Annals of vascular surgery最新文献

{"title":"Risk Factors for Plaque Vulnerability in a Community Population: Endothelial Function and Arterial Stiffness Indexes","authors":"Yan Zhang ,&nbsp;Shiyu Lei ,&nbsp;Fangfang Liu ,&nbsp;Xi Huang ,&nbsp;Xuejun Xu ,&nbsp;Lanying He ,&nbsp;Jian Wang ,&nbsp;Fan Xu","doi":"10.1016/j.avsg.2025.12.021","DOIUrl":"10.1016/j.avsg.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Rupture of atherosclerotic plaques and subsequent acute cardiovascular complications remain a major cause of morbidity and mortality throughout the world. Despite recent advances in treatment, we have not yet identified the means to prevent atherosclerotic vascular disease has not been met. It remains a challenge to determine at an early stage whether an atherosclerotic plaque will become unstable and vulnerable. Therefore, this study aim to identify key risk factors associated with the stability and vulnerability of carotid artery plaques, which may offer valuable insights for the early prevention of cardiovascular and cerebrovascular diseases.</div></div><div><h3>Methods</h3><div>We enrolled a total of 136 patients with stable atherosclerotic plaques and 635 with vulnerable plaques. Arterial stiffness and endothelial dysfunction were assessed using a cardiovascular function monitor and the Endo-PAT2000 device (Itamar Medical Ltd.), respectively. Differences between groups were compared using the Student's <em>t</em>-test for normally distributed data and the chi-squared test for non-normally distributed data. We developed a logistic regression to analyzed the association of these factors with carotid plaque stability.</div></div><div><h3>Results</h3><div>Carotid-femoral pulse wave velocity (cf-PWV) and the reactive hyperemia index (RHI) were not different between the stable and unstable plaque groups (cf-PWV: 9.48 ± 2.07, 9.59 ± 1.79, <em>P</em> &gt; 0.05; RHI: 1.58 ± 0.57, 1.62 ± 0.39, <em>P</em> &gt; 0.05). The male sex, a smoke history, ejection, and duration were risk factors for plaque stability. Correlation analysis showed that lipids were not correlated with plaque stability and aortic hemodynamic parameters were correlated with plaque vulnerability. Multivariate logistic regression analysis demonstrated that the sex (OR: 0.1759, <em>P</em> &lt; 0.001, 95% CI: 0.1077–0.2874), aortic augmentation index (OR: 1.0366, <em>P</em> &lt; 0.001, 95% CI: 1.0175–1.0560), subendocardial viability ratio (OR: 0.9626, <em>P</em> &lt; 0.001, 95% CI: 0.9535–0.9717), and distance (OR: 0.9854, <em>P</em> &lt; 0.001, 95% CI: 0.9804–0.9903) presented significant correlation with plaque vulnerability.</div></div><div><h3>Conclusion</h3><div>There was insufficient evidence to indicate that RHI, cf-PWV were related to plaque stability. However, male, decreased of subendocardial viability ratio, increased of aortic augmentation index, and the shorter the distance between carotid-femoral arteries had the greater the possibility of vulnerable plaque, which provides a reference for the early prevention of cardiovascular and cerebrovascular diseases.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 172-180"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899113","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 the Efficacy and Safety of Endovascular Treatment for Isolated Popliteal Lesions in Peripheral Artery Disease: A Network Meta-Analysis","authors":"Fei Mei ,&nbsp;Peng Jiang ,&nbsp;Wenfei Guan ,&nbsp;Yongpan Cui ,&nbsp;Jian He ,&nbsp;Zihan Zhang ,&nbsp;Wayne W. Zhang","doi":"10.1016/j.avsg.2025.12.028","DOIUrl":"10.1016/j.avsg.2025.12.028","url":null,"abstract":"<div><h3>Background</h3><div>This study employed a network meta-analysis to systematically compare the efficacy and safety of different endovascular interventions for treating isolated popliteal lesions in peripheral arterial disease.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across the Cochrane Library, Embase, and PubMed databases (2010–2025), identifying 11 studies involving 4,179 patients. A network meta-analysis was performed using R software to compare the efficacy of percutaneous transluminal angioplasty (PTA), drug-coated balloon (DCB), atherectomy, and stenting. Primary outcomes included all-cause mortality, major amputation rate, and overall amputation rate, while secondary outcomes comprised primary patency rate, freedom from target lesion revascularization, and technical success rate.</div></div><div><h3>Results</h3><div>In terms of 1-year all-cause mortality, atherectomy demonstrated significantly lower rates compared to both the PTA group (odds ratio [OR] = 0.61, 95% credible interval [CrI]: 0.41–0.87) and the stenting group (OR = 0.66, 95% CrI: 0.44–0.97). Regarding 1-year major amputation and overall amputation rates, stenting significantly outperformed PTA (OR = 0.64 and 0.65, respectively), while no significant differences were observed between atherectomy, DCB, and PTA groups. For 1-year primary patency rates, both atherectomy and stenting significantly outperformed PTA (OR = 2.21 and 2.23, respectively). Furthermore, the technical success rate of atherectomy was significantly higher than that of the other 3 interventions.</div></div><div><h3>Conclusion</h3><div>Atherectomy demonstrates advantages in reducing all-cause mortality and improving technical success rates, while stenting yields superior outcomes in lowering amputation risk. Both atherectomy and stenting significantly outperform PTA in achieving 1-year primary patency rates. Although DCB demonstrates superior efficacy and safety compared with plain PTA, the differences did not reach statistical significance.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 159-171"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931441","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":"Optimizing Femoral Access in EVAR: A Multicentric Comparison of Percutaneous and Surgical Approaches in Elective and Urgent Settings","authors":"Chiara Barillà ,&nbsp;Giulia Colonna ,&nbsp;Filippo Benedetto ,&nbsp;Maurizio Taurino ,&nbsp;Pasqualino Sirignano","doi":"10.1016/j.avsg.2025.12.018","DOIUrl":"10.1016/j.avsg.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular aneurysm repair (EVAR) has become the preferred alternative to open repair for infrarenal abdominal aortic aneurysm, offering lower short-term mortality and morbidity. This study investigates the impact of percutaneous femoral access versus surgical cutdown in elective and urgent/emergent EVAR procedures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on all femoral access procedure performed between 2015 and 2023 from 2 referral academic centers. Primary outcomes were technical success, access site complications, and major adverse events rates. Length of intensive care unit (ICU) stay, and hospital stay, bleeding requiring transfusion, and wound infection rates were also collected. Moreover, anatomical and clinical factors potentially influencing the type of access were investigated.</div></div><div><h3>Results</h3><div>The study included 711 EVAR procedures and 1,422 femoral access. One hundred two procedures (14.3%) were performed in an emergent/urgent setting. Percutaneous approach was performed in 636 (44.7%) cases, while surgical exposure was performed in 786 cases (55.3%). Percutaneous access was associated with lower rates of bleeding (<em>P</em> &lt; 0.001), in-hospital mortality (<em>P</em> &lt; 0.001), both in elective and urgent settings, as well as shorter hospital stays (<em>P</em> &lt; 0.001) and less need for ICU (<em>P</em> &lt; 0.001). Age (<em>P</em> &lt; 0.001), body mass index (<em>P</em> &lt; 0.001), and sheath size (Fr &gt; 16) (<em>P</em> &lt; 0.001) were factors that influenced the choice of percutaneous or surgical approach, both in univariate and multivariate analysis.</div></div><div><h3>Conclusion</h3><div>The present study suggests that percutaneous approach achieves better short-term outcomes than surgical cutdown. However, these findings should be interpreted in light of the study's limitations, including its retrospective design and potential selection bias in access type allocation. Moreover, the success of percutaneous technique remains highly dependent on operator expertise and anatomical challenges. Therefore, the choice of approach should always be tailored for each patient.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 181-188"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931496","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":"Role of Incisional Negative Pressure Wound Therapy within Preventive Bundles in Open Femoral Access: Moving toward Standard Practice","authors":"Laura Rodríguez Lorenzo,&nbsp;Zoilo Madrazo González","doi":"10.1016/j.avsg.2025.12.029","DOIUrl":"10.1016/j.avsg.2025.12.029","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 70-72"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888300","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":"From Equipoise to Evidence: Pre-Trial Setup of the European Uncomplicated Type B Aortic Repair Clinical Trial","authors":"Mohamad Bashir ,&nbsp;Matti Jubouri ,&nbsp;Abdelaziz O. Surkhi ,&nbsp;Yousif Jubouri ,&nbsp;Amr Abdelhaliem ,&nbsp;Ömer Tanyeli ,&nbsp;Murat Ugur ,&nbsp;Alberto Guagliano ,&nbsp;Mario D'Oria ,&nbsp;Raffaello Bellosta ,&nbsp;Luca Bertoglio ,&nbsp;Daniela Mazzaccaro ,&nbsp;Giovanni Nano ,&nbsp;Pasqualino Sirignano ,&nbsp;Giovanni Pratesi ,&nbsp;Stefano Bartoli ,&nbsp;Maria José Alcaraz García ,&nbsp;Joaquin Perez-Andreu ,&nbsp;Tomasz Hirnle ,&nbsp;Karin Pfister ,&nbsp;Gabriele Piffaretti","doi":"10.1016/j.avsg.2025.12.007","DOIUrl":"10.1016/j.avsg.2025.12.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Optimal management of uncomplicated type B aortic dissection (uTBAD) remains debated. While thoracic endovascular aortic repair (TEVAR) promotes false lumen thrombosis (FLT) and remodeling, the early clinical profile and long-term benefits in routine practice need further investigation. The pre-trial setup of the European Uncomplicated Type B Aortic Repair (EU-TBAR) program prospectively collated multicenter outcomes to evaluate real-world clinical outcomes of TEVAR for uTBAD across European centers, and to identify independent predictors of mortality, reintervention, and aortic remodeling to inform the design of a definitive randomized EU-TBAR trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Multicenter observational cohort of consecutive patients undergoing TEVAR for uTBAD and related descending thoracic pathology across European centers. Standardized electronic case-report forms captured demographics, presentation, imaging, procedural details, and outcomes. Primary outcomes were in-hospital and follow-up mortality; secondary outcomes included complications, reintervention, and aortic remodeling. Multivariable logistic regression identified predictors of mortality, reintervention, and remodeling.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We analyzed 263 patients (mean age 61.4 ± 13.4 years; 79.5% male) from six countries. In-hospital mortality was 9.9%, and mortality during follow-up was 14.1% (median follow-up time ≈ 1 year). Postoperative acute kidney injury (AKI) was the strongest independent predictor of death (odds ratio [OR] 9.93, &lt;em&gt;P&lt;/em&gt; &lt; 0.0001); additional predictors included AKI at presentation (OR 4.24, &lt;em&gt;P&lt;/em&gt; = 0.012), syncope (OR 3.15, &lt;em&gt;P&lt;/em&gt; &lt; 0.0001), and ventilation for &gt;48 hr (OR 2.69, &lt;em&gt;P&lt;/em&gt; = 0.024). Higher hemoglobin (OR 0.74 per g/dL, &lt;em&gt;P&lt;/em&gt; &lt; 0.0001) and estimated glomerular filtration rate (OR 0.79 per 10 units, &lt;em&gt;P&lt;/em&gt; &lt; 0.0001) were protective; reintervention was associated with lower mortality (OR 0.26, &lt;em&gt;P&lt;/em&gt; = 0.013). Reintervention occurred in 18.3% at a median of 168 days; discharge endoleak (present in 18.3%) tripled reintervention odds (OR 3.08, &lt;em&gt;P&lt;/em&gt; = 0.003). Imaging at discharge and follow-up was performed in 70.7% and 63.9%, respectively. At follow-up, FLT was complete in 42.1% and partial in 39.3%. Remodeling was associated with beta-blockers (descending aorta OR 3.58, &lt;em&gt;P&lt;/em&gt; = 0.009), prior thoracic surgery (suprarenal OR 5.47; infrarenal OR 8.33; both &lt;em&gt;P&lt;/em&gt; = 0.008), and targeted branch stenting (e.g., celiac OR 31.0, &lt;em&gt;P&lt;/em&gt; = 0.016). Female sex independently predicted FLT (OR 11.53, &lt;em&gt;P&lt;/em&gt; = 0.022). Survival was lower for emergent cases (65% vs 79–78%; &lt;em&gt;P&lt;/em&gt; = 0.039) and in patients with postoperative AKI (36% vs. 86%; &lt;em&gt;P&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;This pre-trial setup and analysis successfully confirm the feasibility and methodological foundation for the definitive EU-TBAR trial. Ther","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 230-247"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800348","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 Randomized Trial Comparing Interwoven and Self-Expandable Nitinol Stents in Trans-Atlantic Inter-Society Consensus II C and D Femoropopliteal Arterial Disease","authors":"Mahmoud Mohamed Meshref,&nbsp;Wageeh Fawzy Abdel-Malek,&nbsp;Amr Abdelghaffar Hanafy,&nbsp;Mohamed Mahmoud Zaki","doi":"10.1016/j.avsg.2025.12.031","DOIUrl":"10.1016/j.avsg.2025.12.031","url":null,"abstract":"<div><h3>Background</h3><div>Peripheral artery disease (PAD) is a global concern due to rising rates of type II diabetes and risk factors like smoking, predominantly affecting the femoral-popliteal segment. The prevalence ranges from 3% to 12%, depending on age and socioeconomic status. To compare outcomes of interwoven nitinol stent [Supera™] and self-expandable nitinol stent [Jaguar™] in treating (TASC II) C and D femoropopliteal occlusive disease on a bailout basis (stenting as a corrective measure when an angioplasty fails or causes complications like flow-limiting dissection or recoil more than 30% or higher pressure gradient across a stenotic area (≥10 mm Hg) after repeated dilatation.)</div></div><div><h3>Methods</h3><div>This prospective, randomized controlled trial at a tertiary care hospital included patients with symptomatic femoropopliteal arterial disease. Participants with TASC II C and D lesions were randomized using a simple randomization method to minimize allocation bias and ensure comparability using computer-generated random number sequences to receive either Supera or Jaguar stents under standard endovascular techniques, ensuring that treatment allocation remained unbiased.</div></div><div><h3>Results</h3><div>The Supera stent demonstrated superior outcomes with lower restenosis rates (20% vs. 55%, <em>P</em> = 0.022) and reduced target lesion revascularization (TLR) (20% vs. 55%, <em>P</em> = 0.022) compared to the Jaguar stent. One-year follow-up showed higher Ankle-Brachial Index (ABI) scores in the Supera group (mean 0.77 vs. 0.63, <em>P</em> = 0.003), indicating improved patency. Complications, including stent fractures (5%) and migrations (5%) were only observed in the Jaguar group. Minor amputation rates were significantly higher in the Jaguar group (25% vs. 10%, <em>P</em> = 0.212). Major amputations and mortality rates were similar between groups.</div></div><div><h3>Conclusion</h3><div>Interwoven nitinol stents (Supera) outperformed self-expandable nitinol stents in treating complex femoropopliteal disease, with better midterm outcomes, lower restenosis rates, reduced TLR, and fewer mechanical complications. Although both stent types managed limb salvage effectively, Supera stents offered better procedural durability and patency.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 248-258"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899136","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 Impact of Sex on Atherectomy Outcomes for Different Anatomic Regions","authors":"Andrew Min,&nbsp;Anais V. Marenco,&nbsp;Ajit Rao,&nbsp;Daniel Han,&nbsp;Christopher Smolock,&nbsp;Windsor Ting,&nbsp;Peter Faries,&nbsp;Ageliki Vouyouka","doi":"10.1016/j.avsg.2025.12.023","DOIUrl":"10.1016/j.avsg.2025.12.023","url":null,"abstract":"<div><h3>Background</h3><div>There is a paucity of research that examines the influence of sex on outcomes after atherectomy for peripheral artery disease. This study examines the impact of sex on atherectomy outcomes, specifically for different anatomic regions.</div></div><div><h3>Methods</h3><div>Data from the Vascular Quality Initiative (2010–2022) were analyzed and atherectomy location was categorized into the following anatomic segments: femoral, popliteal, and tibial. Multivariate logistic regression calculated the odds ratio (OR) for various 1-year major amputation and 1-year reintervention, controlling for demographics, clinical presentation, and comorbidities. Cox proportional hazards analysis calculated the hazard ratio (HR) for major amputation and reintervention, controlling for the same covariates.</div></div><div><h3>Results</h3><div>Of the 51,174 combined infra-inguinal atherectomy patients, 20,132 (39.3%) were female. Overall, female patients were less likely to experience amputation (HR = 0.77, confidence interval [CI] = 0.69–0.86, <em>P</em> &lt; 0.001), with this trend persisting for the femoral arteries (HR = 0.65, CI = [0.51–0.82], <em>P</em> &lt; 0.001) and the popliteal arteries (HR = 0.40, CI = [0.21–0.78], <em>P</em> = 0.007). Female sex was associated with a higher OR for 1-year reintervention in the overall (OR = 1.18, CI = [1.06–1.31], <em>P</em> = 0.002), femoral arteries (OR = 1.27, CI = [1.05–1.52], <em>P</em> = 0.012), and popliteal artery group (OR = 2.28, CI = [1.33–3.97], <em>P</em> = 0.003). Similarly, female sex was associated with a higher HR for reintervention in the overall (HR = 1.20, CI = [1.10–1.30], <em>P</em> &lt; 0.001), femoral arteries (HR = 1.27, CI = [1.10–1.47], <em>P</em> &lt; 0.001), and popliteal artery group (HR = 2.28, CI = [1.47–3.53], <em>P</em> &lt; 0.001). No sex-related differences in time-to-amputation (HR = 0.71, CI = [0.50–1.00], <em>P</em> = 0.053), 1-year reintervention (OR = 0.74, CI = [0.42–1.26], <em>P</em> = 0.3), or time-to-reintervention (HR = 0.84, CI = [0.54–1.31], <em>P</em> = 0.5) were observed for tibial lesions.</div></div><div><h3>Conclusion</h3><div>Female sex was associated with a protective effect against major amputation after atherectomy for lesions above the knee despite being associated with increased risk of reintervention in atherectomy lesions above the knee, specifically the femoral arteries and popliteal artery. However, these disparities were absent for atherectomy lesions below the knee—female sex was not associated with increased or decreased risk of amputation or reintervention in tibial atherectomies. Further studies focused on specific demographics, risk factors, and comorbidities may help us choose the best endovascular approach for different clinical scenarios of peripheral artery disease.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 122-131"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892205","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":"When Infections Hurt More: Black Patients Experience More Severe Surgical Site Infections Following Lower Extremity Bypass","authors":"Anthony N. Eze ,&nbsp;Junette Yu ,&nbsp;Christina L. Cui ,&nbsp;Young Kim","doi":"10.1016/j.avsg.2025.12.042","DOIUrl":"10.1016/j.avsg.2025.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are common complications following lower extremity bypass (LEB). Previous studies have reported that recognition of SSIs may be delayed among patients with darker skin tones, leading to more severe presentations. We examined whether patients of Black race experienced increased severity of SSIs following LEB surgery.</div></div><div><h3>Methods</h3><div>A single-center, retrospective review of patients undergoing LEB surgery from January 2018 to December 2022 was performed. Patients were categorized as Black or non-Black. Postoperative SSI was stratified per Southampton wound score (grade 2–5), with severe SSI defined as grades 4 or 5.</div></div><div><h3>Results</h3><div>Among 505 LEB patients, 216 (42.8%) self-identified as Black and 289 (57.2%) were non-Black. Median age was 65 y (interquartile range [IQR] 59–72 years). Age, smoking status, and body mass index were similar between groups. Black patients more frequently underwent bypass for chronic limb-threatening ischemia compared with non-Black patients (57.4% vs. 40.8% tissue loss, 25.5% vs. 21.5% rest pain, <em>P</em> &lt; 0.001). Surgical technique and time to SSI diagnosis was similar between groups. Incidence of SSI was lower among Black patients (15.3% vs. 28.7%, <em>P</em> &lt; 0.001). Black patients had more severe SSI at the time of diagnosis (30.4% vs. 18.3% grade 4, 15.2% vs. 6.1% grade 5; <em>P</em> = 0.03). Black race was independently associated with severe SSI (odds ratio 1.64, <em>P</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>Postoperative SSI is less frequent among Black patients undergoing LEB surgery but presents with increased severity, which may reflect a delay in diagnosis. These findings underscore the importance of vigilance and early recognition in this patient population.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 259-264"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958307","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":"Midterm Outcomes of Nonoperative Management of Blunt Thoracic Aortic Injury: Systematic Review and Meta-analysis","authors":"Anne-Sophie C. Romijn ,&nbsp;Petar Zlatanovic ,&nbsp;Aleksa Jovanovic ,&nbsp;Jean-Baptiste Ricco ,&nbsp;Lazar Davidovic ,&nbsp;Vincent Jongkind","doi":"10.1016/j.avsg.2025.11.145","DOIUrl":"10.1016/j.avsg.2025.11.145","url":null,"abstract":"<div><h3>Background</h3><div>Blunt thoracic aortic injury (BTAI) is one of the leading causes of death after trauma. Current guideline recommendations are primarily based on short-term outcomes, while longer-term outcomes are not well investigated. This study aims to investigate the safety of nonoperative management (NOM) for minor and more severe aortic injuries and the need for follow-up.</div></div><div><h3>Methods</h3><div>We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included studies from the forming of the databases till May 2025, evaluating the results of NOM on mid-term (≥12 months) or long-term clinical outcomes for patients with BTAI. Nine retrospective and observational studies comprising 438 patients were included. The overall methodological quality was moderate to low. Outcomes evaluated are aortic-related mortality, lesion evolution, aortic-related intervention and all-cause mortality.</div></div><div><h3>Results</h3><div>Nine retrospective and observational studies comprising 438 patients were included. Of all patients, 29% had a Society of Vascular Surgery (SVS) grade I aortic injury, 27% grade II, 35% grade III, and 1% grade IV. After a mean follow-up of 37.7 months, no progression was observed in SVS grade I and II injuries. The pooled estimate for lesion progression in SVS grade III was 7% (95% confidence interval (CI): 0–14; I² = 23.2%). Lesion resolution occurred in 83% of SVS grade I and 50% of grade II injuries. Most grade III lesions (81%) remained stable (95% CI: 63–99; I² = 83.64%). The pooled rate of all-cause mid-term mortality was 3% (95% CI: 0–0.07), while this was 2% for aortic-related intervention (95% CI: 0–4).</div></div><div><h3>Conclusion</h3><div>This meta-analysis, including only retrospective and observational studies, shows that minor aortic injuries will remain stable or resolve with time and can be managed conservatively with appropriate surveillance. The risk of lesion progression for conservatively treated patients with SVS grade III is low.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 218-229"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145888228","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 Pitavastatin on Carotid Plaque Regression in Patients with Hypercholesterolemia","authors":"Ye-Xuan Cao ,&nbsp;Chun-lin Yin ,&nbsp;Chun-fei Zhang ,&nbsp;Xiang-Min Lin ,&nbsp;Zhi-Chen Zhao ,&nbsp;Yun Sun ,&nbsp;Jian Xu ,&nbsp;Hai-Bin Zhang ,&nbsp;Lei Zhang ,&nbsp;Mu-Lei Chen ,&nbsp;Xiao-Tao Zhao","doi":"10.1016/j.avsg.2025.12.019","DOIUrl":"10.1016/j.avsg.2025.12.019","url":null,"abstract":"<div><h3>Background</h3><div>Pitavastatin is a novel 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor with pleiotropic anti-atherosclerotic effects, but there is little evidence on the effects of pitavastatin treatment in inducing carotid atherosclerosis regression in patients with hypercholesterolemia (HC).</div></div><div><h3>Methods</h3><div>A self-controlled multicenter clinical trial of with HC was conducted between October 2018 to November 2020, to assess whether pitavastatin therapy could slow the progression and/or cause regression of carotid atherosclerosis, as determined by carotid ultrasound. Pitavastatin 2 mg/d was given to all patients for 1 month and then increased to 4 mg/d for 11 months. Ezetimibe 10 mg per day was added from the fourth month onward for high-risk and very high–risk patients who did not reach the targets of low-density lipoprotein cholesterol (LDL-C). Carotid ultrasonography and biological exams was used to assess the carotid atheroma burden at baseline and after 12 months of treatment. At the final follow-up visit, a questionnaire was administered to collect information on patients’ medication use in order to assess treatment compliance.</div></div><div><h3>Results</h3><div>The baseline LDL-C level of 188 patients dropped from 4.06 ± 0.60 mmol/L to 2.46 ± 0.73 mmol/L with a mean reduction of 39.4% (<em>P</em> &lt; 0.001). The pitavastatin-based lipid-lowering treatment significantly reduced plaque thickness by 4.0% (<em>P</em> = 0.003), longitudinal thickness by 2.7% (<em>P</em> = 0.018) and plaque length by 5.0% (<em>P</em> = 0.002) from the baseline.</div></div><div><h3>Conclusion</h3><div>The pitavastatin-based lipid-lowering treatment resulted in statistically significant regression of carotid atherosclerotic plaques. More research is needed to determine the effects of the observed changes on clinical outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 189-195"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892112","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}