Journal of Endovascular Therapy最新文献

{"title":"Pedal Arch Integrity is Independently Associated With Limb Salvage in Chronic Limb-Threatening Ischemia With Isolated Peroneal Artery Runoff.","authors":"Laura Costa Pérez, Bahaa Arefai Refai, Jesús Carnicer Cáceres, Cristina Ibarz Giné, Raúl Vidal García","doi":"10.1177/15266028261479298","DOIUrl":"https://doi.org/10.1177/15266028261479298","url":null,"abstract":"<p><strong>Background: </strong>Although current revascularization paradigms emphasize direct inline flow through the target arterial pathway (TAP), the prognostic importance of distal pedal connectivity in this anatomical setting remains uncertain.</p><p><strong>Methods: </strong>Clinical, anatomical, procedural, and follow-up characteristics were analyzed. Kaplan-Meier methods were used for time-to-event analyses, and multivariable logistic regression identified independent predictors of major amputation.</p><p><strong>Results: </strong>During follow-up, major amputation occurred in 29 limbs (25.7%). After multivariable adjustment, increasing Wound, Ischemia, and foot Infection (WIfI) stage was independently associated with a higher risk of major amputation (adjusted odds ratio [OR] 4.47, 95% confidence interval [CI], 2.11-9.45; <i>P</i> < .001), whereas each additional patent deep pedal arch was independently associated with a lower risk of limb loss (adjusted OR 0.23, 95% CI, 0.10-0.53; <i>P</i> < .001). Kaplan-Meier estimates demonstrated significantly better limb salvage in limbs with preserved pedal arch integrity (log-rank <i>P</i> = .003). At 12 months, estimated amputation-free survival was 68.1%, whereas freedom from major adverse limb event among revascularized limbs was 79.7%.</p><p><strong>Conclusions: </strong>In patients with isolated peroneal artery runoff, distal pedal connectivity, reflected by pedal arch integrity, and clinical severity are the principal independent predictors of limb salvage. The peroneal-based global limb anatomic staging system classification improves anatomical stratification in this selected anatomical population but does not provide independent prognostic information beyond WIfI stage and distal pedal connectivity. These findings support the systematic assessment of distal pedal circulation when planning revascularization in this challenging anatomical subgroup.Clinical ImpactIn patients with chronic limb-threatening ischemia and isolated peroneal artery runoff, revascularization planning should extend beyond proximal anatomical complexity and include systematic assessment of distal pedal circulation. This study demonstrates that pedal arch integrity provides clinically relevant prognostic information for limb salvage, while WIfI stage remains a major determinant of amputation risk. Although application of the original GLASS framework using the peroneal artery as the target arterial pathway improves anatomical stratification, it does not independently predict limb loss. These findings support integrating clinical severity and distal pedal connectivity into treatment planning and prognostic assessment in this challenging anatomical subgroup.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479298"},"PeriodicalIF":1.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901441","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":"Zone 2 Versus Zone 3: Thoracic Endovascular Aortic Repair's Tough Choice in Acute Type B Aortic Dissection: Systematic Review and Meta-Analysis.","authors":"Noor Abu Hantash, Hazem El Beyrouti, Yousef Alghzawi, Ahmad Yaish, Leen Aburumman, Abdullah Alzubaidi, Nancy Halloum","doi":"10.1177/15266028261479545","DOIUrl":"https://doi.org/10.1177/15266028261479545","url":null,"abstract":"<p><strong>Background: </strong>Optimal proximal landing zone selection in thoracic endovascular aortic repair (TEVAR) for acute and subacute Stanford type B aortic dissection remains controversial. This meta-analysis compared zone 2 versus zone 3 deployment with respect to perioperative and mid-term outcomes.</p><p><strong>Methods: </strong>This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and Scopus were systematically searched up to August 1, 2025. Eligible studies included adult patients with acute or subacute type B aortic dissection undergoing TEVAR with proximal landing in zone 2 or zone 3. Random-effects meta-analyses were performed using odds ratios (ORs) with 95% CIs. Heterogeneity was assessed using <i>I</i>², and sensitivity analyses included leave-one-out and fixed-effect comparisons.</p><p><strong>Results: </strong>Four studies comprising 907 patients (393 zone 2, 514 zone 3) were included. There was no significant difference in 30-day mortality between groups (OR = 0.94, 95% CI, 0.64-1.39; <i>I</i>² = 0%). Zone 2 repair was associated with increased spinal cord ischemia in the common-effect model (OR = 2.29, 95% CI, 1.20-4.02), while the random-effects model showed a non-significant but consistent trend (OR = 2.96, 95% CI, 0.61-14.38). The risk of stroke showed a similar trend favoring zone 3 (OR = 2.05, 95% CI, 1.08-3.87). Reintervention rates were higher in zone 2 in the common-effect model (OR = 1.91, 95% CI, 1.24-2.95) but were not robust in sensitivity analysis. Endoleak outcomes showed substantial heterogeneity (<i>I</i>² = 81.5%), precluding reliable pooling. Other complications and retrograde type A dissection showed no consistent differences between groups.</p><p><strong>Conclusion: </strong>Zone 2 TEVAR is associated with a potential increase in neurologic and reintervention-related complications, while mortality remains comparable. The evidence is limited by heterogeneity and small study numbers.Clinical ImpactThese findings support a more individualized approach to proximal landing-zone selection during TEVAR for acute and subacute type B aortic dissection. Zone 3 deployment may be preferable when anatomically feasible, given its potential association with lower rates of spinal cord ischemia and stroke. When zone 2 coverage is necessary, clinicians should carefully weigh the neurologic risks against the anatomical and procedural benefits. The study highlights the importance of incorporating spinal cord protection strategies and meticulous patient selection. Its innovation lies in directly synthesizing comparative evidence on proximal landing zones while testing the robustness of observed differences through sensitivity analyses. These findings may help inform procedural planning while underscoring the need for larger prospective comparative studies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479545"},"PeriodicalIF":1.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889186","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":"Safety and Efficacy Evaluation of a Novel High-Frequency Automated-Pullback Peripheral Intravascular Ultrasound System in a Porcine Model.","authors":"Lei Zhang, Rui Li, Pengcheng Guo, Lin Li, Tao Xu, Zhenchang Wang, Chang Shu, Xin Li","doi":"10.1177/15266028261479892","DOIUrl":"https://doi.org/10.1177/15266028261479892","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the efficacy and safety of a novel single-use peripheral intravascular ultrasound (IVUS) system in a porcine model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Six healthy white pigs were randomized into 2 groups. The Efficacy Valuation Group (group A, self-controlled, n = 3) underwent imaging before and after stent implantation with both the test device (automated pullback) and a control IVUS system (manual pullback). The Safety Evaluation Group (group B, n = 3) was imaged with the test device only for safety and pathological evaluation. Endpoints included mean stent cross-sectional area (MSA), stent length, measurement agreement, image quality, device usability, vital signs, adverse events, and vascular safety.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For the primary endpoint, the 95% confidence intervals (CIs) for the relative difference in MSA between devices fell within the prespecified ±10% equivalence margin at both low-speed (2.010%-4.649%) and high-speed (0.844%-6.968%) pullback, as confirmed by two one-sided tests (TOST). A prespecified subgroup analysis by vessel type (arterial vs venous) confirmed consistent equivalence within each subgroup. The 95% limits of agreement for MSA were within ±1.5 mm&lt;sup&gt;2&lt;/sup&gt; for both speeds. Stent length measurements correlated excellently with digital subtraction angiography (&lt;i&gt;r&lt;/i&gt; = .997, &lt;i&gt;P&lt;/i&gt; &lt; .0001). Lumen measurements showed good inter-device agreement. Both systems achieved a 100% image-quality excellence rate. Operators rated the test device significantly higher for overall usability (4.8 ± 0.4 vs 4.5 ± 0.5, &lt;i&gt;P&lt;/i&gt; &lt; .05). All animals remained hemodynamically stable with no device-related adverse events, and pathological examination revealed no significant vascular injury. It should be noted that key study limitations include the comparison of automated versus manual pullback, potential data clustering from multiple measurements per animal, and the use of a healthy animal model that does not replicate human atherosclerotic disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In a porcine model, the novel high-frequency automated-pullback IVUS system demonstrated imaging efficacy noninferior to a control device, with a favorable safety profile and no observed complications. These preclinical findings support its further clinical investigation for peripheral vascular interventions.Clinical ImpactThis preclinical study demonstrates that a novel peripheral IVUS system, featuring a higher-frequency transducer (30 MHz) and automated pullback, achieves imaging efficacy and acute safety comparable to a control device in a porcine model. The higher-frequency design may improve resolution, and automated pullback enables standardized, operator-independent measurements. These features could enhance procedural planning for complex interventions. The system clearly visualized vessel microstructures, supporting more precise device selection with the potential to improve outcomes in prec","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479892"},"PeriodicalIF":1.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Aspiration Thrombectomy of the Superior Mesenteric Artery for Treatment of Acute Mesenteric Ischemia: Results From the ENDO-SMA2MI Registry.","authors":"Mario D'Oria, Sandro Lepidi, Paolo Spath, Mauro Gargiulo, Ciro Ferrer, Gioele Simonte, Stefano Gennai, Francesco Giurazza, Anna Maria Ierardi, Diego Visconti, Reinhold Perkmann, Raffaello Bellosta, Nicolò De Manzini, Cristiano Calvagna, Alan Biloslavo","doi":"10.1177/15266028261479535","DOIUrl":"https://doi.org/10.1177/15266028261479535","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background/objective: &lt;/strong&gt;Acute mesenteric ischaemia (AMI) is a multidisciplinary emergency, requiring the involvement of different medical specialties for successful management. Endovascular aspiration thrombectomy (EAT) has entered the field leading to the possibility of treating acute arterial occlusions with a minimally invasive approach. The aim of the study was to provide contemporary data on results after use of EAT in AMI patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was a retrospective, observational, multicentre study conducted in 10 Italian centres. Patients with AMI, undergoing EAT of the superior mesenteric artery (SMA) with the Penumbra Indigo system (Penumbra Inc., Alameda, CA, USA) from January 1, 2020 to December 31, 2024 were enrolled. Technical success and mortality were the primary outcomes. Secondary outcomes included perioperative complications and length of stay in the hospital and intensive care unit (ICU).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-eight consecutive AMI patients undergoing EAT were enrolled in the study. The median age of the study population was 80 years (interquartile range [IQR] = 68-86), and 52% were male. The median time from emergency acceptance up to referral for definitive treatment was 1 hour (IQR = 1-5), with 77% of patients presenting to the hospital less than 6 hours from onset of symptoms. Overall, 29 patients (60%) received only EAT at presentation, whereas 19 patients (39%) received a combined general surgical procedure at the same time of endovascular intervention. Technical success of EAT was achieved in 44 cases (92%). Thirty-one patients (64%) required ICU stay, with a median duration of 1.5 days. Severe postoperative complications (i.e. Clavien-Dindo scale &gt;3) occurred in 28 patients (58%), and the average duration of hospital stay was 10 days. The overall rate of 90-day mortality was 46% (n = 22); of these, 19 deaths occurred in the first 30 days and 3 additional events occurred between 30 and 60 days after index presentation. On multivariable analysis, a procedure longer than 90 minutes (odds ratio [OR] 6.3; 95% confidence interval [CI], 1.0-37.2; &lt;i&gt;P&lt;/i&gt; = .041) and Clavien-Dindo score greater than 3 (OR 19.5; 95% CI, 3.2-115.5; &lt;i&gt;P&lt;/i&gt; = &lt;.001) resulted as independent factors for mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The application of the Penumbra Indigo system for EAT of the SMA in AMI cases may provide an effective total endovascular procedure for its solution, providing high technical success rates. However, mortality rates are still high, owing to the severity of illness and comorbid status of patients, with most death events occurring in the first 30 days.Clinical ImpactThe results of this study demonstrate that endovascular aspiration thrombectomy of the superior mesenteric artery for treatment of acute mesenteric ischemia may provide a safe and effective procedure for this condition. However, mortality rates are still high, owing to the severity ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479535"},"PeriodicalIF":1.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851936","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":"Mid-term Outcomes of Endovascular Management of Infective Native Abdominal Aortic Aneurysms.","authors":"Victor Bilman, Asher Rottenberg, Ilan Davidov, Sarit Malayev, Moshe Halak, Daniel Silverberg","doi":"10.1177/15266028261479311","DOIUrl":"https://doi.org/10.1177/15266028261479311","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;To evaluate outcomes of endovascular aneurysm repair (EVAR) for infective native abdominal aortic aneurysms (INAAA) and to describe microbiological, imaging, and inflammatory findings, as well as the role of prolonged antibiotic therapy and fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (&lt;sup&gt;18&lt;/sup&gt;F-FDG PET-CT) in follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective single-center experience included all patients diagnosed with INAAA and treated with EVAR at our institution between 2020 and 2025. Demographics, microbiology, inflammatory markers, imaging characteristics, technical outcomes, and follow-up data were analyzed. Descriptive statistics were used, and paired continuous variables were compared using the Wilcoxon signed-rank test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 494 patients treated for abdominal aortic aneurysm, 12 (2.4%) presented with INAAA. Median age was 75 years (interquartile range [IQR], 69-77), and 83% were male. &lt;i&gt;Salmonella&lt;/i&gt; species were identified in 50% of cases. Median white blood cells count at admission was 12.5 × 10&lt;sup&gt;9&lt;/sup&gt;/L (IQR, 8.5-14.3), decreasing to 8.8 × 10&lt;sup&gt;9&lt;/sup&gt;/L at discharge (&lt;i&gt;P&lt;/i&gt; = .26). C-reactive protein decreased significantly from 141.7 mg/L (IQR, 116.6-263.9) to 24.8 mg/L (IQR, 16.1-92.3; &lt;i&gt;P&lt;/i&gt; = .002). All aneurysms were infrarenal, with a median diameter of 48 mm (IQR, 37-51); imaging features included periaortic soft-tissue mass in all patients, saccular morphology in 6 patients, and rapid aneurysm expansion in 4 patients. Technical success was 100%. One patient developed acute kidney injury, and another died from mesenteric ischemia (8.3%). Median follow-up (FU) was 23.8 months (IQR, 5.9-52.8). Complete sac regression occurred in 9 of 11 (81.8%) cases, and the median time to visual PET-CT assessment demonstrating resolution of abnormal FDG uptake was 6.3 months (IQR, 3.9-15.5). Median time of antibiotic treatment was 14.6 months (IQR, 5.4-30.1). Five patients remained on antibiotic therapy, while 3 had it safely discontinued after more than 1 year. During FU, no reinterventions were recorded, and 3 deaths were observed, all non-aortic related.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Endovascular aneurysm repair for INAAA achieved high technical success and durable mid-term infection control. C-reactive protein normalization, PET-CT negativity, and sac regression supported bacterial eradication. Extended but finite antibiotic therapy may be adequate in selected, well-monitored patients.Clinical ImpactEndovascular aneurysm repair (EVAR) offers an effective and less invasive treatment option for infective native abdominal aortic aneurysms (INAAA), traditionally associated with high morbidity and mortality after open repair. In this series, EVAR achieved complete technical success and durable infection control, supported by rapid CRP decline, sac regression, and PET-CT normalization. Identifying a potential ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479311"},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841935","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":"Effects of Atherectomy on Immediate Luminal Gain and Short-Term Patency in Patients With In-Stent Restenosis With or Without Stent Thrombosis.","authors":"Michal S Proczka, Crista E Horton, Michal Macech, John J Ricotta, Joseph J Ricotta","doi":"10.1177/15266028261479288","DOIUrl":"https://doi.org/10.1177/15266028261479288","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Atherectomy may provide benefit by debulking lesions before angioplasty in patients with in-stent restenosis or stent thrombosis. This study evaluated immediate luminal gain, measured by intravascular ultrasound, achieved with excimer laser, solid-state laser, and rotational excisional atherectomy when treating femoropopliteal in-stent restenosis or stent thrombosis before angioplasty. Six-month patency was assessed by duplex ultrasound.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;We retrospectively analyzed 120 consecutive femoropopliteal interventions for &gt;70% in-stent restenosis or chronic (&gt;14 days) stent thrombosis (Rutherford class 3-5) performed in an office-based laboratory. Patients underwent atherectomy with excimer laser, solid-state laser, or rotational excisional atherectomy, followed by balloon angioplasty without drug-based devices or embolic protection. Intravascular ultrasound measured percent area stenosis before and after atherectomy to calculate luminal gain. Patency and &gt;70% restenosis were assessed by duplex ultrasound at 1 and 6 months or earlier if symptom recurrence prompted target lesion revascularization. Statistical analysis used &lt;i&gt;t&lt;/i&gt; tests, Mann-Whitney tests, analysis of variance, and chi-square tests, with significance set at &lt;i&gt;P&lt;/i&gt; &lt; .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean age was 74.5 years (95% CI, 72.9-76.2). Twenty-one patients (17.5%) were treated with excimer laser, 15 (12.5%) with solid-state laser, and 84 (70%) with rotational excisional atherectomy. Sixty-seven patients (55.8%) presented with in-stent restenosis and 53 (44.2%) with stent thrombosis. Stent length, number of stents, stent diameters, and Tosaka classes were similar across groups. Mean luminal gain did not differ between excimer laser (28.9%; 95% CI, 24.5-30.1) and solid-state laser (28.8%; 95% CI, 25.6-29.9). Rotational excisional atherectomy achieved significantly greater luminal gain (39.1%; 95% CI, 36.4-41.9) (&lt;i&gt;P&lt;/i&gt; &lt; .001) and outperformed laser atherectomy for both in-stent restenosis (&lt;i&gt;P&lt;/i&gt; = .014) and stent thrombosis (&lt;i&gt;P&lt;/i&gt; &lt; .001) subgroups. Six-month stenosis-free patency was highest with rotational excisional atherectomy (94%), compared with excimer laser (71.4%) and solid-state laser (73.3%) (&lt;i&gt;P&lt;/i&gt; &lt; .004).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Rotational excisional atherectomy was associated with greater immediate luminal gain and higher 6-month patency compared with excimer and solid-state laser atherectomy in the treatment of femoropopliteal in-stent restenosis and stent thrombosis. These findings suggest that rotational excisional atherectomy may have advantages over laser atherectomy for managing stent-related stenosis or thrombosis.Clinical ImpactRotational excisional atherectomy provides greater luminal gain and higher observed short-term patency compared with laser atherectomy in femoropopliteal in-stent restenosis and stent thrombosis. These findings suggest that rotational","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479288"},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841937","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":"Quantitative Ultrasonography Techniques for Assessing Femoropopliteal Atherosclerotic Lesions Using Peak Systolic Velocity Ratio: The TURN-UP Study II.","authors":"Aiko Hayashi, Masahiko Fujihara, Mitsuyoshi Takahara, Yumiko Komiya, Shun Aoki, Mina Enoki, Takamitsu Miyauchi, Rika Tanimoto, Takashi Araki, Keisuke Ishida, Isao Suminoe, Masayuki Nakakura, Fumiko Teranishi, Akiyuki Seno, Rika Takemoto, Noriko Tomoi, Makoto Utsunomiya, Terutoshi Yamaoka","doi":"10.1177/15266028261479206","DOIUrl":"https://doi.org/10.1177/15266028261479206","url":null,"abstract":"<p><strong>Purpose: </strong>Peak systolic velocity ratios (PSVRs) measured by duplex ultrasound (DUS) are commonly used to evaluate arterial stenosis in patients with lower extremity artery disease. However, standardized measurement protocols have not yet been established. Although guidelines recommend setting the angle correction to 60° or as low as possible below 60°, the optimal angle correction for accurate PSVR measurement remains unclear. This study aimed to determine the appropriate angle correction values. The primary endpoint was the intraclass correlation coefficients (ICCs) for inter-observer and intra-observer agreement in PSVR measurements.</p><p><strong>Results: </strong>The ICCs for inter-observer agreement for PSVR measurements were 0.65 (95% confidence interval = 0.32-0.75), 0.72 (0.40-0.79), and 0.74 (0.51-0.78), for angle correction values of 45°, 50°, and 60°, respectively. No significant differences were observed between the measurement methods. The ICCs for intra-observer agreement in PSVR measurements were 0.95 (95% confidence interval = 0.93-0.97), 0.97 (0.95-0.98), and 0.96 (0.95-0.97) when the angle correction values were set at 45°, 50°, and 60°, respectively. No significant differences were found between the measurement methods (<i>P</i> = .12 for 45° vs 50°, <i>P</i> = .41 for 50° vs 60°, and <i>P</i> = .59 for 60° vs 45°).</p><p><strong>Conclusion: </strong>No significant differences were noted among the 3 angle correction values. Therefore, an angle correction value of 45° to 60°, tailored to the specific clinical context, is considered reasonable.Clinical ImpactThe optimal angle correction for peak systolic velocity ratio (PSVR) measurement has not been clearly established. This prospective multicenter study demonstrates that angle correction values between 45° and 60° provide comparable inter- and intra-observer reproducibility. These findings suggest that strict adherence to a single angle correction value may not be necessary in clinical practice. Instead, selecting an angle close to the actual angle of incidence within this range may improve feasibility without compromising measurement reliability. These results provide practical guidance for standardizing PSVR assessment in routine vascular ultrasound examinations and clinical research.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479206"},"PeriodicalIF":1.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Intravascular Ultrasound in Aortoiliac Endovascular Interventions: International Expert-Based Delphi Consensus.","authors":"Pietro Dioni, Luca Bertoglio, Filippo D'Amico, Eric A Secemsky, Mohamad A Hussain, Marc L Schermerhorn, Michele Antonello, Yamume Tshomba, Stefano Gennai, Giovanni Pratesi, Mark Farber, Vincent Jongkind, Jörg Tessarek, Andrew Holden, Christopher Delaney, Kevin Mani, Erin C Saricilar, Enrico Gallitto, Manar Khashram, Glenn Wei Leong Tan, Nuno V Dias, Barend Mees, Ross Milner, Michele Piazza, Thomas Maldonado, Gustavo S Oderich, Tilo Kölbel, Giovanni Tinelli, Adam W Beck, Thodur Vasudevan, Alexander Oberhuber, Stefano Bonardelli, Sandro Lepidi, Mario D'Oria","doi":"10.1177/15266028261479540","DOIUrl":"https://doi.org/10.1177/15266028261479540","url":null,"abstract":"<p><strong>Introduction: </strong>Intravascular ultrasound (IVUS) provides cross-sectional information on the intraluminal features of blood vessels, aiding procedural planning and postprocedural assessment of results. Although the use of IVUS in aortic procedures is increasing worldwide, consensus on best practices in aortoiliac interventions is still lacking. This study aims to obtain experts' consensus and define recommendations regarding applications of intravascular ultrasound in aortoiliac endovascular interventionsMethods:Delphi consensus methodology was performed over 3 rounds, using a panel of 27 experts. Each member was asked to grade (grade A-grade D) 26 statements regarding various applications of IVUS in aortoiliac surgery. Statements that passed the first round were proposed at the second round unmodified. Statements that failed the first round underwent stylistic modifications without altering their meaning and were proposed in the second and third rounds. Agreement and consistency were used to develop recommendations on the applications of IVUS in aortoiliac endovascular interventions.</p><p><strong>Results: </strong>After 3 rounds, 17 recommendations were made (16 grade B, 1 grade A), whereas 8 statements were rejected, and the core team eliminated 1. Ten recommendations (58.8%) obtained grade IV (poor), 1 (5.9%) grade III (fair), 2 (11.8%) grade II (high), and 4 (23.5%) were classified as grade I (very high).</p><p><strong>Conclusions: </strong>Intravascular ultrasound is an important adjunct imaging technology in hybrid rooms. Most of the recommendations concerned the use of IVUS in aortic dissection. Other important recommendations for preoperative planning and evaluation of postoperative results were made in radioprotection, aortic aneurysms, and blunt thoracic aortic injury. Intravascular ultrasound assistance in aortoiliac occlusive disease is not routinely recommended at the present time.Clinical ImpactThis international expert-based Delphi consensus provides a comprehensive perspective on the current applications of intravascular ultrasound across various aspects of aortoiliac endovascular therapy. Clinical practice guidelines are currently lacking recommendations on the use of intravascular ultrasound (IVUS) as an adjunctive tool in aortoiliac endovascular surgery; therefore, this study aims to fill the current gap in the literature by assessing the role of IVUS across high-volume aortic centers and offering recommendations on possible IVUS applications in aortoiliac endovascular interventions. Areas of ongoing debate regarding IVUS are also highlighted in this article, to provide inputs for further research.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479540"},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834244","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":"Safety-Oriented Endovascular-First Revascularization for Proximal Subclavian Artery Chronic Total Occlusion: Real-World Strategy Selection and Mid-Term Outcomes.","authors":"Tao Shi, Jie Fang, Mingyao Luo, Yongbao Zhang","doi":"10.1177/15266028261479519","DOIUrl":"https://doi.org/10.1177/15266028261479519","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To report real-world outcomes of a safety-oriented, endovascular-first strategy for proximal atherosclerotic subclavian artery chronic total occlusion (CTO) and to develop a pragmatic computed tomography angiography (CTA)-based open-first consideration aid for anatomically unfavorable cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This single-center retrospective study included consecutive patients treated between January 2020 and December 2024. Endovascular-first revascularization was pursued when feasible, with bypass used as primary therapy or after failed endovascular attempts. Computed tomographic angiography morphology was assessed using prespecified definitions. Factors associated with endovascular technical success were evaluated using logistic regression. Hemodynamically significant restenosis during follow-up was defined as recurrence or progression of inter-arm systolic blood pressure difference ≥20 mm Hg relative to the post-discharge baseline. Time-to-event outcomes were assessed using Kaplan-Meier analysis. A CTA-based open-first consideration score (0-4) was derived among patients undergoing definitive revascularization (bypass vs successful endovascular repair).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 122 patients, endovascular-first treatment was attempted in 101, with technical success in 75 (74.3%); definitive revascularization was achieved in 112 patients (91.8%) after inclusion of bypass. Right-sided laterality, absent proximal stump (&lt;3 mm), and severe calcification were independently associated with endovascular technical failure. Periprocedural morbidity was low, with no clinically apparent stroke or transient ischemic attack; 1 localized type B aortic injury after endovascular repair and 1 lymphatic leak after bypass were managed conservatively. During a median follow-up of 26 months, estimated restenosis was approximately 10% at 1 year and 22% at 3 years, whereas clinically driven reintervention remained low at approximately 3% and 6%, respectively. The CTA-based open-first consideration score showed good discrimination for bypass selection (area under the curve, 0.887), with ≥2 points serving as a high-specificity prompt for bypass consideration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In proximal subclavian CTO, a safety-oriented endovascular-first strategy achieved acceptable technical success, low clinically apparent neurologic morbidity, and low reintervention during mid-term follow-up. A CTA-based open-first consideration score may help identify anatomically unfavorable cases for bypass consideration and define escalation boundaries, and warrants external validation.Clinical ImpactThis study supports a safety-oriented, endovascular-first approach for proximal subclavian artery chronic total occlusion, while emphasizing that endovascular and surgical revascularization should be considered complementary rather than competing strategies. Preprocedural CTA can identify anatomically unfavora","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479519"},"PeriodicalIF":1.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834101","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":"Association Between Abdominal Aortic Diameter and Major Cardiovascular and Cerebrovascular Events After Infrarenal Endovascular Aortic Aneurysm Repair.","authors":"Yuhan Qi, Tiehao Wang, Jichun Zhao, Ding Yuan, Jiarong Wang, Bin Huang","doi":"10.1177/15266028261474385","DOIUrl":"https://doi.org/10.1177/15266028261474385","url":null,"abstract":"<p><strong>Background: </strong>Major adverse cardiovascular and cerebrovascular events (MACCE) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) are serious outcomes. The primary aim of this study was to evaluate the incidence of MACCE after EVAR and to investigate the relevant predictive factors for MACCE.</p><p><strong>Materials and methods: </strong>This single-center retrospective cohort study included patients who were diagnosed with infrarenal AAAs and who underwent EVAR from February 2012 to February 2022. The cumulative incidence of MACCE after EVAR in this study was assessed via a competing-risk model.</p><p><strong>Results: </strong>This study included 1090 patients with AAAs who underwent EVAR. Multivariate analyses revealed that the maximum diameter of the AAA may be an independent predictor of MACCE after EVAR (hazard ratio per 10-mm increase = 1.219; 95% confidence interval [CI] = 1.072-1.397; <i>P</i> = .002). During a median follow-up of 42 months, 323 patients experienced at least 1 MACCE, whereas 767 patients did not experience MACCE. The cumulative risks of MACCE excluding noncardiovascular/noncerebrovascular mortality at 12, 36, and 60 months after EVAR were 5.4%, 9.1%, and 19.0%, respectively.</p><p><strong>Conclusion: </strong>The cumulative incidence of MACCE after EVAR for AAAs is relatively high, and the maximum diameter of the AAAs is a predictor of MACCE.Clinical ImpactMajor adverse cardiovascular and cerebrovascular events remain an important long-term concern after EVAR. In this large retrospective cohort, approximately one in five patients experienced MACCE within 5 years, after accounting for competing noncardiovascular/noncerebrovascular mortality. Importantly, larger maximum AAA diameter was independently associated with a higher risk of subsequent MACCE. These findings suggest that aneurysm diameter may provide additional information for cardiovascular risk stratification beyond its established role in determining aneurysm-related treatment. Patients with larger AAAs may therefore warrant closer cardiovascular surveillance and more intensive management of modifiable risk factors after EVAR.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261474385"},"PeriodicalIF":1.8,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814662","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}