Annals of vascular surgery最新文献

{"title":"Prevalence of Isolated Iliac Aneurysm in Patients with Acute Aortic Dissection","authors":"Xinyang Li ,&nbsp;Chong Liu ,&nbsp;Chuanjiang Wang ,&nbsp;Haidi Hu","doi":"10.1016/j.avsg.2025.07.036","DOIUrl":"10.1016/j.avsg.2025.07.036","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between isolated iliac aneurysms (IIAs) and acute aortic dissection (AAD) is uncertain. We aimed to determine the prevalence of IIAs in patients with AAD and evaluate the independent risk factors for the presence of IIAs in them.</div></div><div><h3>Methods</h3><div>Seven patients were confirmed to have AAD with IIAs (AAD + IIA group) who had undergone computed tomography angiography (CTA). The control group comprised 597 patients were confirmed with AAD without IIAs (AAD group). Demographic data or baseline characteristics of patients included in this study were completely obtained. Two readers reviewed all CTA scans independently to assess the data of the IIAs. Baseline characteristics were compared between the aortic dissection group and the control group using propensity score matching, and logistic regression analysis was performed to determine the independent risk factors for the presence of IIAs.</div></div><div><h3>Results</h3><div>The average age was 67.57 ± 10.13 years in the AAD + IIA group and 52.09 ± 12.06 years in the AAD group (<em>P</em> = 0.002). The proportion of smokers was respectively 39.6% and 85.7% in the AAD group and AAD + IIA group (<em>P</em> = 0.037). In the control group, no difference in age was observed between the dissections from the aorta to the iliac artery (<em>n</em> = 251 [42%]; 51.08 ± 11.35 years) and those limited to the aortic region (<em>n</em> = 346 [58%]; 52.82 ± 12.51 years) (<em>P</em> = 0.055). Multivariate analysis revealed age as an independent risk factor for the presence of IIAs (odds ratio, 1.144; 95% confidence interval, 1.059–1.235; <em>P</em> = 0.001). Similarly, smoking was an independent risk factor for the presence of IIAs (odds ratio, 14.601; 95% confidence interval, 1.652–129.073; <em>P</em> = 0.016).</div></div><div><h3>Conclusion</h3><div>The prevalence of IIA in AAD was 1.2%. Age and smoking can increase the prevalence of IIAs in patients with AAD. Our results can represent a valid aid in selecting patients to be screened, which would improve the treatment outcome. Further prospective studies are warranted to demonstrate the substantial prevalence of IIAs in the AAD population.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 447-454"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862033","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 Relationships Between Hospital Support Staff and Vascular Trainee Educational Experience and Well-Being","authors":"Margaret A. Reilly ,&nbsp;Christina L. Cui ,&nbsp;Eric B. Pillado ,&nbsp;Ruojia Debbie Li ,&nbsp;Joshua S. Eng ,&nbsp;Leanne E. Grafmuller ,&nbsp;Kathryn L. DiLosa ,&nbsp;Palma M. Shaw ,&nbsp;Yue-Yung Hu ,&nbsp;Karl Y. Bilimoria ,&nbsp;Malachi G. Sheahan III ,&nbsp;Dawn M. Coleman","doi":"10.1016/j.avsg.2025.08.019","DOIUrl":"10.1016/j.avsg.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Many stakeholders contribute to effective training environments for surgical residents, including program administrators and nursing staff. This study evaluates associations of hospital support staff with trainee educational time and wellness.</div></div><div><h3>Methods</h3><div>Data were collected via confidential voluntary survey of vascular trainees, who were asked about support staff interactions and protected educational time. Responses were recorded on a five-point Likert scale and dichotomized as positive or negative. Multivariable clustered logistic regression was used to evaluate the associations of support staff with educational time and educational time with burnout. A sensitivity analysis was conducted to adjust for experiences of mistreatment.</div></div><div><h3>Results</h3><div>Of 427 trainees with complete data for items of interest (62% response rate), most responded positively to questions of support staff and educational time. On multivariable analysis of associations with support staff, reporting that programs had adequate staffing and clear division of labor were significant predictors for satisfaction with education (odds ratio (OR) 7.0, <em>P</em> &lt; 0.001, and OR 6.3, <em>P</em> &lt; 0.001, respectively). Those who were satisfied with education had lower odds of burnout (OR 0.25, <em>P</em> &lt; 0.001) and thoughts of attrition (OR 0.15, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Trainees with positive support staff relationships were more likely to be satisfied with their education, and satisfaction with education was associated with increased wellness. Addressing sources of mistreatment will likely improve the educational experience. Future work should incorporate support staff experiences to promote successful team-based care.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 492-502"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862036","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 Outcomes of Surgical Strategy for Advanced Renal Cell Carcinoma Extending into the Inferior Vena Cava Requiring Intervention by a Vascular Surgeon","authors":"Shuhei Miura ,&nbsp;Yutaka Iba ,&nbsp;Ayaka Arihara ,&nbsp;Akihito Okawa ,&nbsp;Tomohiro Nakajima ,&nbsp;Junji Nakazawa ,&nbsp;Tsuyoshi Shibata ,&nbsp;Ko Kobayashi ,&nbsp;Toshiaki Tanaka ,&nbsp;Naoya Masumori ,&nbsp;Nobuyoshi Kawaharada","doi":"10.1016/j.avsg.2025.07.037","DOIUrl":"10.1016/j.avsg.2025.07.037","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the long-term surgical outcomes of advanced renal cell carcinoma with a thrombus extending into the inferior vena cava (IVC).</div></div><div><h3>Methods</h3><div>From 2008 to 2023, 29 patients underwent radical nephrectomy with IVC reconstruction. Surgical procedures were stratified by the cephalad extension of the IVC thrombus: from the renal vein into the infrahepatic segment (level I, <em>n</em> = 2), below the hepatic vein (level II, <em>n</em> = 20), and into the suprahepatic segment (level &gt; III, <em>n</em> = 7; including 1 level IV).</div></div><div><h3>Results</h3><div>IVC reconstruction was performed by direct suturing in 18 patients (62.1%), patch repair in 8 (27.6%), and graft replacement in 3 (10.3%). Operative outcomes for levels I, II, and &gt;III were associated with the rate of thoraco-laparotomy (0%, 5.0%, and 43.9%, respectively) and use of cardiopulmonary bypass (0%, 5.0%, and 85.7%, respectively). Although 1 level III patient (3.4%) died due to acute pulmonary embolism during surgery, there was no significant difference in the incidence of postoperative complications according to the level of tumor thrombus extension. The 5-year overall survival and cause-specific survival were 53.8% and 65.7%, respectively.</div></div><div><h3>Conclusion</h3><div>Although tumor thrombus extension can influence surgical invasiveness, our strategy did not impact perioperative outcomes and may enhance advanced renal cell carcinoma prognosis.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 578-586"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862031","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":"Evaluating the Emergency Management of Arteriovenous Fistula and Graft Bleeds","authors":"Andrea Alonso ,&nbsp;James Blum ,&nbsp;Sula Frausto ,&nbsp;Ijeoma M. Okafor ,&nbsp;Elissa M. Schechter-Perkins ,&nbsp;Olivia A. Sacks ,&nbsp;Khuaten Maaneb de Macedo ,&nbsp;Alik Farber ,&nbsp;Elizabeth King ,&nbsp;Brian J. Yun ,&nbsp;Jeffrey J. Siracuse","doi":"10.1016/j.avsg.2025.08.020","DOIUrl":"10.1016/j.avsg.2025.08.020","url":null,"abstract":"<div><h3>Background</h3><div>Arteriovenous (AV) access bleeding requires prompt management, but little is known about short- and long-term outcomes after these events. Our goal was to evaluate emergency management of AV access bleeds and their outcomes.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of emergency department (ED) visits for AV access bleeding at a tertiary care center between 2014 and 2022. Presentation, severity, management, and outcomes were evaluated.</div></div><div><h3>Results</h3><div>There were 66 patients that met the inclusion criteria (mean age was 65.4 years, 51.5% were male, 66.7% were Black, and 18.2% were Hispanic). Access types included brachiocephalic (34.8%), brachiobasilic (28.8%), radiocephalic (9.1%) fistulas, upper extremity AV grafts (16.7%), and lower extremity access (16.7%). The majority (78.8%) were postcannulation bleeds with 18.2% being primary ulcers. Triage emergency severity index classified ED presentation as life-threatening (6.1%), high-risk (31.8%), urgent (60.6%), and semi-urgent (1.5%). ED interventions included manual pressure (37.9%), suture placement (25.8%), topical hemostatic agents (15.2%), a clamp device (13.6%), and tourniquet placement (1.5%). Vascular surgery was consulted in approximately half (48.5%) of cases. In total, 59% of patients were discharged from the ED and 41% of patients were admitted to the hospital for further management. Tunneled dialysis catheters were placed in 15.2% of all hospitalized patients. In total, 45.5% of patients required an intervention on their access (45.5% open and 54.6% endovascular). In total, 60% and 40% of open operations were access revisions and ligations, respectively. The majority (83.3%) of patients undergoing fistulograms required an intervention. At 90 days, 59% of patients represented to the ED, with 23% of all readmissions for related causes. At 1 year, 22.7% of patients required new AV access creation. Six-month follow-up with an access surgeon was low at only 45.5% of patients. Having an access surgeon evaluate patients in the ED resulted in fewer related readmissions (25% vs. 2.9%, <em>P</em> = 0.02) and 1-year interventions (43.8% vs. 17.7%, <em>P</em> = 0.02), but there was no difference in the need for new AV access creations (12.5% vs. 2.9%, <em>P</em> = 0.19), and the 6-month follow-up in both groups was low (34.4% vs 55.9%, <em>P</em> = 0.08).</div></div><div><h3>Conclusion</h3><div>Over one-third of AV access bleeds presenting to the ED were of life-threatening or high-risk severity. Many such patients required a new AV access within 1 year. Improved interdepartmental communication and close patient follow-up remain opportunities for improved outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 469-476"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862029","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":"Five Year Outcomes after Fenestrated Endovascular Aortic Repair in Octogenarians","authors":"Rohan Basu,&nbsp;Joshua Davis,&nbsp;Mackenzie Madison,&nbsp;Alexa Hughes,&nbsp;John Maijub,&nbsp;Raghu Motaganahalli,&nbsp;Andres Fajardo","doi":"10.1016/j.avsg.2025.08.018","DOIUrl":"10.1016/j.avsg.2025.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Elderly patients are prone to complications in aortic surgery. Fenestrated endovascular aortic repair (FEVAR) can be used to treat complex abdominal aortic aneurysms (AAAs). We describe 5-year results with FEVAR using the Zenith Fenestrated device (ZFEN) in an elderly population.</div></div><div><h3>Methods</h3><div>This is a retrospective review of all FEVARs between January 2012 and August 2019 at a tertiary academic medical center. The study compared 60-month outcomes for patients younger than 79.9 (Group 1) and greater than 80.0 years (Group 2). The primary outcome was mortality. Secondary outcomes included reintervention and complications.</div></div><div><h3>Results</h3><div>153 patients met inclusion criteria, 27 of whom were age ≥80.0 years and were included in Group 2. Group 1 had more active smokers at surgery (50.0% vs. 18.5%, <em>P</em> = 0.003) and higher body mass index (29.0 ± 6.1 vs. 25.4 ± 3.4, <em>P</em> = 0.004). The remaining baseline comorbid conditions and medications did not differ between groups. Length of stay (3.5 vs. 3.7 days, <em>P</em> = 0.88) and need for facility discharge did not differ (10.3% vs. 7.4%, <em>P</em> = 0.13). At 60 months, the estimated overall survival was not different between groups (66.7% Group 2 vs. 73.8% Group 1, <em>P</em> = 0.55). Estimated freedom from reintervention also did not differ at 60 months (81.5% Group 2 vs. 72.2% Group 1, <em>P</em> = 0.16).</div></div><div><h3>Conclusion</h3><div>FEVAR with ZFEN is safe and effective for the treatment of complex AAA in patients older than 80 years. Five-year outcomes, overall survival, and complications did not differ between groups, suggesting benefit of performing elective aneurysm repair in well selected elderly patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 524-533"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862030","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":"Luminal Gain after Atherectomy Measured by Intravascular Ultrasound (IVUS) and Impact on Mid-Term Results","authors":"Michal S. Proczka ,&nbsp;Jake D. Forman ,&nbsp;Eric J. Maldonado ,&nbsp;Piotr Kaszczewski ,&nbsp;John J. Ricotta ,&nbsp;Joseph J. Ricotta II","doi":"10.1016/j.avsg.2025.07.042","DOIUrl":"10.1016/j.avsg.2025.07.042","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;While atherectomy is commonly used in peripheral vascular interventions, multiplanar data regarding the degree of luminal gain from the atherectomy procedure itself is lacking. We assessed immediate percent luminal gain, measured by intravascular ultrasound (IVUS) in different atherectomy devices. We also evaluated short-term patency measured by duplex ultrasound (DUS) and mid-term clinical follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;We prospectively collected data on 156 consecutive lower extremity revascularizations for 145 unique patients (11 bilateral staged interventions). Atherectomy was always followed by balloon angioplasty, with selective use of stenting. Indications for intervention were symptoms (Rutherford class 3–6) combined with lesions 70% area stenosis assessed by IVUS. IVUS also identified lesion length, calcification, and percent stenosis pre- and immediately post-atherectomy. This difference represented percent luminal gain by atherectomy alone. Follow-up DUS was performed at 30 days to identify residual/recurrent stenosis &gt; 70%. Patients were followed up clinically to determine incidence of improvement, clinically driven target lesion revascularizations (cdTLRs), need for open surgery, and amputations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Patients were treated for Rutherford class 3–5 ischemia. Two hundred sixty (260) lesions were treated in 156 limbs, including 51 in-stent restenosis (ISR) and 55 total occlusions. Two hundred nine (80.1%) lesions were in femoral-popliteal distribution. Median luminal gain was 26.4 (interquartile range 23; 31) % and was significantly higher in tibial than femoral-popliteal vessels (&lt;em&gt;P&lt;/em&gt; = 0.009). Stenting was required in 46 (22.2%) of femoral-popliteal lesions and no tibial segments. Stenosis &gt; 70% assessed by DUS at 30 days was present in 2.3% of treated lesions. Mean follow-up was 15.2 ± 3.3 months. CdTLR was performed in 53 cases (34%), including 3 (1.9%) open revascularization and major amputation in 2 (1.3%) legs, both Rutherford Class 4–5. Due to the tight range of luminal gain across all procedures, we saw no effect of the degree of luminal gain on the occurrence or timing of cdTLR (hazard ratio 1.006 (95% confidence interval 0.978–1.036), &lt;em&gt;P&lt;/em&gt; = 0.660). CdTLR was related to initial presence of occlusion, lesion length, and ISR as the initial indication for intervention.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Atherectomy consistently results in median luminal gain of 26.4%, which is similar between different atherectomy devices and depends on the baseline vessel size. In this series stent placement was infrequent, with no stents placed in the tibial position. CdTLR was not influenced by degree of calcification or percent luminal gain attributed to atherectomy. There was improvement in the majority of patients across all Rutherford categories, with a low rate of open intervention and amputation, which was restricted to patients with chr","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 422-432"},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858837","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":"Validation of the E-CABG Bleeding Severity Classification in Open Peripheral Arterial Surgery","authors":"Thomas A.H. Steunenberg ,&nbsp;Jitske H. Hakbijl ,&nbsp;Liliane C. Roosendaal ,&nbsp;Arno M. Wiersema ,&nbsp;Kak Kee Yeung ,&nbsp;Vincent Jongkind","doi":"10.1016/j.avsg.2025.07.041","DOIUrl":"10.1016/j.avsg.2025.07.041","url":null,"abstract":"<div><h3>Background</h3><div>Documentation of perioperative bleeding during vascular procedures is crucial for monitoring efficacy, safety, and to evaluate patient outcomes. This study validated the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding classification for evaluating perioperative bleeding in patients undergoing open peripheral arterial surgery (OPAS).</div></div><div><h3>Methods</h3><div>Prospective, multicenter cohort study including adult patients undergoing elective OPAS. Patients undergoing abdominal aortic surgery were excluded to maintain a homogeneous bleeding risk profile. Primary outcome was the incidence of complications categorized per E-CABG grade. Logistic regression was used to evaluate the predictive ability of Grade I or higher on patient outcomes. The model was adjusted for type of OPAS to minimize heterogeneity.</div></div><div><h3>Results</h3><div>A total of 778 patients were included. Ninety-four patients (12%) suffered a bleeding complication (Grade I: <em>n</em> = 47, 6.0%; Grade II: <em>n</em> = 47, 6.0%). Patients suffering Grade ≥ I had significantly more thrombo-embolic complications (TECs) (<em>P</em> &lt; 0.001), myocardial infarction (<em>P</em> = 0.006), bowel ischemia (<em>P</em> &lt; 0.001), graft thrombosis (<em>P</em> = 0.019), graft infection (<em>P</em> = 0.026), wound infection (<em>P</em> &lt; 0.001), pneumonia (<em>P</em> = 0.024), prolonged duration of hospital admission (<em>P</em> &lt; 0.001), higher reoperation (<em>P</em> &lt; 0.001), and mortality (<em>P</em> &lt; 0.001) than patients without a bleeding complication. In a multivariate model, Grade ≥ I predicted 30-day mortality (area under the curve (AUC) 0.81, 95% confidence interval [CI] 0.63–0.96), reoperation other than bleeding (AUC 0.75, 95% CI 0.66–0.85), wound infection (AUC 0.76, 95% CI 0.72–0.80), and TEC (AUC 0.67, 95% CI 0.58–0.76).</div></div><div><h3>Conclusion</h3><div>The E-CABG bleeding classification is applicable for stratifying the severity of perioperative bleeding in OPAS and predicting adverse short-term postoperative outcomes for research and registry databases.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 455-463"},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858855","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":"Outcomes After Utilization of Autogenous Arm Vein Grafts for Lower Extremity Bypasses","authors":"Roberto S. Loanzon ,&nbsp;Hana Shafique ,&nbsp;Christina L. Cui ,&nbsp;Young Kim ,&nbsp;Zachary F. Williams","doi":"10.1016/j.avsg.2025.07.039","DOIUrl":"10.1016/j.avsg.2025.07.039","url":null,"abstract":"<div><h3>Background</h3><div>Lower extremity bypasses performed with autogernous conduit have superior patency and limb salvage. This is often performed with single segment great saphenous vein (GSV), but other options may be required for patients without available GSV. This study presents our experience utilizing arm veins as an alternative autogenous conduit for patients undergoing lower extremity bypass procedures.</div></div><div><h3>Methods</h3><div>A single-center retrospective study of patients at a Veterans Affairs Medical Center with peripheral arterial disease (PAD) who underwent lower extremity bypass with arm vein between January 2009 and July 2023 was performed. The primary outcomes were amputation-free survival (AFS) and major adverse limb event (MALE). Secondary outcomes include postoperative complications, such as postoperative surgical site infection, total hospital length of stay, 30-day mortality, and unplanned 30-day readmission.</div></div><div><h3>Results</h3><div>From January 2009 to June 2023, there were 42 lower extremity bypasses performed in patients who possessed inadequate GSV. All procedures were performed in men (<em>n</em> = 42, 100%). The median age was 67 years (interquartile range (IQR) 62–71 years). Nine procedures (21.4%) were performed for claudication, 21 (50%) for tissue loss, and 12 (28.6%) for rest pain. The majority involved bypassing to infrageniculate targets (<em>n</em> = 39, 93%). Conduit composition included single (<em>n</em> = 19, 45%), two-piece (<em>n</em> = 19, 45%), or three-piece (<em>n</em> = 4, 10%) composite grafts with arm vein. The median AFS was 3.86 years (IQR 1.19–6.65 years). Five patients required major amputation (15.6%). The median time to MALE was 0.88 years (IQR 0.23–1.69 years). Overall, 30-day mortality was 2.4% (<em>n</em> = 1). Postoperative complications included surgical site infection in 9 patients (21.4%), hematoma in 3 patients (7.1%), early graft thrombosis in one patient (2.4%), wound dehiscence in one patient (2.4%), and a lymph leak in one patient (2.4%). The median length of stay was 6 days (IQR 3.3–9.5 days).</div></div><div><h3>Conclusion</h3><div>Arm vein is a viable alternative autogenous conduit for lower extremity arterial bypasses in patients without adequate GSV.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 399-405"},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858838","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":"Reply to Letter to the Editor: Long-Term Outcomes of Open Surgical Repair for Complex Aortoiliac Occlusive Disease in the Age of Endovascular Advancements","authors":"Thomas R. Wyss,&nbsp;Vladimir Makaloski","doi":"10.1016/j.avsg.2025.08.010","DOIUrl":"10.1016/j.avsg.2025.08.010","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Page 396"},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review and Meta-Analysis on the Use of Omniflow for Peripheral Arterial Bypass","authors":"Isabelle Sanders ,&nbsp;Nadia El-Diaz ,&nbsp;Jack Docherty ,&nbsp;Joseph Borucki ,&nbsp;Philip Stather","doi":"10.1016/j.avsg.2025.08.007","DOIUrl":"10.1016/j.avsg.2025.08.007","url":null,"abstract":"<div><h3>Background</h3><div>Omniflow IIⓇ is a biosynthetic material specifically marketed for arterial bypass procedures at high risk of graft infection. This meta-analysis aimed to combine current evidence for the use of Omniflow IIⓇ in peripheral arterial bypass and compare postoperative outcomes.</div></div><div><h3>Methods</h3><div>Seven databases were searched for the term “Omniflow.” Studies were reviewed and included if: they were a randomized control trial, cohort study or case series; some patients in the study received Omniflow graft for peripheral arterial bypass. Primary outcomes were early and late postoperative infection; primary patency; and secondary patency. Number of patients, mode of bypass and postoperative outcomes were extracted from each eligible study. Meta-analysis of pooled results was undertaken using STATA.</div></div><div><h3>Results</h3><div>Literature search identified 30 studies. Following duplicate removal, abstract and full-text review, 12 studies were included, incorporating 1,100 bypass procedures. Follow-up ranged from 3-months to 5-years. Thirty-day postoperative infection data were available for 688 procedures with an average effect size of 0.25 (0.00, 2.12). Late postoperative infection data was available for 977 bypass procedures with an average effect of 1.68 (0.05, 4.67) after 30 days. Weighted pooled primary patency was 71.33% (95% confidence interval [CI] 62.83–79.18) at 1 year, 64.88% (95% CI 55.31–73.92) at 2 years, and 54.00% (95% CI 32.57–74.70) at 4–5 years. Weighted pooled secondary patency was 83.53% (95% CI 75.10–90.64) at 1 year, 76.75% (95% CI 57.84–91.59) at 2 years, and 73.10% (95% CI 60.16–84.35) at 4–5 years. Mortality data were reported for 1,068 procedures. Thirty-day mortality ranged from 0% to 7.69%, with an average mortality rate of 2.23%.</div></div><div><h3>Conclusion</h3><div>Omniflow IIⓇ presents a viable option for peripheral bypass graft material with low rates of early and late postoperative infection. Pooled primary and secondary patency rates for Omniflow IIⓇ appear comparable to other graft materials. Further comparative work is needed to directly compare Omniflow IIⓇ to alternative graft materials.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 503-512"},"PeriodicalIF":1.6,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858821","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}