Annals of vascular surgery最新文献

{"title":"Prognosis of distal segment reflux after proximal segment treatment of an incompetent small saphenous vein.","authors":"Ki Pyo Hong","doi":"10.1016/j.avsg.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.014","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze postoperative changes in distal segment reflux after treatment of the proximal segment of an incompetent small saphenous vein (SSV).</p><p><strong>Methods: </strong>This was a retrospective study of patients treated between April 2017 and July 2022 with a diagnosis of incompetent SSV. Patients who had undergone previous treatment for varicose veins, including sclerotherapy, and those without post-procedure Doppler follow-up were excluded.</p><p><strong>Results: </strong>A total of 129 patients (151 limbs) were studied, with a mean follow-up of 15 months (6-62 months), a male-to-female sex ratio of 1:1.9, and a mean age of 56 years (24-83 years). Residual reflux in the distal segment was present in 19% (29/151) of lower extremities after SSV proximal segment treatment. Only five patients (5/129) had lower extremity symptoms with residual reflux in the distal segment after treatment. The persistence of reflux in the distal segment of the SSV was not associated with age, sex, body mass index, laterality, preoperative SSV diameter and duration of reflux, concomitant popliteal vein reflux, incompetent GSV below the knee, CEAP clinical class, or treatment modality.</p><p><strong>Conclusions: </strong>After treatment of the proximal segment of the incompetent SSV, less than 4% of all patients had residual reflux in the distal segment accompanied by symptoms in the ipsilateral lower extremity.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623322","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":"Comparable Limb Salvage Outcomes on Pop Distal Bypass when Using Plantar Artery as a Distal Target.","authors":"Aihab Aboukheir-Aboukheir, Patricia Mulero, Noash Rovira Julia, Omar J, Ricardo Fraticelli, Alexander Torres, Angelica Santiago, Stefan Sarkovich, Jose Ortiz-Fullana, Gabriel Pereira-Torrellas, Rafael Santini-Dominguez, Jorge Martinez-Trabal","doi":"10.1016/j.avsg.2025.02.020","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.020","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective is to describe limb salvage and patency rates of infra-genicular bypasses using plantar artery as a distal target. The secondary objective is to compare outcomes between bypasses to the plantar artery and those to other tibial arteries.</p><p><strong>Methods: </strong>Retrospective cohort study of all consecutive patients who underwent infra-genicular bypasses using autologous venous conduit from July 2012 to June 2018. Demographic variables, indications for surgery, limb salvage, and bypass patency were recorded, and statistical analysis was performed. Exclusion criteria were inflow vessels above the knee, acute limb ischemia, and use of synthetic conduits.</p><p><strong>Results: </strong>Ninety procedures were performed from the third portion of the popliteal artery (POP) to either the anterior tibial (AT), dorsalis pedis (DP), posterior tibial (PT), peroneal (Per), or plantar artery (plantar). The mean age was 70 years old, with 50 patient's male (56%). Predominant comorbidities were diabetes mellitus (87.8%), hypertension (94.4%), and active smoking (25%). Indications for surgery were gangrene (63%), followed by ulceration (26%) and rest pain (11%). There were forty-one Pop-DP (45.5%), twenty-three Pop-Plantar (25.6%), twenty Pop-PT (22.2%), four Pop-Peroneal (4.4%), and two Pop-AT (2.2%). The median follow-up time was 65 months. The limb salvage at one year for plantar artery bypass was 65% (17 patients) and 82% (58 patients) for all other distal bypasses. Kaplan-Meier analyses showed 1-year patency of 65% for plantar bypass while 82% for all other distal bypasses while 3-year patency rates dropped to 60% and 75%, respectively (P=0.185, Chi-square 1.75).</p><p><strong>Conclusion: </strong>The plantar artery as a target vessel for infra-genicular bypass using autologous vein conduit is an effective surgical option with acceptable limb salvage and patency rates.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623314","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":"Beyond Endovascular Solutions: Open Sac Revision with Graft Preservation for Persistent Aortic Sac Expansion post-EVAR.","authors":"Anastasia Dean, Summer Hassan, Motoharu Yasutomi, Andrew Holden, Andrew Hill","doi":"10.1016/j.avsg.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.013","url":null,"abstract":"<p><strong>Background: </strong>Aortic sac expansion after endovascular aortic aneurysm repair (EVAR) is associated with higher re-intervention rates, late rupture, and long-term all-cause mortality. Endovascular options have limitations, and guidelines recommend open surgical revision (OSR) if these fail. This study reviews the technique, indications, and outcomes for OSR following EVAR at Auckland City Hospital.</p><p><strong>Methods: </strong>We identified all OSR cases with stent graft preservation for aortic sac expansion post-EVAR at Auckland City Hospital from January 2010 to October 2023. Techniques included sac closure, plication, or omental wrapping. Cases involving infected grafts were excluded.</p><p><strong>Results: </strong>Seventeen patients (median age: 82 years, predominantly male) underwent OSR, with a median follow-up of 3 years. The primary indication was sac expansion with type 2 endoleak (T2EL) in 88.24% of patients, while two cases were type V endoleaks. Intraoperatively, endoleaks were found in 94.12% of patients, with 88.24% having T2EL and 17.65% having type 3 endoleaks. Omentoplasty was performed in 58.82% of cases. Although not statistically significant, there was a trend towards lower endoleak recurrence with omentoplasty compared to sac closure. Re-intervention for progressive sac expansion was required in 17.65% of patients (3/17), with two additional patients (11.76%) monitored for recurrent endoleak without further intervention. All patients were discharged, with 82.35% going home without needing rehabilitation. The median hospital stay was 7 days, and the 30-day mortality rate was 0%.</p><p><strong>Conclusion: </strong>OSR with graft preservation is effective for sac expansion post-EVAR, facilitating endoleak identification and repair while avoiding aortic clamping. Ongoing surveillance is necessary.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623312","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":"Improving Depression Detection and Measuring Its Impact Upon Short-Term Survival in Chronic Limb-Threatening Ischemia (CLTI).","authors":"Cuneyt Koksoy, Ilse Torres, Xin Yee Ooi, Zachary S Pallister, Ramyar Gilani, Joseph L Mills, Jayer Chung","doi":"10.1016/j.avsg.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.015","url":null,"abstract":"<p><strong>Background: </strong>Depression is underdiagnosed in chronic limb-threatening ischemia (CLTI) patients, and its impact on outcomes is unclear. This study aims to evaluate a CLTI-specific questionnaire designed to detect depression and anxiety, as well as to quantify its impact on early outcomes.</p><p><strong>Methods: </strong>A serial cross-sectional study was conducted over two four-month periods: Block I, which retrospectively examined depression prevalence based on medical records, and Block II, which prospectively assessed depression using a CLTI-specific questionnaire. Patients were followed for six months to assess early outcomes. Data on demographics, comorbidities, Wound, Ischemia, foot Infection (WIfI) grades, perioperative and six-month limb salvage, and survival were collected and analyzed.</p><p><strong>Results: </strong>We evaluated 101 CLTI patients (58 in Block I; 43 in Block II; median age 68 years [IQR 62-74]; 67 [66.3%] male). In Block I, 20.7% had a prior depression diagnosis; in Block II, 23.3% (p=0.76). The CLTI-specific questionnaire in Block II showed a median depression score of 22 (IQR 19-33), identifying 32.6% with moderate/severe depression and 11.9% more patients compared to chart review alone. Active smoking (Hazard Ratio [HR] 5.16, 95% Confidence Interval [CI] 1.9-14.1) and WIfI clinical stage 4 (HR 4.69, 95% CI 1.39-15.75) were significantly associated with depression. At six months, patients with depression had higher rates of major amputation (18.2% vs. 4.0%; p=0.02) and mortality (27.3% vs. 6.3%; p<0.01).</p><p><strong>Conclusion: </strong>The overall prevalence of depression in CLTI patients is 32.6%. Our novel CLTI-specific questionnaire detects 12% more cases of moderate/severe depression compared to chart review alone. Depression was linked to higher six-month mortality, though confounders like smoking and WIfI stage 4 may contribute. Identifying and treating depression in high-risk CLTI patients could improve outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623319","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":"Use of Suboptimal Great Saphenous Vein in Lower Extremity Bypass Yields Favorable Amputation-Free Survival.","authors":"Colin M Cleary, James Gallagher, Parth Shah, Thomas Divinagracia, Akhilesh Jain, Elizabeth Aitcheson, Mouhanad Ayach, Owen Glotzer, Ya-Huei Li, Ryder White, Kristy Wrana, Edward D Gifford","doi":"10.1016/j.avsg.2025.02.026","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.026","url":null,"abstract":"<p><strong>Objective: </strong>Historically, studies have identified a great saphenous vein (GSV) diameter of at least 3.0 mm for optimal durability following lower extremity bypass. With the recent publication of BEST-CLI and BASIL-2 studies, we sought to compare patency and post-operative complications utilizing GSV conduit of <3.0 mm to veins ≥3.0 mm or alternative conduits from a single institution.</p><p><strong>Methods: </strong>Patients with pre-operative GSV vein mapping in an Intersocietal Accreditation Commission accredited vascular lab who underwent infra-inguinal bypass surgery at a tertiary center were included. Vascular lab software was utilized to compare patient median GSV across at least six anatomic locations. Patients were seperated and stratified based on median GSV size (both overall and limited to above or below-knee GSV). Primary outcomes included post-operative complications, 30-day major adverse limb events (MALE), major adverse cardiac events (MACE), and patency at regular follow-up intervals.</p><p><strong>Results: </strong>From January 2016 to February 2022, 178 patients underwent bypass with pre-operative vein mapping: 82 who received GSV<3.0 mm and 96 who received GSV≥3.0 mm. Patients were evenly distributed in demographics including proximal and distal targets. Median follow-up was 1.90 years. Overall, use of <3.0 mm GSV was not associated with inferior one-year primary patency compared to ≥3.0 GSV (82.1 vs 89.4%), however, there was a significant increase in post-operative creatinine unique to patients with GSV<3.0mm alone (8.5% vs 1.1%, p=0.026). There were no differences in 30-day MACE or MALE between groups. In surveillance up to three years, patients who received GSV≥3.0 mm versus GSV<3.0mm conduits had similar reintervention and amputation-free survival rates (p=0.999).</p><p><strong>Conclusions: </strong>Patients who received GSV bypasses <3.0 mm have the same mid-term patency, reintervention rates, and amputation-free survival as patients who received GSV≥3.0 mm. Use of smaller GSVs may require closer follow-up for acute kidney injury. Nonetheless, under appropriate circumstances, sub-optimal GSV can be utilized for lower extremity arterial bypass.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623326","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":"Contrast Induced Acute Kidney Injury (CI-AKI) in Lower Limb Percutaneous Transluminal Angioplasty: A Machine Learning Approach for Preoperative Risk Prediction.","authors":"Daniel Yz Lim, Jason Ch Goh, Yingke He, Riece Koniman, Haoyun Yap, Yuhe Ke, Yilin Eileen Sim, Hairil Rizal Abdullah","doi":"10.1016/j.avsg.2025.01.043","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.01.043","url":null,"abstract":"<p><strong>Introduction: </strong>Contrast-induced acute kidney injury (CI-AKI) is a common complication of lower limb Percutaneous Transluminal Angioplasty (PTA). Common risk models are based on cardiology cohorts for percutaneous coronary intervention. They include a mix of preoperative and perioperative variables, but do not include important information such as inflammatory parameters and preoperative medications. None make use of machine learning. We aimed to develop an accurate preoperative risk model for CI-AKI in lower limb PTA using machine learning methods and comparing these with conventional logistic regression.</p><p><strong>Materials and methods: </strong>A retrospective cohort of 456 patients who underwent lower limb PTA as an isolated procedure from 2015 - 2019 was identified. Patients <21 years old, patients with a preoperative estimated Glomerular Filtration Rate (eGFR) of <15mL/min/1.73 m² as defined by the Modification of Diet in Renal Disease (MDRD), and patients with no valid preoperative or postoperative serum creatinine (SCr) were excluded. Conventional logistic regression and a range of machine learning models were fitted (Logistic Regression with ElasticNet penalty, Random Forests, Gradient Boosting Machines, K-Nearest Neighbours, Support Vector Machines, MultiLayer Perceptron), using 5-fold cross-validation and grid search for hyperparameter selection. Area under receiver operating curve (AUROC), area under precision-recall curve (AUPRC), F1 score, and the sensitivity and specificity were determined on the test set. Variable importance was examined using SHAP plots.</p><p><strong>Results: </strong>Machine learning models performed well, with the best performance by the K Nearest Neighbours algorithm (AUROC=0.914, AUPRC=0.809). Important variables identified by SHAP plot analysis included MDRD eGFR, haemoglobin, and inflammatory indices (neutrophil:lymphocyte ratio, red cell distribution width).</p><p><strong>Discussion: </strong>We developed machine learning models to accurately predict CI-AKI in patients undergoing elective lower limb PTA, using preoperative variables only. This model may be used for preoperative patient risk counselling by surgeons and anaesthetists, and may assist in identifying high risk patients for further monitoring.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623316","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":"Pediatric vs. Adult Blunt Cerebrovascular Injuries: Patients Characteristics, Management, and Outcomes.","authors":"Sina Asaadi, Martin G Rosenthal, Andrei Radulescu, Kaushik Mukherjee, Xian Luo-Owen, Joseph J Dubose, Maryam B Tabrizi","doi":"10.1016/j.avsg.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.016","url":null,"abstract":"<p><strong>Objectives: </strong>Blunt cerebrovascular injury (BCVI) management in children currently follows guidelines developed for adults, with limited data on their efficacy in the pediatric population. This study aimed to explore injury features in the pediatric population with BCVIs and compare the clinical manifestations, diagnosis, and treatment of pediatric and adult BCVIs.</p><p><strong>Methods: </strong>A retrospective data analysis of BCVI patients was conducted using the PROspective Observational Vascular Injury Treatment (PROOVIT) registry, covering the period from 2013 to 2022. The clinical manifestation, treatment, and outcome were compared between the adult and pediatric populations (<18 years old).</p><p><strong>Results: </strong>This study included 38 pediatric and 1310 adult patients with BCVIs. Pediatric patients had a higher median AIS-head score (4 vs. 3, p<0.001) and a lower Glasgow Coma Scale (GCS) at admission (9 vs. 14, p=0.005). The two groups had no significant differences in Biffl grade injury distribution. Computed tomography angiography (CTA) was the primary diagnostic method used in both groups (78.9% in pediatrics and 87.8% in adults; p=0.084). Carotid artery injuries were the most frequently affected vessels in pediatric patients (71%), while vertebral artery injuries were more prevalent in adults (53.4%) (p<0.001). Treatment methods were similar, with most patients receiving medical treatment (68.4% in pediatrics vs. 77.4% in adults; p=0.264), although fewer pediatric patients continued medical therapy post-discharge (52.6% vs. 81.1%, p=0.031). The incidence of BCVI-related stroke was similar between groups (7.9% in pediatrics vs. 6.3% in adults; p=0.959). In-hospital mortality was not significantly different between the two cohorts, but hospital length of stay differed significantly, with pediatric patients having shorter stays than adults (p=0.047).</p><p><strong>Conclusions: </strong>Our findings suggest that the current management patterns for BCVI in children are not significantly different from those in adults. This similarity may reflect the adoption of care strategies based on adult experience in the absence of pediatric-specific guidelines. Additionally, the outcomes in the pediatric population were comparable to those observed in adults, underscoring the potential effectiveness of these adapted approaches while highlighting the need for further research to develop age-specific guidelines for pediatric BCVI management.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623320","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":"Efficacy of Targeted Teaching Program on the patient care in NHS hospital.","authors":"Anwar Al-Kassar, Mohamed Elkawafi, George Ninkovic-Hall, Ragai R Makar, Tamer Ghatwary Tantawy","doi":"10.1016/j.avsg.2025.02.021","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.021","url":null,"abstract":"<p><strong>Objectives: </strong>Continuous professional development is essential in medical education programs to enhance patient care. Junior Doctors in the UK often experience challenges adapting to new specialty-specific standards during their rotations, potentially compromising patient care. A targeted teaching program was developed to address this issue. This study evaluates the efficacy of a Targeted Teaching Program (TTP) implemented in a regional vascular surgery unit within the NHS on patients' care and safety.</p><p><strong>Methods: </strong>This observational study was designed to gather data about patients' management in the vascular department at the Countess of Chester NHS Foundation trust in the period between 2019 to 2023. Various clinical audits were completed to assess the impact of TTP on clinical outcomes and to gauge the improvement in healthcare delivery standards and adherence to national guidelines.</p><p><strong>Results: </strong>The TTP significantly improved patient care metrics in our vascular surgery service between 2019 to 2023. Key improvements included antiplatelet medication prescriptions increasing from 86% to 100%, lipid modification therapy from 82.9% to 98%, post-amputation pain management from 25% to 92%, and diabetes screening using HbA1c from 32% to 100%. These enhancements demonstrate a marked advancement patient care standards following TTP introduction.</p><p><strong>Conclusion: </strong>Introduction of regular TTP has led to significant improvements in the standard of care for patients by implementing evidence-based practices. Furthermore, it enhanced doctors' knowledge, reduced the adaptation period to new specialties, and positively impacted the national trainee survey. Expanding targeted teaching to other clinical and non-clinical areas is recommended to enhance patient care across various settings.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623317","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 Implications of Oxygen Dependent Chronic Obstructive Pulmonary Disease on Sac Growth and Mortality Following Endovascular Aneurysm Repair.","authors":"Kirthi S Bellamkonda, Bjoern D Suckow, Jesse A Columbo, Gilbert R Upchurch, Benjamin Jacobs, Cassius I Ochoa Chaar, Rebecca E Scully, Philip P Goodney, Salvatore T Scali, David H Stone","doi":"10.1016/j.avsg.2025.02.019","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.02.019","url":null,"abstract":"<p><strong>Objectives: </strong>Chronic obstructive pulmonary disease (COPD) is a known risk factor for abdominal aortic aneurysm (AAA) growth and rupture. The impact of COPD on AAA sac behavior following endovascular AAA repair (EVAR) is poorly understood. This study aimed to determine the association between COPD and sac remodeling after EVAR.</p><p><strong>Methods: </strong>We identified all EVAR patients (2010-2021) in the Society for Vascular Surgery-Vascular Quality Initiative (SVS-VQI) database. COPD severity (none, medication-treated, oxygen (O₂)-dependent) was the primary exposure variable. The primary endpoint was 1-year sac growth post-EVAR. Mixed-effects linear and logistic regression were used to assess effects of COPD severity on sac remodeling, controlling for covariates. Cox-proportional hazards regression and competing risks regression identified predictors of mortality and reintervention.</p><p><strong>Results: </strong>30,686 patients met inclusion criteria. COPD was present in 24% of patients (no COPD, 75.8%[n=23,260], medication-treated COPD, 19.7%[n=6,057], O₂-dependent COPD, 4.5%[n=1,369]). O₂-dependent COPD was associated with persistent sac growth (mean difference: +0.55mm, 95%CI[0.05-1.05], p=.03) following EVAR implantation; however, medication-treated COPD was not (mean difference: -0.06mm, 95%CI [-0.32-0.19]; p=.64). O₂-dependent COPD patients did not experience increased reintervention rates (HR 0.82, 95%CI[0.65-1.02], p=0.07), but were identified to have significantly increased mortality (HR 1.8, 95%CI[1.52-2.22], p<.0001).</p><p><strong>Conclusions: </strong>O₂-dependent COPD was significantly associated with increased sac growth after EVAR. O₂-dependent COPD did not correlate with increased reintervention, likely due to the disproportionately elevated mortality rates in this group. These findings highlight that patients with O₂-dependent COPD have limited life expectancy and potentially less favorable sac remodeling, and elective EVAR should thus be reserved for only those at greatest risk for AAA-related mortality.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623324","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":"Rupture of a Non-Infected, Non-Anastomotic False Aneurysm in a Patient with Prior Femorofemoral Bypass","authors":"Margaret P. Johnson MD,&nbsp;Benjamin J. Pearce MD","doi":"10.1016/j.avsg.2024.12.031","DOIUrl":"10.1016/j.avsg.2024.12.031","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"113 ","pages":"Pages 441-442"},"PeriodicalIF":1.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593934","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}