Journal of Vascular Surgery最新文献

{"title":"A Systematic Review of the Associations between Aortic Curvilinearity and Preoperative Abdominal Aortic Aneurysm Outcomes.","authors":"Kevin Luu, William Kartsonis, Paola Pastena, Ahmad Aljobeh, Praveen Parthasarathy, Jonathan Liao, Victoria N Huynh, Naiji Gong, Apostolos Tassiopoulos","doi":"10.1016/j.jvs.2025.05.032","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.032","url":null,"abstract":"<p><strong>Objective: </strong>Traditional assessment of abdominal aortic aneurysm (AAA) progression has focused primarily on maximum transverse diameter. Emerging evidence, however, suggests that metrics of other AAA geometric characteristics may enhance predictions of aneurysm growth and rupture risk. This systematic review aims to evaluate associations between curvilinearity metrics and AAA outcomes, while examining methodological variability within the literature.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception through December 2024 for human studies investigating relationships between aortic curvilinearity metrics (tortuosity, curvature, angulation) and AAA outcomes (growth or rupture). We included only studies in which the above metrics represented primary variables; exclusions included non-AAA studies, patients with previous aortic interventions, and non-original research. A total of 24 studies met the inclusion criteria. Quality was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool.</p><p><strong>Results: </strong>The 24 studies identified utilized three primary curvilinearity approaches: (1) tortuosity indices calculated from centerline length ratios, (2) angulation measurements quantifying vessel orientation changes, and (3) continuous curvature-based metrics assessing local bending. Among the four studies addressing AAA growth, three reported a significant positive association between increased curvilinearity and accelerated aneurysm expansion. Of the 20 studies evaluating AAA rupture risk, 17 demonstrated a significant positive association with greater curvilinearity. Considerable heterogeneity in centerline definitions, measurement endpoints, and computational algorithms limited direct comparisons across studies.</p><p><strong>Conclusions: </strong>Our review indicates that increased aortic curvilinearity is associated with accelerated AAA growth and a higher rupture risk. Incorporating curvilinearity metrics into AAA risk models may support a more individualized and refined clinical management. However, methodological inconsistencies, particularly regarding centerline definitions and control for confounding variables, need to be addressed. Future prospective studies employing standardized measurement protocols are necessary to validate the predictive utility of curvilinearity and promote its adoption in clinical practice.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Congestive Heart Failure on Mid-term Outcomes After Lower Extremity Revascularization for Peripheral Artery Disease.","authors":"Benjamin Lin, Antonio Solano, Carlos H Timaran, J Gregory Modrall, Shirling Tsai, Melissa L Kirkwood, Bala Ramanan","doi":"10.1016/j.jvs.2025.05.027","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.027","url":null,"abstract":"<p><strong>Introduction: </strong>Congestive heart failure (CHF) and peripheral artery disease (PAD) often coexist, with worse outcomes in patients undergoing PAD procedures. We investigated the impact of CHF on mid-term mortality and postoperative outcomes after PAD interventions.</p><p><strong>Methods: </strong>Patients in the SVS VQI-VISION Medicare-linked database undergoing peripheral vascular interventions (PVI) and lower extremity bypass (LEB) for PAD between 2010-2018 were grouped by CHF severity: Group 1-moderate/severe, Group 2-none/asymptomatic/mild. We analyzed patients with chronic limb-threatening ischemia (CLTI) and intermittent claudication (IC) separately. Primary endpoints were 3-year death, major amputation, and reintervention. We performed propensity matching between groups. Kaplan-Meier, Cox proportional hazards, and Fine-Gray competing risk models were used to compare outcomes.</p><p><strong>Results: </strong>Out of 62,129 patients with PAD and CHF, 47,457 underwent PVI (IC=19,741, CLTI=27,716) and 14,672 underwent LEB (IC=3,688, CLTI=10,984). Propensity matching was performed on 418 claudicants, 1,516 CLTI patients undergoing PVI, and 378 CLTI patients undergoing LEB. There were very few claudicants (N=52) in Group 1 who underwent LEB and this group was not analyzed further. Median age was 71 years; around 70% were male, white, and had coronary artery disease. On Kaplan-Meier analyses, 3-year survival favored Group 2 after both PVI and LEB for CLTI and PVI for IC. After PVI for CLTI, Group 1 had worse freedom from major amputation. On Cox regression analyses, Group 1 was associated with worse 3-year mortality after both PVI and LEB for CLTI and PVI for IC. Fine-Gray analysis for CLTI patients showed lower reintervention rate in Group 1 after LEB with no difference in reintervention after PVI, and no difference in major amputation after PVI or LEB. Group 1 had lower mortality risk at 3 years for CLTI patients after LEB (65.3%) compared to PVI (70.5%) and similar risk of reintervention and major amputation.</p><p><strong>Conclusions: </strong>CHF severity is a strong predictor of 30-day and mid-term mortality after both PVI and LEB for PAD. CHF severity did not significantly affect mid-term major or overall amputation. Conservative management should be strongly considered for claudicants with moderate to severe CHF. CHF severity by symptom status should be considered on an individualized basis when assessing preoperative risk, deciding revascularization strategy, and planning postoperative care.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128011","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":"Technical and clinical results of prophylactic coiling of infrarenal aortic side branches during EVAR.","authors":"Alexandru Barb, Johannes Hatzl, Ahmed Murtaja, Moritz Sebastian Bischoff, Dittmar Böckler","doi":"10.1016/j.jvs.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.030","url":null,"abstract":"<p><strong>Objective: </strong>To analyze technical and clinical results of prophylactic coiling procedures during endovascular aneurysm repair (EVAR) in a single center.</p><p><strong>Methods: </strong>This is a retrospective, single-center observational study of patients who underwent standard elective EVAR between 2019 and 2023. Patients who underwent prophylactic coil embolization of infrarenal aortic side branches were compared with a control group. The study endpoints were technical and clinical success, dose area product, fluoroscopy and intervention time, contrast volume, incidence of Type II Endoleaks (T2EL), freedom from aortic aneurysm expansion or shrinkage > 5 mm and reinterventions of all causes.</p><p><strong>Results: </strong>In total, 187 patients received an EVAR procedure with a mean follow-up (FU) of 308.1 days (SD 296.4). Almost a third of them qualified for a coiling procedure (49 patients). Overall, coil embolization was technically successful in 63.3% of cases (31/49). Prophylactic coiling significantly increased the radiation exposure (10304.3 μGym² (SD = 8253.2) vs. 5844.8 μGym² (SD = 3774.5), p = .001), intervention time (144.8 minutes (SD = 42.7) vs. 120.7 minutes (SD = 39.1), p = .001) and fluoroscopy time (35.8 (SD = 19.3) vs. 23.3 (SD = 13.7), p = .00). Considering clinical success, the rate of T2EL in the group with successful coiling was 51.6% (16/31) in the postoperative computed tomography angiography (CTA) compared to a rate of 36.5% in the control group (57/156) (p = .21). The rate of aneurysm shrinkage in the overall FU was 20% in the coiling group (5/25) versus 40% in the control group (36/90) (p = .24). The rate of aneurysm enlargement was 13% in the coiling group (3/23) versus 6.6% in the control group (6/90) (p = 0.09). During FU, the number of reinterventions due to all causes was 12.9% in the coiling group (4/31) and 12.2% in group 2 and 3 (19/156) (p = .9).</p><p><strong>Conclusions: </strong>In this study, prophylactic coil embolization to the extent in this cohort did not translate to a clinical benefit while leading to a significant increase in radiation exposure. Further research is therefore needed to identify high-risk patients for persistent Type II EL, and to identify the extent of embolization needed to effectively reduce T2EL and its sequelae.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128023","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":"Implementation of Enhanced Recovery Pathway for Lower Extremity Arterial Bypass Decreases Length of Stay.","authors":"Calvin L Chao, Lara Lopes, Nidhi K Reddy, Deena El-Gabri, Lauren A Broucek, Rebekkah B Sobolewski, Nicole Willens, Kyle W Prochno, Eric B Pillado, Joseph R Schneider, Julia B Wilkinson, Andrew W Hoel, Tadaki M Tomita, Ashley K Vavra","doi":"10.1016/j.jvs.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Frailty, nutrition, and comorbid conditions are all challenges that contribute to significant morbidity in patients undergoing lower extremity arterial bypass (LEAB). Evidence supports that enhanced recovery pathways (ERP) can improve perioperative outcomes. However, few studies have demonstrated successful implementation of an ERP for LEAB. The goal of this study was to demonstrate successful implementation of an ERP in a complex patient population undergoing LEAB, including elective, urgent, or emergent procedures with the goal of reducing length of stay and morbidity for patients undergoing these procedures at our institution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Multi-stakeholder meetings with representatives from all vascular surgery practice sites in the Northwestern Medicine system were conducted to review current evidence-based practices and finalize an ERP for patients undergoing LEAB. Pathway elements included standardized patient education, minimal perioperative fasting with preoperative carbohydrate loading, opioid-sparing analgesia, and early postoperative diet and mobilization. The ERP was initiated in February 2022 as a pilot at a single institution. At 20 months, patient data and process and outcome measures were abstracted from the medical record and validated by four independent reviewers for univariate analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Over the 20-month study period, 112 patients underwent LEAB. Process measures were tracked to determine compliance with the ERP. Patients had to receive &gt;70% of the pathway elements to be considered part of the ERP (n=60). If patients missed more than 30% of the elements, they were analyzed as traditional pathway (TP) (n=52). There were no significant differences in patient demographics, BMI, or hemoglobin A1c. ERP patients were more likely to be elective (76.7% vs. 48.1%, p=0.0004) and for CLTI (76.7% vs. 48.1%, p=0.001) and less likely to be urgent or emergent. No significant difference was observed in frequency of infrageniculate bypass target or operative duration. Compliance with 10 perioperative process measures ranged from 28-98% in the ERP group. Compliance was most successful with preoperative education (81.6%), chlorhexidine wash (80.0%), postoperative mobilization (90.0%), early solid diet (98.3%), and postoperative opioid sparing strategies (98.3%). Challenges included preoperative acetaminophen (28.3%), carbohydrate load (33.8%), and postoperative protein supplementation (28.3%). Notably, ERP patients demonstrated significantly reduced total length of stay (7.8 vs. 13.6 days, p=0.014), postoperative length of stay (6.0 vs. 11.0 days, p=0.0058), and unplanned reoperations (10.0% vs. 28.9%, p=0.015) when compared to TP patients. ERP patients trended towards fewer unplanned readmissions (13.3% vs. 26.9%, p=0.095).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Our findings suggest that an ERP for LEAB is feasible in both elective and non-elective settings although ","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128012","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":"Indications, Planning, and Technical Aspects in Physician-Modified Endografts Based on a Cross-Sectional Global Survey.","authors":"Alessandro Robaldo, Maria Antonella Ruffino, Elena Garbero, Estelle Amrein, Luca Giovannacci, Rosaria Del Giorno, Emiliano Chisci, Giovanni B Torsello, Giorgio Prouse","doi":"10.1016/j.jvs.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.019","url":null,"abstract":"<p><strong>Objective: </strong>To assess real-world variability in physician-modified endograft (PMEG) use through a global survey, providing insights to guide standardization and improve patient outcomes.</p><p><strong>Methods: </strong>A global cross-sectional survey was conducted using a 31-question web-based questionnaire distributed to 4,286 vascular specialists via email, professional networks, and online platforms. The survey addressed practitioner demographics, experience, PMEG indications, device selection, planning, and technical aspects. Responses were collected over six months and analyzed with descriptive statistics and subgroup comparisons.</p><p><strong>Results: </strong>The survey received 227 responses from 30 countries; 85% were vascular surgeons, and 21.6% had performed more than 30 PMEG cases. Medico-legal concerns were common, with only 16.1% reporting none. Device selection varied, with 52% preferring thoracic grafts and 30% bifurcated endografts. Planning strategies differed: 26% considered 15 mm a sufficient sealing zone, 33% required at least 20 mm, and 29.1% opted for 25 mm or more. While 67% did not use 3D-printed templates for fenestration positioning, 21.6% routinely did, mostly with in-house printing. Geographic analysis showed U.S. respondents were less likely to use PMEG for post-dissection aneurysms and severe target vessel stenosis, while experience-based analysis identified several significant differences in back-table modification techniques.</p><p><strong>Conclusions: </strong>This survey highlights variability in PMEG practice, with several technical aspects significantly associated with practitioner experience. The findings underscore the need to standardize indications, planning, and execution to enhance procedural safety and consistency, providing a foundation for future research, expert consensus, and structured training programs.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128021","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":"Interpretable machine learning prediction model for major adverse cardiovascular events in patients with peripheral artery disease.","authors":"Pan Song, Xinjun Liu, Liang Wang, Lu Tang, Jing Li, Qin Chen, Xiaoyu Liu, Xiaoyan Quan, Yuxin Niu, Chi Cui, Meihong Shi","doi":"10.1016/j.jvs.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.022","url":null,"abstract":"<p><strong>Background: </strong>Major adverse cardiovascular events (MACE) are severe complications of peripheral arterial disease (PAD), associated with poor prognosis and disease burden. Therefore, the early identification of high-risk individuals is of paramount importance. This study aimed to develop and validate an interpretable machine learning-based prediction model for MACE risk in patients with PAD.</p><p><strong>Methods: </strong>This retrospective study included patients with PAD enrolled between January 2022 and December 2023, with follow-up completed in December 2024. The primary outcome was MACE, defined as a composite of myocardial infarction, stroke, and cardiovascular mortality, and patients were followed up for 12-24 months using data sourced from non-overlapping datasets of four centers: three for model training and internal validation; and one for external validation. Feature selection was performed using univariate analysis, LASSO logistic regression, and Random Forest algorithm. Ten different machine learning (ML) algorithms were employed to construct the risk prediction model. Model performance was evaluated based on discrimination and calibration. The SHapley Additive exPlanations (SHAP) method was used to visualize model features and individual case predictions. The final risk prediction model was presented as a web-based calculator.</p><p><strong>Results: </strong>This multicenter study involved both model development dataset (n = 1110) and external validation dataset (n = 448). Among the 1558 enrolled patients with PAD, 469 (30.1%) experienced MACE. The incidence of MACE was higher in the training cohort (32.0%, 249/777) compared to the internal validation cohort (30.6%, 102/333) and external validation cohort (26.3%, 118/448). The mean follow-up duration was 19.0 ± 11.3 months. Participants' mean age was 73.1 ± 10.8 years, with males comprising 70.0% (1091/1558). We developed ML models incorporating eight clinically significant variables, with Gradient Boosting (GraBoost) demonstrating comparatively better performance by achieving AUC values of 0.864 (95% confidence interval [CI]: 0.822-0.905) in internal validation cohort and 0.777 (95% CI: 0.720-0.833) in external validation cohort. The key predictors included: polyvascular disease, cerebrovascular disease, hemoglobin A1c, C-reactive protein, albumin, peripheral arterial surgery, coronary heart disease, and neutrophils.</p><p><strong>Conclusion: </strong>The GraBoost algorithm outperformed other models in predicting MACE risk in patients with PAD, with external validation confirming its clinical applicability. The SHAP framework and web-based calculator enhanced the model's interpretability, enabling clinicians to better understand the factors contributing to MACE. This tool potentially helps clinicians identify MACE risk of patients with PAD and implement preventive measures more effectively.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128022","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":"Multicomponent strategy for optimized peri- and postoperative wound care after open revascularization for peripheral atherosclerosis.","authors":"Annette Høgh, Andreas K Johannessen, Marie Dahl, Birgit Dashnaw, Chalotte W Nicolajsen","doi":"10.1016/j.jvs.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.017","url":null,"abstract":"<p><strong>Objective: </strong>Patients who undergo open infrainguinal surgical revascularization are at high risk of surgical wound complications. This study aimed to evaluate the effectiveness of introducing an optimized multicomponent surgical wound management strategy involving preoperative risk stratification of patients, perioperative optimized wound closure and dressing and postoperative edema control.</p><p><strong>Methods: </strong>This was a pragmatic pre-post study at a tertiary vascular surgery center. Consecutive patients who underwent surgery from November 2022 to the end of June 2023 (postintervention group) were compared with patients who underwent surgery between November 2021 and the end of June 2022 (preintervention group). The primary outcomes were surgical wound complications (a composite outcome based on prolonged lymphatic secretion or seroma, surgical site infection, bleeding or hematoma and wound dehiscence) during primary admission and within 60 days after surgery. The outcomes are presented as total numbers, and comparisons among groups were performed via logistic regression; the results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Baseline and perioperative characteristics with potential confounding impacts were controlled for by means of propensity scores and the inverse probability of treatment weights.</p><p><strong>Results: </strong>In 122 (preintervention group) and 133 (postintervention group) patient cases, a total of 49 (40.8%) and 27 (20.6%) surgical wound complications, respectively, were observed during primary admission, corresponding to an adjusted OR of 0.43 (95% CI 0.24 to 0.77). The length of stay was lower in the postintervention group, with an adjusted average of -1.19 days (95% CI -2.6 days to 0.2 days). During the 60-day follow-up, 38 (31.1%) and 44 (33.1%) patients experienced surgical wound complications, with ORs of 1.18 (95% CI 0.69 to 2.04). Among these, 11 (9%) and 12 (9%) had deep wound complications, with ORs of 0.95 (95% CI 0.40 to 2.28), and 13 (10.7%) versus 18 (13.5%) were readmitted because of wound complications, with ORs of 1.26 (95% CI 0.58 to 2.74).</p><p><strong>Conclusion: </strong>Optimized peri- and postoperative surgical wound management was found to be associated with a reduced risk of surgical wound complications during primary admission, yet the risk of serious wound complications during follow-up remained high.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094101","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":"Enhanced Recovery After Surgery Protocol Decreases Hospital Length of Stay and Post-Operative Opioid Use for Thoracic Outlet Syndrome Surgical Decompression.","authors":"Kenneth M Rosenberg, David N Blitzer, Sarah Rosenberger, Mirnal Chaudhary, Rajabrata Sarkar","doi":"10.1016/j.jvs.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.013","url":null,"abstract":"<p><strong>Objective: </strong>First rib resection for thoracic outlet syndrome (TOS) requires inpatient hospital stay and causes post-operative pain. We hypothesized that an enhanced recovery after surgery (ERAS) protocol, including multimodal pain management, would reduce post-operative narcotic use and length of stay (LOS).</p><p><strong>Methods: </strong>A retrospective single center case-control study (2016-2022) compared three protocols: 1) conventional peri-operative and pain management, 2) multimodal pain management with implantation of ropivacaine pump, and 3) ERAS peri-operative protocol including ropivacaine pump. Primary (inpatient opioid use and LOS) and secondary outcomes (complications and hospital cost) were assessed.</p><p><strong>Results: </strong>98 patients were evaluated (107 first rib resections). Compared to conventional pain management (median 33 mg/d), daily opioid use significantly decreased with both multimodal pain management alone (14 mg/d, P<0.0001) and full ERAS protocol (11 mg/d, P<0.0001). ERAS patients had shorter LOS than conventional management (1.44 d vs. 3.26 d, P<0.0001), but multimodal pain management alone did not. Complication rates were similar among the three groups, although ERAS patients had increased post-operative ED visits (n=4 (7.4%) vs. n=7 (27%), P=0.024) and readmissions (n=2 (3.7%) vs. n=5 (19%), P=0.034). Index hospital admission cost decreased between the ERAS and conventional groups (mean: $9,327 vs. $13,053, P=0.012). Total hospital cost including ED visits and readmissions, however, was similar between the three protocols.</p><p><strong>Conclusions: </strong>Consistent with other areas of surgery, ERAS yielded a >2-fold decrease in LOS, multimodal pain management alone decreased opioid use, but did not reduce LOS. ERAS protocol increased ED visits and readmissions, suggesting that optimization to decrease readmissions will improve care and lower costs.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086428","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 Biomechanical Forces Associated with Carotid Plaque Disruption and Stroke.","authors":"Georges Jreij, Gador Canton, Daniel S Hippe, Niranjan Balu, Chun Yuan, Juan Cebral, Caroline Crone, Siddhartha Sikdar, Thomas Hatsukami, Vicki Gray, Sarasijhaa Desikan, Kirk Beach, Brajesh K Lal","doi":"10.1016/j.jvs.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.014","url":null,"abstract":"<p><strong>Objective: </strong>Carotid plaque disruption with release of atheroembolic debris and consequent brain infarction is the primary mechanism for brain injury in patients with carotid stenosis. Disease severity is traditionally quantified by the degree of stenosis, though it is not an accurate marker of stroke-risk. It has been proposed that biomechanical forces acting on a carotid plaque may render it vulnerable to rupture by causing adverse remodeling of its morphology, or by direct disruption. We conducted a systematic review to assess the forces acting on carotid plaques and their relationship to adverse plaque outcomes.</p><p><strong>Methods: </strong>A literature search for studies reporting measurements of flow-related biomechanical forces acting on carotid atherosclerotic plaques was conducted using PubMed, Embase and Web of Science. Studies were included if they reported on human carotid plaques, used patient-specific geometry, measured forces on or in the atherosclerotic lesions, and reported on carotid plaque-related adverse outcomes.</p><p><strong>Results: </strong>Of 5,635 manuscripts screened, 154 met eligibility criteria. Forces were computed using patient-specific arterial geometry derived from multiple imaging modalities, mainly magnetic resonance imaging (58.4%) and ultrasonography (25.3%). Methodologies used to quantify the forces included computational fluid dynamics (31.8%), finite element analysis (10.4%), fluid-structure interaction models (27.3%), in-vivo measurements (29.9%), or in-vitro assessments (0.6%). Wall shear stress (WSS) and plaque wall stress (PWS) were the most frequently measured forces, in 72.1% and 45.5% of studies respectively. Principal PWS (n=15 studies) and WSS (n=21 studies) were elevated in patients with adverse outcomes. PWS levels of >160 kPa had a sensitivity of >80% and specificity of >75% in identifying patients with adverse events. Increasing PWS was associated with subsequent ischemic cerebrovascular events (HR=12.98 per 1 kPa increase, p=0.02). WSS levels of >50 dyn/cm2 had a sensitivity of 100% and specificity of 67% in differentiating patients with adverse events (plaque rupture, cerebral infarction, stroke, or transient ischemic attack) compared to those without.</p><p><strong>Conclusions: </strong>There is heterogeneity in sample size, study design, imaging protocols, image-processing methodology, forces assessed, and adverse carotid plaque-related outcomes measured in the literature. Despite these limitations, increasing PWS and WSS were consistently associated with adverse plaque outcomes, and predicted adverse outcomes with moderate to high degrees of sensitivity and specificity. Since the information available is heterogenous, these relationships need to be confirmed in larger prospective studies.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Stratified Outcome Differences Between Fenestrated Endovascular Aneurysm Repair and Open Repair for Juxtarenal Abdominal Aortic Aneurysms.","authors":"Mohit K Manchella, Vinamr Rastogi, Brandon Gaston, Shaghayegh S Kermani, Nikolaos Zacharias, Tiffany R Bellomo, Anahita Dua","doi":"10.1016/j.jvs.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.05.011","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate if benefits in patient outcomes conferred by endovascular repair compared to open repair of complex abdominal aortic aneurysms (cAAA) are maintained across genders. We undertook a comparative analysis of perioperative outcomes between open repair and fenestrated endovascular repair (FEVAR) utilizing the Cook Zenith Fenestrated (ZFEN) graft for complex abdominal aortic aneurysms (cAAA).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from the National Surgical Quality Improvement Program (NSQIP) registry, including patients who underwent open repair or ZFEN for cAAA between 2011 and 2022. The study population stratified by sex contained 1,697 males and 663 females. Perioperative outcomes such as mortality, complications, and reoperation rates were analyzed using inverse probability weighting and logistic regression to adjust for confounding indications for surgery.</p><p><strong>Results: </strong>Among males, those undergoing ZFEN had significantly lower odds of major complications (14% vs. 28%, aOR 0.43, p<.001), reoperation (6.0% vs. 12%, aOR 0.46, p=.03), and major respiratory complications (5.5% vs. 12%, aOR 0.42, p=.02) compared to open repair. In females, the trend towards reduced major complications with ZFEN (19% vs. 31%, aOR 0.50, p=.06) did not reach statistical significance. When comparing males to females undergoing open repair, males had 6.7 times higher odds of myocardial infarction, and 16 times higher odds of wound complications compared to females. Conversely, females undergoing ZFEN had higher odds of reoperation compared to males (12% vs. 4.1%, aOR 0.13, p=.012).</p><p><strong>Conclusions: </strong>The study highlights significant sex-specific differences in outcomes following both ZFEN and open repair for cAAA. ZFEN offers notable advantages in reducing complications for male patients, while its benefits are less pronounced in females. These findings underscore the need for tailored treatment strategies and further research to optimize outcomes for female patients undergoing aortic aneurysm repair.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078577","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}