Annals of vascular surgery最新文献

{"title":"Asymptomatic vs. Symptomatic Carotid Revascularization: A Single Institution Retrospective Review.","authors":"Nuverah Mohsin, Zackery Aldaher, Ankit Dhiman, Michelle Patel, Andrew Soo Hoo, Omar El-Shazly, Gautam Agarwal, William Jordan","doi":"10.1016/j.avsg.2026.09.063","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.063","url":null,"abstract":"<p><strong>Background: </strong>While carotid revascularization reduces stroke risk in both asymptomatic (AD) and symptomatic (SD) carotid disease, its role continues to evolve with advances in medical therapy, surgical techniques, and cost considerations.</p><p><strong>Methods: </strong>This retrospective study reviews outcomes of patients undergoing revascularization at a level one stroke center between 2019 and 2024. Primary endpoints were ipsilateral stroke, myocardial infarction, and death at 30-day, 90-day, and 1-year. Secondary endpoints include restenosis rates.</p><p><strong>Results: </strong>113 patients underwent 127 carotid endarterectomies. Sixty-four percent presented with SD, with a median time to intervention of 9 days (IQR 6-11). SD patients had a longer median length of stay (2 vs 1 day, p = 0.076. Follow-up rates were higher in AD at 1 year (65% vs 36%, p = 0.003). MI rates were 0% at 30- and 90-day and 0.9% at 1-year. Stroke rates were 0.9%, 0.9%, and 1.8% at 30-day, 90-day, and one year, with no difference between AD vs SD. 1-year mortality rates were 0.9% and 5.3% at 90-day and one year, without a difference by AD vs SD. Restenosis occurred in 4% of patients, with no difference between groups.</p><p><strong>Conclusions: </strong>Carotid endarterectomy was associated with low perioperative rates of ipsilateral stroke, MI, and death. Despite a longer LOS, SD patients did not have significantly different outcomes or restenosis rates. While males had improved follow-up rates, there was no significant difference in outcomes by gender or race. These findings support favorable outcomes following CEA in both AD and SD.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206497","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 mid-term outcomes of different patch types for endarterectomy of the common femoral artery. Secondary analysis from the ARISTON multicentre registry.","authors":"Mario D'Oria, Grigorios Korosoglou, Beatrice Grando, Hany Zayed, Athanasios Saratzis, Konstantinos P Donas, Marco Virgilio Usai","doi":"10.1016/j.avsg.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.005","url":null,"abstract":"<p><strong>Background: </strong>We sought to analyze patients who underwent femoral endarterectomy (FEA) for common femoral artery disease (CFAD) within the multicentre ARISTON registry aiming to compare the short-term and mid-term outcomes based on the use of different patch materials.</p><p><strong>Methods: </strong>The study is a secondary analysis of patients from a retrospective multicentre observational registry of FEA with patch angioplasty, extracted the ARISTON collaborative. The primary endpoint of the study was clinically-driven target lesion revascularization (CD-TLR).</p><p><strong>Results: </strong>A total of 547 patients undergoing FEA with patch angioplasty were included in the analysis and stratified according to the patch material into three groups: (i) prosthetic patch or PP (group A, n=249), (ii) bovine pericardium patch or BPP (group B, n=262), and (iii) great saphenous vein patch or GSVP (group C, n=36). Baseline characteristics differed significantly among groups. Technical success of the FEA procedure was achieved in all cases. Perioperative mortality was low and not significantly different between groups. Kaplan-Meier estimates of freedom from CD-TLR at two years were 86.2% (95% CI, 80.8-90.2%) in the PP group, 88.9% (95% CI, 83.1-92.8%) in the BPP group, and 69.8% (95% CI, 49.3-83.3%) in the GSVP group, with no statistically significant difference between groups (log-rank p=0.067). In multivariable analysis for freedom from CD-TLR, neither BPP (HR 0.78, 95% CI 0.47-1.29; P=0.330) nor GSVP (HR 1.99, 95% CI 0.95-4.17; P=0.069) was significantly associated with the outcome.</p><p><strong>Conclusions: </strong>In this contemporary multicentre real-world experience, PP and BPP were the most used materials for patch reconstruction after FEA in patients with primary CFAD. Although the distribution of baseline risk factors was different between groups, mid-term freedom from CD-TLR was not significantly different between-groups. The findings describe contemporary surgeon-selected practice but do not determine the optimal allocation strategy, thereby reinforcing a clinically relevant message for contemporary vascular surgery: appropriate patient selection, meticulous technical execution, and comprehensive revascularization strategy are the key drivers of clinical outcomes, whereas patch material should likely be regarded as a complementary component within an individualized reconstructive framework.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206505","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":"Long-Term Durability of Bare-Metal Stenting in Complex Iliac Disease: External Iliac Artery Involvement as the Principal Determinant of Late Patency Loss.","authors":"D Mastrorilli, C De Massari, E Forcella, M Nicolis, L Garriboli","doi":"10.1016/j.avsg.2026.09.060","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.060","url":null,"abstract":"<p><strong>Objective: </strong>Long-term durability after endovascular treatment of complex aortoiliac disease remains incompletely defined. The present study evaluated late primary patency after bare-metal stenting (BMS) in TASC C-D lesions and examined whether anatomical extension beyond the common iliac artery influences long-term outcomes independently of traditional TASC classification.</p><p><strong>Methods: </strong>A single-center retrospective cohort study was conducted including 153 consecutive iliac limbs with TASC C-D occlusive disease treated with BMS between 2014 and 2024. Covered stents, kissing configurations, and acute occlusions were excluded to ensure a homogeneous technical cohort. The primary endpoint was primary patency. Kaplan-Meier estimates were reported through 72 months. Restricted mean survival time (RMST) regression at τ = 72 months and Firth penalized logistic regression were applied to identify independent predictors while minimizing small-event bias.</p><p><strong>Results: </strong>Technical success exceeded 97%, with no perioperative mortality. Primary patency remained high and comparable between TASC C and D lesions at 72 months (86% vs 84%; log-rank p = 0.8). In contrast, extension into the external iliac artery (EIA) was associated with progressive late attrition. Adjusted RMST analysis demonstrated a 7.6-month reduction in mean primary patency at 72 months for EIA-involved lesions (95% CI -11.6 to -3.6; p < 0.001). Firth regression confirmed increased late risk of patency loss at 60 months (OR 10.5; p = 0.034) and 72 months (OR 25.8; p = 0.003). Technical optimization (best-practice stenting) showed limited and model-dependent mitigation, without consistent protection across time points.</p><p><strong>Conclusions: </strong>In complex iliac BMS reconstruction, long-term durability appears primarily determined by distal anatomical extension rather than TASC class. External iliac artery involvement identifies a subgroup at risk for late failure and may represent a more clinically meaningful stratification parameter for endovascular planning.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190881","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":"Contemporary Management of Subclavian and Axillary Artery Aneurysms in Connective Tissue Disease: Navigating Therapeutic Uncertainty in a Rare Vascular Disease Without Dedicated Guidelines.","authors":"Ottavia Borghese, Teresa Lodico, Arisa Ibrahimi, Giulia Felice, Francesco Sposato, Angelo Pisani, Yamume Tshomba","doi":"10.1016/j.avsg.2026.09.057","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.057","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Subclavian artery aneurysms (SAAs) represent one of the rarest forms of peripheral arterial aneurysmal disease. Despite their low incidence, management in patients with underlying connective tissue disorders poses specific challenges related to intrinsic vessel fragility. Because of their rarity, the available literature is largely confined to case reports and small, heterogeneous retrospective series, and management remains largely experience-based rather than evidence-based. Explicit guidance from the Society for Vascular Surgery and the European Society for Vascular Surgery is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a systematic review of the English-language literature to identify all reported cases of subclavian and axillary artery aneurysms in patients with heritable connective-tissue disorders. Searches were conducted in PubMed, Scopus, and Web of Science from inception to June 30, 2025. Data were extracted on treatment modality (open surgical, endovascular, or hybrid) and clinical outcomes (limb loss, revascularization patency, complications, and need for reintervention). The review protocol was registered on PROSPERO (CRD420261332695) RESULTS: Of 142 records identified, 24 studies met the inclusion criteria after duplicate removal and screening. These studies described 43 subclavian and axillary artery aneurysms in 25 patients (15 men [60%] and 10 women [40%]; median age, 46 years; range, 11-68). Aneurysm diameter was reported for 36 of 43 aneurysms (84%; median, 40 mm; range, 22-100 mm) and was not reported for the remaining 7 (16%). Marfan syndrome was the most frequent underlying disorder (20/25, 80%), followed by vascular Ehlers-Danlos syndrome type IV (3/25, 12%) and Loeys-Dietz syndrome/TGFBR2-related arteriopathy (2/25, 8%). Eight aneurysms (8/43, 19%) required urgent or emergent treatment. Treatment modalities comprised open surgical repair in 22 of 43 aneurysms (51%) - including interposition grafting in 12/22 (55%), bypass in 5/22 (23%), arterial ligation in 3/22 (14%), and aneurysmectomy with end-to-end anastomosis in 2/22 (9%) - hybrid procedures in 15 (35%), and endovascular therapy in 6 (14%) - including covered stent-grafting in 5/6 (83%) and coil/liquid embolization in 1/6 (17%). Immediate technical success - complete aneurysm exclusion without endoleak at the index procedure- was 95% (41 of 43 aneurysms). Two aneurysms (4.7%), both in the hybrid group, represented an index-procedure failure due to endoleak (one type I, one type III); freedom from reintervention was therefore 95% (41/43). Both were subsequently excluded after a secondary reintervention, yielding a delayed technical success rate of 100% (43/43). No 30-day mortality or limb loss was reported. Primary patency of the treated segment was 100% (43/43), as no graft/segment thrombosis, occlusion, or flow-limiting stenosis occurred; secondary patency was 100% (43/43). Where a numeric follow-up duration could be extract","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190840","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":"Diagnostic accuracy of the BlueDop Vascular Expert for detecting peripheral arterial disease in people with suspected intermittent claudication referred to secondary care: A cross-sectional study.","authors":"Jonathon Prosser, Josie Hatfield, Tracey Roe, Helen Gray, Amy Keld, Anna Firth, Louise McClean, Natalie Stedman, George Smith, Daniel Carradice, Ian Chetter, Sean Pymer","doi":"10.1016/j.avsg.2026.09.054","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.054","url":null,"abstract":"<p><strong>Introduction: </strong>Manual ankle-brachial pressure index (ABI) assessment requires significant time and expertise, precluding its use in primary care. Automated vascular assessment tools may offer a simple and efficient alternative for detecting peripheral arterial disease (PAD). However, further evidence is needed before they can be recommended. This study considers the diagnostic accuracy of the BlueDop Vascular Expert (BVE) in people with suspected intermittent claudication.</p><p><strong>Methods: </strong>We performed a cross-sectional cohort study including people referred to our nurse-led intermittent claudication clinic. BVE measurements were compared to the manual resting ABI/TBI method, using traditional cut-off values of <0.9 and <0.7, respectively.</p><p><strong>Results: </strong>217 participants and 430 limbs were included, with an overall PAD prevalence of 46%. Sensitivity, specificity, positive (PPV) and negative predictor values (NPV) for the BVE were 88.5%, 80.7%, 81.3% and 88.1% respectively, when compared to the manual ABI. When compared to the manual TBI, the sensitivity, specificity, PPV and NPV for the BVE were 45.5%, 88%, 62.5% and 78.6% respectively, though this analysis included only 38 limbs. No BVE diagnoses were based on ABI alone, 71% were based on waveform alone and 29% were based on a combination of ABI and waveform. The BVE assessment was significantly quicker to perform than the manual method (p<0.01).</p><p><strong>Conclusion: </strong>The BVE demonstrated favourable sensitivity and specificity for detecting or excluding PAD compared to the manual ABI. Further work is needed comparing this device to others, across a range of clinical populations and settings before it can be considered in routine clinical practice.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179192","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":"Embolic and atherosclerosis-associated acute mesenteric ischemia: distinct clinical entities with different outcomes.","authors":"Dominik Peter, Annette Thurner, Amos Kroth, Lars Kollmann, Matthias Kelm, Ralph Kickuth, Christoph-Thomas Germer, Sven Flemming","doi":"10.1016/j.avsg.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.006","url":null,"abstract":"<p><strong>Background: </strong>Acute arterial occlusive mesenteric ischemia is associated with high mortality. Embolic and atherosclerosis-associated forms differ in vascular pathology, collateral circulation, and ischemic tolerance, which may contribute to differences in clinical presentation and outcomes. This study compared clinical presentation, treatment strategies, and outcomes between embolic acute mesenteric ischemia (EAMI) and atherosclerosis-associated acute mesenteric ischemia (AAMI).</p><p><strong>Methods: </strong>This retrospective single-center study included all consecutive patients diagnosed with acute arterial occlusive mesenteric ischemia between January 2004 and March 2026. Patients were stratified into EAMI and AAMI groups. The primary endpoint was in-hospital mortality. Secondary analyses evaluated clinical presentation, imaging findings, and treatment strategies. Multivariable logistic regression was performed to assess the association between etiology and in-hospital mortality.</p><p><strong>Results: </strong>Of 216 patients identified, 190 were included in the final analysis (EAMI, 56.8%; AAMI, 43.2%). Patients with EAMI more frequently presented with sudden-onset abdominal pain, whereas AAMI was characterized by acute-on-chronic symptoms and longer symptom-to-treatment intervals. Imaging findings indicative of advanced bowel ischemia, including pneumatosis intestinalis and portomesenteric venous gas, as well as bowel resection at initial surgical exploration, were more common in AAMI (40.2% vs. 21.3%, p = 0.005). In-hospital mortality was higher in AAMI than in EAMI (75.6% vs. 60.2%, p = 0.025). In multivariable analyses, EAMI was independently associated with lower in-hospital mortality (adjusted odds ratios 0.41-0.47; both p < 0.05).</p><p><strong>Conclusion: </strong>EAMI and AAMI represent distinct clinical entities with different presentations and outcomes. AAMI is associated with delayed presentation, more advanced ischemic injury at diagnosis, and higher in-hospital mortality. Etiology is independently associated with in-hospital mortality and should be considered in risk stratification and the design of future studies.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179156","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":"Postoperative complications following carotid endarterectomy are differentially impacted by sex and plaque instability.","authors":"Alvin Kuate Defo, Karina Gasbarrino, Stella S Daskalopoulou","doi":"10.1016/j.avsg.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.007","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to provide novel evidence on the role of sex and plaque instability in post-carotid endarterectomy outcomes. Current clinical guidelines regarding recommendation for carotid endarterectomy rely solely on grade of stenosis and cerebrovascular symptomatology, despite emerging evidence emphasizing the role of sex and plaque instability in determining postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of an ongoing cohort study of males and females undergoing carotid endarterectomy for clinical indications. We performed multivariable binary logistic regression to examine the relationship of biological sex and plaque instability with postoperative outcomes.</p><p><strong>Results: </strong>Data of 394 participants (31% female) were analyzed. Plaque instability was independently associated with decreased odds of hemorrhagic complications at 1 month and 1 year post-surgery, as well as with decreased respiratory complications at 1 year post-surgery. Plaque features accounting for these associations were lipid core, cap infiltration, and plaque inflammation. Female sex was independently associated with increased odds of restenosis at 1 month and 1 year post-surgery. Additionally, females with unstable plaques had more cerebrovascular complications at 1 month than males with unstable plaques, and females with stable plaques had double the odds of any complication at 1 month compared with males with unstable plaques.</p><p><strong>Conclusions: </strong>Our findings show that sex and plaque instability differentially impact post-endarterectomy outcomes, with males with unstable plaques experiencing the least postoperative complications. Sex and plaque instability may therefore be important factors that play a role in postoperative complications, highlighting their importance in the context of surgical decision-making.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179206","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 type of portal vein reconstruction does not affect the outcomes of pancreatic surgery or the patency of the portal vein.","authors":"Juha Virtanen, Ellinoora Aro, Ivika Heinola, Arto Kokkola, Caj Haglund, Ilkka Kantonen, Hanna Seppänen, Pirkka Vikatmaa","doi":"10.1016/j.avsg.2026.09.062","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.062","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety of the four types of portal vein reconstruction (PVR) as defined by the International Study Group of Pancreatic Surgery (ISGPS) and to analyse long-term survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>A prospectively collected pancreatic surgery registry that was supplemented retrospectively was used. Patients who underwent open pancreatic resection with PVR between 2005 and 2024 were included. Clinicopathological characteristics, outcomes, and computed tomography images were analysed and tested in multivariate and survival analyses. For survival analyses, patients with PDAC who underwent pancreatectomy without PVR served as controls.</p><p><strong>Results: </strong>Pancreatectomies with PVR (n=386) comprised 63 tangential resections with venorrhaphy (ISGPS type I), 25 patch reconstructions (type II), 147 end-to-end anastomoses (type III), and 151 resections with graft interposition (type IV). Most type IV reconstructions (98.7%) used spiral grafts, predominantly made from the great saphenous vein (GSV). PVR thrombosis rate was 3.1% at 30 days and 5.7% at 90 days following surgery. There were no significant differences between PVR types I-IV in the incidence of PVR thromboses, complications, or mortality. Median survival for PDAC patients with PVR was 22.8 months, with no survival differences between types I-IV, compared with 31.7 months in patients without PVR, p=.003.</p><p><strong>Conclusions: </strong>In this setting, where PVR was performed using GSV spiral grafts for interposition, the type of PVR did not associate with pancreatic surgery outcomes or portal vein patency. The rate of PVR thrombosis was low, and other complication rates and long-term survival outcomes were comparable with international standards.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179195","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 for Predicting Amputation and Related Outcomes in Peripheral Artery Disease: A Systematic Review and Meta-Analysis.","authors":"Hsin Hsu, Melanie J Wang, Yu-Ying Chu, Yu-Jui Huang, Che-Hsiung Lee","doi":"10.1016/j.avsg.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) affects over 236 million individuals globally and carries substantial risks of amputation, major adverse limb events (MALE), and mortality. Existing clinical scoring systems focus on short-term surgical outcomes and lack generalizability. Machine learning (ML) has emerged as a promising tool for PAD outcome prediction.</p><p><strong>Objective: </strong>To conduct the first quantitative meta-analysis evaluating the discriminative performance, methodological rigor, and certainty of evidence of ML-based prognostic models for adverse limb outcomes in PAD.</p><p><strong>Methods: </strong>Following PRISMA/PRISMA-S guidelines, PubMed, Embase, Cochrane Library, and Web of Science were searched from inception through March 15, 2026. Two reviewers independently performed study selection, data extraction, and PROBAST risk-of-bias assessment. Random-effects meta-analysis (DerSimonian-Laird with Hartung-Knapp-Sidik-Jonkman correction) and hierarchical summary ROC (HSROC) analysis were performed; certainty was rated with GRADE.</p><p><strong>Results: </strong>Ten studies were included. The pooled AUC for amputation-related outcomes was 0.88 (95% CI, 0.83-0.94; prediction interval, 0.79-0.98) with substantial heterogeneity (I² = 95.4%). HSROC yielded pooled sensitivity 0.855 and specificity 0.836. Registry-based studies showed higher pooled AUC than non-registry studies (0.92 vs 0.80; p = 0.004). All models had high or unclear risk of bias in the analysis domain; none underwent independent external validation. GRADE certainty was very low.</p><p><strong>Conclusions: </strong>ML models demonstrate high discriminative performance for predicting amputation-related outcomes in PAD, but very low certainty of evidence, absence of external validation, and high risk of bias currently limit clinical implementation. Prospective multicenter validation and adherence to AI reporting guidelines are essential before clinical translation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179201","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 Iliac Stenting versus Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease: A Retrospective Multicentre Cohort Study.","authors":"Ahmed Elmetwally, Ahmed M Morshed, Amr Meselhi, Moustafa Mabrouk, Mohammed Elkassaby","doi":"10.1016/j.avsg.2026.09.061","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.061","url":null,"abstract":"<p><strong>Background: </strong>Aortoiliac occlusive disease (AIOD) causing chronic or critical limb-threatening ischaemia can be treated by open aortobifemoral bypass (ABF) or endovascular reconstruction. Comparative-effectiveness data adjusted for treatment-selection bias remain limited. This multicentre study compared mid-term outcomes of endovascular versus open reconstruction for AIOD.</p><p><strong>Methods: </strong>Retrospective, non-randomised cohort study of 171 patients with AIOD (Rutherford 3-6) treated at three centres (UK, Ireland, Egypt) between January 2023 and February 2026. Outcomes were primary patency, freedom from reintervention (FFR), amputation-free survival (AFS), overall survival, and perioperative complications. Cox regression and inverse-probability-of-treatment weighting (IPTW) were used to adjust for confounding.</p><p><strong>Results: </strong>125 patients (73.1%) underwent endovascular treatment and 46 (26.9%) open bypass. Endovascular patients were older (66.8 vs 60.8 years, p<0.001) and had a lower burden of TASC C-D disease (53.6% vs 93.5%, p<0.001). Primary patency at 24 months was 62.7% vs 91.8% (log-rank p<0.001; IPTW-adjusted HR 5.67, 95% CI 1.75-18.37). Freedom from reintervention at 24 months was 63.1% vs 93.3% (p<0.001). Amputation-free survival (85.0% vs 87.4%, p=0.992) and overall survival (93.3% vs 90.0%, p=0.335) were comparable between groups. Wound infection was less frequent after endovascular treatment (0.8% vs 10.9%, p=0.006). Major amputation was independently predicted by CLTI presentation (OR 4.0) and age, not treatment group. Progressive infrainguinal disease, rather than failure of proximal revascularisation, accounted for most amputations in both groups.</p><p><strong>Conclusion: </strong>Open bypass confers a substantial mid-term patency and reintervention-free survival advantage over endovascular reconstruction for AIOD, most pronounced in TASC D and CLTI subgroups, without a corresponding difference in limb salvage or survival. These findings support risk-stratified rather than uniformly endovascular-first treatment selection, pending confirmation from the ongoing EVOCC randomised trial.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179122","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}