European Journal of Vascular and Endovascular Surgery最新文献

{"title":"One Year Stable Sac Predicts Worse Overall Survival and Mid-Term Outcomes Compared with Sac Regression after Complex Abdominal Aortic Aneurysm Repair with Fenestrated/Branched Endografts.","authors":"Davide Esposito, Tuukka Kaartama, Martina Bastianon, Sani Laukontaus, Walter Dorigo, Amjad Belramman, Raffaele Pulli, Alun H Davies, Maarit Venermo, Giovanni Pratesi","doi":"10.1016/j.ejvs.2025.06.027","DOIUrl":"10.1016/j.ejvs.2025.06.027","url":null,"abstract":"<p><strong>Objective: </strong>This multicentre, retrospective, observational study investigated the correlation of sac dynamics and outcomes in patients with complex abdominal aortic aneurysms (AAAs) after fenestrated/branched endovascular repair (FB-EVAR).</p><p><strong>Methods: </strong>Consecutive patients undergoing FB-EVAR for short neck infrarenal, juxtarenal, pararenal, and paravisceral AAAs between 2015 and 2022 were included. Based on one year sac dynamics, patients with sac expansion were excluded. Comparisons were made between patients with sac regression and those with sac stability. Primary endpoints included overall survival, freedom from re-interventions, and last follow up sac regression. Secondary outcomes included freedom from aorta related death, freedom from any endoleak, and freedom from cumulative adverse events.</p><p><strong>Results: </strong>The study cohort consisted of 98 patients, 36 with sac regression and 62 with sac stability at one year. Median follow up was 34 months (interquartile range 32). The four year estimated overall survival was lower for patients with sac stability (57.2 vs. 87.5%, p = .029), which also demonstrated a lower freedom from re-interventions (89.2 vs. 94.4%, p = .11). The four year estimates of last follow up sac regression were statistically significantly higher in those with initial sac regression (46 vs. 94.7%, p < .001). Cox regression analysis identified treatment of all renal/visceral vessels (hazard ratio [HR] 2.18, p = .035) and sac regression at one year (HR 2.37, p = .015) as independent predictors of follow up sac regression. Conversely, the presence of an endoleak (HR 0.31, p = .050) predicted the absence of sac regression. One year sac regression was an independent predictor of survival (HR 3.11, p = .050). Freedom from aorta related death (96.6 vs. 100%, p = .263), endoleak (66.3 vs. 90.2%, p = .035), and cumulative adverse events (89.7 vs. 94.4%, p = .08) were in favour of patients with sac regression.</p><p><strong>Conclusion: </strong>Sac dynamics correlate with midterm outcomes after FB-EVAR for complex AAAs. One year sac regression predicted better outcomes and survival, suggesting the need for closer surveillance in patients with stable sacs.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337282","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":"Dissection Inside the Stent Graft after Previous Thoracic Endovascular Aortic Repair.","authors":"Yi Liu, Jifu Lai","doi":"10.1016/j.ejvs.2025.06.022","DOIUrl":"10.1016/j.ejvs.2025.06.022","url":null,"abstract":"<p><p>A 45 year old man was admitted to hospital after follow up computed tomography angiography (CTA) revealed a neointimal tear with a dissection inside the stent graft (A, B, arrow). He had a previous history of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection and thoracic endovascular aortic repair (T-EVAR) using a Hercules stent graft (MicroPort, Shanghai, China) performed because of a type B intramural haematoma with a focal ulcer like projection. Despite the absence of symptoms, the patient underwent a secondary relining T-EVAR using the same type of Hercules stent graft. At one year follow up, no complications or recurrence of the disease were observed, while control CTA showed good aortic remodelling.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337280","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":"SYSTEMATIC REVIEW Ultrasound Guided versus Conventional Closure Device Deployment following Transfemoral Endovascular Procedures: A Systematic Review and Meta-analysis.","authors":"I Kalaja, R R Smeets, M Wegner, S Macherey-Meyer, S Heyne, C Espinola-Klein, Barend M E Mees, Max M Meertens","doi":"10.1016/j.ejvs.2025.06.023","DOIUrl":"10.1016/j.ejvs.2025.06.023","url":null,"abstract":"<p><strong>Objective: </strong>Femoral access site complications influence short term survival and outcomes in patients undergoing endovascular procedures. While ultrasound guided puncture is a reliable method to reduce such complications, ultrasound guidance is rarely utilised for closure device deployment.</p><p><strong>Data sources: </strong>Web of Science, PubMed, and the Cochrane Library.</p><p><strong>Review methods: </strong>A systematic literature search was conducted to assess the safety and efficacy of ultrasound guided vascular closure device deployment compared with vascular closure device deployment without ultrasound guidance, referred to as conventional closure. All studies reporting on ultrasound guided closure in transfemoral arterial interventions were eligible, and those directly comparing ultrasound guided with conventional closure were included in the meta-analysis.</p><p><strong>Results: </strong>Overall, 2 738 patients receiving ultrasound guided closure were included: 1 025 for introducer sheaths measuring 12 F or larger and 1 713 for introducer sheaths smaller than 12 F. The incidence of access complications was 5.7% (0.8 - 21.6%) for large sheath procedures and 2.6% (0.9 - 4.7%) for small sheath procedures. The meta-analysis, which included 2 339 patients who received ultrasound guided closure and 1 175 who underwent conventional closure, showed that ultrasound guided closure was associated with reduced access site complications compared with conventional closure (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.37 - 0.65; p < .001). This was consistently seen both for small sheath (OR 0.45, 95% CI 0.28 - 0.75; p = .002) and large sheath procedures (OR 0.50, 95% CI 0.37 - 0.71; p < .001), but with a low certainty of evidence in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis.</p><p><strong>Conclusion: </strong>Ultrasound guided vessel closure of the femoral artery appeared to be associated with a lower rate of overall access site complications compared with conventional closure techniques. Therefore, ultrasound guided closure might offer the potential to increase procedural and patient safety in percutaneous arterial access.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337285","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":"Identification of Clinical and Patient Reported Outcomes for Patients with Intact Abdominal Aortic Aneurysms Not Undergoing Repair: A Systematic Review.","authors":"Sabrina L M Zwetsloot, Samira E M van Knippenberg, Venkat Ayyalasomayajula, Kak K Yeung, Vincent Jongkind","doi":"10.1016/j.ejvs.2025.06.036","DOIUrl":"10.1016/j.ejvs.2025.06.036","url":null,"abstract":"<p><strong>Objective: </strong>Current literature on abdominal aortic aneurysms (AAAs) is characterised by heterogeneous outcome reporting and lack of standardisation. Thus, a core outcome set (COS) for patients with intact AAA not undergoing repair is being developed. The disease course in these patients is uncertain; some may progress, necessitating surgery, while others may remain stable over time. Therefore, both outcomes following conservative therapy and post-operative outcomes are important in research on AAA not undergoing repair. A systematic review identifying clinical and patient reported AAA related outcomes was conducted.</p><p><strong>Data sources: </strong>PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were systematically searched from 1 January 2020 until 24 November 2023.</p><p><strong>Review methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adhered to. The study protocol was pre-registered in the PROSPERO registry (CRD42023478594) and Core Outcome Measures in Effectiveness Trials (COMET) database (study no. 2856). All studies on clinical and or patient reported outcomes on all types of AAA, including those on AAA not undergoing repair and post-operative AAA, from 2020 onwards were included. Abstract and full text screening was performed by three independent authors. Outcomes and their definitions were extracted verbatim from each article. Each outcome was harmonised into an agreed outcome term based on similarities in definitions. Agreed outcome terms were categorised into domains according to the Dodd taxonomy.</p><p><strong>Results: </strong>Of the 5 611 articles identified through the literature search, 612 full texts were screened for eligibility and 380 studies were included. A total of 264 unique outcomes were identified. The most frequently reported outcomes were death (n = 341), myocardial infarction (n = 148), and re-intervention (n = 145). After classification into agreed outcome terms, the final longlist comprised 77 AAA outcomes.</p><p><strong>Conclusion: </strong>The definitive 77 item AAA outcome longlist will be used in a Delphi study to create a COS for research on intact AAA not undergoing repair.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337281","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":"Safety and Efficacy of Rotational Thrombectomy and Drug Coated Balloon Angioplasty in Patients with In Stent Re-stenosis and Occlusions: A Prospective, Two Centre Study.","authors":"Martin Andrassy, Safeer A Najam, Dalibor Dukic, Amila Jehn, Christoph Schöfthaler, Grigorios Korosoglou","doi":"10.1016/j.ejvs.2025.06.021","DOIUrl":"10.1016/j.ejvs.2025.06.021","url":null,"abstract":"<p><strong>Objective: </strong>Rotational thrombectomy using a Rotarex S device aids the removal of organised thrombus and soft atherosclerotic material in complex femoropopliteal lesions. The aim of this study was to assess the safety and efficacy of the Rotarex S device in combination with drug coated balloon (DCB) angioplasty for the treatment of in stent re-stenosis (ISR).</p><p><strong>Methods: </strong>Rotarex S (Straub Medical) was used in combination with DCB for the treatment of patients with lower limb ISR and stent occlusions (Tasaka II or III) who presented with subacute or chronic symptoms. Primary endpoints were freedom from clinically driven target lesion revascularisation (CD-TLR) and patency at 12 month follow up. The secondary procedural endpoint was procedural success. Secondary safety endpoints were perforation and peripheral embolisation.</p><p><strong>Results: </strong>Between January 2017 and August 2023, 215 consecutive patients were enrolled, comprising 84 (39.1%) with claudication, 79 (36.7%) with ischaemic rest pain, and 52 (24.2%) with ischaemic ulcerations due to femoropopliteal lesions (popliteal artery involved in 42.8% of cases). The median patient age was 73.0 years (interquartile range [IQR] 68.0, 77.0), 59.1% were male, and 44.7% had diabetes mellitus. Tosaka III lesions (total occlusions) were present in 165 patients (76.7%). Median lesion length was 22.0 cm (IQR 17.0, 27.0). No perforations occurred, whereas three (1.4%) peripheral embolisations were noted (all three observed with subacute presentation and total stent occlusion). All complications were treated within the index procedure by manual catheter aspiration without requiring surgery or lysis. After one year, 28 patients (13.0%) underwent CD-TLR, whereas primary patency was present in 156 patients (79.2%).</p><p><strong>Conclusion: </strong>Rotarex S thrombectomy can be used safely for debulking and removal of organised thrombus in subacute and chronic ISR lesions and occlusions. Additional DCB after debulking provides clinically acceptable CD-TLR and patency rates in this complex patient cohort.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337284","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":"Precise Reporting is Imperative for Both Quality of Research and Daily Clinical Practice.","authors":"Stavros K Kakkos, Martin Björck","doi":"10.1016/j.ejvs.2025.06.018","DOIUrl":"10.1016/j.ejvs.2025.06.018","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337283","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":"Ultrasound Guidance for Supporting Vascular Closure Devices: A Sound Decision?","authors":"Maram Darwish, David Bosanquet","doi":"10.1016/j.ejvs.2025.04.032","DOIUrl":"10.1016/j.ejvs.2025.04.032","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337286","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":"Management and Outcomes of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use: A Systematic Review and Meta-analysis.","authors":"Caitlin S MacLeod, David Strachan, Andrew Radley, Faisel Khan, John Nagy, Stuart A Suttie","doi":"10.1016/j.ejvs.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.ejvs.2025.06.030","url":null,"abstract":"<p><strong>Objective: </strong>Infected arterial pseudoaneurysms secondary to groin injecting drug use are challenging, and surgical strategies are controversial. This review evaluated existing evidence on their management and outcomes.</p><p><strong>Data sources: </strong>Embase, MEDLINE, and Scopus from inception to 10 March 2024.</p><p><strong>Review methods: </strong>Systematic review and meta-analysis. Study quality assessment involved the Joanna Briggs Institute critical appraisal tool and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Outcomes, stratified by ligation and debridement alone and immediate arterial reconstruction (at the initial intervention), were pooled and analysed using random effects models.</p><p><strong>Results: </strong>Fifty six observational studies were included, with 1783 ligation and debridement alone and 414 immediate arterial reconstructions (open and endovascular) undertaken. The major limb amputation rate was 4.36% (95% confidence interval [CI] 2.56 - 7.34%) following ligation and debridement alone and 3.53% (95% CI 1.59 - 7.66%) for immediate arterial reconstruction, with no statistically significant difference between strategies (p=.59; GRADE, very low). Ligation and debridement alone resulted in lower re-intervention rates (7.04%, 95% CI 4.38 - 11.13%) vs. immediate arterial reconstruction (19.85%, 95% CI 12.19 - 30.63%; p<.001; GRADE, low). Re-bleeding rates were reduced for ligation and debridement alone (0.63%, 95% CI 0.17 - 2.29%) vs. immediate arterial reconstruction (4.05%, 95% CI 1.57 - 10.04%; p<.001; GRADE, low). Chronic limb threatening ischaemia (0.29%, 95% CI 0.05 - 1.85% vs. 0.04%, 95% CI 0 - 0.79%, p=.65; GRADE, very low) and 30 day mortality (0.86%, 95% CI 0.35 - 2.09% vs. 1.45%, 95% CI 0.64 - 3.27%, p=.42; GRADE, very low) did not statistically significantly differ between groups. Claudication was higher for ligation and debridement alone (25.75%, 95% CI 17.08 - 36.88% vs. 5.38%, 95% CI 2.71 - 10.39%, p<.001; GRADE, low). Subgroup analysis demonstrated fewer major limb amputations for endovascular immediate arterial reconstruction compared with ligation and debridement alone (p=.048). There was no statistically significant difference in re-intervention rates (p=.89); however, re-bleeding for endovascular immediate arterial reconstruction remained higher than ligation and debridement alone (p=.048).</p><p><strong>Conclusion: </strong>Surgical strategies should be individualised for patients presenting with infected arterial pseudoaneurysms secondary to groin injecting drug use, with demonstrable safety of ligation and debridement alone balanced against the re-intervention risk for immediate arterial reconstruction for potential functional gain.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327826","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":"Evaluation of Sex Specific Representation and Sex Disaggregated Reporting in European Society for Vascular Surgery 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.","authors":"Joshua Tsai, Tiondre Brown, Isabelle van Herzeele, Carlota Prendes, Anna L Pouncey","doi":"10.1016/j.ejvs.2025.06.025","DOIUrl":"https://doi.org/10.1016/j.ejvs.2025.06.025","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the extent to which women are reported and represented within evidence supporting best practice recommendations for abdominal aortic aneurysms (AAAs).</p><p><strong>Data sources: </strong>Data were extracted from all studies supporting recommendation statements within the European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms (AAAs), including study type, journal, year of publication, country, funding, gender of authors, participant sex, demographics, use of a sex stratified main outcome, and sex disaggregated reporting.</p><p><strong>Review methods: </strong>This was a PRISMA equity analysis (Prospero registration: CRD42024559537). Prevalence adjusted estimates (e.g., participation prevalence ratio [PPR]) were derived by dividing the proportion of women enrolled by the proportion of women expected in the disease population. Under-enrolment of women was defined as a PPR < 0.8. Binary logistic regression was used to evaluate factors associated with reporting of a sex stratified main outcome. Weighted linear regression was used to evaluate factors associated with an increased PPR for women.</p><p><strong>Results: </strong>Of 160 guideline recommendations, 32 were consensus statements. The remaining 128 recommendations used evidence from 419 published studies, 30% (126/419) of which did not specify the overall number of women and men. Only 7% (31/419) reported a sex stratified main outcome and 11% (46/419) of studies presented sex disaggregated data. The odds of sex stratified reporting increased with a woman first author and with an increased PPR for women. Nearly 50% (141/293) of studies demonstrated under-enrolment of women. A higher journal impact factor, woman first author, more recent studies, and North American studies were associated with increased enrolment of women, while multinational studies, aortic specific studies, and woman last author were associated with decreased enrolment.</p><p><strong>Conclusion: </strong>Women are under reported and under represented in the evidence supporting ESVS AAA guideline statements. In depth evaluation is needed regarding best practice guidance for women and proportionate enrolment of women in AAA research should be encouraged.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310843","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":"CYP2C19 Allele Distribution in Patients with Peripheral Arterial Disease.","authors":"Linde J Vijn, Emilien C J Wegerif, Manon I Generaal, Robbert B M Wiggers, Çağdaş Ünlü, Gert J de Borst","doi":"10.1016/j.ejvs.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.ejvs.2025.06.007","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303660","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}