers, the majority of SCI cases resulted in permanent, severe deficits (75%).</p><p><strong>Conclusions: </strong>Early commercial experience demonstrates that TAMBE can be safely adopted in broader clinical practice, with high technical success and low 30-day mortality across participating centers. Although POST centers demonstrated higher overall 30-day AE rates and longer procedural times, MAE was similar across center types. These findings underscore the importance of comprehensive training, standardized perioperative protocols, and continued monitoring of neurologic outcomes as TAMBE implementation expands.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447719","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":"Repositionable aortic endograft limb twisting and thrombosis.","authors":"Linh Nguyen, M Wayne Causey, Lyssa Ochoa","doi":"10.1016/j.jvs.2026.07.004","DOIUrl":"10.1016/j.jvs.2026.07.004","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148412348","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}