Vascular最新文献

{"title":"Long-term impact of dyslipidemia on sac dynamics after endovascular aortic repair for abdominal aortic aneurysms in the GREAT registry: An insight in dyslipidemia using propensity matched controls.","authors":"Bibombe P Mwipatayi, James E Dodd, Shannon D Thomas, Elizabeth L Chou, Ross Milner, Ali Azizzadeh, Santi Trimarchi, Jan Mm Heyligers, Dittmar Böckler, Markus P Schlaich","doi":"10.1177/17085381251377316","DOIUrl":"https://doi.org/10.1177/17085381251377316","url":null,"abstract":"<p><p>ObjectivesTo investigate the differences in aneurysmal sac regression after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in patients with and without dyslipidemia.MethodsThis was a retrospective analysis of 3453 patients from an international prospective registry (Europe, United States of America, Brazil, Australia, and New Zealand) of patients treated with the GORE® EXCLUDER® endograft. All scheduled EVARs for infrarenal AAAs between 2014 and 2016 with complete 6-year follow-up imaging data were included. Logistic regression analysis was performed to assess changes in aneurysm diameter based on dyslipidemia after adjusting for sex, age, body mass index, tobacco use, hypertension, coronary artery disease, aneurysm diameter, aneurysm neck length, and aneurysm neck angle. The secondary outcomes included all-cause mortality, stroke/transient ischemic attack (TIA), paraplegia/paraparesis/spinal cord ischemia, reintervention, endoleaks, and aortic rupture. A control group of patients without dyslipidemia with similar age and comorbidities was selected using propensity scores and matched using a 1:1 scheme.ResultsOf the 3453 patients, 85.3% in the non-dyslipidemia group and 85.5% in the dyslipidemia group were men. The mean age was 73.5 ± 8.8 years for the non-dyslipidemia group and 73.4 ± 8.2 years for the dyslipidemia group (<i>p</i> < .001). The mean body mass index was 26.7 ± 4.9 kg/m<sup>2</sup> for the non-dyslipidemia group, whereas it was 28.0 ± 5.2 kg/m<sup>2</sup> for the dyslipidemia group (<i>p</i> < .001). Overall, 2269 patients (64.0%) were identified as having dyslipidemia. After propensity score matching (PSM), the dyslipidemia group had higher rates of hypertension (<i>p</i> < .001), TIA (<i>p</i> = .006), carotid disease (<i>p</i> = .002), coronary artery bypass grafting (<i>p</i> = .005), congestive cardiac failure (<i>p</i> = .018), and peripheral artery disease (<i>p</i> < .001). The indications for device placement were similar between the groups. After PSM, the non-dyslipidemia group was more likely to be treated off-label (<i>p</i> = .030) and to have an aneurysm neck length of <15 mm (<i>p</i> = .035). There was no significant difference in the sac size changes within 1 year (<i>p</i> = .7) or 6 years (<i>p</i> = .14) between the groups. After PSM, all-cause mortality was 6.7% in individuals with dyslipidemia and 10.6% in those without (p = .018). However, there were no significant differences in aortic-related mortality between the overall (<i>p</i> = .571) and the matched (<i>p</i> = .662) populations. The rates of reintervention, stroke/transient ischemic attack, and spinal cord ischemia were not significantly different. Among patients with dyslipidemia, larger aneurysm size at 1 year (<i>p</i> = .037) and increased age at 6 years (<i>p</i> < .001) were associated with sac expansion.ConclusionIn this comprehensive real-world study of patients who underwent EVAR with the GORE® EXCLUDER endopros","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251377316"},"PeriodicalIF":0.9,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readmission following early thoracic endovascular aortic repair compared to optimal medical treatment for uncomplicated acute type B aortic dissection.","authors":"Elliott A Orloff, Li Ding, Jeniann Yi, Sukgu M Han, Gregory A Magee","doi":"10.1177/17085381251379293","DOIUrl":"https://doi.org/10.1177/17085381251379293","url":null,"abstract":"<p><p>BackgroundThere is a lack of consensus on the benefit of early thoracic endovascular aortic repair (TEVAR) over medical management for uncomplicated acute type B aortic dissection (aTBAD). The aim of this study is to compare readmissions of TEVAR versus medical management as the initial treatment strategy for uncomplicated aTBAD using the Nationwide Readmissions Database (NRD).MethodsThe NRD was created under the Healthcare Cost and Utilization Project, comprising over half of the U.S. inpatient population. Patients admitted for uncomplicated aTBAD were queried from the NRD from 2016 to 2018. Risk of index admission mortality, spinal cord ischemia, stroke, and overall major complication; 90-day readmission and 90-day treatment failure, between TEVAR and medical management alone.ResultsA total of 12,645 patients with an uncomplicated aTBAD were identified (TEVAR 12% and medical management 88%). Overall major complications during index admission were higher in the medical management group (27% vs 40%, <i>p</i> < .0001). On multivariate analysis TEVAR was associated with lower mortality (OR: 0.47, <i>p</i> < .0001), but a significantly higher rate of spinal cord ischemia (OR: 2.49, <i>p</i> < .0001), with no difference in stroke (OR: 0.93, <i>p</i> = .73). 90-day readmission rates were high but were not significantly different between treatment types (22% vs 25%, OR: 0.88, <i>p</i> = .14). Similarly, TEVAR was not associated with a lower rate of 90-day treatment failure (OR: 0.61, <i>p</i> = .22). Four TEVAR (0.3%) and 40 medical management (0.5%) patients were readmitted for treatment failure due to retrograde type A dissection.ConclusionsTEVAR for uncomplicated aTBAD was not associated with a lower 90-day readmission rate. Similarly, TEVAR was not associated with a lower rate of 90-day treatment failure. These findings provide further evidence to the equipoise of treatment options and support the need for the randomized trials currently ongoing in the U.S. and Europe investigating outcomes of TEVAR versus medical management for the treatment of uncomplicated aTBAD.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379293"},"PeriodicalIF":0.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned from a single-center vascular quality improvement audit for thoracic and complex endovascular aortic repair.","authors":"Siwei Dong, Ahmed A Sorour, Donna Fleming, Ali Khalifeh, Ravi N Ambani, Francis J Caputo, Levester Kirksey, Sean P Lyden, Jon G Quatromoni","doi":"10.1177/17085381251379288","DOIUrl":"https://doi.org/10.1177/17085381251379288","url":null,"abstract":"<p><p>IntroductionThe Vascular Quality Initiative (VQI) of the Society for Vascular Surgery (SVS) is a collection of 14 registries that collects data on over 1,000,000 vascular procedures performed in North America. These registries exist in order to improve the quality, safety, and cost of vascular healthcare. Centers participating in the VQI are subject to routine audits to ensure accurate and comprehensive data entry. The aim of the study is to describe a single-institution experience with the VQI audit of the thoracic endovascular aortic repair (TEVAR)/complex endovascular aneurysm repair (EVAR) registry, highlighting the benefits and lessons learned from participating in the audit.MethodsIn 2022, our institution received a VQI audit notification to review all TEVAR/complex EVAR procedures performed between January 1^st, 2021 and December 31^st, 2021. The institutional financial department obtained claims validation data for all procedures billed under corresponding CPT codes for the listed dates. This was matched against the procedures entered manually into the VQI database by institutional data managers and abstracters. Mismatches between claims validation data and VQI entries were identified and sent to a coding specialist for review and possible revision.ResultsBetween January 1, 2021 and December 31, 2021, there were 125 unique TEVAR/complex EVAR patients identified by either the claims validation data or manually entered VQI registry data. Sixteen patients were listed in the VQI registry only and one patient was identified by claims validation data only, leaving 108 patients that were identified by both the registry and claims data, for an 86% (108/125) match rate. The audit revealed that 13 patients were incorrectly billed, of which 12/13 patients were incorrectly billed as TEVAR extensions (CPT 33886) instead of new TEVAR procedures (CPT 33880). Recoding and rebilling these patients had significant financial implications to the institution.ConclusionThis audit highlighted the importance of meticulous coding and manual review to maintain registry accuracy and optimize financial outcomes. Our findings underscore the necessity of ongoing education for coding and billing personnel and the value of VQI participation in identifying coding discrepancies and improving institutional practices.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379288"},"PeriodicalIF":0.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycotic internal carotid artery aneurysm: A literature review inspired by a case.","authors":"Madeleine de Boer, Connor Greatbatch, David Cottier, Catherine Thoo","doi":"10.1177/17085381251379290","DOIUrl":"https://doi.org/10.1177/17085381251379290","url":null,"abstract":"<p><p>BackgroundMycotic aneurysms of the extracranial carotid artery are a rare consequence of localised or systemic infection. Typically caused by <i>Staphylococcal</i> infections, sequelae include further bacterial dissemination, stroke, rupture and death. Scarcely discussed in literature, the management of this pathology is limited to case reports and general consensus.MethodThe case of an internal carotid artery mycotic aneurysm in the setting of contralateral internal carotid artery occlusion managed with urgent endovascular repair is discussed. A systematic review was subsequently conducted according to PRISMA guidelines to further review the preferred management for this uncommon pathology.ResultA total of 38 articles discussing the clinical details of 48 mycotic ICA aneurysms in the adult population were reviewed. Similarly to the described case, the majority of infections were due to <i>Staphylococcus</i> species; however, contrary to the present case, most were managed with open repair. All cases were managed with antibiotic therapy.ConclusionWhilst most cases previously described in the literature have been managed with open bypass grafting, the present case describes an alternative treatment method with endovascular management in the emergent setting with good outcomes at 1-year post-stent placement.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379290"},"PeriodicalIF":0.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of a cadaveric pressurized circulation model and an electronic simulator for vascular and endovascular surgery training.","authors":"Hugo Laparra-Escareño, Alejandro Cancino-Escobar, Carlos A Vergara-Ascencio, Jose R García-Alva, Alberto M Angeles-Castellanos, Ruben Argüero-Sánchez, Eduardo E Montalvo-Javé, Omar Sánches-Ramírez, Benjamin León-Mancilla, Carolina Baños-Galeana, José J García-Loyola Bioeng, Javier E Anaya-Ayala, Carlos A Hinojosa","doi":"10.1177/17085381251379298","DOIUrl":"https://doi.org/10.1177/17085381251379298","url":null,"abstract":"<p><p>BackgroundSimulators are used for improvement of vascular surgical skills. This study compares a cadaveric pressurized circulation model (CPCM) with electronic simulators to perform of endovascular and open procedures.MethodsA cadaveric pressurized simulation model was developed and implemented for Endovascular Aortic Repair and peripheral arterial angioplasties. We utilized a system to infuse the body with an extracorporeal perfusion pump; and participants performed the same endovascular procedures on an electronic simulator. Addtionally, simulation for an open aortic repair was also conducted and evaluated. Data were analyzed with the statistical package SPSS version 22.ResultsWe found significant differences in median comparison between simulators; 100% agree CPCM is very similar to an actual patient, median 5 IQR (4-5) (<i>p</i> = 0.001), it enhances the acquisition of endovascular skills (<i>p</i> = 0.001), offers benefits over other simulators (<i>p</i> = 0.001), and simulated conditions of a real procedure (<i>p</i> = 0.01), likewise can replace animal models (<i>p</i> = 0.001). All participants agree or strongly agree it could help improve the success rate and minimize complications in real patients (<i>p</i> = 0.01).ConclusionsThe cadaveric model provides superior experience fidelity for endovascular training over an electronic simulator.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379298"},"PeriodicalIF":0.9,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of true dorsalis pedis aneurysm.","authors":"Elizabeth Christophel, Zachary Matthay, Jordan R Stern","doi":"10.1177/17085381251379917","DOIUrl":"https://doi.org/10.1177/17085381251379917","url":null,"abstract":"<p><p><b>Background:</b> True aneurysms of the dorsalis pedis artery (DPA) are a rare vascular condition. The pathophysiology of DPA aneurysms remains poorly understood, and there is no established consensus on indications for intervention or the optimal treatment approach. <b>Methods:</b> A review of the existing literature highlights a variety of treatment strategies. In this report, we describe the management of a 78-year-old woman who presented with a pulsatile mass on the dorsum of her left foot. <b>Results:</b> Diagnostic imaging and surgical exploration confirmed a true DPA aneurysm with mural thrombus, and she underwent a successful resection with end-to-end anastomosis that resulted in excellent distal perfusion. This case and review of the literature underscore the importance of individualized surgical decision making based on anatomical and functional considerations. <b>Conclusion:</b> The key takeaway is that early surgical intervention, including reconstruction when appropriate, is recommended for DPA aneurysms to prevent potential complications such as distal embolization and ischemia.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379917"},"PeriodicalIF":0.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of all-cause mortality in endovascularly treated patients with peripheral arterial disease of the lower extremities.","authors":"Veronika Pavlíková, Martin Koščo, Marek Hudák, Jakub Čery, Barbara Čeryová, Mária Rašiová","doi":"10.1177/17085381251379804","DOIUrl":"https://doi.org/10.1177/17085381251379804","url":null,"abstract":"<p><p>ObjectivesLower extremity peripheral arterial disease (PAD) is associated with increased morbidity and mortality. The primary objective of the study was to identify nonspecific risk factors for 2- and 5-year all-cause mortality in endovascularly treated patients with PAD. The secondary objective was to develop a clinically applicable scoring system to estimate the probability of 2- and 5-year all-cause mortality based on our results.MethodsWe performed a retrospective study using data from patients with PAD who underwent endovascular treatment between January 2016 and December 2018. All data were collected from electronic medical records. A Cox proportional hazards regression model was used to examine the association between variables and all-cause mortality. Multivariate analyses were performed after adjusting for age, chronic limb-threatening ischaemia (CLTI), creatinine and fibrinogen in model 1, and for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, CLTI, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, fibrinogen and creatinine in model 2. Variables associated with mortality with p-value <.02 in all analyses were included in the scoring system. The predictive performance of the scoring system was evaluated using the Area Under Curve (AUC) of Receiver Operating Characteristic curve.ResultsA total of 676 patients with a mean age of 68.6 ± 9.74 years were analyzed, 66.7% of patients had CLTI. The 2-year mortality rate was 22.3%; 29.5% in patients with CLTI and 8% in patients with claudications. The 5-year mortality rate was 48.8%; 60.5% in patients with CLTI and 25.3% in patients with claudications. CLTI presence, creatinine, age and fibrinogen were included in the scoring system. Based on the cut-off values of creatinine >102.4 umol/l, fibrinogen >5.41 g/L, age ≥68 years and CLTI presence, patients were categorized into five groups. For 2-year mortality, a score of 0 points corresponded to a 5.0% risk of death, 1 point to an 11.1% risk, 2 points to a 23.0% risk, 3 points to a 41.7% risk and a score of 4 points to a 63.1% risk of death (AUC 0.73; p = .000). For 5-year mortality, a score of 0 points corresponded to a 13.5% risk of death, 1 point to a 31.3% risk, 2 points to a 57.1% risk, 3 points to a 79.5% risk and a score of 4 points to a 91.9% risk of death (AUC 0.74; p = .000).ConclusionsThe all-cause 2-year mortality rate in patients with PAD was 22.3%, and the 5-year mortality rate was 48.8%. The strongest associations with 2- and 5-year mortality were observed for CLTI presence, creatinine, age and fibrinogen. The scoring system based on these variables predicts 2- and 5-year all-cause mortality risk in patients with PAD, with a probability approaching 75%.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379804"},"PeriodicalIF":0.9,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of peripheral arterial disease in Nepal: A cross-sectional study.","authors":"Danielle J Wilson, Jaclyn A Gellings, Colleen Flanagan, Swechha Bhatt, Satish Vaidya, Michael Malinowski, Robin Man Karmacharya, Dean E Klinger","doi":"10.1177/17085381251379330","DOIUrl":"https://doi.org/10.1177/17085381251379330","url":null,"abstract":"<p><p>BackgroundPeripheral arterial disease (PAD) represents a significant cardiovascular burden in low- and middle-income countries (LMICs), yet its prevalence in Nepal remains unknown. As Nepal undergoes demographic transition with increasing life expectancy and cardiovascular disease burden, understanding PAD prevalence is crucial for healthcare planning. We aimed to determine PAD prevalence among Nepali adults aged ≥45 years using ankle-brachial index (ABI) screening.MethodsThis cross-sectional study was conducted at two sites in Nepal between October 2022 and March 2023. Participants aged ≥45 years without a prior PAD diagnosis were recruited through voluntary screening during routine care visits. We collected demographic data, cardiovascular risk factors, and claudication symptoms. PAD was defined as ABI <0.9, with ABI >1.4 considered non-diagnostic due to incompressible vessels.ResultsAmong 639 participants (median age 60 years, IQR 53-68; 52% male), 638 were included in the analysis. The overall PAD prevalence was 7.4% (95% CI 5.6%-9.7%), increasing to 8.7% (95% CI 6.6%-11.3%) when excluding incompressible ABIs (14.9% of participants). PAD prevalence increased with age, reaching 12.1% in those >75 years. Participants with PAD showed significantly higher rates of cardiac disease (15% vs 4%, <i>p</i> = .002) and claudication symptoms (26% vs 10%, <i>p</i> = .001) compared to those with normal ABIs. Diabetes was more prevalent in those with incompressible ABIs compared to normal ABIs (26% vs 15%, <i>p</i> = .02).ConclusionsThis first systematic assessment of PAD in Nepal reveals a prevalence comparable to other South Asian countries, with significant associations with cardiac disease and claudication symptoms. The findings highlight the need for enhanced vascular disease education in Nepal, where only 25 vascular surgeons serve 31 million people. Future research should include expanded geographic sampling and longitudinal outcomes to inform national screening policies and resource allocation.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379330"},"PeriodicalIF":0.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of internal iliac interventions on mortality and intestinal ischemia in ruptured abdominal aortic aneurysm endovascular repair.","authors":"Jose Oyama Leite, Sung H Yang, Amit Jain, Joseph S Giglia, Jiarong Ouyang, Xuan Cao","doi":"10.1177/17085381251379846","DOIUrl":"https://doi.org/10.1177/17085381251379846","url":null,"abstract":"<p><p>ObjectivesRuptured abdominal aortic aneurysm (RAAA) is a life-threatening vascular emergency with high mortality rate despite advances in surgical and endovascular techniques. This study evaluates the impact of internal iliac artery interventions on short-term (30-day) and long-term (up to 6564 days) mortality and intestinal ischemia in patients undergoing endovascular aneurysm repair (EVAR) for RAAA.MethodsA retrospective analysis of 4274 patients who underwent emergent EVAR for RAAA between 2004 and 2022 was conducted using the Vascular Quality Initiative (VQI) database. Patients were stratified into four groups based on the type of internal iliac intervention: no intervention, revascularization of at least one internal iliac artery, occlusion of both internal iliac arteries, and occlusion of one internal iliac artery. Mortality and intestinal ischemic outcomes were compared using chi-square tests, and logistic regression models were used to identify significant predictors.ResultsNo statistically significant differences in short-term (<i>p</i> = .5638) or long-term mortality (<i>p</i> = .5776) were observed between groups. Group 3 (occlusion of both internal iliac arteries) had the highest rates of intestinal ischemia (11.36%) and 30-day mortality (31.11%), though these differences were not statistically significant. Intestinal ischemia increased the odds of long-term mortality by 2.82 times (<i>p</i> < .001). Advanced age and preoperative creatinine levels were strong predictors of mortality: each additional year of age increased the odds of death by 7% (<i>p</i> < .0001), and the presence of COPD raised the odds of long-term mortality by 51% (<i>p</i> < .001). Prolonged procedure time and blood loss were also associated with higher risks of both long-term mortality and intestinal ischemia.ConclusionsThe type of internal iliac intervention did not significantly affect short-term or long-term mortality, but mitigating intraoperative factors such as prolonged procedure time and excessive blood loss is critical for improving short-term survival and reducing the risk of intestinal ischemia. Managing chronic conditions like COPD and optimizing renal function are essential to improving long-term outcomes, especially in high-risk patients with advanced age and systemic disease.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379846"},"PeriodicalIF":0.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tunnel-transposition with veno-venous or veno-arterial re-anastomosis versus skin-flap elevation for second-stage superficialization of brachiobasilic arteriovenous fistula.","authors":"Moustafa Mabrouk, Ahmed Fouda, Rasha Gawish, Mohammed ElKassaby","doi":"10.1177/17085381251379847","DOIUrl":"https://doi.org/10.1177/17085381251379847","url":null,"abstract":"<p><p>IntroductionArteriovenous fistula is the preferred vascular access for patients with chronic kidney disease on hemodialysis. Brachiobasilic arteriovenous fistulas are valued for their durability and long-term patency in patients with unsuitable superficial venous anatomy. The basilic vein, located deeper within the arm, offers a larger diameter. However, due to its depth, surgical interventions like superficialization or transposition are necessary to make the vein accessible for routine cannulation. This study compares the outcomes of three different surgical techniques used during the second stage of brachiobasilic arteriovenous fistula superficialization.Patients and MethodsThis retrospective study analyzed data from patients who underwent a second-stage brachiobasilic arteriovenous fistula between January 2020 and February 2023. The procedure involved elbow brachiobasilic AVF, resulting in vein dilatation and arterialization, followed by superficialization using techniques like skin-flap elevation or tunnel-transposition with veno-venous re-anastomosis or veno-arterial re-anastomosis. Follow-ups included routine clinic visits, duplex ultrasound scans, and monthly surveillance visits.ResultsA study of 238 second-stage brachiobasilic arteriovenous fistula procedures revealed no significant differences among the three groups. The skin-flap elevation technique had shorter operative times and higher technical success rates but was associated with higher postoperative complications like hematomas, infections, and nerve injuries. The veno-venous re-anastomosis and veno-arterial re-anastomosis groups had lower complication rates, particularly nerve injuries and steal syndrome, but required longer operative times and had lower technical success rates.ConclusionSuperficial tunneling techniques provide better healing and less complications as compared to skin-flap elevation.</p>","PeriodicalId":23549,"journal":{"name":"Vascular","volume":" ","pages":"17085381251379847"},"PeriodicalIF":0.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}