Journal of Vascular Surgery最新文献

{"title":"Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry","authors":"Brant W. Ullery MD, MBA , Fanny Alie-Cusson MD, MS , Gregory A. Magee MD , Sukgu M. Han MD , Jordan R. Stern MD , Andrew Barleben MD , Jeromy S. Brink MD , Robert Allen MD , Mark Fugate MD , Kenneth Tran MD , Jason T. Lee MD , Frank R. Arko MD , Chase Schlesselman MPH , Jonathan M. Bath MD","doi":"10.1016/j.jvs.2025.09.056","DOIUrl":"10.1016/j.jvs.2025.09.056","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent nonelective surgical acuity. The present study aims to assess the feasibility and midterm outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during thoracic endovascular repair (TEVAR).</div></div><div><h3>Methods</h3><div>Patients who underwent LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers, and data were collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions.</div></div><div><h3>Results</h3><div>A total of 82 patients who underwent LIFE with supra-aortic arch involvement were included. The mean age was 62.4 years (29.3% female and 78.0% White). Select demographics of the cohort featured previous stroke in 17.1% of cases, chronic lung disease in 12.2%, and renal insufficiency in 30.5%. Indication(s) for TEVAR included type B aortic dissection in 70.7% of cases, aneurysm in 11.0%, and penetrating atherosclerotic ulcer/intramural hematoma in 4.9%. Repair was performed for nonelective pathologies in 47.9% of cases. Eighty-nine supra-aortic arch branch vessels (innominate, n = 6; left common carotid artery, n = 9; and left subclavian artery, n = 74) were incorporated via LIFE to achieve proximal seal in zone 0 (19%), zone 1 (5%), and zone 2 (75%). LIFE repair was performed for a single-branch vessel in 90% of cases and a double-branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was achieved in 95.1% of cases. Thirty-day mortality was 2.4% (n = 2). Early (<30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range, 1-81 months), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17-1479 days) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months, and reintervention-free survival was 78.0% at 36 months.</div></div><div><h3>Conclusions</h3><div>Results from the multicenter LIFE registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, midterm survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. Although perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durabil","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 647-655"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274966","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":"Robotic-assisted left renal vein transposition with distal gonadal vein anastomosis: A novel technique for dual venous drainage in nutcracker syndrome","authors":"J. Xu, S.U. Cheong, G. Deng, Z. Xu, Z. Huang, Y. Ye, H. Wang, W. Liu, X. Li, J. Li, Q. Huang, T. Li, J. Di","doi":"10.1016/j.jvs.2025.12.339","DOIUrl":"10.1016/j.jvs.2025.12.339","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page A17"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172610","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 value of vascular surgeons in modern health care systems: A systematic review and meta-analysis","authors":"Luis Morales Ojeda MD ,&nbsp;Stefania Montero Arcila MD ,&nbsp;Victor Andrade Nunes MD ,&nbsp;Cristiano Marciano Duarte BA ,&nbsp;Melina Papi MD ,&nbsp;Donald L. Jacobs MD, MSC ,&nbsp;Emily A. Malgor MD ,&nbsp;Rafael D. Malgor MD, MBA","doi":"10.1016/j.jvs.2025.07.062","DOIUrl":"10.1016/j.jvs.2025.07.062","url":null,"abstract":"<div><h3>Background</h3><div>Vascular surgeons are crucial in modern health care, offering indispensable support across surgical services. Despite their clinical and economic contributions, their full value often goes unrecognized. This systematic review and meta-analysis aimed to assess the interdisciplinary and financial impact of vascular surgeons within contemporary health care systems.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in August 2024 across MEDLINE, PubMed, the Cochrane Vascular Registers, and other databases. The studies included randomized controlled trials, cohort studies, and economic evaluations published from 2010 onward. Dual reviewer screening and data extraction followed PRISMA guidelines, and the study protocol was registered with PROSPERO (CRD42024589273). Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analyses employed random effects models, with heterogeneity assessed via I² and Cochran's Q tests.</div></div><div><h3>Results</h3><div>Of 3031 screened records, 29 studies involving 6557 patients met the inclusion criteria. Vascular surgery consultations were most frequently requested by emergency medicine (15.3%), orthopedics (14.1%), trauma (12.2%), and neurosurgery (10.1%). Hemorrhage control (16.4%) and ischemia (14.1%) were the primary reasons for consultations. Vascular surgeons performed 928 procedures, predominantly primary repairs (49.2%) and graft placements (17.7%). Multidisciplinary collaboration, particularly in surgical oncology and podiatry, significantly improved outcomes, including revascularization success in cases of acute limb ischemia and intraoperative arterial injuries (94%), decreased amputation rates, and enhanced margin-negative resections. Financial analyses revealed that vascular surgery contributes substantial work relative value units (wRVUs) and revenue, with some services generating &gt;$130 million over 5 years. Meta-analysis identified pooled consultation proportions of 22% among urology, orthopedics, and general surgery, with significant heterogeneity (I² = 98.7%). Meta-regression confirmed consultation volume as a significant predictor of pooled effect size.</div></div><div><h3>Conclusions</h3><div>Vascular surgeons play a crucial role in interdisciplinary health care and are a valuable financial resource in medical services. Their participation improves surgical results, decreases complications, and enhances hospital profitability. It is essential to strategically incorporate and acknowledge vascular surgery within multidisciplinary teams and institutional planning to optimize patient care, revenue generation, and system efficiency.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 933-951"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409129","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":"Ruptured spontaneous superior mesenteric artery pseudoaneurysm, a multidisciplinary challenge","authors":"Jaime López-Sánchez PhD ,&nbsp;Asunción García Plaza PhD ,&nbsp;Luis Velasco Pelayo MD ,&nbsp;Francisco Blanco Antona PhD","doi":"10.1016/j.jvs.2025.09.005","DOIUrl":"10.1016/j.jvs.2025.09.005","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 963-964"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040503","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":"Using precision medicine methods to identify disease stages for chronic limb-threatening ischemia in participants of the BEST-CLI trial","authors":"Christina W. Zhou PhD, MS ,&nbsp;Margaret Hoch BA ,&nbsp;Nikki L.B. Freeman PhD, MA ,&nbsp;Matthew T. Menard MD ,&nbsp;Alik Farber MD, MBA ,&nbsp;Jayer Chung MD, MSc ,&nbsp;Michael R. Kosorok PhD ,&nbsp;Katharine L. McGinigle MD, MPH","doi":"10.1016/j.jvs.2025.10.029","DOIUrl":"10.1016/j.jvs.2025.10.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Chronic limb-threatening ischemia (CLTI), the most severe form of peripheral artery disease, is associated with a high risk of limb loss. CLTI clinical presentation is highly heterogeneous, ranging from neuropathic ulcers with only mild to moderate ischemia to gangrene resulting from severe ischemia. Understanding the etiology and limb- and systemic-based disease patterns, as well as differential procedural risks and outcomes, is pivotal for making treatment choices over the course of this chronic disease. In other words, accurate staging (and restaging over time) of CLTI that includes limb-based and systemic features is needed to improve the treatment decision-making process and clinical outcomes. Precision medicine analytics can integrate and synthesize multimodal data, in this case anatomy data alongside comorbidities and physical examination findings, offering a more complete staging system from which to make nuanced treatment decisions well-tailored to patient-specific risks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Using data from the BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) international randomized controlled trial, we used supervised latent topic modeling to identify clusters of patient features associated with amputation-free survival after stratifying for each assigned revascularization type. Patients were assigned to the cluster they belonged to with highest probability; clusters were characterized by analyzing the characteristics of patients within them. Although the clusters were not naturally ordinal, we subsequently organized them to mirror stages of disease progression for clearer clinical interpretation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Based on patient- and limb-focused characteristics, we identified three distinct clusters as disease stages. Across the three stages, rates of 2-year mortality were 11.59%, 20.91%, and 24.73% and rates of 2-year amputation-free survival were 83.26%, 70.03%, and 65.82%, respectively, for patients undergoing open bypass. Patients receiving endovascular therapy had 2-year mortality rates of 15.88%, 22.62%, and 20.32% and 2-year amputation-free survival rates of 77.98%, 66.06%, and 67.74%, respectively, for stages 1, 2, and 3. Stage 1 generally included patients who were less likely to have wounds, diabetes, and renal disease. Stage 2 was primarily driven by diabetes and some foot infection. Stage 3 is characterized by high rates of comorbidities, particularly end-stage renal disease and diabetes, as well as higher Wound, Ischemia, and foot Infection grades.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We identified three distinct stages of CLTI using precision medicine methods. The results from this analysis of the BEST-CLI randomized clinical trial dataset are consistent with previous findings in other cohorts. Future research focused on tailored treatment algorithms for each specific stage of CLTI is warranted.&lt;/div&gt;&lt;/div","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 784-792.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409135","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":"Endovascular versus open surgical approach in patients with acute limb ischemia: A systematic review and meta-analysis","authors":"Maram Abuajamieh MBBCh ,&nbsp;Mohammed S. Beshr MBBS ,&nbsp;Abdelaziz H. Salama MD ,&nbsp;Dua Rajab Khalleefah MBBCh ,&nbsp;Eman Basheer MBBCh ,&nbsp;Maram Darwish MD ,&nbsp;David C. Bosanquet MD ,&nbsp;Muhammed Elhadi MBBCh, MSC","doi":"10.1016/j.jvs.2025.11.004","DOIUrl":"10.1016/j.jvs.2025.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>This meta-analysis compares clinical outcomes and procedural complications of endovascular vs open surgical techniques for the treatment of acute limb ischemia.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Cochrane Library, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> were searched from inception to March 1, 2025. Studies comparing endovascular interventions with open surgical techniques for acute limb ischemia were included. Primary outcomes were amputation and mortality rates (early and long term). Secondary outcomes included reintervention, 30-day technical success, hospital stay, and procedural complications. Risk ratios (RRs) and mean differences were calculated using a random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A <em>P</em> value of &lt;.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Twenty-six studies (4 randomized controlled trials and 22 cohort studies) involving 214,683 patients were included. No significant differences were observed in early amputation rates (RR, 0.93; 95% CI, 0.80-1.09; <em>P</em> = .39; GRADE, very low) or long-term amputation rates. Early mortality (RR, 0.75; 95% CI, 0.56-0.99; <em>P</em> = .05; GRADE, very low) and 6-month mortality (RR, 1.37; 95% CI, 0.70-2.70; <em>P</em> = .45; GRADE, very low) were also similar. However, long-term mortality was significantly lower with the endovascular group at 1, 2, 3, 4, and 5 years. Technical success and 30-day reintervention rates were comparable. Hospital stay was shorter with endovascular treatment (mean difference, −2.43 days; 95% CI, −3.84 to −1.02; GRADE, low). Myocardial infarction, stroke, fasciotomy, and nonintracranial bleeding were similar between groups. However, endovascular therapy was associated with higher intracranial hemorrhage (RR, 1.89; 95% confidence interval, 1.13-3.15; GRADE, low) and lower infection rates (RR, 0.33; 95% CI, 0.15-0.73; GRADE, moderate).</div></div><div><h3>Conclusions</h3><div>Endovascular and open revascularization yielded comparable early outcomes. Endovascular treatment offered modest improvements in long-term survival, shorter hospital stays, and fewer infections, but with an increased risk of intracranial hemorrhage. Given the heterogeneity and limited number of randomized trials, further high-quality evidence is needed.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 826-838.e24"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513181","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":"Magnetic resonance angiography-detected vulnerable plaque features at 3.0 T field strength are associated with symptomatic presentation in carotid artery disease: A systematic review and meta-analysis","authors":"Camila Esquetini-Vernon MD ,&nbsp;Camilo Polania-Sandoval MD ,&nbsp;James F. Meschia MD ,&nbsp;Tara Brigham MLIS ,&nbsp;Josephine Huang MD ,&nbsp;Kevin M. Barrett MD ,&nbsp;Christopher W. Fox MD ,&nbsp;David A. Miller MD ,&nbsp;Christopher Jacobs MD ,&nbsp;Richard D. Beegle MD ,&nbsp;Houssam Farres MD ,&nbsp;Sukhwinder J.S. Sandhu MD ,&nbsp;Young Erben MD","doi":"10.1016/j.jvs.2025.11.003","DOIUrl":"10.1016/j.jvs.2025.11.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate the association between 3.0 T Magnetic resonance angiography with vessel wall imaging (MRA-VWI) detected vulnerable plaque features and the risk of symptomatic presentation and first-ever neurovascular events.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This study followed PRISMA guidelines and was registered in PROSPERO. We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, Epistemonikos, and the gray literature up to July 2024. Eligible studies included five or more adult patients undergoing 3.0 T MRA-VWI for carotid plaque characterization with reporting outcomes of stroke or transient ischemic attack. Exclusion criteria were recurrent or post-revascularization events, animal studies, and reviews. Data were extracted from cross-sectional, case-control, and prospective cohort studies. Pooled odds ratios (OR) were recorded for symptomatic presentation, and hazard ratios (HR) for incident first-ever events. Random-effects models were applied, and heterogeneity was assessed using I&lt;sup&gt;2&lt;/sup&gt;. A parallel analysis was performed for cohort studies to assess incident risk of asymptomatic patients including 1.5 T and 3.0 T strength fields.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thirteen studies met the inclusion criteria, of which 11 contributed to the quantitative analysis. In unadjusted meta-analyses of 3.0 T case-control/cross-sectional studies, type VI plaques (including intraplaque hemorrhage [IPH], ruptured cap, or surface thrombus) showed a strong association with symptoms (pooled OR, 5.03; 95% confidence interval [CI], 3.22-7.85; I&lt;sup&gt;2&lt;/sup&gt; = 0%), as did IPH with or without thrombus (OR, 5.31; 95% CI, 3.10-9.11; I&lt;sup&gt;2&lt;/sup&gt; = 8%) and IPH alone (OR, 4.88; 95% CI, 1.90-12.50; I&lt;sup&gt;2&lt;/sup&gt; = 43.6%). Ruptured fibrous cap showed a large but nonsignificant association unadjusted (OR, 4.59; 95% CI, 0.77-27.32; I&lt;sup&gt;2&lt;/sup&gt; = 15.2%), and type IV/V plaques showed no association (OR, 0.50; 95% CI, 0.12-2.01; I&lt;sup&gt;2&lt;/sup&gt; = 6.6%). After adjustment, the associations remained and were significant for type VI (pooled adjusted OR, 3.56; 95% CI, 2.04-6.24; I&lt;sup&gt;2&lt;/sup&gt; = 0%), IPH with or without thrombus (OR, 4.92; 95% CI, 1.56-15.53; I&lt;sup&gt;2&lt;/sup&gt; = 19.8%), and ruptured cap (OR, 2.85; 95% CI, 2.28-3.56; I&lt;sup&gt;2&lt;/sup&gt; = 0%); IPH alone remained strong but imprecise (OR, 5.36; 95% CI, 0.56-51.46; I&lt;sup&gt;2&lt;/sup&gt; = 43.5%). In the parallel analysis, results remained consistent after including three additional cohorts of 1.5 T with one of 3.0 T, as type VI (pooled HR, 3.61; 95% CI, 2.32-5.62; I&lt;sup&gt;2&lt;/sup&gt; = 0.4%) and IPH (HR, 3.51; 95% CI, 2.42-5.10; I&lt;sup&gt;2&lt;/sup&gt; = 0%) predicted first-ever events in both 1.5 T and 3.0 T strength fields. Lipid-rich necrotic core was inconsistent and overall nonsignificant with high heterogeneity (HR, 2.38; 95% CI, 0.15-38.76; I&lt;sup&gt;2&lt;/sup&gt; = 65.8%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We found the3.0 T MRA-VWI detection of vulnerable plaque was consistently associated wit","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 747-758.e2"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513187","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":"Information for Readers","authors":"","doi":"10.1016/S0741-5214(26)00015-7","DOIUrl":"10.1016/S0741-5214(26)00015-7","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page A12"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172607","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 impact of intervention timing, etiology, and revascularization strategy on acute mesenteric ischemia outcomes","authors":"Hassan Chamseddine MD ,&nbsp;Mouhammad Halabi MD ,&nbsp;Hadi Hamdan MD ,&nbsp;Loay Kabbani MD ,&nbsp;Jeffrey L. Johnson MD ,&nbsp;Anthony Falvo DO ,&nbsp;Timothy Nypaver MD ,&nbsp;Mitchell Weaver MD ,&nbsp;Andi Peshkepija MD ,&nbsp;Kevin Onofrey MD ,&nbsp;Yasaman Kavousi MD ,&nbsp;Alexander Shepard MD","doi":"10.1016/j.jvs.2025.11.013","DOIUrl":"10.1016/j.jvs.2025.11.013","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Acute mesenteric ischemia (AMI) is a highly lethal presentation associated with significant perioperative morbidity. Unlike other acute cardiovascular emergencies, outcomes of AMI have shown minimal improvement over time. Among the strategies explored to decrease AMI-related mortality, early diagnosis and prompt surgical revascularization remain most critical for improving both short- and long-term AMI outcomes. This study aims to investigate the impact of time from acute symptom onset to operative intervention on AMI outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;All patients who underwent revascularization for AMI between January 2014 and December 2024 at our quaternary medical center were identified. AMI was defined as mesenteric ischemia with acute symptom onset of ≤2 weeks duration. Patients with AMI secondary to mechanical bowel obstruction, trauma, aortic dissection, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia were excluded. Patients were then categorized and compared based on the time interval from acute symptom onset to revascularization, etiology of AMI, and revascularization strategy. Kaplan-Meier and Cox regression analyses were used to estimate long-term event rates and evaluate the independent association between exposure variables and long-term outcomes or survival, AMI recurrence, and reintervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;There were 92 patients who met the inclusion criteria. An inflection point at 48 hours was identified (sensitivity 81%, specificity 63%), where patients treated &gt;48 hours after symptom onset had significantly higher rates of perioperative mortality (39% vs 14%; &lt;em&gt;P&lt;/em&gt; = .012) and short bowel syndrome (39% vs 12%; &lt;em&gt;P&lt;/em&gt; = .002) compared with patients treated within 48 hours of symptom onset. Revascularization &gt;48 hours after acute symptom onset was also associated with higher long-term mortality (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.43-6.07; &lt;em&gt;P&lt;/em&gt; = .003), AMI recurrence (HR, 6.36; 95% CI, 1.59-25.38; &lt;em&gt;P&lt;/em&gt; = .009), and reintervention (HR, 3.89; 95% CI, 1.22-12.36; &lt;em&gt;P&lt;/em&gt; = .021) compared with revascularization within 48 hours. AMI secondary to acute thrombosis was associated with an increased risk of AMI recurrence (HR, 5.97; 95% CI, 1.05-25.38; &lt;em&gt;P&lt;/em&gt; = .048) and reintervention (HR, 8.02; 95% CI, 1.04-61.95; &lt;em&gt;P&lt;/em&gt; = .046) compared with embolic AMI, with no difference observed in long-term mortality (HR, 0.79; 95% CI, 0.34-1.82; &lt;em&gt;P&lt;/em&gt; = .577). No difference was observed between open and endovascular/retrograde open mesenteric stenting revascularization in long-term mortality (&lt;em&gt;P&lt;/em&gt; = .344), AMI recurrence (&lt;em&gt;P&lt;/em&gt; = .268), and reintervention (&lt;em&gt;P&lt;/em&gt; = .685). Significant predictors of perioperative mortality were age (&lt;em&gt;P&lt;/em&gt; = .049), time from acute symptom onset to revascularization &gt;48 hours (&lt;em&gt;P&lt;/em&gt; = .021), and lactate level at presentation (&lt;em&gt;P&lt;/em&gt; = .029).&lt;/","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 718-728.e4"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534676","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":"Increased clinical frailty is associated with aortic-related mortality following fenestrated and branched endovascular repair for thoracoabdominal aortic aneurysm","authors":"Silvia Chen BS ,&nbsp;Elizabeth Ramirez BS ,&nbsp;Blake E. Murphy MD ,&nbsp;Anjali Sribalaskandarajah BS ,&nbsp;Martin Bunker BS ,&nbsp;Joel Kruger MD, MPH ,&nbsp;Karina A. Newhall MD, MS ,&nbsp;Rebecca A. Sorber MD ,&nbsp;Sara L. Zettervall MD, MPH ,&nbsp;Matthew P. Sweet MD, MS","doi":"10.1016/j.jvs.2025.10.011","DOIUrl":"10.1016/j.jvs.2025.10.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Clinical frailty is associated with reduced long-term survival after fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for thoracoabdominal aortic aneurysm.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Patients who underwent F/BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS) was used to determine phenotypic frailty. Patients with a preoperative CFS of ≥4 (vulnerable) and a CFS of &lt;4 were compared. We used χ&lt;sup&gt;2&lt;/sup&gt; and Fischer exact tests to compare patient demographics, anatomical and operative characteristics, and perioperative outcomes. Fine-Gray analysis was used to compare cause of death between groups. Long-term survival and reintervention were assessed with Kaplan-Meier and Cox regression analyses.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We included 233 patients; 60 (25.8%) had a CFS of ≥4 and 173 (74.2%) had a CFS of &lt;4. Patients with a CFS of ≥4 were more likely to have chronic obstructive pulmonary disease (53% vs 27%) and were treated for slightly larger aneurysms (72 mm vs 68 mm; &lt;em&gt;P&lt;/em&gt; = .04). There were no differences in symptomatic presentation, aneurysm extent, or operative complexity between patient groups. Additionally, there were no differences in perioperative complications including 30-day mortality, stroke, and spinal cord ischemia. Patients with a CFS of ≥4 had an increased length of hospitalization (11.3 days vs 6.9 days; &lt;em&gt;P&lt;/em&gt; &lt; .01) and were less likely to return to preoperative functional status (62.7% vs 86.1%; &lt;em&gt;P&lt;/em&gt; &lt; .01). The 3-year all-cause and aortic-related mortality rates were 35.2% and 5.7%, respectively. Patients with a CFS of ≥4 had a lower survival at 1 year (74% vs 89%), 3 years (39% vs 73%), and 5 years (25% vs 56%), compared with patients with a CFS of &lt;4 (&lt;em&gt;P&lt;/em&gt; &lt; .01). The most common causes of death among both groups were pulmonary comorbidities (14.0%), oncologic conditions (14.0%), cardiovascular comorbidities (11.2%), and procedure-related complications (11.2%). Patients with a CFS of ≥4 were more likely to die from aortic-related mortality (10.3% vs 5.9%; &lt;em&gt;P&lt;/em&gt; = .02), pulmonary comorbidities (15.4 vs 13.2%; &lt;em&gt;P&lt;/em&gt; = .04), systemic decline (7.7% vs 1.5%; &lt;em&gt;P&lt;/em&gt; = .02), and infection (12.8% vs 7.4%; &lt;em&gt;P&lt;/em&gt; = .03). Aortic-related mortality for the entire patient cohort was 2.2% and 5.7% at 1 year and 3 years, respectively. Aortic-related deaths among clinically frail patients were often due to an inability to tolerate further aortic operations (eg, arch repair), and secondary to follow-up nonadherence in patients with a CFS of &lt;4.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In an expanded cohort of patients, clinical frailty was associated with lower long-term survival and an increased risk for aortic-related mortality after F/BEVAR for the tr","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 688-698"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308579","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}