Annals of vascular surgery最新文献

{"title":"Paraplegia Events and Follow-Up Results after Thoracic Endovascular Aortic Repair.","authors":"Zhenchun Ji, Chengkai Su, Biwen Yang, Yunsheng Yu, Wenxue Ye, Yihuan Chen, Haoyue Huang, Zhenya Shen","doi":"10.1016/j.avsg.2025.06.039","DOIUrl":"10.1016/j.avsg.2025.06.039","url":null,"abstract":"<p><strong>Background: </strong>To retrospectively investigate the clinical characteristics, risk factors, and prognosis of paraplegia complications after thoracic endovascular aortic repair (TEVAR).</p><p><strong>Methods: </strong>A total of 420 patients with Stanford type B acute aortic dissection who underwent TEVAR between December 2015 and December 2020 were divided into a non-paraplegic (403 patients) or paraplegic group (17 patients) according to the presence or absence of paraplegia. Logistic regression analysis was used to identify the risk factors for paraplegia. The patients were followed-up for a median of 38 months (interquartile range[IQR]: 24-50 months), and the clinical outcomes of the patients in the 2 groups were assessed. The primary endpoint was death from any cause. The Kaplan-Meier estimation was applied to determine the time to the primary endpoint, while the log-rank test was employed to compare group survival rates. Additionally, Cox regression analysis was used to detect the factors influencing the survival rate of the 2 groups.</p><p><strong>Results: </strong>The overall incidence of paraplegia after TEVAR was 4.05% (17/420 patients). The paraplegic and non-paraplegic groups were significantly different in terms of hypertension, false lumen thrombosis, perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (P < 0.1). One-way logistic regression analysis of these factors showed that hypertension, false lumen thrombosis, perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were significant risk factors for paraplegia (P < 0.1). Further, multivariate logistic regression analysis demonstrated significant differences in perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (P < 0.01). The Kaplan-Meier curves revealed significant differences in all-cause mortality between the paraplegic and non-paraplegic groups (hazard ratio [HR], 11.57; 95% confidence interval [CI], 2.58-51.76; P = 0.00). Moreover, Cox regression analysis indicated that paraplegia was an independent risk factor for all-cause mortality after TEVAR (HR, 3.05; 95% CI, 1.20-7.79; P = 0.01).</p><p><strong>Conclusion: </strong>The overall incidence of concomitant paraplegia after TEVAR was 4.05%. Perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were independent risk factors for the postoperative occurrence of paraplegia. During a median follow-up of 38 months, a significant difference in survival rate was found between the patients in the paraplegic and non-paraplegic groups. Furthermore, paraplegia was an independent risk factor for all-cause mortality in patients after endovascular aortic repair.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"382-391"},"PeriodicalIF":1.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Radiofrequency Ablation and High Ligation Stripping for Varicose Veins: A Retrospective Analysis.","authors":"Caijuan Geng, Yu Xie, Lifeng Zhang, Yao Lin, Junyu Zhang, Yuqian Xie, Wei Zeng","doi":"10.1016/j.avsg.2025.07.025","DOIUrl":"10.1016/j.avsg.2025.07.025","url":null,"abstract":"<p><strong>Background: </strong>To compare the clinical efficacy, postoperative complications, and quality-of-life (QoL) outcomes of ultrasound-guided radiofrequency ablation (RFA) combined with tributary phlebectomy and foam sclerotherapy versus high ligation and stripping (HLS) combined with tributary phlebectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed 2,740 patients (1,588 women; mean age 59.01 ± 12.03 years) treated between October 2020 and October 2023. Among them, 1,756 (64.1%) underwent RFA and 984 (35.9%) underwent HLS. We assessed immediate success rate, 12-month recanalization, symptomatic recurrence, reintervention rate, and complications; The Aberdeen varicose vein questionnaire (AVVQ) and chronic venous insufficiency quality of life questionnaire (CIVIQ-14) scores were used to evaluate QoL, while the venous clinical severity score (VCSS) was used to assess disease severity at 1, 6, and 12 months postoperatively.</p><p><strong>Results: </strong>Immediate success was achieved in both groups. At 12 months, the RFA group had 7 recanalizations (0.40%) versus 0 in the HLS group (P = 0.112); symptomatic recurrence was 0.17% versus 0.20% (P = 1.000); reintervention rate was 2.62% versus 3.05% (P = 0.064); and each group had 2 cases of deep vein thrombosis. Minor complications in the HLS group included bruising (25.20% vs. 20.16%, P = 0.002), pain (25.41% vs. 20.39%, P = 0.002), and numbness (10.98% vs. 3.30%, P < 0.001); the RFA group had higher induration (17.20% vs. 3.25%, P < 0.001) and pigmentation (2.62% vs. 0.81%, P = 0.001). Both groups showed significant improvements in AVVQ, VCSS, and CIVIQ-14 scores (P < 0.05), with the RFA group demonstrating greater early improvement at 1 month.</p><p><strong>Conclusion: </strong>Ultrasound-guided RFA with foam sclerotherapy reduces minor complications such as pain, bruising, and numbness and significantly improves early QoL, though it carries a higher risk of induration and pigmentation. Both RFA and HLS offer good long-term efficacy and low recurrence rates; treatment should be individualized based on patient condition and recovery needs.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"392-399"},"PeriodicalIF":1.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Compliance With Elastic Compression Stockings On Severity Of PTS After 2 Years in Patients Who Underwent Pharmacomechanical Catheter-Directed Thrombolysis For Acute Iliofemoral Deep Vein Thrombosis.","authors":"Ali Baran Budak, Orhan Eren Günertem, Muhammet Sefa Sağla M, İhsan Alur, Tonguç Saba","doi":"10.1016/j.avsg.2025.09.055","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.055","url":null,"abstract":"<p><strong>Background: </strong>Deep Venous Thrombosis (DVT) poses significant risks, particularly Post-Thrombotic Syndrome (PTS). This study investigates the role of elastic compression stockings (ECS) in preventing PTS, focusing on patient adherence and its impact on therapeutic outcomes following pharmacomechanical catheter-directed thrombolysis (PMCDT) for acute iliofemoral DVT.</p><p><strong>Methods: </strong>This study evaluated 230 patients post-PMCDT for acute iliofemoral DVT, comparing 74 compliant and 156 non-compliant patients regarding PTS incidence and severity using Villalta and VCSS scores. Follow-ups included both clinical assessments and D-Dimer measurements, along with evaluation of adherence to elastic compression stockings.</p><p><strong>Results: </strong>The compliant group (74 patients) showed a higher proportion of females (48.7%) compared to the non-compliant group (31.0%, p=0.0435). Hospital stays were longer for compliant patients (3.91 days) than non-compliant (3.28 days, p=0.002). At the 6-month follow-up, the rate of severe PTS was 4.05% in the compliant group and 7.05% in the non-compliant group (OR=0.56; 95% CI: 0.15-2.06; p=0.05). At 24 months, severe PTS was observed in 4.05% versus 8.97% (OR=0.43; 95% CI: 0.12-1.54; p=0.05). D-Dimer levels were significantly lower in the compliant group at 6 months (1103 ng/ml vs. 1945 ng/ml, p<0.001), but not at 24 months.</p><p><strong>Conclusion: </strong>This study highlights the importance of patient adherence to ECS in reducing long-term complications following DVT treatment. Enhanced compliance strategies, including education and monitoring, are essential for improving recovery. Further research is necessary to optimize ECS use and prevent PTS.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Versus Open Repair for Non-Complex Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis.","authors":"En Qing Lim, Gavin O'Brien","doi":"10.1016/j.avsg.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.044","url":null,"abstract":"<p><strong>Background: </strong>The risk of rupture and mortality associated with abdominal aortic aneurysms (AAA) necessitates timely surgical intervention. Open surgical repair (OSR) and endovascular aneurysm repair (EVAR) are the two primary surgical techniques, frequently compared for efficacy and safety. EVAR is less invasive and reduces perioperative mortality but carries a higher risk of long-term complications. This meta-analysis evaluates short- and long-term outcomes of EVAR and OSR in infrarenal non-complex AAA.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Primary outcomes included perioperative mortality, long-term all-cause mortality, and aneurysm-related mortality. Secondary outcomes assessed reintervention, complication and limb graft occlusion (LGO) rates. Random-effects model were used for statistical analysis.</p><p><strong>Results: </strong>Compared with OSR, EVAR significantly reduced perioperative mortality (OR = 0.45; 95% CI: 0.27-0.75; p = 0.002; I² = 63%). At the longest follow-up (6-15 years), all-cause mortality did not differ significantly (OR = 1.06; 95% CI: 0.97-1.17; p = 0.22). Aneurysm-related mortality showed a non-significant trend toward higher rates after EVAR (OR = 1.17; 95% CI: 0.88-1.56; p = 0.29). Secondary interventions were significantly more frequent after EVAR (OR = 2.27; 95% CI: 1.32-3.93; p = 0.003). Pooled analysis demonstrated over fourfold increased odds of LGO with EVAR compared to OSR (OR = 4.07; 95% CI: 2.15-7.71; p < 0.0001). Endoleaks were the most common EVAR-related complication, with higher rates of Type I endoleak and LGO for Zenith Flex versus Endurant II in the Enzen Trial.</p><p><strong>Conclusions: </strong>EVAR confers a perioperative survival benefit over OSR but does not improve long-term all-cause mortality. Late aneurysm-related deaths, reinterventions, and LGO are more frequent after EVAR, emphasizing the need for lifelong surveillance and careful patient selection.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MID-TERM RESULTS OF SURGICAL DEBRANCHING FOR AORTIC ARCH ENDOVASCULAR REPAIR.","authors":"Paolo Spath, Stefania Caputo, Enrico Gallitto, Antonino DI Leo, Gemmi Sufali, Rodolfo Pini, Andrea Vacirca, Gianluca Faggioli, Mauro Gargiulo","doi":"10.1016/j.avsg.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.042","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the outcomes of surgical debranching of supra-aortic trunks(dSAT) for the endovascular treatment of aortic arch pathologies.</p><p><strong>Methods: </strong>Single-center retrospective analysis (2014-2024) of patients undergoing dSAT associated with endovascular treatment involving thoracic endovascular repair (TEVAR) in the aortic arch, was performed. Primary endpoints were defined on dSAT; secondary endpoints on patients. Subgroup analyses considered dSAT combined vs deferred to endovascular procedure. Cross-table analysis was performed for categorial variables and Kaplan-Meier for follow-up analysis.</p><p><strong>Results: </strong>Eighty-two patients (mean age:71, 78% male), were included. Pathologies included aortic arch(24%) and thoracic/thoracoabdominal(76%) diseases. A total of 87 dSAT were performed: a left common carotid artery(LCCA)-left subclavian artery(LSA) bypass in 57(70%) cases, a right-common carotid artery to LSA with reimplant of LCCA in 18(22%), bilateral carotid-subclavian bypasses in 5(6%), two(2%) direct reimplants(LCCA; vertebral artery). Seventy patients(85%) had a single and 12(15%) had a deferred endovascular repair. Technical success was 100%. 30-days dSAT related reinterventions were 7(8%)(one arterial dissection and 6 bleedings). Non-surgical dSAT complications were 4(5%)(3 left vocal cord paralysis; 1 chylothorax). Thirty-day mortality was 8%(7 patients), unrelated to dSAT. No cases of stroke were reported. Subgroup analysis showed absence of debranching related complications/reinterventions in deferred group. Median follow-up 20 months(IQR10-37). Follow-up debranching primary patency was 100% without reinterventions.</p><p><strong>Conclusions: </strong>The dSAT is a safe and effective procedure for endovascular treatment of aortic pathologies involving the aortic arch. Patency is high and reinterventions/complications are mainly linked to bleedings and seem to have a positive trend when endovascular procedure is performed in deferred stage.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Chronic Steroid Use on Postoperative Outcomes following Open Surgical Repair of Unruptured Abdominal Aortic Aneurysm.","authors":"Elio R Bitar, Celina R Bou Jaoude, Joelle Hassanieh, Jamal J Hoballah","doi":"10.1016/j.avsg.2025.09.043","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.043","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic corticosteroid use is associated with impaired wound healing and increased postoperative complications, but its impact on open surgical repair (OSR) of unruptured abdominal aortic aneurysms (AAA) remains unclear. Given the physiologic stress of OSR, identifying risk factors is essential. We aimed to evaluate the association between chronic steroid use and 30-day postoperative outcomes following elective OSR of unruptured AAA.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program from 2011-2023. Patients undergoing OSR of unruptured AAA were identified and stratified by chronic steroid use. Thirty-day postoperative outcomes were compared between groups. Univariate and multivariate logistic regression models evaluated the association between chronic steroid use and postoperative complications.</p><p><strong>Results: </strong>5,166 patients were included, with 143 (2.8%) on chronic steroids. After adjusting for preoperative and intraoperative factors, chronic steroid use was independently associated with increased risk of any surgical site infection (SSI) (aOR 2.02), deep incisional SSI (aOR 4.91), pneumonia (aOR 1.70), pulmonary embolism (aOR 5.18), transfusion requirement (aOR 1.61), systemic infection (aOR 2.24), sepsis (aOR 3.02), ischemic colitis (aOR 2.12), and bleeding from the prior AAA site (aOR 5.00) (all p < 0.05). Steroid use was linked to longer hospital stay (β=1.31 days) and ICU length of stay (β=0.94 days) (p < 0.05).</p><p><strong>Conclusion: </strong>Chronic steroid use is associated with increased risk of postoperative complications following OSR of unruptured AAA. These findings suggest that chronic steroid use should be considered during patient selection and perioperative management to optimize outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid Blowout Syndrome in Head and Neck Cancer Patients After Free Flap Reconstruction.","authors":"Pao-Jen Kuo, Pi-Chieh Lin, Ching-Hua Hsieh","doi":"10.1016/j.avsg.2025.09.039","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.039","url":null,"abstract":"<p><p>Carotid blowout syndrome (CBS) is a rare but potentially fatal complication in head and neck cancer patients who have undergone free flap reconstruction and/or radiotherapy. This review examines CBS, with incidence ranging from 0.5-0.9% in patients treated with modern radiotherapy to 3-4% in postoperative patients, and exceeding 20% in previously irradiated cases. CBS carries high mortality (40-60%) and neurological morbidity (∼60%). The pathogenesis involves arterial wall breakdown due to radiation-induced endarteritis, surgical exposure of vessels, wound complications, and tumor recurrence. CBS is classified as threatened (exposed carotid), impending (sentinel bleed), or acute (active hemorrhage). Diagnosis relies primarily on clinical assessment, CT angiography (CTA), and catheter angiography with balloon occlusion testing. Management requires a multidisciplinary approach with immediate stabilization followed by definitive intervention. Treatment options include surgical management (ligation, bypass, flap coverage) and endovascular techniques (deconstructive embolization or reconstructive stent grafting). The endovascular approach has become first-line for many CBS cases, though hybrid approaches combining endovascular stabilization followed by surgical intervention show promise. Despite advancements, prognosis remains guarded with 30-day survival of 70-77% and one-year survival as low as 32% in patients with active cancer. Rebleeding occurs in 20-40% of cases despite successful initial treatment. Prevention through prophylactic flaps in high-risk cases and early recognition of warning signs are emphasized. A multidisciplinary strategy with timely intervention offers the best chance for improved outcomes in this surgical emergency.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Based ABI Dynamic Fluctuation Patterns Predict Adverse Vascular Events in PAD: A Multicenter Prospective Study.","authors":"Ma Zhen, Feng Tao, Zhang Rui, Gu Jingliang, Hui Ting, Zhai Ziyi, Liu Xiao","doi":"10.1016/j.avsg.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.009","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop an artificial intelligence-based predictive model utilizing ankle-brachial index (ABI) dynamic fluctuation patterns and evaluate its predictive value for major adverse limb events (MALE) in patients with peripheral arterial disease (PAD), thereby providing a novel risk stratification tool for precision medicine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter prospective cohort study enrolled 412 consecutive PAD patients from six tertiary hospitals between January 2020 and December 2022. The cohort included 289 males (70.1%) with a mean age of 67.8±12.1 years. Using a standardized ABI measurement protocol, values were obtained at baseline, 1, 3, 6, 12, 18, and 24 months. The ABI dynamic fluctuation index (ABI-DFI) was defined as a composite metric incorporating the standardized ABI coefficient of variation with trend analysis. Machine learning algorithms (random forest, support vector machine, neural network) were employed to construct MALE prediction models. The primary outcome was MALE within 24 months, including major amputation and failed revascularization. Major adverse cardiovascular events (MACE), including cardiovascular death, were analyzed separately. Time-dependent ROC curves, competing risk models, and nomogram approaches were utilized to assess predictive performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During the 24-month follow-up, 73 patients (17.7%) experienced MALE, including major amputation in 31 cases (7.5%) and failed revascularization in 42 cases (10.2%). Additionally, 16 patients (3.9%) experienced cardiovascular death, which was analyzed as part of MACE. The ABI-DFI was significantly higher in the MALE group compared to the non-MALE group (0.34±0.12 vs. 0.18±0.08, P&lt;0.001). The random forest algorithm-based prediction model demonstrated superior performance with a time-dependent area under the ROC curve (td-AUC) of 0.847 (95%CI: 0.801-0.893) in the validation dataset and 0.831 (95%CI: 0.789-0.873) in the testing dataset, significantly outperforming traditional single-point ABI values (td-AUC=0.692, P&lt;0.001). The optimal ABI-DFI cut-off value was 0.26, with sensitivity of 81.5% and specificity of 78.2% in the validation dataset. When applied to the independent testing dataset, this cut-off demonstrated a sensitivity of 79.8% and specificity of 76.4%. After adjusting for traditional risk factors, the competing risk model identified ABI-DFI as an independent predictor of MALE (HR=3.42, 95%CI: 2.18-5.37, P&lt;0.001). The nomogram prediction model exhibited a C-index of 0.834, with bootstrap validation demonstrating good calibration and discriminative capability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The artificial intelligence-based ABI dynamic fluctuation prediction model accurately predicts the risk of adverse vascular events in PAD patients, offering significant advantages over traditional assessment methods and providing new scientific evidence for clinical precision medicine and individua","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 a new microporous stent-graft for reconstructing porcine supra-aortic arch branches and excluding thoracic aortic aneurysm.","authors":"Qiaohao Wan, Xiaoming Zhang","doi":"10.1016/j.avsg.2025.09.041","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.041","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of a new microporous stent-graft for reconstructing porcine supra-aortic arch branches and excluding porcine thoracic aortic aneurysm.</p><p><strong>Methods: </strong>Aneurysm models were established in the descending aorta of six ternary large white pigs; simultaneously, microporous stent-grafts were placed to exclude the aneurysms. Digital subtraction angiography (DSA) was performed 7 ± 1 days postoperatively to assess the aneurysms. Microporous stent-grafts were placed in the aortic arch, and the supra-aortic arch branches were reconstructed in an additional 6 ternary large white pigs. The time required to reconstruct the supra-aortic arch branches was recorded. The peak systolic velocity (PSV) in the right internal carotid artery was measured before and after stent placement using color Doppler ultrasound.</p><p><strong>Results: </strong>The aneurysms were noted to fade on DSA immediately after placement of microporous stent-grafts. Follow-up DSA at 6-8 days postoperatively showed no visualization of the aneurysms. The PSV in the right internal carotid artery was 81.5 ± 7.3 cm/s before stenting and 65.1 ± 7.6 cm/s after stenting, a mean decrease of 20% (p < 0.0001). The time required to reconstruct a single and double branch was 4.5 ± 0.5 min and 11.5 ± 1.9 min, respectively. During the follow-up period, all 12 pigs showed no infection, lameness, paraplegia, cerebral infarction, or death. DSA showed that all the stent-grafts were patent; further, there was no endo-leak, or fracture/migration of the stents.</p><p><strong>Conclusion: </strong>The microporous stent-graft allows complete thrombosis of the aortic aneurysm by altering its hemodynamics, and the micropores maintain the blood supply to the supra-aortic arch branches for a safe period. Enlarging the micropores of the stent-graft allows rapid reconstruction of the supra-aortic arch branches; moreover, the procedure is easy to perform and the technology is easily accessible.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF ELECTIVE OPEN AAA REPAIR VOLUME CUTOFFS ON PATIENT ACCESS TO SURGICAL CARE IN NEW YORK STATE.","authors":"Mario Matabele, Aaron Litvak, Baqir Kedwai, Joshua T Geiger, Adam J Doyle","doi":"10.1016/j.avsg.2025.09.030","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.030","url":null,"abstract":"<p><strong>Objectives: </strong>Volume-outcome relationships have established improved outcomes for patients undergoing open AAA repair if performed by surgeons with a yearly volume of ≥7 open aortic procedures and at hospitals with a perioperative mortality rate of <5%. However, the impact of this recommendation on patients' driving distance and access to surgery is unknown. This study seeks to quantify the impact on patients' access to care in such high-volume centers.</p><p><strong>Methods: </strong>Patients undergoing elective open AAA repair were identified using the New York SPARCS database from 2003 to 2014. An average of 7 open aortic repairs per year was considered high-volume. Travel distances to hospitals were obtained using patient addresses via Google Distance Matrix and compared before and after surgeon and hospital standards were implemented. Patient addresses were stratified as urban or rural based on USDA Rural-Urban Commuting Area cutoffs. Comparisons were performed using both geospatial data analysis by county and Mann-Whitney U-test.</p><p><strong>Results: </strong>6,337 patients who underwent open AAA had identifiable addresses for which distances to their surgical center could be obtained. Only 2,077 (32.8%) patients were treated by surgeons and at centers that met previously proposed criteria. If recommended guidelines were implemented, the travel distances would change from 8.1 (IQR:3.7-15.3) to 11.1 (IQR:6.2-18.5) miles (p<0.001) for patients in urban locations (n=3024). For patients who live in rural locations (n=1236) the travel distances would change from 31.3(IQR:12.8-52.3) to 39.4 (IQR:23.2-61.1) (p<0.001) (Figure 1).</p><p><strong>Conclusions: </strong>These data show that travel times would increase for open AAA patients should volume guidelines be implemented. Alternative solutions, such as allowing lower volume surgeons who operate at centers with high volume surgeons, should be considered to increase patient access to care.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}