Journal of Endovascular Therapy最新文献

{"title":"What Have We Learned From Explanted Peripheral Stents Analysis?","authors":"Salomé H Kuntz, Arielle Bellissard, Aloke V Finn, Anne Lejay, Nabil Chakfé, Renu Virmani","doi":"10.1177/15266028251349486","DOIUrl":"10.1177/15266028251349486","url":null,"abstract":"<p><strong>Introduction: </strong>The behavior of endovascular devices used to treat peripheral artery obstructive disease (PAOD) is evaluated on in vitro and in vivo animal models that do not necessarily predict their behavior in humans. Direct in vivo analysis is not feasible; therefore, studying explanted stents might help the approach understand their in vivo behavior and their potential long-term complications. Consequently, studying their in vivo behavior in human diseased vessels is necessary to improve them. This study aims to summarize current knowledge on the analysis of peripheral stents explanted in humans suffering from PAOD.</p><p><strong>Methods: </strong>A descriptive review of the MEDLINE and EMBASE databases was performed by a combined strategy of MeSH terms: \"peripheral stenting,\" \"histology,\" \"stents,\" \"pathology,\" \"neoatherosclerosis,\" and \"explants\"; with no time limit.</p><p><strong>Results: </strong>The literature search identified 18 publications; 4 addressed both femoral and iliac stents, 9 addressed exclusively femoral explanted stents, and 5 addressed carotid explanted stents. No reports addressing subclavian, vertebral, or renal stents were found. The total number of cases reported was 42, with 46 stented lesions including 58 devices. Twenty-seven femoral stented lesions were analyzed, and out of them, 20 presented with failure (74.1%). Eleven iliac stented lesions were analyzed; out of them, 9 (82%) had restenosis, and all of them presented with delayed healing. Eight carotid stented lesions were analyzed, of which 4 (50%) presented failures. Stent failures in iliac arteries were due to delayed healing, in femoral arteries due to intimal calcifications and stent integrity, and in carotid arteries due to underlying lipid-rich necrotic core causing ulceration; delayed healing (bare struts) was a common reason for stent failure in every type of peripheral bed.</p><p><strong>Conclusion: </strong>Our review showed that we have minimal data on the actual behavior of stents in humans, although it is fundamental to understand their performance. Failed peripheral stent explants are associated with delayed healing, and plaque-type morphology is linked to stent outcome. It is essential for peripheral stent explants to be analyzed in larger numbers to gather more pathologic data to make meaningful improvements.Clinical ImpactThis review identified only 18 publications addressing peripheral stent explant analysis, demonstrating that stent healing and failures are different within peripheral beds. This review highlights the need for a greater understanding of peripheral stenting pathology, and the only way we can do that is by analyzing a greater number of stent explants. It brings to light the fact, that we need to characterize each plaque to choose the appropriate endovascular treatment.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2276-2290"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555594","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":"A Systematic Review and Meta-Analysis of Outcome After Repeat Revascularization for Primary Carotid Artery Restenosis.","authors":"Mert Kök, Franziska Röder, Reinoud P H Bokkers, Maarten Uyttenboogaart, Barzi Gareb, Clark J Zeebregts","doi":"10.1177/15266028251325054","DOIUrl":"10.1177/15266028251325054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Carotid artery restenosis can occur after both carotid artery stenting (CAS) and carotid endarterectomy (CEA). This systematic review and meta-analysis aim to determine which revascularization technique, CAS, or CEA, is superior for treating primary carotid restenosis, irrespective of the initial revascularization method used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRALs) databases were searched for eligible studies on December 19th, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Primary endpoint was the occurrence of transient ischemic attack (TIA) or any stroke. Secondary endpoints were technical success, death within 30 days, myocardial infarction (MI), local complications, cerebral hyperperfusion syndrome (CHS), cranial nerve injury (CNI), dys-/arrythmia, secondary restenosis, repeat revascularization, and long-term survival. Results were adjusted for symptomatic status and primary treatment strategy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nineteen studies comprising 10,171 procedures in 10,041 patients were included. Baseline characteristics were comparable between groups. Main findings were (1) No difference in primary outcome; however, if adjusted for symptomatic status the rate of TIA/any stroke is higher (OR: 2.05, 95% CI: 1.29-3.27, p &lt; 0.01) after CEA compared to CAS; (2) Significant higher rate of MI (OR: 1.85, 95% CI: 1.19-2.86, p &lt; 0.01) after CEA; (3) Besides CNI, which appears to be commonly temporary and occurred only after CEA (7.56%, 95% CI: 4.21%-13.22%), no significant differences in other secondary endpoints were observed between groups. Long-term risk of secondary restenosis was similar between CEA compared to CAS (OR: 0.98, 95% CI: 0.39-2.49, p = 0.95); (4) Correction for the index procedure did not affect conclusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Based on limited-quality studies, mostly retrospective and nonrandomized in design, both CAS and CEA represent feasible treatment approaches for patients with primary restenosis, with comparable primary outcome between the two groups. However, based on the obtained results, CAS appears to be preferable. Patients should be critically evaluated in a multidisciplinary team and further research is desirable.Clinical ImpactThis review expands on previous studies by incorporating a larger patient cohort and more recent literature while offering new insights into restenosis. Unlike earlier research, this study uniquely evaluates first repeat revascularization outcomes (CAS and CEA) independently of the initial procedure, suggesting that patient and plaque characteristics might be more influential than the primary technique. Sensitivity analysis confirmed this, as stratification by index procedure did not alter conclusions. Although lower TIA/stroke and mortality ra","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2188-2203"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Experimental Evaluation of In Situ Laser-Fenestrated Versus Custom-Made Fenestrated Endografts.","authors":"Florian Elger, Marcello Silvano, Teodora Krasimirova Ormandzhieva, Ingo Kutschka, Giovanni Battista Torsello, Giovanni Federico Torsello","doi":"10.1177/15266028251350485","DOIUrl":"10.1177/15266028251350485","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the biomechanical performance and long-term durability of in situ laser fenestration (ISLF) compared to custom-made fenestrated endografts (CMD) using a controlled bench-top experimental setup.</p><p><strong>Methods: </strong>In situ, laser fenestration was performed in a RelayPro Dacron endograft using a 2.0 mm Turbo Elite OTW Laser Atherectomy catheter. Ten BeGraft Bridging Stent-Grafts (BSG) were implanted in 5 ISLF and 5 CMD Zenith fenestrations and subjected to 50 million fatigue cycles. Fenestrations were evaluated radiographically and microscopically for shape, size, fraying, endograft tearing, and BSG integrity.</p><p><strong>Results: </strong>Fenestration areas (median 8.1 mm²) and axis lengths (median long axis: 4.03 mm, median short axis: 2.33 mm) in the ISLF group were significantly less than CMD fenestrations (median area: 24 mm²; median long axis: 5.83 mm, median short axis: 5.8 mm) immediately post-manufacturing (p=0.002), but increased significantly after stenting and fatigue (p=0.002). Tearing was observed in 3 of 5 ISLF after ballooning but resolved after BSG implantation. BSG integrity was superior in the ISLF group, with no all-layer defects, while 3 of the 5 tested BeGrafts used in the CMD group revealed fabric defects with partial fracture of the stent in 2 (p=0.007).</p><p><strong>Conclusion: </strong>ISLF fenestrations demonstrated comparable durability to CMD fenestrations after long-term fatigue testing, with distinct advantages in BSG integrity preservation. These findings support ISLF as a viable option for urgent treatment, although further research is warranted to validate these results.Clinical ImpactIn-situ laser fenestration is a feasible technique for urgent complex aortic repair when customized or off-the-shelf devices are unavailable or technically unfeasible. However, long-term mechanical stability and durability under fatigue testing have not been previously evaluated. This study is the first to directly compare the long-term mechanical performance of industry-made custom fenestrations with in-situ laser fenestrations using a fatigue model. Results demonstrate non-inferiority of in-situ laser fenestrations, supporting their use as an effective off-label strategy for emergency or bailout interventions.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2739-2745"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Value of the Peripheral Arterial Calcium Scoring System on Computed Tomography Angiography in Patients With Chronic Limb-Threatening Ischemia Undergoing Below-the-Knee Endovascular Interventions.","authors":"Michael J Nugteren, Çağdaş Ünlü, Olaf J Bakker, Koen M van de Luijtgaarden, Morsal Samim, Hester J Scheffer, Gert J de Borst, Constantijn E V B Hazenberg","doi":"10.1177/15266028251363475","DOIUrl":"10.1177/15266028251363475","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Endovascular below-the-knee (BTK) revascularization is safe and effective in patients with chronic limb-threatening ischemia (CLTI), but outcomes depend on the severity of limb ischemia, anatomical pattern, comorbidity, and degree of vessel calcification. The most commonly used peripheral calcification score, the peripheral arterial calcium scoring system (PACSS), is angiography based and is therefore limited by low sensitivity and interobserver agreement. This study aimed to determine the prognostic value of the original and a modified PACSS (mPACSS) based on computed tomography angiography (CTA) imaging on short-term outcomes after BTK endovascular interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;All consecutive patients included in the prospective Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) between February 2021 and July 2023 who underwent CTA imaging within 6 months before the procedure were included. The mPACSS also takes calcification of the entire target vessel into account. Primary outcomes were limb salvage and amputation-free survival (AFS) at 3 months. Secondary outcomes were technical success, primary patency, and overall survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 419 patients with 473 limbs were included (mean age 74.1 ± 10.2 years; 71.1% male). PACSS 4 was present in 39.7% of the limbs and associated with higher age and higher rates of hypertension, diabetes mellitus, cardiovascular morbidity, wound, ischemia, foot infection stage, global limb anatomic staging system stage and use of stents. In multivariable analysis, PACSS 4 was significantly associated with lower limb salvage (hazard ratio [HR] 2.75, 95% confidence intervals [CI] 1.49-5.08, &lt;i&gt;P&lt;/i&gt; = .001) and AFS (HR 1.64, 95% CI 1.07-2.53, &lt;i&gt;P&lt;/i&gt; = .025), as was mPACSS ≥5 (limb salvage: HR 2.22, 95% CI 1.88-5.46, &lt;i&gt;P&lt;/i&gt; = .015; AFS: HR 1.68, 95% CI 1.06-2.65, &lt;i&gt;P&lt;/i&gt; = .026). No significant differences were found in terms of technical success, primary patency, and overall survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both PACSS and mPACSS scored on CTA imaging are significantly associated with 3-month limb salvage and AFS after BTK endovascular interventions.Clinical ImpactCurrent peripheral calcification scores are based on angiography and limited by a low sensitivity and minimal interobserver agreement. Scoring the original and modified peripheral arterial calcium scoring system (mPACSS) on computed tomography angiography (CTA) has proven to be more reliable and fast. Accordingly, this study shows that both PACSS and mPACSS scored on CTA are independent predictors of 3-month outcomes after below-the-knee interventions. This reinforces the importance of using a reliable peripheral calcification score in the preoperative assessment of CLTI patients eligible for revascularization. Future evaluations in larger cohorts with longer follow-up should investigate the PACSS and mPACSS in different clinical","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2609-2620"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Risk Carotid Lesion Segmentation: Advancing Stroke Risk Detection With Deep Learning.","authors":"Dylan Fischer, Claire Webster, Fabien Lareyre, Eric Ducasse, Caroline Caradu","doi":"10.1177/15266028251381672","DOIUrl":"10.1177/15266028251381672","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;While the benefits of carotid surgery for symptomatic carotid artery disease are well-established, the management of asymptomatic carotid lesions remains controversial, with wide variation in clinical practice. Recent studies suggest that plaque characteristics, such as thrombus versus calcium content, may predict cerebral events more accurately than the degree of stenosis alone. This study investigates the feasibility of segmenting carotid lesions on computed-tomography (CT) angiography using artificial intelligence (AI), and evaluates differences in plaque composition between symptomatic and asymptomatic patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Carotid plaques were analyzed using 2 segmentation approaches: physician-controlled manual segmentation and fully automated segmentation with the AI-based software PRAEVAorta2 (Nurea). Thrombus content, calcium burden, and residual lumen were analyzed and compared between the 2 techniques. The AI-based software was pre-trained on 19 CT angiograms. Sensitivity, specificity, Dice similarity coefficient (DSC), and volumetric similarity were calculated to evaluate the performance of both methods. A total of 156 patients who underwent carotid artery surgery between February 2019 and February 2022 were included in the analysis, comprising 81 symptomatic and 75 asymptomatic lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The DSC between fully automatic segmentation and physician-controlled manual segmentation was strong for lumen (0.83), calcification (0.68) and plaque (0.60) assessments but weaker for thrombus (0.33). Volume similarity, intra- and inter-observer reliability were high, with correlation coefficients of 0.98 for intra-observer, 1.00 for inter-observer analyses and 0.86 for fully automatic vs physician-controlled manual segmentation. Symptomatic carotid lesions exhibited significantly larger thrombus-to-total volume ratios (p&lt;0.0001), higher raw thrombus volumes (p&lt;0.0001), and greater total lesion volumes (p=0.003) than asymptomatic lesions. Conversely, asymptomatic lesions demonstrated higher calcification-to-total volume ratios (p=0.002).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study demonstrates the potential of PRAEVAorta2 to automate carotid lesion analysis, offering promise for identifying high-risk asymptomatic plaques and therefore aid surgical decision-making. Symptomatic carotid lesions displayed higher thrombus volume, lower calcium content, and larger plaque volumes than asymptomatic lesions.Clinical ImpactThis study introduces an AI-based tool, PRAEVAorta2, capable of automatically segmenting and quantifying carotid plaque components on CT angiography. By distinguishing between thrombus and calcification, the tool provides a more nuanced assessment of plaque vulnerability beyond stenosis grading. Clinically, this innovation could enhance risk stratification in asymptomatic carotid stenosis, supporting more individualized decisions for surgery. The demonstr","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2689-2701"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145650195","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":"Automated Laser Modified EndoGraft (ALMEG).","authors":"Wajdi Alrawi, Samuel Saers, Robert C Lind","doi":"10.1177/15266028251340305","DOIUrl":"10.1177/15266028251340305","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the technical details of a new and innovative method for modifying endografts to treat complex aortic aneurysms, especially in limited time and under stressful conditions. The first case ever performed using this method is also described.Method description:Automated Laser Modified EndoGraft (ALMEG) is a new method developed in Thoracic and cardiovascular Center, Linköping University Hospital, Sweden. A simple planning program was designed, and an automated laser fenestration machine was built to assist in planning and modification of endograft in cases with complex aortic aneurysm anatomy requiring repair. The planning program generates a patient's template based on computerized tomography angiography. The endograft is un-sheathed in a sterile environment and then scanned to generate an endograft template. The 2 templates are used to identify the optimal positions of fenestrations on the endograft. The laser machine then cuts fenestrations automatically and shortens the endograft if needed. The fenestrations are reinforced with nitinol wire and diameter-reducing ties are added to the endograft. The endograft is then re-sheathed and deployed in patient's aorta.</p><p><strong>Conclusion: </strong>ALMEG is a standardized and automated version of Physician Modified EndoGraft (PMEG) to minimize human error and to speed up the endograft modification procedure. The high precision and high speed of laser galvanometer together with the simplicity of our planning program refine and escalate the potential of PMEG. In stressful conditions and when the time factor is crucial as in ruptured complex aortic aneurysm, ALMEG offers a promising solution.Clinical ImpactThe introduction of Automated Laser Modified EndoGraft (ALMEG) marks a significant advancement in the management of complex aortic aneurysms. This innovative method is faster and less prone to human error compared to the traditional Physician Modified EndoGraft (PMEG). The simplicity and accuracy of ALMEG, along with its high speed, optimize the PMEG process, potentially setting a new standard in the field. Further integration with artificial intelligence may streamline endograft modification even more, broadening its applicability in acute clinical scenarios.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2746-2756"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585478","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":"Use of Fenestrated/Branched Devices for Rescue of Proximal Endograft Failure After Endovascular Aneurysm Repair: A Systematic Review of the Literature and an Updated Meta-Analysis.","authors":"Spyridon N Mylonas, Vasileios Papavlasopoulos, Konstantinos G Moulakakis, John Kakisis","doi":"10.1177/15266028251325430","DOIUrl":"10.1177/15266028251325430","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To present the current outcomes of fenestrated and branched endovascular aneurysm repair (F/BEVAR) for rescue of proximal endograft failure after endovascular aneurysm repair (EVAR). A systematic review of the currently published literature on F/BEVAR for failed EVAR is undertaken, and the eligible studies are combined into a meta-analysis with the intention of evaluating the safety, efficacy, and the durability of this treatment option.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A systematic review of the literature up to September 2024 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (CRD42024590847). Studies were included in the meta-analysis if they reported ≥10 patients and at least one of the major outcomes was stated. Primary endpoint was technical success (efficacy). Secondary endpoints included 30-day/in-hospital mortality and morbidity (safety) and survival and reinterventions rate (durability). Methodological quality and robustness of the results of the eligible articles were assessed according to Joanna Briggs Institute (JBI's) critical appraisal tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 16 studies with overall 1079 patients were included. The pooled estimate for technical success was 94.4% (95% CI 92.5-95.8), whereas for the 30-day/in-hospital mortality 3.9% (95% CI 2.9-5.4). Permanent paraplegia was developed in a pooled rate of 1.6% (95% CI 0.8-3.0), whereas a cerebrovascular event in a pooled rate of 1.5% (95% CI 0.9-2.8). An acute renal function impairment requiring new onset dialysis occurred with a pooled rate of 4.4% (95% CI 3.2-6.1). Postoperative respiratory failure was observed with a pooled estimate of 7.2% (95% CI 5.5-9.4). The pooled estimate for 12-month overall survival was 88% (95% CI 83.4-91.4), and the pooled estimate for 24- and 36-month survival were 79.8% (95% CI 75.6-83.4) and 72.2% (95% CI 66.7-77.2), respectively. Freedom from reintervention was estimated at 83.7% (95% CI 79.9-86.9) for 12 months, 75.8% (95% CI 61.0-86.2) for 24 months and 59.3% (95% CI 36.5-78.7) for 36 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study showed that F/BEVAR is a feasible, safe, and reliable strategy for achieving proper proximal endograft sealing when previous EVAR has failed. The midterm survival of these patients is acceptable, whereas reinterventions are not negligible.Clinical ImpactThis work summarizes the current experience with fenestrated and branched endovascular aneurysm repair for the rescue of failed endovascular aneurysm repair in the most contemporary meta-analysis including 16 studies with a total of 1079 analyzed patients. Feasibility of the method is proven with a technical success of 94.4%, whereas a 30-day/in-hospital mortality of 3.9% was recorded. The compromised survival and freedom from reinterventions rates (72.2% and 59.3% for 36 months, respectively) pose, however, concerns regarding durability","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2214-2231"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626712","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":"Twelve-Month Outcomes of the Prospective, Multicenter, Single-Arm Study of the 355-nm Laser for Treatment of Below-the-Knee Arteries: Final Results of the Auryon BTK.","authors":"Nicolas W Shammas, Timothy Yates, Ashwani Sastry, Joseph Ricotta, Robert Beasley, Warren Swee, Gail A Shammas, Sue Jones-Miller, Venkat Shankarraman, Steve Ratchford","doi":"10.1177/15266028251352772","DOIUrl":"10.1177/15266028251352772","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Auryon laser atherectomy system has been shown to have high procedural success in the prospective, multicenter Auryon BTK study. We present the 12-month outcomes of the Auryon BTK in treating infrapopliteal arterial disease in patients with chronic limb-threatening ischemia (CLTI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients at 4 US centers with CLTI were prospectively enrolled in the Auryon BTK study after obtaining informed consent. The study was approved by a central ethics committee. The 30-day primary safety and procedural success were recently published. Secondary endpoints included target lesion revascularization (TLR), clinical patency (defined as peak systolic velocity ratio ≤2.4 and no TLR), major adverse limb events (amputation, target vessel revascularization, and/or all-cause mortality), Walking Impairment Questionnaire (WIQ), Rutherford Becker (RB) category, and EQ-5D quality of life questionnaire. Proportional and Kaplan-Meier (K-M) survival analysis were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 patients (61 lesions) were enrolled. At 12-month, 42 patients were still in the study (7 lost-to-follow-up, 5 withdrawals, 7 deceased). The mean age was 74.6 ± 10.3 years with 58.3% diabetics, 43.3% RB IV, and 56.7% RB V. Of the 61 lesions, 59% had severe calcification, 31.1% were chronic total occlusions, and 90.2% were de novo disease. Bailout stenting occurred in 1/61 lesions (1.6%). Proportional analysis for freedom from TLR at 1-year was 94.2%, and TVR was 89.4%. K-M analysis for freedom from TLR was 94.0% at 12-month. There was a significant difference in median WIQ score from to baseline to 3-month (p = 0.0020) and baseline to 6-month (p = 0.0290) but not from baseline to 12-month (Δ-0.073, p = 0.678). Wounds healed in 33.3% (n = 4/12) of patients at 12-month. There was also a significant difference in median EQ-5D total score from baseline to 30-day (p = 0.0030), 3-month (p = 0.0060), 6-month (p = 0.0500), and 12-month (p = 0.00005). In addition, there was a significant median difference between 30-day ankle-brachial index (ABI) and baseline ABI (p &lt; 0.0005) and the 12-month ABI and baseline ABI (p = 0.2100). Rutherford-Becker category improved by ≥1 category among 67.6% (n = 23/34) patients, stayed the same in 29.4% (n = 10/34) patients and worsened in 2.9% (n = 1/34) patients at 1-year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The 355-mm laser has a high rate of freedom from TLR at 12-month with a significant improvement in RB categories, WIQ and quality of life (EQ-5D).Clinical ImpactThe Auryon BTK demonstrates the safety and effectiveness of the 355-nm Auryon laser system in treating infrapopliteal arterial disease in patients with critical limb ischemia yielding high freedom from TLR and improvement in quality of life despite complex disease. The Auryon laser can treat all lesion morphologies below the knee including severe calcium and needs to be considered by operators for vessel pre","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2555-2560"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644037","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":"Physician Modification of Polytetrafluoroethylene Based Endografts for Aortic Aneurysm Repair.","authors":"Benjamin R Zambetti, Anahita Shiva, Josiah T Hardy, Olivia M Babick, Anthony G DeMartino, Nisarg N Shah, Mehrdad Ghoreishi, Saurabh Gupta, Shahab Toursavadkohi","doi":"10.1177/15266028251353359","DOIUrl":"10.1177/15266028251353359","url":null,"abstract":"<p><strong>Objective: </strong>Physician-modified endografts (PMEGs) have provided an endovascular approach for repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. While the use of polyethylene terephthalate (Dacron)-based grafts is growing, we aimed to evaluate the use and outcomes of a polytetrafluoroethylene (PTFE)-based system for such cases.</p><p><strong>Materials and methods: </strong>In a retrospective, single-center cohort study from November 2021 to June 2024, treatment with physician-modified PTFE endograft for complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms was assessed. Stent modification and deployment was described and illustrated. Patient demographics, procedural details, and postoperative outcomes were collected and analyzed. Major adverse events, 30-day mortality, reintervention, endoleak, and aortic related mortality were analyzed in this cohort.</p><p><strong>Results: </strong>Twenty-nine patients who received physician modified PTFE endograft were included in this study. Of these patients, 25 had urgent or emergent indication for intervention. Of the grafts modified, 83% were conformable thoracic stent graft devices and 17% were excluders. Endoleaks were observed in 24.1% of patients postoperatively; 1 patient had a type 1C endoleak and 6 patients had type 2 endoleak. Reinterventions were necessary in 3 patients. The 30-day survival observed in this study was 96.6% and freedom from total aortic related mortality was 93.1%.</p><p><strong>Conclusions: </strong>PTFE-PMEG can be employed with limited risk of endoleak and aortic related mortality. Further study involving long-term follow up and prospective data is necessary.Clinical ImpactPMEGs are increasingly utilized for patients unfit for open repair of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms. Our study provides evidence in support of PMEGs for primarily medically urgent cases of this nature. We report limited complications, including endoleak or aortic related mortality, with a median follow up of over 7 months. While most of the current literature explores the use of Dacron-based grafts for PMEG, our study explores the use of PTFE-PMEG, which provides ease of manipulation and implantation. This technique can be employed with promising outcomes and necessitates further study by other vascular surgeons.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2529-2535"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621069","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":"Application of Wharton's Jelly Mesenchymal Stem Cells in Critical Limb Ischemia.","authors":"Hao Liang, Bin Zhao, Yuanyuan Ren, Peng Li, Xiangchen Dai","doi":"10.1177/15266028251361770","DOIUrl":"10.1177/15266028251361770","url":null,"abstract":"<p><p>Peripheral artery disease (PAD) is a chronic vascular condition, and patients in the advanced stages typically do not respond favorably to interventional or surgical approaches. Recent advancements in Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) fundamental research have produced promising data in the context of PAD management. As recent pilot studies have suggested WJ-MSCs efficacy in patients with end-stage PAD who lack alternative treatment option, WJ-MSCs may offer a novel therapeutic strategy for managing end-stage PAD. The abundance, ease of isolation, and absence of ethical concerns associated with WJ-MSCs facilitate their potential clinical use. However, randomized, appropriately powered clinical trials are necessary to comprehensively assess their safety and effectiveness. This review aims to summarize the molecular and cellular mechanisms underlying the emerging role of WJ-MSCs in critical limb ischemia.Clinical ImpactThis review establishes Wharton's Jelly MSCs (WJ-MSCs) as a paradigm-shifting therapy for end-stage critical limb ischemia (CLI).This review pioneers a translational roadmap for WJ-MSCs in CLI by integrating molecular mechanisms, preclinical models, and clinical outcomes. It uniquely identifies anatomic sourcing heterogeneity as a critical efficacy variable and proposes combination therapy with revascularization.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2232-2242"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976786","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}