EJVES Vascular Forum最新文献

{"title":"Simple and Effective Techniques to Minimise Contrast Dosage During Infrarenal Endovascular Aneurysm Repair","authors":"Elsamoual Mohammed,&nbsp;Arindam Chaudhuri","doi":"10.1016/j.ejvsvf.2026.04.001","DOIUrl":"10.1016/j.ejvsvf.2026.04.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Endovascular aortic repair (EVAR) is the standard of care for abdominal aortic aneurysms owing to its minimally invasive nature and favourable peri-operative outcomes. However, reliance on iodinated contrast media (ICM), including unnecessarily high volumes, raises concerns regarding contrast induced nephropathy, particularly in patients with pre-existing renal impairment. This study describes simple, pragmatic, and cost effective strategies to minimise ICM use during EVAR and presents an institutional experience.</div></div><div><h3>Technique</h3><div>Three contrast injection strategies were applied, designated the wet protocol (ICM only), mixed protocol (ICM + carbon dioxide [CO₂]), and dry protocol (CO₂ only). Key strategies included meticulous pre-operative planning using C-arm optimisation and bony landmarks, automated contrast injector systems for controlled (specifically ‘low volume, high rate’) ICM delivery, and selective adoption of CO₂ angiography using the CO₂mmander II System (AngioAdvancements, Fort Myers, FL, USA).</div></div><div><h3>Discussion</h3><div>An exemplar analysis was undertaken of 150 patients (98 men and 52 women, mean age 76 ± 7 years) who underwent infrarenal EVAR between March 2017 and June 2025 by author A.C., applying these contrast protocols. These were used accordingly: wet protocol (<em>n</em> = 120), mixed protocol (<em>n</em> = 26), and dry protocol (<em>n</em> = 4). The median ICM volume used in the wet protocol was 36 mL (interquartile range 18 mL), and 16 mL (interquartile range 18.5 mL) in the mixed protocol. A significant improvement in post-EVAR estimated glomerular filtration rate was noted for the wet protocol (<em>p</em> &lt; 0.001, paired <em>t</em> test), whereas for the mixed protocol, the improvement was marginal (<em>p</em> = 0.053, paired <em>t</em> test). Such approaches reduce contrast dose overall and are particularly valuable for patients at risk of contrast induced nephropathy, supporting safer and more individualised EVAR practice. This experience demonstrates that these pragmatic techniques significantly reduce ICM use without compromising technical success or safety. Application of CO₂ angiography is dependent on access to appropriate injection systems. Such considerations can be applied to the operative workflow at the time of multidisciplinary peri-operative discussion.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 200-203"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147858473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedal Acceleration Time: A Functional Indicator of Success in Revascularisation","authors":"Odette Hart ,&nbsp;Jhanvi Dholakia ,&nbsp;Khai Tuck Lee ,&nbsp;Manar Khashram","doi":"10.1016/j.ejvsvf.2026.03.003","DOIUrl":"10.1016/j.ejvsvf.2026.03.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-invasive measurement of foot perfusion is vital in the assessment of patients with peripheral artery disease. Pedal acceleration time (PAT) has emerged as a quick and effective analysis tool in the management of lower limb arterial insufficiency. This study aimed to investigate the validity of PAT in a functional measurement of foot perfusion pre- and post-revascularisation, including the differences in PAT post-revascularisation between diabetic and non-diabetic cohorts.</div></div><div><h3>Method</h3><div>A prospective, observational study was performed, using STROBE guidelines, between 2020 and 2022 at a single centre in New Zealand. PAT was measured on multiple pedal arteries within the foot, and the best and worst PAT values of the three arteries in the foot (i.e., low and high measurements in milliseconds [ms], respectively) were assigned to the foot for analysis.</div></div><div><h3>Results</h3><div>PAT measurements were performed on 443 patients during the study period, of whom 142 patients and limbs had revascularisation interventions and pre- and post-PAT measurements, and were included in the study. The mean (standard deviation [SD]) PAT at presentation were class 4 (245.2 ms ± SD 71.8 ms), and this improved to PAT class 2 (125.1 ms ± SD 45.4 ms) post-intervention. Patients with diabetes mellitus (DM) were found to have a smaller improvement in PAT post-revascularisation (difference between DM and without DM groups = 48.7 ms, 95% confidence interval 24.4–73; <em>p</em> &lt; .001). Patients who underwent open revascularisation had a greater improvement in PAT compared with endovascular treatment.</div></div><div><h3>Conclusion</h3><div>PAT is a reliable tool to assess foot perfusion and can be used to quantify improvement post-revascularisation. The study showed that patients with DM have a smaller change in PAT post-revascularisation, and adds to the growing literature on the usefulness of PAT in arterial insufficiency management.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 175-180"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147749125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation with a Footnote: A Rare Limitation in an Otherwise Promising Endograft","authors":"Nikolaos Kontopodis,&nbsp;Christos V. Ioannou","doi":"10.1016/j.ejvsvf.2026.01.006","DOIUrl":"10.1016/j.ejvsvf.2026.01.006","url":null,"abstract":"","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 87-88"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147449302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Chronic Limb Threatening Ischaemia with Severely Impaired Pedal Arteries Successfully Treated with Viscosity Intervention and Subsequent Pedal Bypass Surgery","authors":"Taro Yamasumi,&nbsp;Keisuke Miyake,&nbsp;Shigeru Miyagawa","doi":"10.1016/j.ejvsvf.2026.04.004","DOIUrl":"10.1016/j.ejvsvf.2026.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>This case report presents a 49 year old man with chronic limb threatening ischaemia (CLTI) and seronegative rheumatoid arthritis who presented with ischaemic foot ulcers, rest pain, and severely impaired pedal circulation. Imaging revealed occlusions of the dorsalis pedis, common plantar, and medial plantar arteries, with no visualised perfusion around the foot wounds, classifying the case as no option CLTI in which conventional revascularisation was deemed unfeasible.</div></div><div><h3>Report</h3><div>The lateral plantar artery was barely visualised and measured 0.4 mm in diameter, initially considered too small for bypass. As a bridging strategy in an initially deemed no option situation, viscosity intervention using Rheocarna (Kaneka Medix Corporation, Osaka, Japan), a selective apheresis system designed to reduce low density lipoprotein cholesterol and fibrinogen via double plasma filtration, was initiated with the expectation that it would improve rest pain and wound condition, and potentially sufficiently enhance pedal microcirculation to enable bypass surgery. Following this intervention, the patient exhibited improvements in wound size, rest pain, and circulatory status. Notably, ultrasound revealed an increase in diameter of the lateral plantar artery to 0.8 mm, after which bypass to this artery became technically feasible.</div></div><div><h3>Discussion</h3><div>The combined approach of pre-operative viscosity intervention and subsequent pedal bypass surgery resulted in marked improvement in pedal perfusion and complete wound healing. The patient regained ambulatory function and returned to daily life. This case highlights the potential of viscosity intervention with Rheocarna as an adjunctive pre-operative strategy to convert no option CLTI into operable cases by optimising pedal circulation status.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 212-217"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148001274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late Non-anastomotic Perforation of a Bifurcated Dacron Graft Caused by a Calcified Aneurysm Wall Remnant 11 Years After Open Abdominal Aortic Aneurysm Repair","authors":"Narumitsu Kagoshima,&nbsp;Uchida Takayuki,&nbsp;Matsumoto Takashi","doi":"10.1016/j.ejvsvf.2026.04.003","DOIUrl":"10.1016/j.ejvsvf.2026.04.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Non-anastomotic rupture of a vascular prosthesis is an extremely rare complication in the late post-operative period. Modern gelatine coated woven Dacron grafts have demonstrated excellent long term durability and resistance to intrinsic degeneration. However, they remain susceptible to physical damage resulting from sustained mechanical irritation by surrounding hard tissues. A life threatening case of graft perforation caused by direct contact with a remnant calcified aortic wall 11 years after abdominal aortic aneurysm repair is reported.</div></div><div><h3>Report</h3><div>An 82 year old man, who had undergone bifurcated graft replacement (18 × 10 mm) (Gelsoft, Terumo Corporation, Tokyo, Japan) for abdominal aortic aneurysm 11 years earlier, presented to the emergency department with sudden abdominal pain and haemorrhagic shock. Contrast enhanced computed tomography revealed contrast extravasation into a new pseudo-aneurysm surrounding the right graft limb. Emergency exploratory laparotomy was performed. Intra-operative findings identified a pinhole perforation on the body of the right graft limb, distinct from the anastomotic sites. The perforation was in direct contact with a sharp, calcified lesion on the dorsal aspect of the remnant aneurysm wall that had been used for wrapping during the initial surgery. The defect was successfully repaired with direct sutures, and the surrounding sharp calcification was debrided. The patient was discharged on post-operative day 15 without complications.</div></div><div><h3>Discussion</h3><div>The mechanism of injury was attributed to physical fraying of polyester fibres caused by repeated mechanical friction against the sharp calcified intima over a decade. Previous experimental studies support that pulsatile contact with hard tissues can physically disrupt woven Dacron fibres. Sharp calcified lesions should be removed, or cushioning material should be interposed between the graft and the aortic wall during the initial repair. This case highlights the need for long term morphological surveillance to assess the spatial relationship between the graft and calcified remnants, even in the very late post-operative phase.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 208-211"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148001285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcome After Surgery for Popliteal Artery Entrapment Syndrome","authors":"Lucille Treil ,&nbsp;Salomé Kuntz ,&nbsp;Nabil Chakfe ,&nbsp;Anne Lejay","doi":"10.1016/j.ejvsvf.2026.01.002","DOIUrl":"10.1016/j.ejvsvf.2026.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Popliteal artery entrapment syndrome (PAES) is a rare but underdiagnosed vascular disorder in young, active individuals, frequently athletes. Although surgery is considered the gold standard, data on functional outcomes, return to sport, and long term quality of life remain scarce. This study aimed to evaluate the functional outcomes of the surgical management of PAES using validated patient reported measures.</div></div><div><h3>Method</h3><div>Pre- and post-operative functional assessments were performed using the VascuQOL (Quality of Life)-25 questionnaire, complemented by sport specific questions. Imaging (dynamic duplex ultrasound, computed tomography angiography, magnetic resonance imaging when indicated) guided diagnosis was according to the Whelan classification. Primary outcomes were changes in VascuQOL scores; secondary outcomes included arterial patency, return to physical activity, and correlations with PAES type.</div></div><div><h3>Results</h3><div>Fourteen patients (18 limbs) were analysed (mean age, 30.3 ± 13.6 years; ten men and four women). Most patients presented with exertional claudication; imaging identified predominantly type VI (functional) and type V PAES. VascuQOL-25 scores demonstrated statistically significant improvements in activity, symptoms, pain, and social domains, with overall total score increasing from 4.3 ± 1.2 to 5.2 ± 1.5 (<em>p</em> = 0.002). At a mean follow up of 70.4 months, one and five year primary patency rates were 94.4%. Nevertheless, only six of 13 previously active patients returned to pre-symptomatic athletic levels.</div></div><div><h3>Conclusion</h3><div>Surgical treatment of PAES yields excellent long term patency and significant quality of life gains. However, return to pre-symptomatic athletic performance was limited, highlighting the importance of realistic counselling, tailored rehabilitation, and multidisciplinary management strategies to optimise recovery.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 75-82"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Cross Sectional Survey on the Management of Mesenteric Arterial Ischaemia and Renal Artery Stenosis from the European Visceral Artery Revascularisation Study Participants","authors":"Nicola Leone,&nbsp;Mario D’Oria,&nbsp;George Antoniou,&nbsp;Mark J. Koelemay,&nbsp;Jorg L. De Bruin,&nbsp;Sonia Ronchey,&nbsp;Giovanni F. Baresi,&nbsp;Desiree van Noord,&nbsp;Alexander Gombert,&nbsp;Stefano Gennai","doi":"10.1016/j.ejvsvf.2026.07.001","DOIUrl":"10.1016/j.ejvsvf.2026.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>The European Visceral Artery Revascularisation (EVisAR) Study initiative (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT06913530) is an ambispective study focusing on long term outcomes of visceral arterial diseases. Despite recent advances, optimal management remains uncertain owing to limited and fragmented evidence. The present survey aimed to assess the current clinical practices of EVisAR participants.</div></div><div><h3>Methods</h3><div>All 107 EVisAR physicians were invited in a single-round, international, cross-sectional survey. The survey covered chronic mesenteric ischaemia (CMI), acute mesenteric ischaemia (AMI), and renal artery stenosis (RAS), focusing on diagnostic pathways, indications for intervention, treatment preferences, and follow up strategies. Responses were analysed descriptively, and inter-rater agreement was assessed using the Fleiss κ method (agreement: ≥0.80 almost perfect, 0.60 – 0.79 substantial, 0.40 – 0.59 moderate, 0.20 – 0.39 fair, and &lt;0.20 poor).</div></div><div><h3>Results</h3><div>Sixty four (60%) EVisAR physicians’ responses were obtained. Vascular surgeons (98%) from university hospitals (84%) were predominant. Less than ten cases per year were treated by 62%, 78%, and 83% of participants for CMI, AMI, and RAS, respectively. Endovascular treatment was preferred, especially in elderly, obese, and comorbid patients. For CMI, the thresholds for intervention varied widely (κ = 0.23), and endovascular stenting was preferred (95%). In AMI, revascularisation through aspiration thrombectomy followed by damage control surgery was the predominant strategy (73%). RAS was primarily managed medically (95%); revascularisation was reserved for resistant hypertension or worsening renal function, with a nearly universal preference for endovascular techniques (98%). CMI had the least concordance (κ = 0.36, 95% CI 0.28 – 0.44]); moderate agreement was found for AMI and RAS, with κ values of 0.46 (95% CI 0.35 – 0.57) and 0.41 (95% CI 0.28 – 0.54), respectively. Follow up strategies had the lowest degree of concordance for each pathology (CMI, 0.27; AMI, 0.13; and RAS, 0.19).</div></div><div><h3>Conclusion</h3><div>This survey revealed substantial heterogeneity in the management of CMI, AMI, and RAS. Consensus is lacking, particularly regarding follow up strategies. These findings highlight the need for better quality data to refine clinical practice.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"66 ","pages":"Pages 49-57"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148770440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle Sparing Open Descending Thoracic Aortic Aneurysm Repair","authors":"Lucas Ribé,&nbsp;Akiko Tanaka,&nbsp;Rana O. Afifi,&nbsp;Anthony L. Estrera","doi":"10.1016/j.ejvsvf.2026.02.004","DOIUrl":"10.1016/j.ejvsvf.2026.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>The advantages of a latissimus dorsi (LD) muscle sparing thoracotomy include a reduced incidence of post-operative complications and preservation of the LD muscle for potential future reconstructive use. This case study presents the successful open repair of a descending thoracic aortic aneurysm (DTAA) performed through an LD muscle sparing thoracotomy, highlighting the technique's feasibility and clinical benefits.</div></div><div><h3>Report</h3><div>A 47 year old woman was referred for management of a 5.2 cm DTAA accompanied by a heavily calcified, “coral reef” stenosis of the descending thoracic aorta in zone 4. A left LD muscle sparing thoracotomy was performed through the sixth intercostal space. Under cardiopulmonary bypass, the aneurysmal segment was reconstructed using a 28 mm inlay Dacron graft. The patient had an uneventful post-operative recovery and was discharged home on post-operative day nine.</div></div><div><h3>Discussion</h3><div>Muscle sparing thoracotomy may confer several post-operative advantages, including reduced incisional discomfort, and a lower risk of pulmonary complications. Maintaining the integrity of the LD is particularly important, as it preserves a valuable reconstructive option should wound healing issues arise. An LD muscle sparing thoracotomy represents a safe and effective approach for open repair of descending thoracic aortic pathology, offering excellent exposure and may reduce the morbidity associated with conventional thoracic access.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 123-126"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147612433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Endovenous Thermal Ablation With Concomitant Anticoagulation in Chronic Venous Insufficiency Complicated by Superficial Venous Thrombosis: A Retrospective Observational Study","authors":"Jiasheng Zhang ,&nbsp;Ruihao Li ,&nbsp;Bingyao Zhang ,&nbsp;Hui Yuan ,&nbsp;Mao Zhang","doi":"10.1016/j.ejvsvf.2026.03.006","DOIUrl":"10.1016/j.ejvsvf.2026.03.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Whether endovenous thermal ablation (EVTA) can be performed soon after the diagnosis of superficial venous thrombosis (SVT) in patients with chronic venous insufficiency (CVI) remains uncertain. This study assessed the safety and clinical benefit of early EVTA performed under anticoagulation.</div></div><div><h3>Method</h3><div>Consecutive CVI patients with acute SVT (symptom onset ≤14 days) who underwent endovenous laser ablation (EVLA), radiofrequency ablation (RFA), or endovenous microwave ablation (EMA) between January 2022 and March 2025 were identified. All received peri-procedural anticoagulation. Co-primary endpoints were technical success (first post-procedural duplex) and clinical improvement (change in Venous Clinical Severity Score [VCSS] to six months). Secondary endpoints included immediate pain relief (numerical rating scale [NRS] at rest and movement to discharge), Venous Insufficiency Epidemiological and Economic Study–Quality of Life (VEINES-QoL) change to six months, and complications (including deep vein thrombosis [DVT] and pulmonary embolism [PE]) and recurrence.</div></div><div><h3>Results</h3><div>The study analysed 255 patients (262 limbs) with a median follow up of 14 months. Mean procedure duration was 54.3 ± 22.1 minutes. Complications were uncommon: DVT 1.2% (3 of 262), minor bleeding 0.78% (2 of 255); there was no PE, re-operation, or infection. Pain improved substantially (NRS decreased by 2.59 points at rest and 4.15 points with movement). Clinical severity and QoL also improved (VCSS decreased by 5.73 ± 1.78 points; VEINES-QoL increased by 12.87 ± 1.92 points). Outcomes and complication rates did not differ between EVLA, RFA, and EMA.</div></div><div><h3>Conclusion</h3><div>In this cohort, early EVTA under anticoagulation appeared feasible and was associated with low thrombotic and bleeding complication rates and clinically meaningful improvements in pain, clinical severity, and quality of life. Given the non-controlled design, findings should be interpreted as hypothesis generating and warrant confirmation in comparative prospective studies.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 187-194"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147802773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemorrhagic Safety Update of CLEAR-PATH: 30 Day and 12 Month Antiplatelet Therapy After Peripheral Angioplasty","authors":"Emilien C.J. Wegerif ,&nbsp;Manon I. Generaal ,&nbsp;Linde J. Vijn ,&nbsp;Rutger M. van den Bor ,&nbsp;Peter M. van de Ven ,&nbsp;Michiel L. Bots ,&nbsp;Gert J. de Borst ,&nbsp;Çağdaş Ünlü","doi":"10.1016/j.ejvsvf.2025.11.005","DOIUrl":"10.1016/j.ejvsvf.2025.11.005","url":null,"abstract":"<div><h3>Objective</h3><div>Antiplatelet therapy (APT) bleeding risks after endovascular revascularisation (EVR) in peripheral arterial disease (PAD) patients are lacking. Therefore, this Dutch, multicentre, double blind, placebo controlled randomised trial aimed to determine the haemorrhagic safety of APT within 30 days and 12 months after EVR by using data from the ongoing CLEAR-PATH trial.</div></div><div><h3>Methods</h3><div>Symptomatic PAD patients after successful EVR were randomised to clopidogrel plus placebo or acetylsalicylic acid for 12 months. The primary endpoint was major bleeding (MB) following the TIMI (Thrombolysis in Myocardial Infarction) classification within 12 months. Secondary endpoints included MB within 12 months following ISTH (International Society on Thrombosis and Haemostasis) and BARC (Bleeding Academic Research Consortium) classification, within 30 days following all classifications, and any bleeding. Analyses were blinded for treatment since the CLEAR-PATH is ongoing. It was agreed that APT groups had MB events above 0.0% and that a difference of 3.0% within 12 months was acceptable.</div></div><div><h3>Results</h3><div>Between August 2022 and January 2024, 470 patients were randomised. Of these, 103 patients were eligible for 12 month analysis, and 440 patients for 30 month analysis. Patients presented with chronic limb threatening ischaemia (32%) or intermittent claudication (68%). MB incidences within 12 months following TIMI, ISTH, and BARC classifications were 1.9% (95% confidence interval 0.5–6.8), 1.0%, and 2.9%, respectively. The maximum difference between APT groups was 2.8%. MB incidences within 30 days following the TIMI, BARC, and ISTH were 0.9%, 0.7%, and 1.4%, respectively. Six of seven events occurred within 30 days, three of seven events were related to vascular procedures, and one event led to cardiovascular death.</div></div><div><h3>Conclusion</h3><div>CLEAR-PATH is building a unique, large, well phenotyped PAD cohort. The incidence of MB under APT after EVR differed per classification but was overall low; most occurred within the first 30 days and were related to vascular procedures. The APT regimens raised no haemorrhagic safety concerns; therefore, CLEAR-PATH continues per protocol.</div></div><div><h3>Trial registration</h3><div>NL80009.041.21, <span><span>www.clinicaltrialsregister.eu</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":36502,"journal":{"name":"EJVES Vascular Forum","volume":"65 ","pages":"Pages 32-39"},"PeriodicalIF":1.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}