The British journal of surgery最新文献

{"title":"Acute limb ischaemia: from neglected emergency to international collaborative action.","authors":"Sandip Nandhra, Arun D Pherwani","doi":"10.1093/bjs/znag110","DOIUrl":"10.1093/bjs/znag110","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of safe-anastomosis digital training on 30-day anastomotic leak after right colectomy: international prospective cohort study (EAGLE-2).","authors":"","doi":"10.1093/bjs/znag107","DOIUrl":"10.1093/bjs/znag107","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak (AL) is the leading cause of major morbidity after right colectomy, affecting 5-10% of patients and accounting for up to one-third of postoperative deaths. The multicentre EAGLE randomized trial demonstrated reductions in AL when surgeons completed a digital safe-anastomosis training package, but its effectiveness outside a trial setting remains untested.</p><p><strong>Methods: </strong>EAGLE-2 was an international prospective cohort study conducted across participating centres over an 8-week intervals (June-September 2024). Consecutive adults undergoing right colectomy surgery with primary anastomosis were included. The EAGLE safe-anastomosis training platform was made open access and surgeons were categorized according to whether they had completed the modules before surgery. The primary outcome was 30-day AL, defined as a defect of intestinal wall integrity at the anastomotic site leading to frank AL and/or intra-abdominal collection. Secondary outcomes included collection alone, training uptake, and implementation of the recommended checklist. Mixed-effects logistic regression adjusting for ASA grade, urgency, and intraoperative contamination was performed with hospital as a random effect.</p><p><strong>Results: </strong>A total of 2875 patients were recruited across 332 hospitals in 60 countries. Of these, 2242 (78.0%) operations were performed by trained surgeons and 633 (22.0%) by untrained surgeons. AL/collection occurred in 16.4% of the non-trained group versus 9.1% of the trained group, giving a difference of 7.3% (P < 0.001). Adjusted analysis found training was associated with almost a halving of the OR for AL (adjusted OR (aOR) 0.56 (95% c.i. 0.41 to 0.78)), as well as lower reoperation (aOR 0.64) and readmission (aOR 0.65) rates.</p><p><strong>Conclusion: </strong>Completion of a brief digital training programme was associated with a clinically and statistically significant lower rate of AL after right colectomy, alongside lower rates of reoperation, readmission, and death. Scalable digital education should be embedded into colorectal quality improvement programmes worldwide.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard reporting on duodenal stump leakage after gastric cancer resections: multicentre analysis from the GASTRODATA Study Group (the STARDUST study).","authors":"Mattia Molteni, Francesco Puccetti, Gian Luca Baiocchi, Guillaume Piessen, William Allum, Andrew Davies, Arnulf Hoelscher, Ines Gockel, Daniel Reim, Paolo Morgagni, Uberto Fumagalli Romario, Domenico D'Ugo, Rossella Reddavid, Giovanni De Manzoni, Johanna van Sandick, Suzanne Gisbertz, Bas Wijnhoven, Wojciech Polkowski, Piotr Kołodziejczyk, Wojciech Kielan, Paulo Matos da Costa, Lucio Lara Santos, Manuel Pera, Stefan Moenig, Paul M Schneider, Christian A Gutschow, Ugo Elmore, Riccardo Rosati","doi":"10.1093/bjs/znag105","DOIUrl":"10.1093/bjs/znag105","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer surgery has historically implied significant levels of clinical burden and mortality. Postoperative duodenal stump leakage (DSL) represents a leading cause of postoperative mortality, but international occurrence rates and treatment strategy are lacking. The aim of this multinational retrospective cohort study was to evaluate the occurrence rate and treatment strategy factors for duodenal stump leakage after gastrectomy for cancer.</p><p><strong>Methods: </strong>This retrospective multinational multicentre cohort study (the STARDUST study) retrospectively analysed a consecutive series of gastric cancer patients who underwent gastrectomy from 2019 to 2022 at 24 high-volume European members of the GASTRODATA registry. The primary outcomes included postoperative incidence and 90-day mortality after DSL. Secondary outcomes were clinical presentation, perioperative determinants, and complication treatment.</p><p><strong>Results: </strong>A total of 2558 consecutive gastric cancer patients were identified from the registry and 2422 were eligible for the study. DSL occurred in 2.6% (64 of 2422) of the patients with a subsequent 90-day mortality rate of 17.2% (11 of 64). Conservative treatment was used for nine patients, followed by successful recovery without readmission. Interventional radiology was used for 16 patients (treatment success rate of 75%), while 39 patients required reoperation for acute presentation or failure of conservative options (treatment success rate of 74.4%). Multivariate analysis identified statistically significant independent prognostic factors for DSL, including preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion.</p><p><strong>Conclusion: </strong>Postoperative DSL was uncommon (2.6%), but it was associated with a 90-day mortality rate of 17.2%, which varied according to the severity of the clinical presentation and the invasiveness of the treatment. Preoperative weight loss, unreinforced duodenal stump, Billroth II reconstruction, and postoperative blood transfusion were prognostic factors associated with complication occurrence. The results need to be validated and prospectively endorsed within a standardized protocol guiding the intraoperative management of the duodenal stump and the choice of complication treatment.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative delirium.","authors":"Joaquin Mascaró-Martínez, María Lorenzo Fernández, Nicolas M Gonzalez-Senac","doi":"10.1093/bjs/znag113","DOIUrl":"https://doi.org/10.1093/bjs/znag113","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149033016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical rectus sheath block versus laparoscopic bilateral dual transversus abdominis plane block after minimally invasive colorectal cancer surgery: randomized clinical trial of impact on recovery.","authors":"Takeharu Kato, Shunsuke Tsukamoto, Yuri Oishi, Gen Tomizawa, Yudai Kumamoto, Kohei Takura, Hiroshi Nagata, Yasuyuki Takamizawa, Tetsufumi Sato, Yukihide Kanemitsu","doi":"10.1093/bjs/znag109","DOIUrl":"10.1093/bjs/znag109","url":null,"abstract":"<p><strong>Background: </strong>Effective multimodal analgesia is essential after minimally invasive colorectal surgery. This randomized trial evaluated whether adding surgeon-performed surgical rectus sheath block (SRSB) or laparoscopic bilateral dual transversus abdominis plane (BD-TAP) block to intravenous patient-controlled analgesia (IV-PCA) improved postoperative quality of recovery.</p><p><strong>Methods: </strong>This single-centre, three-arm superiority trial randomized adults undergoing minimally invasive colorectal resection (1 : 1 : 1) by stratified block allocation at a Japanese cancer centre. Patients and outcome assessors were blinded. The primary outcome was the Japanese version of the 15-item Quality of Recovery questionnaire (QoR-15) score 24 h after arrival in the postanaesthesia care unit. Missing postoperative QoR-15 item responses were handled using multiple imputation, and treatment effects were estimated using ANCOVA adjusted for the four randomization stratification factors. Each primary comparison used a Bonferroni-adjusted one-sided significance level of 0.025. Secondary outcomes included the 48-h QoR-15 score, postoperative pain scores, time to first rescue analgesia, and cumulative consumption of analgesics and antiemetics over 48 h.</p><p><strong>Results: </strong>Between July 2024 and December 2025, 320 patients were randomized (control, 110; SRSB, 107; and BD-TAP block, 103); 309 were analysed (105, 103, and 101 respectively). Compared with control, BD-TAP block resulted in a higher 24-h QoR-15 score (adjusted mean difference 10.44 (95% c.i. 3.06 to 17.83) points; one-sided P = 0.003), whereas superiority of SRSB was not demonstrated (adjusted mean difference 5.50 (95% c.i. -1.88 to 12.89) points; one-sided P = 0.072). At 48 h, the adjusted mean difference for BD-TAP block versus control was 8.01 (95% c.i. 0.18 to 15.83) points (two-sided P = 0.045), an exploratory finding unadjusted for multiplicity. The median time to first rescue analgesia was longer with SRSB (27.8 h) and BD-TAP block (25.3 h) than control (3.3 h), but cumulative 48-h fentanyl consumption and length of hospital stay did not differ significantly. No block-related complications were observed.</p><p><strong>Conclusion: </strong>BD-TAP block resulted in better 24-h recovery than IV-PCA alone. Superiority of SRSB was not demonstrated.</p><p><strong>Registration number: </strong>jRCT1031240153 (Japan Registry of Clinical Trials).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"World Prehabilitation Day: advancing surgical optimisation beyond proof of concept.","authors":"Gabriele Baldini, Francesco Carli, Linda Denehy, Chelsia Gillis, Sandy Jack, Denny Levett, Daniel I McIsaac, Daniel Santa Mina, Tom Parkington, Raquel Sebio, Gerrit Slooter, Daniel Steffens, Malcolm A West","doi":"10.1093/bjs/znag119","DOIUrl":"10.1093/bjs/znag119","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of infrarenal aortic diameter in siblings within the Stockholm abdominal aortic aneurysm screening programme.","authors":"Antti Siika, Rebecka Hultgren, Jonas Brinck, Daniel P Andersson","doi":"10.1093/bjs/znag108","DOIUrl":"10.1093/bjs/znag108","url":null,"abstract":"<p><strong>Background: </strong>The aim was to investigate the increased risk for siblings to have similar aortic pathology (wide or small) in an abdominal aortic aneurysm (AAA) screening population with ultrasonographic measurement of infrarenal aortic diameter (IAD).</p><p><strong>Methods: </strong>The population-based cohort of men who had participated in the Stockholm AAA screening programme between 2010 and 2024 (107 336 men) were linked to the Swedish Multigeneration Registry (MGR), via the STRIREG cohort. All individuals except one had data available in the MGR. A subaneurysmal aorta (SAA) was defined as having an IAD of 25-29 mm, an AAA was defined as having an IAD of ≥30 mm, and a small aorta was defined as having an IAD of <17 mm. Descriptive statistics and cumulative probability models were stratified for relatedness. Quantitative genetic modelling was used to estimate heritability.</p><p><strong>Results: </strong>From 16 005 screened 65-year-old men, 8987 sibling pairs (7625 pairs of full siblings, 1152 pairs of half siblings, and 210 pairs of twins) were included. In total, 161 (1.0%) had an AAA, 155 (1.0%) had an SAA, and 2700 (16.9%) had a small aorta. IAD correlated stronger in twins than full siblings and weakest among half siblings (half siblings, r = 0.1; full siblings, r = 0.19; and twins, r = 0.52). Overall, 316 (2.0%) individuals had an IAD ≥25 mm and, if a sibling's IAD was 30 mm, the estimated probability of IAD ≥25 mm was 2.7% (95% c.i. 1.9% to 3.7%) in half siblings, 5.3% (95% c.i. 4.5% to 6.2%) in full siblings, and 21% (95% c.i. 10.2% to 38.2%) in twins. Heritability estimates were 0.41 for IAD, 0.61 for SAA/AAA, and 0.58 for small aorta.</p><p><strong>Conclusion: </strong>This study provides further evidence for familial aggregation and heritability of IAD and pathologies of the infrarenal aorta, which reinforces the advice for screening of siblings, and especially twins, of individuals with an abnormal aortic diameter including subaneurysms.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of indocyanine green on nodal dissection and staging for gastric cancer surgery: iGreenGO prospective multicentre study.","authors":"Pietro Maria Lombardi, Michele Mazzola, Gian Luca Baiocchi, Francesca Bazzocchi, Felice Borghi, Carlo Castoro, Fabio Cianchi, Ugo Elmore, Federica Filippini, Gianluca Garulli, Massimo Oldani, Stefano Olmi, Alberto Patriti, Marco Realis Luc, Leonardo Solaini, Jacopo Viganò, Monica Gualtierotti, Paolo De Martini, Vincenzo Nicastro, Massimiliano Mutignani, Davide Paolo Bernasconi, Giovanni Ferrari","doi":"10.1093/bjs/znag116","DOIUrl":"10.1093/bjs/znag116","url":null,"abstract":"<p><strong>Background: </strong>Lymphadenectomy is critical for accurate staging and prognostication of advanced gastric cancer. Indocyanine green (ICG) fluorescence imaging may optimize lymph node dissection but its applicability in Western patients is unclear. The aim of this study was to evaluate whether intraoperative ICG fluorescence is associated with change in surgical conduct (CSC) and stage migration during gastrectomy.</p><p><strong>Methods: </strong>This was a prospective, multicentre observational study (iGreenGO) conducted at 15 Italian referral centres. Patients with cT2-4a N0-3 M0 gastric adenocarcinoma undergoing minimally invasive distal or total gastrectomy with D2 lymphadenectomy were eligible. Endoscopic peritumoral ICG injection (2 ml at a concentration of 0.125 mg/ml) was performed within 20 h before surgery. The primary outcome was CSC, defined as additional tissue dissection prompted by residual fluorescence after standard white-light D2 lymphadenectomy.</p><p><strong>Results: </strong>A total of 316 patients (median age of 71.2 years; 185 male) were included between January 2022 and December 2024. The median number of dissected lymph nodes was 38 (interquartile range 29-47). CSC occurred in 61 patients (19.3%). Additional lymph nodes were retrieved in 47 of 61 patients (77.0%), with metastatic involvement in 10 of 47 patients (21.3%). Stage migration occurred in 3 of 316 patients (0.9%). ICG fluorescence showed a high false-positive rate for nodal metastases.</p><p><strong>Conclusion: </strong>Although ICG frequently led to additional dissection of nodal stations after standard white-light D2 lymphadenectomy, it rarely resulted in stage migration. Use of ICG fluorescence to optimize lymph node dissection likely does not have a clinically relevant benefit in Western patients with gastric cancer.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated driver gene-based survival prediction in resected pancreatic cancer.","authors":"Zheng Li, Brady A Campbell, Marco Dal Molin, Yi Song, Thomas McPhaul, Shuang Zhang, John L Cameron, Ming-Tseh Lin, Ralph H Hruban, Christopher R Shubert, Kelly J Lafaro, Richard A Burkhart, William R Burns, Jin He","doi":"10.1093/bjs/znag123","DOIUrl":"10.1093/bjs/znag123","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to develop an overall survival (OS) prediction model integrating key somatic driver gene mutations in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing curative-intent pancreatectomy.</p><p><strong>Methods: </strong>Patients with resected PDAC from a prospectively maintained pancreatectomy database from 2018 to 2023 were identified. Somatic mutations in KRAS, TP53, SMAD4, and CDKN2A were assessed using in-house or commercial sequencing panels. Restricted cubic spline analyses were used to assess non-linear effects. An integrated Cox proportional hazards model incorporating genomic and clinicopathological variables was developed to predict OS and validated using 1000 bootstrap resamples.</p><p><strong>Results: </strong>In total, 885 patients were identified, of whom 663 met the inclusion criteria. After a median follow-up of 40.8 months, 387 deaths occurred (median OS of 28.4 months). The 1-, 2-, and 3-year OS rates were 80.0%, 56.2%, and 41.5% respectively. In univariable analysis, mutations in KRAS, TP53, SMAD4, and CDKN2A were each associated with inferior OS. Mortality risk increased with the cumulative number of mutated driver genes and remained independently significant in multivariable analysis (0-4; HR per mutation 1.27; P < 0.001). Other independent OS predictors included advanced age, resectability status, elevated pretreatment carbohydrate antigen 19-9 (CA19-9), larger tumour size, positive nodal stage, lymphovascular invasion, poor differentiation, neoadjuvant response classification, and receipt of adjuvant chemotherapy. The integrated model showed moderate discrimination (C-index 0.690 (95% c.i. 0.669 to 0.723); optimism-corrected C-index 0.676), which was significantly higher than AJCC eighth edition pathological staging alone (C-index 0.568 (95% c.i. 0.545 to 0.599); ΔC = 0.122; P < 0.001), with reasonable calibration.</p><p><strong>Conclusion: </strong>The cumulative burden of driver gene mutations provided independent and incremental prognostic information after PDAC resection. External validation is required before clinical application.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 9","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macrophage-mediated inflammation and microcalcification are associated with abdominal aortic aneurysm progression and clinical events.","authors":"Rachael O Forsythe, Olivia M B McBride, Jennifer M J Robson, Alex T Vesey, Allison C Winarski, Callum Weston, Samuel Debono, Scott I Semple, Calum D Gray, Thomas J MacGillivray, Julie Brittenden, Giles Roditi, Wesley Stuart, Edwin J R van Beek, Andrew L Tambyraja, Michelle C Williams, Marc R Dweck, David E Newby","doi":"10.1093/bjs/znag100","DOIUrl":"https://doi.org/10.1093/bjs/znag100","url":null,"abstract":"<p><strong>Introduction: </strong>Molecular and cellular imaging biomarkers of abdominal aortic aneurysms (AAA) show promise as potential predictors of clinical events. This study assessed long-term clinical outcomes using ultrasmall superparamagnetic particles of iron oxide (USPIO) enhanced magnetic resonance imaging (MRI; ISRCTN76413758) and fluorine-18 sodium fluoride ([18F]NaF) positron emission tomography computed tomography (PET/CT; NCT02229006).</p><p><strong>Methods: </strong>A prospective multi-centre co-enrolled observational cohort studies of patients with asymptomatic AAA. Evaluation of aortic wall inflammation using USPIO-enhanced MRI in 338 patients was followed by [18F]NaF PET/CT in a sub-group of 72 patients, to evaluate microcalcification. Aneurysms were classified according to aortic wall USPIO enhancement and into tertiles of [18F]NaF uptake. Aneurysm expansion, composite of rupture or repair, and overall survival were compared.</p><p><strong>Results: </strong>In 338 predominantly elderly (74±7.2 years) men (85%) with mean aneurysm diameter 49.5±7.3 mm, aneurysm expansion was increased in patients with USPIO enhancement (median [inter-quartile interval], 3.3 [2.0-4.6] versus 2.5 [1.4-3.6] mm/y; p=.002) or high [18F]NaF uptake (4.0 [2.6-5.4] versus 1.9 [0.9-3.0] mm/y; p<.001), even when adjusted for hypertension, smoking and baseline AAA diameter (p=.04 and p=.003). After a median follow up of 102 [58-119] months, 63% patients met the composite endpoint of rupture or repair with high [18F]NaF uptake associated with more than two-fold higher risk (72% versus 36%; log rank p=.002). There was no association between USPIO enhancement and future rupture or repair.</p><p><strong>Conclusions: </strong>Aortic wall USPIO enhancement and [18F]NaF uptake are independently associated with AAA expansion. These non-invasive imaging biomarkers provide an opportunity to identify those are at greatest risk of AAA progression and may help inform further research to determine optimal surveillance intervals.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}