Annals of vascular surgery最新文献

{"title":"Male Sex and Distal Aortic Expansion After TEVAR: A Single-Center Analysis with Bayesian Evidence Synthesis.","authors":"Dongsheng Cui, Xiang Li, Chuang Xu, Hongrui Pan, Lijian Fang, Jiaxue Bi, Xiangchen Dai","doi":"10.1016/j.avsg.2026.04.032","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.032","url":null,"abstract":"<p><strong>Objective: </strong>A prior meta-analysis identified male sex as a predictor of distal aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (pooled risk ratio [RR] 3.00; 95% confidence interval [CI] 1.22-7.35). This study aimed to evaluate the association between sex and distal aortic expansion in a single-center patient-level cohort and to explore the integration of prior evidence using Bayesian methods.</p><p><strong>Methods: </strong>We retrospectively analyzed 145 consecutive patients who underwent TEVAR for type B aortic dissection or intramural hematoma between 2014 and 2023. Distal aortic expansion was defined as an increase ≥5 mm in maximal thoracic aortic diameter during follow-up. Firth logistic regression assessed the association between male sex and expansion, adjusting for preoperative aortic diameter and hypertension. Bayesian logistic regression was performed using weakly informative priors and a secondary exploratory informative prior derived from the published meta-analysis, with consideration of differences between RR and OR, to obtain posterior probabilities of clinically relevant effect thresholds.</p><p><strong>Results: </strong>Twenty-six patients (17.9%) developed expansion. Firth regression yielded an adjusted OR of 3.92 (95% CI 0.94-36.29; P = 0.064). Under a weakly informative prior, the posterior distribution remained centered near the maximum likelihood estimate with wide credible intervals, reflecting substantial uncertainty. Bayesian analysis (informative prior: log OR ∼ Normal [1.10, 0.46]) produced a posterior median OR of 3.43 (95% credible interval 1.58-7.85). The posterior probability that the true OR exceeds 1 was 99.8%, and that it exceeds 2 was 90.4%. Results were similar under weakly informative priors; the posterior distribution remained centered near the maximum likelihood estimate, indicating consistency with the observed data while reducing imprecision.</p><p><strong>Conclusion: </strong>In this single-center cohort, male sex showed a directionally consistent association with distal aortic expansion compared with prior meta-analytic findings, although the precision of the estimate was limited by sample composition. Despite limited frequentist precision, Bayesian analysis provides a probabilistic interpretation of the effect size and demonstrates how incorporation of prior evidence may influence inference in small-sample settings. These findings should be interpreted with caution and warrant confirmation in larger, independent cohorts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855602","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 Early Sac Regression On Post-Endovascular Aneurysm Repair Midterm Outcomes.","authors":"Alp Yıldırım, Hakkı Zafer İşcan, Bekir Boğaçhan Akkaya, Sinan Özçelik, Ahmet Etkin Sevim, Zülküf Selvitopi, Ferit Kasımzade, Bahadır Aytekin","doi":"10.1016/j.avsg.2026.04.040","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.040","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify predictors of aortic sac regression after Endovascular Aortic Repair (EVAR) and to evaluate the impact of early sac regression and these factors on adverse events such as endoleak, reintervention, and late mortality.</p><p><strong>Method: </strong>Retrospective analysis of 383 consecutive patients undergoing EVAR (2019-2025) at a single centre. Sac regression was defined as ≥5 mm decrease in maximum diameter or ≥10% volume reduction. Follow-up included CTA up-to three years (or DUS/non-contrast CTA in renal impairment). Binary logistic regression identified predictors; Cox regression and Kaplan-Meier assessed late mortality, endoleak and reintervention.</p><p><strong>Results: </strong>Median follow-up was 25 months (max 99). Sac regression occurred in 293 patients (76.5%). Non-regression was associated with older age (p=0.04), dual antiplatelet therapy (p<0.001), larger inferior mesenteric artery diameter (>3 mm; p=0.04), and more patent lumbar arteries (p=0.06). Non-regressors had significantly higher rates of all endoleak types, reinterventions, and longer hospital stays (p<0.05). No aneurysm-related mortality occurred in the regression group (vs. 1 case). Volume change showed superior AUC for predicting endoleak (0.927 vs. 0.852) and reintervention compared with diameter change. Multivariable predictors of non-regression included age, dual antiplatelet use, neck length, and IMA diameter.</p><p><strong>Conclusion: </strong>Sac regression was strongly associated with markedly improved midterm outcomes, including significantly lower rates of all endoleak types, reinterventions. Advanced age, dual antiplatelet therapy use, shorter neck length, and larger inferior mesenteric artery diameter emerged as independent predictors of failure to regress. Volume-based assessment outperformed diameter-based measurement in predicting sac changes more sensitively. These findings support the integration of volumetric monitoring into risk-stratified surveillance protocols, particularly for stabilised sacs and emphasise the value of individualised follow-up strategies guided by both sac regression status and volumetric changes, to further improve long-term outcomes following EVAR.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855559","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":"A systematic review and study-level meta-analysis investigating the association between pre-endovascular intervention C-reactive protein levels and femoropopliteal artery restenosis.","authors":"Hermann Pasha, Krishi Jain, Daniel O'Callaghan, Jj Coughlan, Roisin Colleran, Robert A Byrne, Himanshu Rai","doi":"10.1016/j.avsg.2026.04.031","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.031","url":null,"abstract":"<p><strong>Introduction: </strong>Restenosis in previously treated femoral or popliteal arteries remains a clinical issue, leading to repeat procedures, and major adverse limb events. Elevated pre-endovascular intervention levels of C-reactive protein (CRP), a marker of systemic inflammation, have previously been associated with coronary restenosis, however, its association with femoropopliteal artery restenosis is unclear. We conducted a systematic review and study-level meta-analysis to assess the association between pre-endovascular intervention CRP levels and femoropopliteal artery restenosis.</p><p><strong>Methods: </strong>Online databases of PubMed, EMBASE, MEDLINE (OVID), Scopus and Web of Science were searched for relevant articles published until September 30^th, 2025. A Z-test using a random effects model was used to pool study-level results to obtain pooled standardized mean differences (SMD) and its 95% confidence intervals (CI). A p value of <0.05 indicated statistical significance.</p><p><strong>Results: </strong>After screening a total of 331 unique articles, 14 studies, including 2,097 patients (562 restenosis cases/1,535 no-restenosis controls) were available for quantitative synthesis. Pooled results suggested a significant association between higher pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. (SMD= 0.44, 95% Cl, 0.09-0.78, p= 0.01). There was no evidence of publication bias, both visually via Begg's funnel plot and statistically via Egger's test results (p= 0.52). Leave-one-out sensitivity analysis supported the robustness of the pooled results.</p><p><strong>Conclusions: </strong>This systematic review and study-level meta-analysis suggests a significant association between higher pre-endovascular intervention CRP levels and the subsequent development of femoropopliteal artery restenosis. Our findings should be interpreted with caution and further large-scale prospective investigations are warranted to substantiate our results.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855726","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":"Baseline Descending Aortic Diameter Drives Long-Term Failure of Conservative Management in Uncomplicated Type B Aortic Dissection.","authors":"D Becker, C Frenzer, M Messerli, E Khanicheh, H von Tengg-Kobligk, V Makaloski, D Kotelis, S Jungi","doi":"10.1016/j.avsg.2026.04.033","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.033","url":null,"abstract":"<p><strong>Objective: </strong>Failure of conservative management in patients with initially uncomplicated acute type B aortic dissection (TBAAD) remains clinically relevant. This study evaluated whether commonly cited imaging-based morphologic features are associated with long-term failure of conservative management.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included consecutive patients treated for uncomplicated TBAAD between 2000 and 2018 with high-quality baseline computed tomography angiography and ≥1 year of imaging follow-up. Baseline morphologic parameters were assessed with centerline-based analysis and included descending thoracic aortic diameter (DTAD), ascending aortic diameter, true and false lumen dimensions, and primary entry tear (PET) characteristics. Failure of conservative management was defined as the need for surgical or endovascular intervention >3 months after initial presentation. Cox proportional hazards models evaluated associations between morphologic parameters and subsequent intervention.</p><p><strong>Results: </strong>Eighty-nine patients (median age 65 years; 65.2% male) were included with a median follow-up of 7.6 years. During follow-up, 33 patients (37.1%) required aortic intervention, mainly due to aneurysmal degeneration or rapid growth. Baseline DTAD was significantly larger in patients requiring intervention (median 41 mm vs. 37 mm; p=0.026). DTAD ≥40 mm was independently associated with intervention (adjusted hazard ratio [HR] 2.15; 95% confidence interval [CI] 1.05-4.42; p=0.037). DTAD analyzed as a continuous variable remained associated with intervention risk (HR 1.09 per mm; 95% CI 1.02-1.16; p=0.011). Other morphologic features were not associated with aortic growth or need for intervention.</p><p><strong>Conclusion: </strong>Baseline descending thoracic aortic diameter was the only morphologic imaging feature consistently associated with long-term failure of conservative management in uncomplicated TBAAD.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855738","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":"Comparing BEST-CLI participants with patients treated at a tertiary centre serving a regional-remote population.","authors":"Shivshankar Thanigaimani, David Sun, Oh Sung Choy, Kevin Tian, Jonathan Golledge","doi":"10.1016/j.avsg.2026.03.060","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.03.060","url":null,"abstract":"<p><strong>Background: </strong>The BEST-CLI trial established the first large-scale evidence for revascularisation of chronic limb-threatening ischaemia (CLTI), but its restrictive eligibility criteria may limit applicability to regional-remote populations.</p><p><strong>Methods: </strong>We retrospectively evaluated BEST-CLI eligibility in a consecutive cohort of patients treated for CLTI at a tertiary vascular centre serving the North Queensland regional and remote Australian population. Trial criteria were applied independently by two vascular surgeons. The primary outcome was the composite of all-cause mortality and major adverse limb events (MALE) and was compared by eligibility and procedure type using risk-factor adjusted Cox proportional model.</p><p><strong>Results: </strong>Patients (n=388) were followed for a median of 2.4 (inter-quartile range 1.3, 3.9) years, and 277 (71.4%) of them were deemed ineligible for BEST-CLI. Ineligible patients lived significantly further from the tertiary centre than eligible patients (median 225.6 vs 73.1 km, p=0.038), with rurality significantly associated with ineligibility (p=0.011). BEST-CLI eligible patients had a significantly lower risk of primary outcome events compared with ineligible patients (adjusted hazard ratio: 0.53, 95% confidence intervals: 0.39, 0.71, p<0.001).</p><p><strong>Conclusions: </strong>The strict eligibility criteria in the BEST-CLI trial would have excluded many rural and remote patients with CLTI who have worse outcomes then eligible patients. Trial findings may not be generalisable to regional populations, underscoring the need for relevant benchmarks and strategies to address inequities to clinical trial access.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855906","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":"Management of Secondary Aortoduodenal Fistula: The Role of Emergency Endovascular Repair and Timing of Definitive Open Surgery in a Single-Center Case Series.","authors":"Kentaro Akabane, Ken Nakamura, Yoshinori Kuroda, Masahiro Mizumoto, Jun Hayashi, Shuto Hirooka, Kimihiro Kobayashi, Tomonori Ochiai, Shusuke Arai, Tetsuro Uchida","doi":"10.1016/j.avsg.2026.04.030","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.030","url":null,"abstract":"<p><strong>Objectives: </strong>Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after abdominal aortic surgery, characterized by catastrophic hemorrhage and persistent infection. Emergency endovascular aortic repair (EVAR) is increasingly performed initially as a less invasive approach for rapid hemostasis in patients presenting with hemorrhagic shock; however, it does not eliminate the underlying source of infection. Although definitive open surgery to remove the infectious source remains essential, the optimal timing has not been established due to the rarity of this condition. Therefore, we evaluated emergency EVAR as an initial hemostatic strategy and the association between timing of definitive surgery and clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed six consecutive patients with SADF treated at our institution from 2016 to 2025. Emergency EVAR was performed in patients presenting with hemorrhagic shock, followed by definitive surgery. Until 2021, definitive surgery was performed electively after stabilization of the patient's general condition, whereas since 2022, it has been performed as early as clinically feasible.</p><p><strong>Results: </strong>Emergency EVAR was performed in five patients to achieve hemostasis, and none of the patients died before definitive surgery. During follow-up, four patients died of sepsis due to recurrent infection within 2 years after surgery. Longer intervals from diagnosis to definitive surgery were observed in these patients.</p><p><strong>Conclusion: </strong>Emergency EVAR was an effective life-saving strategy for initial hemostasis. However, unfavorable outcomes were associated with prolonged delays before definitive surgery, suggesting that earlier transition to definitive surgery for infection control may be related to overall outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855527","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":"Neurologic outcome of patients with blunt traumatic aortic injury - an observational single-center cohort study.","authors":"Lukas Mayer-Suess, Maximilian Lutz, David Wippel, Kurt Moelgg, Florian Frank, Stefan Kiechl, Michaela Kluckner, Sabine Wipper, Elke R Gizewski, Michael Knoflach, Martin Freund, Alexander Loizides, Florian K Enzmann","doi":"10.1016/j.avsg.2026.04.039","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.039","url":null,"abstract":"<p><strong>Background: </strong>Evidence on blunt traumatic aortic injury (BTAI) associated neurological complications is limited. We aimed to assess their prevalence and long-term impact.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included consecutive BTAI patients treated at the University Hospital of Innsbruck (2005-2023). This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients were identified by keyword search and confirmed by two independent raters; clinical records and imaging were reviewed, and neurologic diagnoses adjudicated by two independent neurologists.</p><p><strong>Results: </strong>Eighty-six BTAI patients were included. Concomitant neurologic pathologies were present in 51/86 (59.3%), including traumatic brain injury diagnoses (intracranial bleeding 30.2%, diffuse axonal injury 15.1%, skull fractures 10.5%), potentially vascular- or treatment related cerebral ischemia (11.6%), trauma-related cervical artery dissections (8.1%), peripheral nerve injuries (10.5%), and spinal cord injuries (7.0%). In-hospital complications included 10 cases (11.6%) of neurologic worsening (NIHSS or mRS increase ≥1), with one of the 7 intra-hospital deaths being due to a neurologic cause. Of 86 BTAI patients, 51 (59.3%) had neurologic pathologies-traumatic brain injury (55.8%), cerebral ischemia (11.6%), peripheral nerve (10.5%), cervical artery dissection (8.1%), and spinal cord injuries (7.0%). Ten (11.6%) had in-hospital neurologic worsening; 1/7 deaths was neurologic. Upon follow-up (median 6.8 years), 40.5% remained functionally dependent (mRS >1). Higher GCS was associated with lower in-hospital mortality (OR .833 [CI95% 0.717, 0.969]), concomitant neurologic injuries (OR 0.692 [CI95% 0.536, 0.893]) and functional dependence (OR 0.782 [CI95% 0.651, 0.940]; P = 0.009). Higher ISS showed the reverse for mortality (OR 1.063 [1.022, 1.106]; P = 0.002), neurologic injuries (OR 1.077 [1.025, 1.131]; P = 0.003) and dependency (OR 1.191 [1.061, 1.336]; P = 0.003). Only 3/33 (9.1%) thoracic endovascular aortic repair (TEVAR)-related °III-subclavian steal cases were symptomatic, all with upper-extremity ischemia.</p><p><strong>Conclusion: </strong>Concomitant neurologic pathologies in BTAI are frequent and have long-term impact, underscoring the need for multidisciplinary care with neurologic screening and early neurorehabilitation; TEVAR-associated subclavian steal had minimal clinical impact.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855674","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 Rising Procedural Burden in Vascular Surgery: An 8-Year Nationwide Population-Based Analysis with Projections to 2035.","authors":"Sandra Vicente-Jiménez, Elia Perez-Fernández, Carlos Maria Elvira-Martinez, Patricia Lucia Barber-Pérez, Manuel Maynar, Luis de Benito, Beatriz Gonzalez Lopez-Valcarcel","doi":"10.1016/j.avsg.2026.04.035","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.035","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the evolving procedural burden in vascular surgery within a nationwide health system and to estimate future workload projections through 2035.</p><p><strong>Methods: </strong>A retrospective, population-based study was conducted using the Spanish National Hospital Discharge Registry (RAE-CMBD) from 2016 to 2023. All surgical and endovascular procedures performed in Vascular Surgery Departments were identified and classified by type. Age- and sex-adjusted incidence rates per 100,000 inhabitants were calculated using direct standardization. Temporal trends were assessed using multivariable Poisson regression models with population size as an offset. Linear projections of procedural volume were estimated through 2035 based on observed annual trends.</p><p><strong>Results: </strong>Between 2016 and 2023, the adjusted incidence of vascular procedures increased from 266.8 to 380.4 per 100,000 population, representing a 43% relative increase. Growth was consistent across age and sex groups (IRR 1.04; 95% CI 1.00-1.08; p = 0.049). The largest annual increases were observed in thoracic endoprosthesis implantation (+13%), venous stenting (+10%), endovascular lower limb revascularization (+9%), varicose vein interventions (+8%), and endovascular aortoiliac revascularization (+7%) (all p < 0.01). Projections indicate a further 59% increase in overall procedural volume by 2035 compared with 2023.</p><p><strong>Conclusions: </strong>Vascular surgery is experiencing a sustained and clinically significant increase in procedural demand, driven largely by expanding endovascular activity. If current trends continue, workload will rise substantially over the next decade. These findings highlight the need for anticipatory workforce planning, training adaptation, and resource allocation to ensure the sustainable delivery of vascular surgical care.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855698","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":"EXCLUSION OF HEALTHY AORTA IN COMPLEX ANEURYSMATIC AORTIC PATHOLOGIES IN ENDOVASCULAR REPAIR.","authors":"Rocio Garralda Díaz de Lope-Díaz, Manuela M Hernández Mateo, Manuel Hernando Rydings, María Sánchez- Cantalejo Ferrer, Isaac Martínez López","doi":"10.1016/j.avsg.2026.04.037","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.037","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular repair (ER) requires to seal within a healthy aorta, resulting in longer exclusion in comparison to open repair. This study aimed to quantify the length and the number of occluded segmental arteries after every ER compared to a hypothetical open repair (HOR) and, secondary, to assess the anatomical factors related to spinal cord ischemia (SCI) in juxtarenal (JAAAs) and pararenal aneurysms (PAAAs).</p><p><strong>Methods: </strong>Patients treated by ER between 2014-2023 in our center were included. Using Osirix® we reviewed every pre and postoperative CTA, generating center lumen lines (CLL) for measurements.</p><p><strong>Results: </strong>Seventy-seven patients were included (37 JAAA, 6 PAAA and 34 TAA) undergoing 39 FEVAR, 31 BEVAR and 7 B/FEVAR. Median length of aortic exclusion in ER is 276,41 ± 112,31 mm compared to HOR 182,07 ± 87,18 mm (p <0.001, with significance maintained in JAAA, PAAA, and type III TAAA. The number of occluded segmental arteries after ER was significant in the juxtarenal (p <0,001) and type III TAA compared to HOR. Four cases of transient SCI in the JAAA and PAAA, with significant association identified for aortic exclusion >250 mm and with the chronic or intended internal iliac arteries occlusion.</p><p><strong>Conclusions: </strong>ER results in significantly longer aortic exclusion and more occluded segmental arteries than HOR, particularly in JAAA and PAAA. It is necessary to perform a comparative study with OR to better evaluate the potential increased risk of SCI in these subgroups.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855544","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":"Multicenter Registry Validation of the Modified Harborview Risk Score for Risk Stratification in Ruptured Abdominal Aortic Aneurysm.","authors":"Arjun Chaturvedi, Jeffrey Balian, Oh Jin Kwon, Kevin Tabibian, Yas Sanaiha, Peyman Benharash, Christian de Virgilio, Nina Bowens","doi":"10.1016/j.avsg.2026.04.028","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.04.028","url":null,"abstract":"<p><strong>Background: </strong>The modified Harborview Risk Score (mHRS) has been proposed as a bedside tool to stratify operative risk in patients with ruptured abdominal aortic aneurysms (rAAA), but its performance across operative strategies in contemporary multicenter settings remains incompletely characterized.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed using the 2012-2022 American College of Surgeons National Surgical Quality Improvement Program Targeted EVAR dataset. Adult patients undergoing OSR and EVAR of rAAA were included. The mHRS was calculated by assigning 1-point for age>76years, creatinine>2mg/dL, international normalized ratio>1.8, and systolic blood pressure<70mmHg. Multivariable regression and Royston-Parmar flexible parametric models were constructed to assess risk-adjusted outcomes stratified by mHRS.</p><p><strong>Results: </strong>Among 2,291 patients, 55.8% underwent EVAR and 44.2% OSR. The distribution of the mHRS was similar between groups, with median of 1 [1-2] in both cohorts (P=0.007). After multivariable adjustment, each point increase in the mHRS with OSR (reference: EVAR) yielded higher odds of mortality and complications, including aneurysm hemorrhage (all P<0.001). When assessed across the mHRS stratum, the risk-adjusted mortality progressively increased for both modalities, with EVAR demonstrating improved outcome at each mHRS level compared to OSR. Time-to-event analysis demonstrated that the decline in freedom from mortality at 30 days was more pronounced following OSR compared to EVAR, particularly at higher mHRS (≥3).</p><p><strong>Conclusions: </strong>Our findings using the mHRS suggest that higher scores are associated with increased morbidity and mortality following OSR and EVAR for rAAA, with EVAR demonstrating more favorable outcomes across risks strata.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855605","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}