Annals of vascular surgery最新文献

{"title":"Sex related outcomes after fenestrated and branched endovascular repair.","authors":"Eva Deveze, Camille Quillot, Tom Le Corvec, Justine Mougin, Beatrice Guyomarch, Guillaume Guimbretière, Blandine Maurel","doi":"10.1016/j.avsg.2025.07.030","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.030","url":null,"abstract":"<p><strong>Introduction: </strong>Sex discrepancies in outcomes after fenestrated and branched endovascular repair (FBEVAR) have recently been reported, with female sex being an independent predictor for worse perioperative outcomes. The aim of this study was to investigate sex-related outcomes after complex aortic aneurysm repair and factors associated with target vessel instability (TVI).</p><p><strong>Methods: </strong>Retrospective analysis of a prospectively maintained database of patients treated with FBEVAR at a single tertiary centre between January 2016 and December 2022. The primary endpoint was sex-specific morbidity at 30 days and target vessel instability after FBEVAR during follow-up. The secondary endpoint was factors independently associated with target vessel instability during follow-up.</p><p><strong>Results: </strong>169 patients were included: 21 (12.4%) females and 148 (87.6%) males, mean age of 72.3±9.6 and 73.0±8.9 years, respectively. 30-day mortality was 1 patient in each group (4.7% vs 0.6% P=0.23). During the study period, deaths occurred in 4 (19.0%) females (including 1 aorta-related death) and 39 (26.4%) males (including 8 aorta-related deaths) (p=0.81). The global cumulative incidence of TVI was 2.2% (95%CI 1.2-3.8%) at 1 year, 6.3% (95%CI 4.3-9.0%) at 2 years and 10.5% (95% CI 7.7-14.3%) at 5 years with no significant differences between males and females. In multivariate analysis, longer stent length was independently associated with TVI for left renal artery (LRA) and superior mesenteric artery (SMA), thoracoabdominal aneurysm for right renal artery (RRA) and previous endovascular surgery for SMA.</p><p><strong>Conclusion: </strong>Similar results were reported for male and female after FBEVAR, with sex having no significant effect on TVI. Longer stent length, thoracoabdominal aneurysm rather than pararenal, FEVAR rather than BEVAR and previous endovascular surgery were factors independently associated with target vessel instability.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697477","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":"2 YEAR PATENCY OF THE LEFT VERTEBRAL ARTERY AFTER CAROTID-SUBCLAVIAN BYPASS OR TRANSPOSITION BEFORE THORACIC ENDOVASCULAR AORTIC REPAIR IN ZONE II.","authors":"Aude Gatinot, Simon Rinckenbach, Thomas Foret, Tom Le Corvec, Guillaume Guimbretière, Blandine Maurel","doi":"10.1016/j.avsg.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.031","url":null,"abstract":"<p><strong>Background: </strong>Carotid subclavian artery bypass (CSB) and subclavian transposition (SCT) are the two surgical options for revascularization of the left subclavian artery (LSA) prior to coverage during thoracic endovascular aneurysm repair (TEVAR) in zone 2. This helps to prevent spinal cord injury by maintaining blood flow to the spine via the vertebral artery. The aim was to compare CSB with SCT prior to TEVAR regarding vertebral patency and surgical outcomes.</p><p><strong>Methods: </strong>Bicentric retrospective comparative study of consecutive patients who underwent CSB or SCT for thoracic aortic disease (dissection, aneurysm, lusoria) from 2017 to 2022.</p><p><strong>Results: </strong>86 patients were included: 41 bypasses and 49 transpositions. Median follow-up was 27 and 24.8 months, respectively. Indications for TEVAR were aneurysm (42.2%) and aortic dissection (57.8%). Complication rate was 24.4% for CSB vs. 8.2% for SCT, including stroke (2.4 vs. 2%), spinal cord injury (4.9 vs. 2%). At 2 years: 6 (14.6%) vertebral arteries and 3 (7.3%) grafts occluded in the CSB group; and 2 (4%) vertebral arteries occluded without LSA event among the SCT.</p><p><strong>Conclusion: </strong>In our experience, CSB prior to LSA coverage by TEVAR shows a higher rate of postoperative complications and a non-significant higher incidence of vertebral and LSA occlusion as compared to SCT.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697455","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":"Predictors of one-year major adverse cardiovascular events following elective thoracic endovascular aortic repair: a single-centre retrospective study.","authors":"Samuel Cardoso, Tomás Calisto, Andreia Pinelo, Henrique Almeida, Miguel Queirós, João Marcelo Cabral, Mónica Bandeira, Carlos Pereira, Rui Machado, Ivone Silva","doi":"10.1016/j.avsg.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.022","url":null,"abstract":"<p><strong>Background: </strong>Elective thoracic endovascular aortic repair (TEVAR) is a widely adopted intervention for descending thoracic aortic aneurysms. Over recent years, this endovascular technique has surpassed open surgery due to its reduced complications and mortality rates. However, certain preoperative and periprocedural clinical and analytical factors may significantly impact one-year mortality and the incidence of major adverse cardiovascular events (MACE) in patients. Identifying these predictors is essential for optimizing patient selection and improving postoperative outcomes. This study aims to evaluate the impact of these factors on one-year MACE following elective TEVAR.</p><p><strong>Methods: </strong>This retrospective, single-centre study included 41 patients with degenerative descending thoracic aneurysm who underwent elective TEVAR between January 2010 and December 2023. Procedures with emergent or urgent indications and patients with a prior history of aortic surgical intervention were excluded. Preoperative variables, including baseline comorbidities, laboratory values, anatomical characteristics, and procedure-specific planning details, were recorded. The primary endpoint was MACE at 1-year after TEVAR. MACE included acute myocardial infarction, cardiorespiratory arrest, stroke or death. Logistic regression analysis was used to identify predictors of one-year MACE.</p><p><strong>Results: </strong>The study cohort included 41 patients (80.5% male) with a mean age of 70.2 ± 10.5 years. The 30-day mortality and MACE rates was 4.9% (n = 2) and 7.3% (n = 3), respectively. At one year, the mortality and MACE rates was 22.0% (n = 9) and 24.4% (n = 10), respectively. Patients who experienced MACE at one year had a significantly larger descending aorta diameter (74.2 ± 24.7 mm vs. 51.7 ± 17.4 mm; p = 0.003) and lower preoperative haemoglobin levels (11.4 ± 2.0 g/dL vs. 13.2 ± 2.2 g/dL; p = 0.036) compared to those without MACE. Multivariable analysis identified descending aortic diameter as an independent predictor of one-year MACE (OR 1.1; 95% confidence interval (CI), 1.0 - 1.2; p = 0.013).</p><p><strong>Conclusion: </strong>Larger descending aortic diameter was an independent predictor of one-year MACE post-TEVAR. These findings underscore the critical importance of incorporating these parameters into preoperative risk stratification to optimize patient selection and improve long-term outcomes. By emphasizing careful preoperative assessment, we can enhance patient safety and surgical success, ultimately guiding clinical decision-making towards more personalized and effective therapeutic strategies.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673809","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":"Non-Surgical Care of Neurogenic Thoracic Outlet Syndrome in a NCAA Division 1 Athletic Conference.","authors":"Stephanie D Talutis, Jesus G Ulloa, Sharon L Hame, Hugh A Gelabert","doi":"10.1016/j.avsg.2025.07.017","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.017","url":null,"abstract":"<p><strong>Objectives: </strong>Thoracic outlet syndrome (TOS) is a disabling condition which may end an athletic career. While physical therapy is the initial treatment for TOS, there is a paucity of management outcomes data. Our goal is to report the outcome of non-surgical care in a NCAA Division 1 athletic conference.</p><p><strong>Methods: </strong>The prospectively maintained PAC-12 Health Analytics Program Database was searched for athletes with TOS from 2016-2022. Athletes with neurogenic (NTOS) diagnosis were identified. Outcomes of non-surgical care were analyzed according to success of physical therapy alone, need for specialty consultation and interventional procedures. Analysis compared non-surgical and surgical management.</p><p><strong>Results: </strong>15,609 athletes (6,874 men and 8,735 women) in 21 sports were registered. TOS was identified in 76 (0.48%) athletes: 69 (90.8%) NTOS. All 69 athletes with NTOS were initially managed with non-surgical modalities. Ultimately, this failed in 9 (13%), who required surgery. Non-surgical care included physical therapy 69 (100%), subspecialty consultation in 48 (69%), and interventional procedures in 5 (7%). Of the 69 athletes with NTOS, 55 (79.7%) experienced compete resolution of symptoms and 14 (20%) noted partial resolution. Physical therapy alone was used to treat 21 athletes, 17 (81%) of these noted complete resolution of symptoms. Of the 48 who required specialty consultation complete resolution of symptoms was noted in 48 (79.2%). Interventional procedures were used to treat 5, and 3 (60%) noted complete symptom resolution. Of the 60 athletes managed with non-surgical care complete resolution of symptoms was noted in 81.7%, whereas surgical decompression resulted in resolution of symptoms in 66.7% of athletes. All athletes returned to competition: 95% returned to unrestricted competition, and 5% with some restriction. This included 96.2% of NTOS managed without surgery and 85.7% of NTOS managed surgically.</p><p><strong>Conclusion: </strong>This report details outcomes of non-surgical care of TOS in a Division 1 NCAA Collegiate Conference based on a prospective, conference-wide database. The majority (84%) of athletes were managed with non-surgical care. This was successful with resolution of symptoms in 93% and unrestricted return to competition in 96%. Non-surgical care is successful and provides effective resolution of TOS symptoms for most elite collegiate athletes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673808","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 Modified Frailty Index-11 is a Poor Predictor of One-Year Mortality and Morbidity after Ruptured Abdominal Aortic Aneurysm Repair.","authors":"Moira A McGevna, Lily S F Adler, James Y Lu, Michael A Ciaramella, Saum A Rahimi, William E Beckerman","doi":"10.1016/j.avsg.2025.07.018","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.018","url":null,"abstract":"<p><strong>Objective: </strong>Previous research has shown that frailty, using the modified frailty index (mFI-11), does not correlate with 30-day outcomes after repair of a ruptured abdominal aortic aneurysm (rAAA). However, there are no studies to date investigating whether mFI-11 is associated with longer-term mortality and morbidity after rAAA repair. The aim of this study was to evaluate whether mFI-11 can be used as a risk assessment tool for predicting one-year mortality and morbidity in patients undergoing both open and endovascular rAAA repair.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all patients undergoing rAAA repair at a single tertiary care center from January 2011 to November 2022. Frailty was assessed for each patient using the mFI-11, a validated frailty metric based on the Canadian Study of Health and Aging, and was defined as an mFI-11 ≥0.27. The primary outcome was one-year mortality. Logistic regression, cox regression, and receiver operating characteristic (ROC) curves were used to assess mFI-11 with one-year morbidity and mortality. Kaplan-Meier analysis was used to compare rates of survival. Categorical and continuous data were compared using χ² and Student's t-tests, respectively. For all tests, a p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Seventy-eight patients were identified during the study period (35 frail vs. 43 non-frail) with a median follow up of 7 months (6 months frail vs. 10 months non-frail) and a one-year mortality rate of 40% overall (49% frail vs. 33% non-frail, p=0.10). Multivariable analysis showed no correlation between frailty and reintervention (odds ratio 1.6 [95% confidence interval 0.1-27.6], p=0.75), dialysis dependence (0.8 [0.1-9.2], p=0.83), home oxygen use (1.6 [0.2-13.0], p=0.6), and dependent mobility (0.8 [0.12-4.7], p=0.79). The area under the ROC curve (AUC) for mFI-11 was 0.58 for one-year mortality (p=0.2). Kaplan Meier analysis showed no difference in rates of survival between frail and non-frail patients (p=0.29).</p><p><strong>Conclusions: </strong>MFI-11 was not predictive of one-year outcomes after open or endovascular rAAA repair. Other metrics are needed to more accurately assess long term risk to enable better patient and family counseling after repair of rAAA.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673720","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":"Patient insurance status and race modify outcomes for diabetic patients undergoing care for diabetic foot ulcers and infections.","authors":"Garrett M Eakers, Zoona Sarwar, Zane Nassar, Chason Farnell, Benjamin A Greif, Morgan M Bonds","doi":"10.1016/j.avsg.2025.07.013","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.013","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to understand the impact of lowering the age of Medicare eligibility from 65 to 60 years on outcomes for patients with diabetic foot ulcer/infection. Furthermore, it aims to provide greater insight into how insurance status, insurance provider, and patient demographic factors modify outcomes for these patients.</p><p><strong>Methods: </strong>This study queried National Inpatient Sample data from the years 2015 to 2019 for hospitalized patients ages 60-65 who experienced diabetic foot ulcers and/or infections and examined outcomes for these patients based on a variety of factors, including their insurance status/provider, race, and sex. 38,610 patients met criteria for inclusion. Outcomes of interest included amputations (the primary outcome), limb salvage surgeries, in-hospital mortality, and disposition. Bivariate associations between the patient factors and outcomes of interest were determined, and those that were significant were used in a multivariate linear model to determine their association with our primary outcome.</p><p><strong>Results: </strong>38,610 patients met inclusion criteria. Patients without insurance were significantly more likely to undergo lower extremity amputation than those with insurance (aOR 1.20, 95% CI 1.09-1.33, p<.0002). Additionally, the demographic factors of male sex, Black, Hispanic, and Asian/Pacific Islander racial/ethnic identity were all significantly associated with greater odds of undergoing lower extremity amputation (all p<.05).</p><p><strong>Conclusions: </strong>Lack of insurance is associated with increased odds of undergoing lower extremity amputation for inpatients with diabetes who have diabetic foot ulcers or infections. There is potential that lowering the Medicare age based on the present study may benefit patients with diabetic foot ulcers.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666881","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":"Letter to the Editor in Response to Long-Term Results of Radiofrequency Ablation for Unilateral Great Saphenous Vein Insufficiency and Hemodynamic Changes in the Contralateral Leg.","authors":"Muhammad Ameer Hamza, Noor Un Nisa","doi":"10.1016/j.avsg.2025.07.011","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.011","url":null,"abstract":"<p><p>We commend the authors for their valuable contribution on the long-term outcomes of radiofrequency ablation (RFA) in unilateral great saphenous vein insufficiency and its hemodynamic effects on the contralateral limb. While the study provides meaningful data, we highlight several methodological concerns, including limited ethnic diversity, unexplored causes of recanalization, high loss to follow-up, and potential observer bias. To enhance the clarity and generalizability of the findings, we pose specific questions to the authors regarding these aspects. Addressing these concerns may help reinforce the reliability and applicability of the study's conclusions in broader clinical contexts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625299","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":"Bypass Versus Endovascular Therapy in Chronic Limb Threatening Ischemia Requiring Infra-Popliteal Interventions.","authors":"Randall A Bloch, Alex Lin, Elisa Caron, Scott G Prushik, Katie E Shean, Marc L Schermerhorn, Mark F Conrad","doi":"10.1016/j.avsg.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.006","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic Limb Threatening Ischemia (CLTI) involving the crural arteries is clinically and anatomically challenging. The BASIL-2 trial and a sub-analysis of the BEST-CLI trial examined the efficacy of endovascular therapy (EVT) versus surgical bypass (BP) among this cohort, but arrived at differing conclusions. This study aimed to compare the outcomes of EVT and surgical bypass among patients with CLTI requiring infra-popliteal interventions in a real-world registry.</p><p><strong>Methods: </strong>All infra-popliteal procedures performed for CLTI were identified in the peripheral vascular intervention and infra-inguinal bypass registries of the Vascular Quality Initiative (VQI) from 2017-2022. 19,505 EVT and 9,185 BP were identified with significantly different risk profiles. Propensity score-matched cohorts were constructed to compare EVT versus BP, BP with autologous vein (BPAV), and BP with prosthetic conduit (BPPC). Amputation-free survival (AFS), overall survival (OS), and freedom from major amputation were examined.</p><p><strong>Results: </strong>5,236 well-matched pairs of EVT vs BP, 3,892 well-matched pairs of EVT vs BPAV, and 1,971 well-matched pairs of EVT vs BPPC were included. BP and EVT demonstrated equivalent AFS (two-year AFS: 50.3% vs 49.0%, HR amputation/death: 0.947 [0.876-1.024], P=0.229), which was due to superior OS in the BP group (two-year OS: 79.7% vs 75.6%, HR all-cause mortality: 0.841 [0.761-0.928] P=0.002) matched by inferior limb salvage in the BP group (two-year freedom from major amputation: 71.4% vs 81.4%, HR major amputation: 1.432 [1.266-1.620], P<0.001). BPAV, composed primarily (91%) of great saphenous vein bypass (GSV BP), was associated with significantly greater AFS than EVT (two-year AFS: 53.9% vs 52.5%, HR amputation/death: 0.854 [0.778-0.938], P<0.001), which was driven by greater OS (two-year OS: 81.1% vs 77.4%, HR all-cause mortality: 0.872 [0.776-0.980], P=0.015) with equivalent limb salvage (two-year freedom from major amputation: 76.0% vs 81.4%, HR major amputation: 1.102 [0.951-1.278], P=0.353). However, BPPC was associated with significantly lower AFS than EVT (two-year AFS: 44.1% vs 46.9%, HR amputation/death: 1.279 [1.126-1.452], P=0.001), which was driven inferior limb salvage in the BPPC group (two-year freedom from major amputation: 63.3% vs 77.5%, HR major amputation: 2.165 [1.780-2.633], P<0.001) despite higher OS in the BPPC group (two-year OS: 78.8% vs 75.8%, HR all-cause mortality: 0.837 [0.706-0.992], P=0.012).</p><p><strong>Conclusion: </strong>When feasible, BPAV (particularly with GSV) should be considered over EVT due to superior AFS and OS with equivalent limb salvage. However, when autologous vein is unavailable, an aggressive approach to EVT may be warranted due to superior AFS and limb salvage despite slightly higher OS in the BPPC group.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625298","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 LDL Level on Lower Extremity Revascularization Outcomes.","authors":"Warren Carter, Uma Alappan, Ashwin Chetty, Nicholas Wells, Dana Alameddine, Martin D Slade, Stephen Possick, Cassius Iyad Ochoa Chaar","doi":"10.1016/j.avsg.2025.07.016","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.016","url":null,"abstract":"<p><strong>Background: </strong>Recent guidelines recommend achieving low-density lipoprotein (LDL) <70 mg/dL in patients with peripheral arterial disease (PAD). This study assesses the trends in LDL testing and its impact on lower extremity revascularization (LER) outcomes in a tertiary center.</p><p><strong>Methods: </strong>A retrospective chart review of patients who underwent open, endovascular or hybrid LER between 2013-2020 was performed, with follow up extending into 2024. Patients were divided into two groups based on baseline LDL<70mg/dL or higher prior to LER. Characteristics and outcomes of the two groups were compared.</p><p><strong>Results: </strong>Of 2,039 patients that underwent LER, 33.1% did not have LDL testing prior to intervention. The proportion of patients with preoperative LDL testing significantly increased over the study period (39.3% to 66.2%) concomitantly with increased statin use (74.4% to 81%) while the proportion of patients with baseline LDL<70mg/dL remained low (∼36%). Patients with low LDL were more likely to be older white males with significantly higher burden of comorbidities treated for chronic limb-threatening ischemia. Survival and cox regression analysis did not demonstrate significant association of baseline LDL<70mg/dL with major adverse cardiovascular events, limb events or mortality.</p><p><strong>Conclusions: </strong>Lipid testing and statin use prior to LER have increased but most patients had baseline LDL higher than the suggested target by most recent guidelines. A preoperative LDL<70mg/dL did not demonstrate an association with outcomes. This study highlights a significant gap in the care of patients with PAD undergoing LER and an opportunity for improvement by application of contemporary guidelines.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615981","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":"Inflammatory biomarker-based risk prediction model for endovascular reconstruction in acute limb ischemia: A multicenter development and validation study.","authors":"Sai Xiang, KaiPing Lu, Zhi Yu, Tao Jin, Xiaodong Wang","doi":"10.1016/j.avsg.2025.06.049","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.06.049","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory markers are associated with poor prognosis of peripheral vascular diseases. We aim to determine the relationship between inflammatory markers and the prognosis of acute lower limb ischemic disease and to construct and verify a prognostic model based on inflammatory indicators.</p><p><strong>Methods: </strong>We evaluated 295 patients with a diagnosis of acute lower limb ischemia (ALI) from multiple centers between 2020 and 2023.The association between baseline disease characteristics with length of stay and half-year cut-off results were determined using SPSS software and R language, respectively. We identified predictive factors and built a nomogram to predict 30-day amputation rate in patients with ALI after endovascular surgery.</p><p><strong>Results: </strong>In the training cohort, 34 patients underwent amputation within 30-day after endovascular surgery. Atrial fibrillation, diabetes, Rutherford grade IIb, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), lower hemoglobin (Hb), higher low-density lipoprotein (LDL), and higher triglycerides (TG) were independently associated with 30-day amputation. Pre-operative NLR, PLR and LDL presented a good discriminative ability (NLR: AUC=0.927; PLR: AUC=0.839; LDL: AUC=0.724). Five independent risk factors, diabetes, Rutherford grade, NLR, PLR, LDL, were screened from the results of the multivariate logistic analysis of the training cohort and included in the nomogram. The calibration curve also proved that the nomogram predicted outcomes were close to the ideal curve and the decision curve analysis (DCA) curve showed that all patients could benefit with threshold probability within 0-95%.</p><p><strong>Conclusions: </strong>A nomogram for postoperative endovascular reconstruction of ALI was constructed with good predictive performance, which can be used as an auxiliary diagnosis of the potential risk factors and assist surgeon in making a personalized diagnosis and treatment for patients.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615953","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}