European Journal of Vascular and Endovascular Surgery最新文献

{"title":"Predictors of Delayed Ischaemic Stroke following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury.","authors":"Madeline Petrikas, Lili Sadri, Chinyere Agba, Priya Mahableshwarkar, Pedro Teixeira, Joseph DuBose","doi":"10.1016/j.ejvs.2026.04.001","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.04.001","url":null,"abstract":"<p><strong>Objective: </strong>Delayed ischaemic stroke (DIS) remains a feared complication following thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI), particularly when the left subclavian artery (LSCA) is covered. This study aimed to understand the impact of LSCA revascularisation and other peri-operative factors on delayed stroke risk.</p><p><strong>Methods: </strong>This was a retrospective cohort study querying the Aortic Trauma Foundation registry to identify patients with BTAI undergoing TEVAR from 2016 to 2025. Patients with DIS after TEVAR were identified, and patient level factors, intra-operative data, and post-operative course variables were analysed.</p><p><strong>Results: </strong>Six hundred and twenty TEVARs for BTAI were identified. The overall DIS rate was 3.1% (19 of 620). LSCA coverage occurred in 32.6% (202 of 620) and was associated with a statistically significantly higher rate of DIS (5.4% vs. 1.9%; p = .017). Adjunctive LSCA revascularisation during or after TEVAR was undertaken in 11.4% (23 of 202) of patients. Among patients requiring LSCA coverage (n = 202), there was no statistically significant difference in the incidence of DIS between those who underwent adjunctive revascularisation (one of 23; 4.3%) and those who did not (ten of 179; 5.6%) (p = .81). Factors associated with DIS included the need for any intra-operative transfusion, mechanical ventilation > 48 hours, and initial post-TEVAR pressor requirement. Traumatic brain injury related factors, age, sex, and TEVAR timing were not identified as being associated with an increase in DIS risk.</p><p><strong>Conclusion: </strong>LSCA coverage during TEVAR for BTAI is associated with a significant increase in DIS rates. These data do not, however, demonstrate that LSCA revascularisation procedures mitigate the risk of these events in this setting. These findings may be limited by the small number of revascularised patients. Peri-operative physiological indicators emerge as the most reliable predictors of DIS in acute trauma, supporting an individualised approach where global trauma burden is considered a primary driver of neurological outcomes.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blunt Aortic Injury and Left Subclavian Management: Can we Mitigate Delayed Ischaemic Stroke?","authors":"Mina Boutrous, Kwame S Amankwah","doi":"10.1016/j.ejvs.2026.03.033","DOIUrl":"10.1016/j.ejvs.2026.03.033","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Ischaemia and White Matter Hyperintensities: Challenges in Translating Emerging Evidence into Clinical Practice.","authors":"Andreia Coelho, Gianluca Faggioli","doi":"10.1016/j.ejvs.2026.03.048","DOIUrl":"10.1016/j.ejvs.2026.03.048","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical Peri-operative Myocardial Injury following Complex Endovascular Aortic Repair is Associated with Increased Midterm Mortality: A Retrospective Study.","authors":"David E Vecht, Alexander Vanmaele, Vinamr Rastogi, Nicolas M Van Mieghem, Sanne E Hoeks, Felix van Lier, Hence J M Verhagen, Jorg L de Bruin","doi":"10.1016/j.ejvs.2026.03.056","DOIUrl":"10.1016/j.ejvs.2026.03.056","url":null,"abstract":"<p><strong>Objective: </strong>Peri-operative myocardial injury (PMI), defined by an asymptomatic increase in troponin levels, has been recognised as a prognostic marker for impaired survival following non-cardiac surgery, with therapy for improvement potentially available. Patients undergoing complex endovascular aneurysm repair (cEVAR) may be at particular risk of PMI owing to their cardiovascular burden. However, due to lack of routine peri-operative troponin monitoring, the incidence proportion and association between PMI and long term mortality following cEVAR remains unclear, with no possibility of applying improvement strategies.</p><p><strong>Methods: </strong>Pre-operative and consecutive post-operative high sensitivity troponin T (hsTnT) levels were retrospectively analysed from all patients who underwent elective cEVAR in a Dutch tertiary hospital between 2012 and 2022. PMI was defined as the difference between pre- and post-operative troponin concentrations (ΔhsTnT) of ≥ 14 ng/L in the absence of clinical features of myocardial infarction. Primary objectives were the incidence proportion of PMI following cEVAR and its association with 4 year mortality. The study adhered to the STROBE guidelines.</p><p><strong>Results: </strong>A total of 187 patients were included. The median follow up was 56 months. Forty-one patients (21.9%) developed PMI. Coronary artery disease was more prevalent (65.9% vs. 41.8%; p = .018) and American Society of Anesthesiologists (ASA) scores were higher (ASA 4, 13.1% vs. 7.8%; p = .023) in patients with PMI. PMI was independently associated with an increased 4 year mortality rate (adjusted hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.21 - 4.67; p = .013). Pre-operative elevated troponin levels (adjusted HR 2.91, 95% CI 1.41 - 6.33; p = .005) and longer operation time (adjusted HR 1.01, 95% CI 1.00 - 1.01; p = .002) were independently associated with an increased risk of PMI.</p><p><strong>Conclusion: </strong>Asymptomatic PMI is relatively common following cEVAR and is associated with impaired midterm survival. Given the high prevalence of cardiovascular comorbidities in patients with PMI, prospective follow up studies should focus on the potential of routine peri-operative hsTnT monitoring for identifying high risk patients who could potentially benefit from enhanced cardiac care.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Zone 1 Thoracic Endovascular Aortic Repair with Single Branched Stent Graft and Left Common Carotid Artery Chimney Stenting for Zone 2 Aortic Arch Pathologies.","authors":"Jie Fang, Zhongze Cao, Ying Zhang, Chuan Tian, Mingyao Luo, Kun Fang, Chang Shu","doi":"10.1016/j.ejvs.2026.03.050","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.03.050","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the safety and efficacy of an innovative, single stage, two target vessel revascularisation endovascular repair strategy, namely single branch and chimney stenting during thoracic endovascular aortic repair (sc-TEVAR), for zone 2 aortic pathologies requiring proximal sealing in zone 1.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study of consecutive patients undergoing sc-TEVAR at a Chinese tertiary centre between June 2021 and December 2024. Aortic diameter, centreline distance, tortuosity, and angulation were measured for pre-operative assessment. All procedures adhered to established surgical protocols. Outcomes of interest included technical success, death, stroke, type Ia endoleak, re-intervention, and branch patency. Descriptive statistical analyses were performed using R software.</p><p><strong>Results: </strong>Sixty-six patients (94% male; median age 67 years, interquartile range [IQR] 60, 72) were included. The technical success rate was 91% (60 of 66), with the remaining six patients requiring proximal cuff extension with physician modified fenestration due to intra-operative \"sail effect\". All additional procedures were successful. Another patient (2%) developed retrograde type A aortic dissection and received emergency surgical repair on the eighth post-operative day. No death, stroke, or type Ia endoleak occurred during a median follow up of 22 months (IQR 13, 31). Freedom from re-intervention was 93.8% (95% confidence interval [CI] 88.3 - 99.9%) at both 1 and 3 year follow up. The left subclavian artery branch patency rate was 96.8% (95% CI 92.6 - 100.0%) at 1 year and 94.1% (95% CI 87.7 - 100.0%) at 3 years. All left common carotid artery stents were patent during follow up.</p><p><strong>Conclusion: </strong>sc-TEVAR is a standardised and clinically effective single stage endovascular arch repair strategy for zone 2 aortic pathologies, which enables two target vessel revascularisation and proximal sealing zone extension to zone 1. Peri-operative and 2 year safety and efficacy profiles in anatomically suitable candidates were satisfactory. Studies with improved design on larger cohorts are required to further confirm its durability and safety profiles.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aneurysmal Disease Meets Pulmonary Sequestration.","authors":"Alina-Marilena Bresler, Moritz S Bischoff","doi":"10.1016/j.ejvs.2026.03.054","DOIUrl":"10.1016/j.ejvs.2026.03.054","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptation of the Transtibial Tunnel Technique for Limb Salvage Arterial Bypass with Anatomic Challenges.","authors":"Walid A Alnatsheh, Mohammed Ashrafi, Frank L Bowling, S Tawqeer Rashid","doi":"10.1016/j.ejvs.2026.03.051","DOIUrl":"10.1016/j.ejvs.2026.03.051","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Sideways Look at Acute Leg Ischaemia.","authors":"Jonothan J Earnshaw, Martin Björck","doi":"10.1016/j.ejvs.2026.03.053","DOIUrl":"10.1016/j.ejvs.2026.03.053","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Troponin a Vascular Surgeon's Third Eye for More Appropriate Patient Assessment?","authors":"Alexander Gombert","doi":"10.1016/j.ejvs.2026.03.055","DOIUrl":"10.1016/j.ejvs.2026.03.055","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147624471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long Term Risk of Clinical Recurrence following Endovenous Laser Ablation of the Great Saphenous Vein with 810 nm Laser and Bare Tip Fibre: An Observational Study.","authors":"Maarten C Tol, Quinten Vos, Debby S Knol-Loerakker, Ramona M G Bruins, Rolf Erkens, Bas P Vierhout, Michiel van den Berg, Rutger J Hissink","doi":"10.1016/j.ejvs.2026.03.047","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.03.047","url":null,"abstract":"<p><strong>Objective: </strong>Varicose veins are highly prevalent and most patients present with great saphenous vein (GSV) reflux. Treatment of truncal venous reflux is the cornerstone in the management of C2 disease. Endovenous laser ablation (EVLA) is widely accepted as the preferred treatment. This study aimed to estimate the long term risk of clinical recurrence in the treated leg after successful EVLA of the GSV.</p><p><strong>Methods: </strong>This single centre, observational study included patients with C2 varicose veins in whom refluxing GSV was diagnosed. EVLA was performed from 10 - 15 cm below the knee and occlusion was confirmed with duplex after 3 months. Additional treatment after EVLA was always in a staged approach. Clinical recurrence was defined as a patient actively seeking retreatment at least 6 months after EVLA for symptoms due to varicose veins in the treated leg. Recurrence was identified through electronic health records or, when not documented, by telephonic survey.</p><p><strong>Results: </strong>This study included 543 patients with a median follow up of 6.0 (interquartile range 1.3, 10.3) years. Mean age at treatment was 52.8 ± 13.3 years and 79.2% were women. Clinical recurrence occurred in 210 patients, with an estimated 10 year recurrence rate of 47.6% (95% confidence interval 42.5 - 52.1%). Additional therapy within 6 months following EVLA was associated with a hazard ratio of 1.31 (95% confidence 0.99 - 1.72; p = .055), adjusted for age and sex.</p><p><strong>Conclusion: </strong>Clinical recurrence after EVLA of the GSV occurred in approximately half of patients within 10 years of the procedure, exceeding rates reported with concomitant additional treatment and EVLA of the entire refluxing GSV. The association between early additional therapy and a higher recurrence rate suggests that it may indicate an unmet therapeutic need.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}