{"title":"Interdisciplinary vascular reconstructive considerations for pediatric tumors","authors":"Alyssa Stetson MD, MPH , Ashley Gutwein MD , Alexander Bondoc MD , Roshni Dasgupta MD, MPH , John Maijub MD , Greg Tiao MD , Raghu Motaganahalli MD","doi":"10.1016/j.jvs.2025.10.035","DOIUrl":"10.1016/j.jvs.2025.10.035","url":null,"abstract":"<div><div>Solid tumors with vascular involvement in pediatric patients are challenging to address. They are rare with limited data to guide treatment recommendations. Multidisciplinary management with a pediatric oncologist, pediatric surgeon, vascular surgeon and on occasion cardiac surgeon is paramount. Below, we review the scope of this problem in specific for treatment of Wilms tumor, hepatoblastoma, hepatocellular carcinoma, neuroblastoma, and sarcoma with involvement of the adjoining major vascular structures. Included in this manuscript is the role of vascular reconstruction principles as it applies to pediatric patients. We highlight the importance of individualized treatment plans taking into consideration the nature of the tumor, histology, and extent of disease; the role of neoadjuvant therapy in minimizing extent of resection; and discuss the variety of options that exist for vascular reconstruction.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 920-932"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426911","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}
A.L. Maia, E.M. Lins, F.A. Rocha, L.C. Mahnke, F.C.M. Pinto, T. de Oliveira Pereira, M.V. Neves, S.B. Palácio, K.V.S. Hodel, J.D.V. Barbosa, S.O. Penello, J.G.M. da Silva, J.L.A. Aguiar
{"title":"Application of bacterial cellulose film as a wound dressing in varicose vein surgery: A randomized clinical trial","authors":"A.L. Maia, E.M. Lins, F.A. Rocha, L.C. Mahnke, F.C.M. Pinto, T. de Oliveira Pereira, M.V. Neves, S.B. Palácio, K.V.S. Hodel, J.D.V. Barbosa, S.O. Penello, J.G.M. da Silva, J.L.A. Aguiar","doi":"10.1016/j.jvs.2025.12.338","DOIUrl":"10.1016/j.jvs.2025.12.338","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":"146172609","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}
Mina Abdelmalak MBChB, MSc, FRCS , Louise M. Finch MBChB, MPhil, MRCS , Haydn Richards MBChB , Mark Tawadrous MBChB , Ragai Makar MBChB, MSc, MD, FRCS
{"title":"Revision of below-knee amputation stumps to a higher level in patients with peripheral vascular disease","authors":"Mina Abdelmalak MBChB, MSc, FRCS , Louise M. Finch MBChB, MPhil, MRCS , Haydn Richards MBChB , Mark Tawadrous MBChB , Ragai Makar MBChB, MSc, MD, FRCS","doi":"10.1016/j.jvs.2025.10.026","DOIUrl":"10.1016/j.jvs.2025.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate clinical and anatomical factors associated with failure of below-knee amputation (BKA) resulting in revision to a higher level amputation, with the aim of identifying predictors of stump healing and reducing the need for reoperation.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included all patients who underwent a BKA between April 2014 and October 2021 for peripheral vascular disease excluding other etiologies, such as burns, trauma, or malignancy. Patients were stratified into two groups based on whether revision surgery was required. Demographic characteristics, clinical indications, prior revascularization, arterial imaging, laboratory parameters, and inpatient outcomes were compared between groups. The primary outcome was the need for revision surgery. Statistical analyses were performed using Fisher's exact test for categorical variables and Mann-Whitney <em>U</em> test or <em>t</em> test for continuous variables. Significance was set at a <em>P</em> value of <.05.</div></div><div><h3>Results</h3><div>A total of 212 patients underwent BKA during the study period using long posterior flaps. Of these, 48 patients (22.6%) required revision surgery, predominantly to above-knee amputation (73%). No significant differences in age, gender, comorbidities, or smoking status were observed between groups. Indications for initial BKA were comparable; however, patients with uncontrolled infection as the primary indication had a significantly lower revision rate (15% vs 30%; <em>P</em> = .04). Revascularization procedures were performed in 42% of patients but were not associated with revision risk. Arterial patency was a key differentiator. Patent profunda femoris artery (PFA) and common iliac artery were significantly more prevalent in the healed group (PFA, 73% vs 35% [<em>P</em> < .0001]; common iliac artery, 84% vs 58% [<em>P</em> = .0003]). A diseased or occluded PFA was significantly more common in patients requiring revision. Unexpectedly, superficial femoral artery occlusion was more common in the healed group (27% vs 8%; <em>P</em> = .006), suggesting collateral-dependent perfusion. Preoperative blood parameters did not correlate with healing. Length of hospital stay was significantly longer in the revision group (31 days vs 22 days; <em>P</em> = .0017).</div></div><div><h3>Conclusions</h3><div>Approximately one in four patients undergoing BKA required revision. Patency of the PFA emerged as the strongest predictor of stump healing, highlighting the importance of preoperative vascular assessment. Consideration should be given to performing profundoplasty before BKA in cases with compromised profunda flow to improve outcomes and reduce the need for higher-level amputations.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 859-865"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409190","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}
Tze-Woei Tan MBBS, MPH , Kirsten D. Dansey MD, MPH , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Matthew T. Menard MD , Kenneth Rosenfield MD , Michael S. Conte MD , Maarit Venermo MD, PhD , Philippe Kolh MD, PhD , Michael B. Strong MA , Niten Singh MD
{"title":"High rates of nonindex limb amputation in the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial","authors":"Tze-Woei Tan MBBS, MPH , Kirsten D. Dansey MD, MPH , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Matthew T. Menard MD , Kenneth Rosenfield MD , Michael S. Conte MD , Maarit Venermo MD, PhD , Philippe Kolh MD, PhD , Michael B. Strong MA , Niten Singh MD","doi":"10.1016/j.jvs.2025.11.009","DOIUrl":"10.1016/j.jvs.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence and risk factors associated with nonindex limb (NIL) above-ankle amputations among BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) trial participants.</div></div><div><h3>Background</h3><div>BEST-CLI compared endovascular therapy and infrainguinal bypass for patients with chronic limb-threatening ischemia (CLTI), focusing on the ipsilateral index limb. However, it is recognized that peripheral artery disease (PAD) can also impact the contralateral limb. We sought to evaluate the incidence and risk factors associated with NIL above-ankle amputations among BEST-CLI trial participants.</div></div><div><h3>Methods</h3><div>We analyzed data from 1400 participants in BEST-CLI. The primary outcome was the occurrence of above-ankle amputation in the NIL. Secondary outcomes included revascularization in the NIL, above-ankle amputation in the index limb, and mortality at the 3-year follow-up for the cohort that underwent NIL above-ankle amputations. Multivariable Cox regression was used to identify factors associated with above-ankle amputation in the NIL.</div></div><div><h3>Results</h3><div>Ninety-six participants (6.9%) underwent a NIL above-ankle amputation over the course of follow-up. These patients were more likely to be younger at enrollment (63 vs 67 years; <em>P</em> < .001), have diabetes mellitus (81.3% vs 66.1%; <em>P</em> = .002), end-stage renal disease (ESRD) (28.1% vs 9.0%; <em>P</em> < .001), and lower NIL toe pressure at enrollment (52 ± 31.6 mm Hg vs 64 ± 32.2 mm Hg; <em>P</em> = .015). Participants who underwent NIL amputation had significantly higher rates of open or endovascular revascularization in NIL (90.6% vs 17.7%; hazard ratio [HR], 10.95; 95% CI, 8.56-14.01; <em>P</em> < .001) and above-ankle amputations in the index limb (45.8% vs 12.1%; HR, 4.62; 95% CI, 3.28-6.50; <em>P</em> < .001). On 3-year Kaplan-Meier analysis, there was no significant difference in all-cause mortality between participants with and without NIL amputations (26.2% vs 28.2%; HR, 1.28; 95% CI, 0.92-1.77; <em>P</em> = .15). In multivariable Cox regression, NIL above-ankle amputation was associated with younger age at baseline (HR, 0.94; 95% CI, 0.89-1.00; <em>P</em> = .047), ESRD (HR, 10.73; 95% CI, 3.09-37.30; <em>P</em> < .001), and lower NIL toe pressure at baseline (HR, 0.98; 95% CI, 0.97-1.00; <em>P</em> = .049).</div></div><div><h3>Conclusions</h3><div>In the BEST-CLI trial cohort, NIL above-ankle amputations were associated with ESRD, lower NIL toe pressure, and younger age. A significant proportion of patients who had a NIL above-ankle amputation also underwent revascularization of NIL and an index limb above-ankle amputation within 3 years. Our findings highlight the need for targeted preventive strategies that focus on both limbs in high-risk populations to enhance limb preservation after revascularization for peripheral artery diseas","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 905-913"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534692","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}
M. Kawka, C. Caradu, R. Scicluna, C. Bicknell, M. Bown, M. Gohel, A.L. Pouncey
{"title":"Editor’s Choice – Sex Specific Differences in Abdominal Aortic Aneurysm Morphology Based on Fully Automated Volume Segmented Imaging: A Multicentre Cohort Study and Propensity Score Matched Analysis","authors":"M. Kawka, C. Caradu, R. Scicluna, C. Bicknell, M. Bown, M. Gohel, A.L. Pouncey","doi":"10.1016/j.jvs.2025.12.164","DOIUrl":"10.1016/j.jvs.2025.12.164","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page 965"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170067","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}
Alexander B. Crichton MBChB, MSc , Judit Csore MD, PhD , Eniko Pomozi MD , Bright Benfor MD , Janak Lamichhane MD , Christof Karmonik PhD , Alan B. Lumsden MD , Trisha Roy MD, PhD
{"title":"Clinical magnetic resonance imaging-defined plaque morphology predicts guidewire crossing failure in below-the-knee occlusions in a translational model using amputated lower limbs","authors":"Alexander B. Crichton MBChB, MSc , Judit Csore MD, PhD , Eniko Pomozi MD , Bright Benfor MD , Janak Lamichhane MD , Christof Karmonik PhD , Alan B. Lumsden MD , Trisha Roy MD, PhD","doi":"10.1016/j.jvs.2025.10.034","DOIUrl":"10.1016/j.jvs.2025.10.034","url":null,"abstract":"<div><h3>Background</h3><div>The endovascular treatment of peripheral artery disease in the below knee arteries has high rates of immediate technical failure, most commonly owing to an inability to cross the lesion with a guidewire. Noncontrast magnetic resonance imaging (MRI) is able to characterize plaque composition and may identify patients at high risk for failed endovascular crossing. This study evaluates a novel noncontrast MRI protocol in an amputated limb model to identify impenetrable plaques, offering clinicians a tool for improved patient selection and procedural planning.</div></div><div><h3>Methods</h3><div>Patients with chronic limb-threatening ischemia undergoing major limb amputation were included and underwent 3T noncontrast MRI. Lesions with >75% stenosis or occlusion in the below the knee arteries were evaluated and defined as either hard (>50% calcium/collagen) or soft (<50%). Hard lesions were then further delineated into two groups: minimally calcific hard (<50% calcium) and significantly calcific hard lesions (>50% calcium). Lesions were also scored using Trans-Atlantic Inter-Society Consensus Score (TASC) II and Global Limb Anatomic Severity Score (GLASS) systems. Amputated limbs then underwent percutaneous vascular intervention to cross each lesion. The primary end point was to compare crossing success in MRI-defined hard vs soft lesions. Secondary outcomes included comparing TASC C/D with TASC A/B lesions, GLASS III/IV and I/II lesions, ability to cross in minimally vs significantly calcified hard lesions, and stenotic vs total occlusions.</div></div><div><h3>Results</h3><div>The study included 27 patients with 46 arterial lesions. Twelve (26%) lesions were defined as soft and 34 (74%) were hard. MRI plaque characteristics demonstrated a strong predictive value: hard lesions were significantly less likely to be crossable compared with soft lesions (91% vs 8%; <em>P</em> < .001). TASC C/D lesions had significantly higher crossing failure rates compared with TASC A/B lesions (77% vs 33%; <em>P</em> = .039), whereas GLASS III/IV lesions did not achieve statistical significance when compared with GLASS I/II lesions (73% vs 44%; <em>P</em> = .129). Among hard lesions, there was no significant difference in ability to cross between minimally calcific and significantly calcific lesions (92% vs 90%; <em>P</em> > .99). There was also no significant difference in the ability to cross occluded vs stenotic lesions (67% vs 80%; <em>P</em> = .70).</div></div><div><h3>Conclusions</h3><div>Ultrashort echo timeUTE)/steady-state free precession (SSFP) noncontrast MRI identifies critical plaque components that predict crossing failure, including dense collagen, which is not visible on conventional imaging yet appears to play a critical role in crossing failure that is independent of calcium burden. This MRI protocol could transform decision-making. Its implementation in clinical practice offers an evidence-based appro","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 803-813"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409574","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}
Sai Divya Yadavalli MD , Elisa Caron MD , Daniel Colome BS , Lucas Souza-Mota MD , Winona W. Wu MD , Carla Moreira MD , Jeffrey J. Siracuse MD , Marc L. Schermerhorn MD , Lars Stangenberg MD, PhD
{"title":"Outcomes following unilateral axillofemoral bypass versus crossover femorofemoral bypass in chronic limb-threatening ischemia patients","authors":"Sai Divya Yadavalli MD , Elisa Caron MD , Daniel Colome BS , Lucas Souza-Mota MD , Winona W. Wu MD , Carla Moreira MD , Jeffrey J. Siracuse MD , Marc L. Schermerhorn MD , Lars Stangenberg MD, PhD","doi":"10.1016/j.jvs.2025.10.025","DOIUrl":"10.1016/j.jvs.2025.10.025","url":null,"abstract":"<div><h3>Objective</h3><div>In patients with chronic limb-threatening ischemia (CLTI), extra-anatomical bypasses are viable options to establish inflow when aortic cross-clamping necessary for anatomical reconstruction cannot be tolerated or in those with a hostile abdomen. Given their infrequent use, direct comparisons between unilateral axillofemoral bypass (AxFB) vs cross-over femorofemoral bypass (FFB) for CLTI remain scarce. We evaluated postoperative and 5-year outcomes after AxFB vs FFB for CLTI.</div></div><div><h3>Methods</h3><div>Patients undergoing nonemergent unilateral AxFB and FFB in the Vascular Quality Initiative linked to Medicare claims between 2014 and 2019 were identified, excluding procedures with other concomitant bypasses/interventions. We performed 1:2 (AxFB:FFB) propensity score matching for baseline demographics, comorbidities, urgency, ipsilateral presentation, and contralateral symptoms (rest pain vs ulcer/gangrene), and prior interventions/bypass procedures. Perioperative and 5-year outcomes were analyzed using logistic regression and Cox regression models.</div></div><div><h3>Results</h3><div>We included 1185 patients (27% AxFB), of whom 224 AxFBs matched with 374 FFBs. After matching, perioperative mortality was comparable between the AxFB and FFB bypass groups (15% vs 10%; <em>P</em> = .12). However, AxFB patients had higher rates of any postoperative complication (30% vs 15%; <em>P</em> < .01) as well as ipsilateral major amputations (below knee, 1.8% vs 0.5%; above knee, 5.4% vs 2.4%; <em>P</em> = .05), in-hospital reintervention (13% vs 7.2%; <em>P</em> = .04), and surgical site infections (5.8% vs 1.6%; <em>P</em> = .01). Patency rates at discharge were similar between the two groups. Postoperative length of stay was higher in the AxFB patients (6.9 ± 5.3 vs 6.2 ± 20; <em>P</em> < .01), and rates for discharge to home were lower (57% vs 68%; <em>P</em> = .07). At 5 years, AxFB was associated with lower rates of 5-year overall survival (41% vs 46%; adjusted hazard ratio [aHR]. 1.3; 95% confidence interval [CI], 1.0-1.7; <em>P</em> = .046), and comparable reintervention free survival (49% vs 45%; aHR, 0.86; 95% CI, 0.59-1.2; <em>P</em> = .40). There was a suggestion of lower major amputation-free survival (69% vs 89%; aHR, 1.7; 95% CI, 0.92-3.1; <em>P</em> = .089), albeit not significantly.</div></div><div><h3>Conclusions</h3><div>Unilateral AxFB for CLTI was associated with lower 5-year survival rates and similar amputation-free survival and reintervention free-survival rates, alongside similar perioperative mortality and higher postoperative complication rates when compared with FFB. Our data confirm that, among the extra-anatomical bypass options, FFB remains first-line therapy and unilateral AxFB is an alternative option for the treatment of aortoiliac occlusive disease in select CLTI patients with acceptable outcomes.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 793-802.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409222","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":"Percutaneous carotid access for endovascular arch repair: Can it simplify and minimize complication of the repair?","authors":"Thomas Lindsay MDCM, MSc, FRCS","doi":"10.1016/j.jvs.2025.10.042","DOIUrl":"10.1016/j.jvs.2025.10.042","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 662-663"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172612","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}
S. Oud, T. Alozai, F.S. Jamaludin, S. van Dieren, M.A. Schreve, M.C. Mooij, R. Balm, Ç. Ünlü
{"title":"Anatomic Success of Treatment Modalities for Small Saphenous Vein Incompetence: A Systematic Review and Network Meta-analysis","authors":"S. Oud, T. Alozai, F.S. Jamaludin, S. van Dieren, M.A. Schreve, M.C. Mooij, R. Balm, Ç. Ünlü","doi":"10.1016/j.jvs.2025.12.168","DOIUrl":"10.1016/j.jvs.2025.12.168","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page 966"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173081","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}