Journal of Endovascular Therapy最新文献

{"title":"Impact of Active Smoking in Peri-operative Outcomes of Patients Undergoing FB-EVAR for Thoracoabdominal and Complex Abdominal Aortic Aneurysms.","authors":"Diego V S Rodrigues, Richard T Rogers, Jesse Chait, Armin Tabiei, Randall R DeMartino, Gustavo S Oderich, Bernardo C Mendes","doi":"10.1177/15266028261484740","DOIUrl":"https://doi.org/10.1177/15266028261484740","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate outcomes of fenestrated-branched endovascular aortic repair (FB-EVAR) of thoracoabdominal aortic aneurysms (TAAAs) and complex abdominal aortic aneurysms (CAAAs) in patients actively smoking at the time of repair compared with previous smokers and non-smokers.</p><p><strong>Methods: </strong>Single-center retrospective review of elective FB-EVARs for TAAA and CAAAs between 2007 and 2023 was conducted. Demographics, comorbidities, aneurysm extent/ morphology, technical details, and peri-operative outcomes were collected. Patients were grouped into 1 of 3 groups: active smokers, prior smokers, and never smokers. Patients who stopped smoking within 6 weeks to surgery were considered active smokers. Rupture and symptomatic aneurysms were excluded. Endpoints included early (<30 days) mortality and major adverse events (MAEs).</p><p><strong>Results: </strong>There were 676 patients (73% male, mean age 74 ± 7.8). There were 141 (21%) active smokers, 455 (67%) prior smokers, and 80 (12%) never smokers. Active smokers were significantly younger than prior or never smokers (71 ± 6.7, 75 ± 6.9, and 76 ± 12, respectively; <i>P</i> < .001). Cardiovascular risk factors were similar, except active smokers were significantly more likely to have chronic obstructive pulmonary disease (60% vs 42% vs 6.2%, <i>P</i> < .001) and peripheral arterial disease (31% vs 24% vs 10%, <i>P</i> = .002) when compared to prior and never smokers, respectively. Patients who never smoked had significantly more extent II aneurysms (34%) than prior (18%) and active (15%) smokers, <i>P</i> = .001. Univariable and multivariable logistic regression analyses showed no statistically significant associations between smoking status and any specific peri-operative adverse events following surgery.</p><p><strong>Conclusion: </strong>Active smoking status does not appear to affect peri-operative outcomes after FB-EVAR for complex aortic aneurysms. Although smoking cessation must be strongly encouraged, repair should not be delayed due to active smoking status.Clinical ImpactThese data suggest that active smoking, in isolation, should not be considered a contraindication to elective FB-EVAR when anatomy is suitable and patients are otherswise optimized. This is particularly relevant for high-risk patients who may have limited alternative treatment options. Proceeding with FB-EVAR in active smokers does not appear to compromise early safety or procedural efficacy.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261484740"},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026597","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":"TEVAR for Nontraumatic Ruptured Type B Aortic Dissections: A European Multicentre Study.","authors":"Erika Lilja, Kevin Mani, Anders Wanhainen, Vibeke Bjerg Hansteen, Jacob Budtz-Lilly, Nicola Leone, Stefano Gennai, Marco Virgilio Usai, Martin Austermann, Imam Tongku Padesma Ritonga, Nikolaos Tsilimparis, Baban Assaf, Michele Piazza, Giuseppe Asciutto","doi":"10.1177/15266028261484805","DOIUrl":"https://doi.org/10.1177/15266028261484805","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Ruptured acute type B aortic dissection (TBAD) is rare, carries high mortality risk, and presents major challenges with limited supporting evidence. This study evaluated early and mid-term outcomes after thoracic endovascular aortic repair (TEVAR) for nontraumatic ruptured TBAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective multicentre study included patients undergoing TEVAR for nontraumatic ruptured TBAD at 6 vascular centres (2010-2023). Rupture was defined as haemothorax (30-45 HU) on preoperative computed tomography with or without aortic wall disruption or active extravasation. Outcomes were 30-day and mid-term mortality, reinterventions, and complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-four patients treated with TEVAR for nontraumatic ruptured TBAD were identified; 11 haemodynamically unstable. Distal dissection extended to Lombardi zone ≤5 in 12 (35.3%), and ≥6 in 22 (64.7%), and distal landing zone was within dissected aorta in 20 (58.8%). Visceral branch revascularisation and intentional coverage of the left subclavian artery were performed in 14 (41.2%) and 15 (44.1%) patients, respectively. Median follow-up for those surviving the first 30-day period was 17.5 months (interquartile range [IQR] 4.75-39.5). Thirty-day mortality was 20.6% (n = 7) and 90-day mortality 35.3% (n = 12). At 3-year follow-up, 14 patients (41.2%) had died, of which 8 patients suffered an aortic-related death. No difference in survival between distal TEVAR landing in non-dissected versus dissected aorta (42.9% vs 57.1%; log-rank &lt;i&gt;P&lt;/i&gt; = .738) was observed. Seven patients had aortic reinterventions (20.6%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this multicentre cohort of ruptured TBAD treated with TEVAR, the perioperative mortality at 90 days was high, but patients surviving that period had an acceptable mid-term outcome. These findings suggests that strict healthy-to-healthy landing may not always be necessary when rapid haemorrhage control is required in ruptured TBAD. Prospective registries and international collaborative studies are needed to refine patient selection, treatment strategies and long-term outcomes.Clinical ImpactEvidence regarding TEVAR for ruptured TBAD remains limited. The present multicentre study therefore provides valuable new insights with real-world outcomes across multiple vascular institutions. The findings suggests that strict healthy-to-healthy landing may not always be necessary when rapid haemorrhage control should be prioritized in ruptured TBAD.TEVAR remains the primary treatment for ruptured TBAD, but perioperative risk is substantial, with a 90-day mortality of 35%. Clinicians should recognize that patients surviving this critical early window have acceptable mid-term outcomes, supporting continued aggressive intervention despite the early risk. In this study distal landing within dissected aorta does not compromise survival compared to healthy-to-healthy landing, challenging conven","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261484805"},"PeriodicalIF":1.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013112","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 Preoperative Gluteal Muscle Quality on CT and Buttock Claudication After EVAR With Internal Iliac Artery Embolization.","authors":"Kenta Yoshikawa, Tsuyoshi Shibata, Yutaka Iba, Hirokazu Sugiura, Shingo Tsushima, Shun Hayasaka, Hajime Maeda","doi":"10.1177/15266028261485135","DOIUrl":"https://doi.org/10.1177/15266028261485135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Internal iliac artery (IIA) embolization is frequently performed during endovascular aneurysm repair (EVAR) to secure an adequate distal sealing zone or to treat iliac artery aneurysms; however, it may result in postoperative buttock claudication. This study investigated the association between preoperative gluteal muscle mass and quality assessed on noncontrast computed tomography (CT) and the risk of postoperative buttock claudication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a 2-center retrospective observational study conducted across 2 institutions. A total of 116 patients who underwent EVAR with concomitant IIA embolization between May 2015 and February 2025 were included. Preoperative noncontrast CT was used to assess gluteal muscle quality, defined by CT attenuation, and muscle mass, defined by cross-sectional area (CSA), of the gluteus medius and gluteus maximus muscles. The primary outcome was newly developed postoperative buttock claudication. Logistic regression analyses were performed to identify factors associated with buttock claudication. Variables that remained significant in multivariable analysis were further evaluated using receiver operating characteristic (ROC) curve analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Buttock claudication occurred in 54 of 116 patients (46.6%). While CSA was not associated with buttock claudication, CT attenuation values of both the gluteus medius and gluteus maximus were significantly higher in patients who developed buttock claudication (both &lt;i&gt;P&lt;/i&gt; &lt; .001). In multivariable analysis, bilateral IIA embolization, gluteus medius CT attenuation, and gluteus maximus CT attenuation were independently associated with buttock claudication. Receiver operating characteristic analysis demonstrated moderate discriminatory ability, with an area under the curve of 0.764 for the gluteus medius and 0.717 for the gluteus maximus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients undergoing EVAR with IIA embolization, preoperative gluteal muscle quality assessed by noncontrast CT was independently associated with the development of buttock claudication, whereas muscle mass was not. Preoperative assessment of gluteal muscle quality may provide complementary information for risk stratification and patient counseling. In anatomically feasible cases, it may also serve as an adjunctive factor when discussing pelvic perfusion-preserving options.Clinical ImpactButtock claudication after EVAR with internal iliac artery embolization has traditionally been explained by anatomical and technical factors. This study demonstrates that gluteal muscle quality, assessed by CT attenuation on routine preoperative noncontrast CT, is independently associated with the development of buttock claudication, whereas muscle mass was not associated with this outcome. By introducing muscle quality as a patient-related risk factor, these findings suggest that preoperative assessment of gluteal muscle quality may pro","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261485135"},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992181","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":"Prospective Sirolimus Coated Angioplasty for Arterial Disease in Patients Presenting Chronic Limb-Threatening Ischemia Study (PROSCAD-CLTI STUDY).","authors":"Salvatore Bruno, Domenico Mirabella, Ettore Dinoto, Giulia Carlotti, Edoardo Rodriquenz, Felice Pecoraro","doi":"10.1177/15266028261485137","DOIUrl":"https://doi.org/10.1177/15266028261485137","url":null,"abstract":"<p><strong>Background: </strong>Angioplasty in chronic limb-threatening ischemia (CLTI) with paclitaxel-coated device has raised doubts on its long-term safety. Consequently, sirolimus-coated balloons (SCBs) have gained more interest given a better safety profile, maintaining good outcomes. This study aims to evaluate the safety and efficacy of SCB (SELUTION SLR; M.A. Med Alliance SA, Nyon, Switzerland) for femoropopliteal arterial disease in patients presenting with CLTI.</p><p><strong>Methods: </strong>This prospective, single-center study included patients with CLTI with femoropopliteal arterial disease treated between October 2022 and July 2024. Exclusion criteria included planned primary amputation and long-segment occlusions (>25 cm) of the femoropopliteal axis. Primary endpoints were technical success and primary patency (PP). Primary patency was defined as freedom from restenosis determined by a duplex ultrasound peak systolic velocity ratio ≤2.4. Secondary endpoints included mortality, clinically driven target lesion revascularization, freedom from reintervention, and from major amputation.</p><p><strong>Results: </strong>A total of 24 patients were treated during the study period with a mean lesion length of 152 ± 54.7 mm. All procedures were conducted successfully. One early death occurred after 3 days of the index procedure because of worsening of pre-existing cardiac failure. At 30 months, PP, mortality, and freedom from major amputation were 95.5%, 91.7%, and 95.7%, respectively.</p><p><strong>Conclusions: </strong>These findings suggest that using an SCB is a safe and effective treatment option for femoropopliteal steno-occlusive lesions in CLTI. These results will need to be confirmed by long-term follow-up and randomized controlled trials.Clinical ImpactConcerns about paclitaxel-coated devices have driven the search for safer alternatives. Sirolimus-coated balloons (SCBs) have demonstrated promising results in terms of primary patency and freedom from clinically driven target lesion revascularization. The SELUTION SLR SCB, with its unique drug delivery technology, emerges as a strong candidate in this context. This observational study aims to evaluate its performance in treating femoropopliteal arterial disease in patients with chronic limb-threatening ischemia. Overall, the SELUTION SLR shows encouraging and consistent outcomes in this challenging patient population.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261485137"},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992210","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":"Early Multicentre Outcomes of Endovascular Aortic Arch Repair Using a Custom-Made Triple-Branch NEXUS TRE Endograft System (TRE-ASURE Study).","authors":"Prakash Saha, Michele Antonello, Theodosios Bisdas, Semih Buz, Ignacio Michel, Marina Ansuategui, Rafael García-Borbolla Fernández, Angel Flores Herrero, Gino Gemayel, Giacomo Isernia, Adrien Kaladji, Alexander Oberhuber, Gianbattista Parlani, Timothy A Resch, Gioele Simonte, Jean-Paul P M de Vries, Said Abisi","doi":"10.1177/15266028261485095","DOIUrl":"https://doi.org/10.1177/15266028261485095","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To report the first multicentre European experience with the custom-made NEXUS TRE triple-branch endograft for fully endovascular, debranch-free repair of complex aortic arch pathology, focusing on technical feasibility and early safety outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective multicentre analysis included 21 consecutive patients treated with the NEXUS TRE system across 13 European centres between August 2024 and October 2025. Baseline characteristics, procedural metrics, and early (≤30-day) outcomes were assessed. The primary endpoint was device technical success. Secondary endpoints included 30-day mortality, neurological events, spinal cord ischaemia, device-related reintervention, branch patency, and endoleaks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median age was 75 years (range 59-86), and 19 patients (90.5%) were male. Indications included degenerative aortic arch aneurysm in 11 patients (52.4%) and aneurysmal degeneration following chronic dissection in 10 (47.6%). Primary technical success of the NEXUS TRE device was achieved in 20/21 patients (95.2%), with assisted technical success in 21/21 (100%). There was no in-hospital or 30-day mortality, and no disabling stroke or spinal cord ischaemia occurred. Two patients (9.5%) had nondisabling ischaemic strokes, both with diffusion-weighted-MRI-confirmed embolic infarction; a third patient developed a transient left vocal-cord palsy on a background of established infarcts, without new acute infarction on MRI. All symptoms resolved without disabling deficit (30-day modified Rankin Scale &lt;2). Median procedure time was 227 minutes (IQR 200-278), fluoroscopy time 68.3 minutes (IQR 55.5-87.0), and contrast volume 145 mL (IQR 100-160). One type Ic endoleak that was identified on completion angiography (at the left subclavian bridging stent) was treated intra-operatively with no residual leak. Two type II endoleaks were managed conservatively, with no type Ia, type Ib, or persistent type III endoleak noted on postoperative CT angiography, with all supra-aortic target vessels remaining patent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this first multicentre European experience, the custom-made NEXUS TRE triple-branch system demonstrated high device technical success and an encouraging early (30-day) safety profile in selected high-risk patients. These findings support the feasibility of fully endovascular, debranch-free multi-branch repair of the aortic arch. Larger studies with longer follow-up are now required to assess durability.Clinical ImpactThis first multicentre European experience suggests that fully endovascular, debranch-free aortic arch repair using the custom-made NEXUS TRE triple-branch system is technically feasible in selected high-risk patients unsuitable for open repair. In 21 patients treated across 13 European centres, primary device technical success was 95.2%, assisted technical success was 100%, and no 30-day mortality, disabling st","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261485095"},"PeriodicalIF":1.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992236","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":"Outcomes Analysis of 3 Different Device Platforms for the Covered Endovascular Reconstruction of the Aortic Bifurcation.","authors":"Gabriele Piffaretti, Sergio Zacà, Martina Palughi, Francesco Squizzato, Walter Dorigo, Alessandra Bandiera, Federico Villa, Domenico Angiletta, Pasqualino Sirignano, Michele Antonello, Raffaele Pulli, Lucia Di Stefano, Sara Speziali","doi":"10.1177/15266028261484791","DOIUrl":"https://doi.org/10.1177/15266028261484791","url":null,"abstract":"<p><strong>Objectives: </strong>To analyze the major aortoiliac obstructive disease (AIOD)-related outcomes after covered endovascular reconstruction of aortic bifurcation (CERAB), comparing 3 different endovascular platforms.</p><p><strong>Materials and methods: </strong>It is a physician-initiated, unsupported, multicenter, observational, retrospective, cohort study. We identified all CERABs between March 1, 2016 and September 30, 2024. We compared 3 different endovascular platforms: Viabahn VBX (W.L. Gore, Flagstaff; Arizona), AFX/AFX-2 (Endologix, Irvine, California), and BeGraft (Hechingen, Germany). Inclusion criteria were CERAB procedure for primary or de novo AIOD; exclusion criteria were CERAB using a combination of different platforms, traumatic lesions, and missing preoperative/follow-up data. Specifically, for the purposes of this study, the primary outcomes were overall survival and CERAB-related reintervention.</p><p><strong>Results: </strong>We analyzed 220 (96.9%) CERABs: 132 (60.0%) with the VBX, 60 (27.3%) with the AFX/AFX-2, and 28 (12.7%) with the BeGraft. Patients in the VBX group were older [median-25th-75th interquartile: VBX, 71 [IQR, 65.2-77] vs AFX/AFX-2, 64 [IQR, 59-72] vs BeGraft 68 [IQR, 55.7-73.5], <i>P</i> = .002], whereas AFX/AFX-2 group had the lowest rate of critical limb-threatening ischemia as presenting scenario (VBX, 36.4% vs AFX/AFX-2, 18.2% vs BeGraft 35.7%, while AFX/AFX-2 <i>P</i> = .039). Technical success was achieved in 217 (98.6%) procedures: all 3 failures occurred in the VBX group. The median follow-up was 21 months (IQR, 9-30), with a difference among the groups (months: BeGraft 21 [IQR, 10.7-42] vs VBX, 13.5 [IQR, 6-26] vs AFX/AFX-2, 25 [IQR, 17.2-38.7], <i>P</i> = .001]. Estimated survival was 92% ± 0.2 (95% CI, 87.0-94.9) at 12 months, 87% ± 0.3 (95% CI, 81.4-91.6) at 24 months, and 76 ± 0.5 (95% CI, 64.6-84.2) at 60 months. The freedom from CERAB-related reintervention rate was 94% ± 0.2 (95% CI, 89.7-96.5) at 12 months, 93% ± 0.2 (95% CI, 88.3-95.9) at 24 months, and 89 ± 0.3 (95% CI, 81.4-94.1) at 60 months. Survival and freedom from CERAB-related reintervention did not differ among the groups (<i>P</i> = .696 and <i>P</i> = .497, respectively).</p><p><strong>Conclusion: </strong>In patients with AIOD, the CERAB technique proved to be safe procedure with acceptable durability at mid- to long-term follow-up independently of the type of endovascular platform.Clinical ImpactWith the current technical expertise and wide availability of a variety of endovascular platforms and geometries of reconstruction, the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) endovascular reconstruction of aorto-iliac obstructive disease proved to be a satisfactory technique based on durable results at mid-term follow-up with independently of the device used.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261484791"},"PeriodicalIF":1.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972090","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":"CHA2DS2-VASc Score for Risk Stratification After Endovascular Therapy in Patients With Symptomatic Peripheral Artery Disease.","authors":"Yuki Shima, Eiji Karashima, Shingo Kurimoto, Takashi Shimonaga, Tomohiro Yoshino, Hironobu Toda, Kohei Kawamura, Akira Takashima, Yoji Urabe, Yasunori Arai, Yusuke Kobayashi, Takanobu Okazaki, Naoto Ohsawa, Gakuto Bando, Narumi Irie, Kazunori Mushiake, Naoya Inoue, Mitsuru Abe","doi":"10.1177/15266028261484801","DOIUrl":"https://doi.org/10.1177/15266028261484801","url":null,"abstract":"<p><strong>Objective: </strong>Risk stratification after endovascular therapy (EVT) for symptomatic peripheral artery disease (PAD) remains clinically important, particularly in patients with multiple comorbidities. The CHA2DS2-VASc score is a simple clinical score that incorporates major cardiovascular risk factors, but its prognostic utility after EVT for PAD has not been well established. This study evaluated the association between the CHA2DS2-VASc score and 3-year mortality in patients undergoing EVT for symptomatic PAD.</p><p><strong>Methods: </strong>This multicenter retrospective study included 1584 patients who underwent EVT for symptomatic PAD between 2018 and 2020. Patients were classified into low, intermediate, and high CHA2DS2-VASc score groups. The primary outcome was all-cause mortality at 3 years. Kaplan-Meier analysis and multivariable Cox proportional hazards models were used to assess the association between the score and mortality. Subgroup analyses were additionally performed according to atrial fibrillation (AF) status and PAD severity, including intermittent claudication (IC) and chronic limb-threatening ischemia (CLTI).</p><p><strong>Results: </strong>The rates of 3-year all-cause mortality increased stepwise across the low, intermediate, and high-score groups (4.4%, 17.2%, and 25.3%, respectively; log-rank <i>P</i> < .001). After adjustment for PAD-specific clinical factors, the CHA2DS2-VASc score remained independently associated with all-cause mortality (hazard ratio per 1-point increase, 1.31; 95% CI, 1.21-1.43; <i>P</i> < .001). This association was evident in patients without AF and was also observed in both IC and CLTI subgroups.</p><p><strong>Conclusions: </strong>In patients undergoing EVT for symptomatic PAD, a higher CHA2DS2-VASc score was independently associated with increased 3-year mortality. This widely available score may serve as a simple adjunctive tool for initial risk stratification after EVT and may complement established PAD-specific prognostic assessments.Clinical ImpactPatients undergoing endovascular therapy (EVT) for symptomatic peripheral artery disease remain at substantial risk of long-term mortality. In this multicenter study, the CHA₂DS₂-VASc score was independently associated with 3-year mortality across a broad spectrum of symptomatic PAD, including intermittent claudication and chronic limb-threatening ischemia. Although PAD- and CLTI-specific prognostic models provide superior discrimination, the CHA₂DS₂-VASc score is simple, universally recognized, and immediately available without disease-specific assessments. It may serve as an adjunctive tool for initial risk stratification and complement established prognostic models in routine clinical practice.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261484801"},"PeriodicalIF":1.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972083","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":"Two-Year Patency and Reintervention Patterns of Stent Graft Placement for Arteriovenous Graft Outflow Stenosis From a Prospective Multicenter Study.","authors":"Kotaro Suemitsu, Masaaki Murakami, Masahito Miyamoto","doi":"10.1177/15266028261485124","DOIUrl":"https://doi.org/10.1177/15266028261485124","url":null,"abstract":"<p><strong>Objective: </strong>Stent graft placement is an established treatment for arteriovenous graft venous anastomotic stenosis. However, maintaining secondary patency often requires frequent reinterventions, burdening patients, and health care systems. This study evaluated the 2-year outcomes of stent graft placement, focusing specifically on the frequency and anatomical distribution of subsequent reinterventions.</p><p><strong>Methods: </strong>This 2-year analysis of a prospective, multicenter postmarket surveillance study in Japan involved 103 patients (105 lesions) treated with the GORE VIABAHN Endoprosthesis with Heparin Bioactive Surface for arteriovenous graft venous anastomotic stenosis or thrombosis. Primary endpoints were target-lesion primary patency (TLPP) and access circuit primary patency (ACPP). Reintervention topology across 5 anatomical zones was analyzed.</p><p><strong>Results: </strong>At 2 years, TLPP was 30.5% (95% confidence interval [CI]: 21.0, 40.5), whereas ACPP was lower at 12.4% (95% CI: 6.4, 20.7). Secondary patency was 83.5% (95% CI: 73.6, 90.0) for both measures. A total of 242 reinterventions were performed, with a mean cumulative number of 1.76 per patient at 2 years. Topological analysis revealed that the intra-arteriovenous graft segment was the most frequent site of failure (134 events), followed by stent graft outflow (66 events). Failure at the intra-stent graft was rare (2 events). The median time to first reintervention was shortest for intra-arteriovenous graft lesions (205 days).</p><p><strong>Conclusions: </strong>Stent graft placement provided durable patency at the target venous anastomosis. However, the primary site of access failure shifted to the intra-arteriovenous graft segment, driving high reintervention rates. These findings highlight the need for therapeutic strategies targeting the graft body to reduce the overall intervention burden.Clinical ImpactThis prospective multicenter study maps, over two years, where reinterventions actually occur after stent graft placement for arteriovenous graft outflow stenosis. Although the treated venous anastomosis remained durable, access circuit primary patency fell to 12.4%, because failure migrated to the graft body, which accounted for 134 reinterventions at a median of 205 days. This reframes success for clinicians: treating the target lesion does not preserve the circuit. Surveillance after stent grafting should anticipate early intra-graft restenosis, and efforts to reduce the intervention burden-cannulation strategy, graft materials, adjunctive devices-should target the graft body rather than the anastomosis.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261485124"},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931738","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 the Institutional Volume of Endovascular Treatment for Lower Extremity Artery Disease on Radiation Exposure.","authors":"Tomomichi Ishibashi, Yoshinori Takao, Toru Ishibashi, Yuji Sakai, Yudai Fujimoto, Mitsuharu Osawa, Akihiro Shinobu, Kenji Hasegawa, Hajime Sakamoto","doi":"10.1177/15266028261479905","DOIUrl":"https://doi.org/10.1177/15266028261479905","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The procedure time of endovascular treatment (EVT) for lower extremity artery disease (LEAD) may increase as its application expands to more complex lesions. Given this trend and the growing importance of radiation protection, this study investigated the association between annual institutional EVT volume and radiation exposure in patients with LEAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data from 1638 cases of EVT for LEAD were collected from 167 institutions between April 2020 and March 2022. The locations of treated vascular lesions were classified into 3 anatomical segments: aortoiliac (AI), femoropopliteal (FP), and below-the-knee (BTK) regions. Institutions were categorized as a high-volume group (≥147 EVT cases/year) or low-volume group (&lt;147 EVT cases/year). Propensity score matching was performed using the following covariates: age, sex, body mass index, number of digital angiography and digital subtraction angiography acquisitions, the presence of chronic total occlusion, and fluoroscopy dose rates. The primary endpoints were air kerma at the entrance reference point (K&lt;sub&gt;a,r&lt;/sub&gt;), air kerma area product (P&lt;sub&gt;KA&lt;/sub&gt;), and fluoroscopy time (FT).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fluoroscopy time was significantly shorter in all regions in the high-volume group (AI: 21.0 vs 33.8 minutes, &lt;i&gt;P&lt;/i&gt; = .043; FP: 20.3 vs 28.2 minutes, &lt;i&gt;P&lt;/i&gt; = .022; BTK: 30.6 vs 34.9 minutes, &lt;i&gt;P&lt;/i&gt; = .009). No significant differences were observed in K&lt;sub&gt;a,r&lt;/sub&gt; or P&lt;sub&gt;KA&lt;/sub&gt; in any regions between the groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In EVT for LEAD, FT was significantly shorter in high-volume institutions, whereas cumulative radiation dose metrics did not differ significantly. These findings suggest that radiation exposure is influenced by multiple technical and patient-related factors. Optimizing radiation exposure therefore requires not only reducing FT but also implementing comprehensive dose management strategies, including standardization of imaging protocols, equipment settings, and education in radiation techniques.Clinical ImpactThis study demonstrates that institutions performing a higher annual volume of endovascular treatments (EVT) for lower extremity artery disease achieve significantly shorter fluoroscopy times compared with lower-volume centers, although no significant differences were observed in radiation dose indicators such as K&lt;sub&gt;a,r&lt;/sub&gt; and P&lt;sub&gt;KA&lt;/sub&gt;. These findings highlight that procedural efficiency gained through institutional experience does not necessarily translate into reduced radiation exposure, as total dose is influenced by multiple factors including imaging conditions, equipment parameters, and patient characteristics. From a clinical perspective, this underscores the importance of comprehensive dose management strategies that extend beyond reducing fluoroscopy time, incorporating the standardization of imaging protocols, optimization of device settings, and continu","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479905"},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908059","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 Leak-Loop Technique for In Situ Fenestrated Thoracic Endovascular Arch Repair in Extensive Aortic Intramural Haematoma With Zone 0 Involvement: A Case Report.","authors":"Ye Tian, Kristine J S Kwan, Jin Li, Zai-Ying Yeerbao, Min Mu, Xin-Xi Li, Jing-Dong Tang","doi":"10.1177/15266028261485140","DOIUrl":"https://doi.org/10.1177/15266028261485140","url":null,"abstract":"<p><strong>Purpose: </strong>To report the first application of the Leak-Loop Technique (LLT) that combines controlled endoleak and dual guidewire loop stabilization to address cerebral perfusion maintenance and endograft malpositioning during in situ fenestrated thoracic endovascular arch repair (fTEVAR) under urgent resource-limited setting.</p><p><strong>Case report: </strong>A 52-year-old man presented with acute progressive chest pain. Computed tomographic angiography identified an extensive subacute intramural haematoma (IMH) with penetrating atherosclerotic ulcer (PAU). In the absence of open surgical infrastructure and a customized device, in situ fTEVAR using the LLT was performed. Dual U-shaped guidewire loops created via same-sheath snare capture at each carotid access site anchored the proximal endograft and prevented rotational displacement during deployment. A pre-positioned balloon inflated at zone 0 prior to endograft deployment created a controlled gutter between the balloon shaft and aortic wall, maintaining antegrade supra-aortic branch perfusion throughout the fenestration interval. Sequential in situ fenestration and supra-aortic branch reconstruction were completed without complications. At 6-month follow-up, all branch stents were patent and the endograft was stable without endoleak.</p><p><strong>Conclusions: </strong>The LLT maintained cerebral perfusion through a self-limited controlled gutter and prevented endograft malpositioning during in situ arch fTEVAR for extensive subacute IMH with PAU. Six-month branch patency supports technical feasibility pending prospective validation.Clinical ImpactThe Leak-Loop Technique provides a reproducible, fully endovascular solution to cerebral perfusion maintenance and endograft malpositioning during in situ fenestrated thoracic endovascular arch repair (fTEVAR) using only commercially available equipment, making it particularly applicable in urgent or resource-limited settings where custom devices and open surgical infrastructure are unavailable. The 6-month outcomes suggest its potential as a viable approach in this challenging clinical scenario pending prospective validation.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261485140"},"PeriodicalIF":1.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907994","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}