Annals of vascular surgery最新文献

{"title":"THE CLINICAL PROFILE OF RUPTURE: A 19-YEAR CASE-CONTROL STUDY OF ABDOMINAL AORTIC ANEURYSMS.","authors":"Ma Lourdes Del Río Solá, Clara de la Torre Casaseca, Marina Jiménez de la Caja, Sandra Pérez Fernández, Sergio Asensio Rodríguez","doi":"10.1016/j.avsg.2026.09.070","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.070","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors associated with ruptured infrarenal abdominal aortic aneurysm (AAA) presentation and quantify ruptures below current sex-specific elective repair thresholds.</p><p><strong>Methods: </strong>This retrospective case-control study compared patients presenting with ruptured infrarenal AAA with a contemporaneous comparison group undergoing elective infrarenal AAA repair. Multivariable logistic regression assessed associations with ruptured presentation. The primary model included maximum aneurysm diameter, age, female sex, and calendar year; the extended model additionally included hypertension, diabetes mellitus, and dyslipidemia. Discrimination was evaluated using optimism-corrected area under the curve (AUC).</p><p><strong>Results: </strong>Among 394 patients with infrarenal AAA, 194 presented with rupture and 200 underwent elective repair. Median diameter was 80.0 versus 53.0 mm (P < .001), and women comprised 10.9% versus 3.0% (P = .002), respectively. Diameter per 10-mm increase (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.84-2.61) and female sex (OR, 4.72; 95% CI, 1.49-14.94) were independently associated with ruptured presentation. Optimism-corrected AUCs were 0.836 for diameter alone, 0.832 for the primary model (diameter, age, female sex, and calendar year), and 0.840 for the extended model (primary model plus hypertension, diabetes mellitus, and dyslipidemia). Sixteen of 160 ruptures (10.0%) occurred below sex-specific thresholds.</p><p><strong>Conclusions: </strong>Diameter was the dominant factor associated with ruptured presentation, but female sex remained independently associated. These findings support diameter-based practice while highlighting the need for prospective, sex-aware, multiparametric risk assessment.</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":"149179137","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 of Open vs Endovascular Repair of Abdominal Aortic Aneurysm Involving the Iliac Bifurcation.","authors":"Narek Veranyan, Dong-Jin E Kang Sim, Sadia Ilyas, Sophie Wang, Gustavo S Oderich, Mahmoud B Malas","doi":"10.1016/j.avsg.2026.09.069","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.069","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal involvement of the iliac bifurcation increases the complexity of both open and endovascular repair of abdominal aortic aneurysm (AAA), potentially raising the risk of postoperative complications. Randomized trials comparing endovascular aneurysm repair (EVAR) and open aortic repair (OAR) for AAA showed that EVAR is associated with a lower postoperative mortality rate. However, it remains unclear whether these results apply to AAA involving the iliac bifurcation (AAAIB). Several small single-institutional studies have shown conflicting results. This study aims to compare the outcomes of EVAR and OAR for AAAIB in a real-world, multi-institutional setting.</p><p><strong>Methods: </strong>The Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) database was queried for patients who underwent repair for AAAIB. The cohort was divided into two groups based on the intervention: EVAR vs OAR. Baseline demographic, clinical, and perioperative characteristics, as well as outcomes such as overall 30-day mortality, in-hospital mortality, Major Adverse Cardiovascular Events (MACE: death, myocardial infarction, stroke), intestinal ischemia, overall reinterventions, and 1-year survival, were compared between the groups. Univariable analysis, multivariable inverse probability-weighted regression (IPWR), survival analysis with the Kaplan-Meier method, log-rank test, and Cox proportional hazards regression were performed.</p><p><strong>Results: </strong>Of all reviewed patients, 7,535 were included in the final analysis, of whom 5,742 (76.2%) underwent EVAR, whereas 1,793 (23.8%) underwent OAR. In IPWR models, patients who underwent EVAR had significantly lower odds of overall in-hospital mortality (OR: 0.25, 95%CI: 0.18-0.34, p<0.001), 30-day mortality (OR: 0.31, 95%CI: 0.23-0.42, p<0.001), MACE (OR: 0.24, 95%CI: 0.19-0.31, p<0.001), and other postoperative adverse events compared to OAR. The Cox proportional hazards model demonstrated a significantly higher 1-year survival rate for EVAR compared to OAR (HR: 0.61, 95% CI: 0.50-0.76, p<0.001).</p><p><strong>Conclusions: </strong>In this real-world, multi-institutional study, EVAR for AAAIB was associated with lower odds of overall in-hospital mortality, 30-day mortality, MACE, as well as a higher 1-year survival rate, compared to the OAR. EVAR should be considered the primary method for repairing aortoiliac aneurysm involving the iliac bifurcation in anatomically suitable patients. Longer follow-up studies are needed to confirm these findings and compare the long-term reintervention and aorta-related mortality rates between the two treatment modalities.</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":"149179120","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":"SPATIAL ORGANIZATION OF DISTURBED FLOW AFTER CAROTID ENDARTERECTOMY AND CAROTID ARTERY STENTING.","authors":"Eduardo Soudah, Sergio Asensio-Rodríguez, Ma Lourdes Del Río-Sola","doi":"10.1016/j.avsg.2026.09.066","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.066","url":null,"abstract":"<p><strong>Objective: </strong>Carotid endarterectomy (CEA) and carotid artery stenting (CAS) create distinct postoperative geometries. Conventional wall shear stress (WSS)-derived biomarkers quantify disturbed-flow magnitude but not its spatial organisation. We evaluated whether spatial organisation provides complementary haemodynamic information after CEA and CAS.</p><p><strong>Methods: </strong>In this retrospective, patient-specific computational fluid dynamics study, nine carotid geometries (three healthy, three post-CEA, three post-CAS) were reconstructed from computed tomography angiography. Identical pulsatile boundary conditions were applied to isolate morphological effects. Time-averaged WSS (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP) were computed. Regions of adverse flow were defined using percentile thresholds (P90, P95, and P99). Spatial organisation was quantified by total area at risk, largest connected hotspot area, hotspot number, and the Spatial Dominance Index (SDI), defined as the largest hotspot area divided by total area at risk.</p><p><strong>Results: </strong>ECAP, OSI, and RRT colocalised with low TAWSS, and spatial descriptors were consistent across biomarkers. Healthy carotids showed the most focal pattern (SDI approximately 0.22; 8-12 hotspots). CEA had the largest total area at risk and largest hotspot but retained relatively high dominance (SDI 0.16-0.17; 48-75 hotspots). The Roadsaver-treated CAS geometries had the smallest total area at risk but the most fragmented pattern, with smaller hotspots and the lowest dominance (SDI 0.09-0.12; 39-70 hotspots). These patterns persisted across P90-P99 thresholds.</p><p><strong>Conclusion: </strong>Spatial organisation distinguished carotid revascularisation strategies beyond biomarker magnitude. CEA largely preserved a focal, dominant pattern, whereas the Roadsaver-treated CAS geometries showed fragmented, distributed disturbed flow. The simple, dimensionless SDI may complement established WSS-derived biomarkers in patient-specific haemodynamic assessment.</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":"149179146","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":"\"Not so minor\" - Digital Amputation as a precursor to Major Amputation and Mortality in an Irish tertiary vascular centre.","authors":"Ubaid Ullah, Megan Power Foley, Shahla AlBalushi, Conor O'Reilly, Kenneth Thornton, Sayed Aly, Daragh Moneley, Peter A Naughton, Seamus McHugh, Elrasheid Kheirelseid","doi":"10.1016/j.avsg.2026.09.058","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.058","url":null,"abstract":"<p><strong>Background: </strong>Minor (toe) amputations are a common consequence of peripheral arterial disease (PAD) and/or diabetes. They can herald further forefoot and major amputations and are a poor prognostic indicator for five-year survival. This study aimed to identify prognostic indicators for progression from minor amputation to major amputation and all-cause mortality.</p><p><strong>Methods: </strong>Index digital amputations performed by vascular surgeons in a tertiary referral hospital between 2017-2022 were identified from Hospital In-Patient Enquiry (HIPE) data. Electronic records for each limb were followed up to October 2025 for further ipsilateral minor and major amputations and mortality.</p><p><strong>Results: </strong>224 limbs in 209 patients underwent at least one minor amputation. The cohort was predominantly male (86%) with a mean age of 66.3 years (± 12.7). 70% had PAD and 80% had diabetes. In total, 34% (n=73/215) required further ipsilateral amputation, 78.3% of which occurred within 12 months of index surgery. Minor and major re-amputation rates were 25.6% and 11%, respectively. Predictors of further amputation at any level included ischaemic heart disease (IHD) (OR 2.796, 95% CI 1.54-5.06), diabetes (OR 2.31, 95% CI 1.04-5.136) and dialysis (OR 2.20, 95% CI 1.021-4.915). Index hallux amputation, IHD, and revascularisation at index admission were risk factors for further major ipsilateral amputation. All-cause mortality was 11.4%, 24.8% and 48% at one, three and five years, respectively.</p><p><strong>Conclusion: </strong>Consistent with international data, minor amputations are poor prognostic factor for limb loss and death. In this cohort, patients with IHD and dialysis were most at risk for further amputation.</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":"149179187","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":"Association between increased superficial calcification clusters in carotid atherosclerosis and cardiovascular events after carotid artery stenting: A retrospective cohort study.","authors":"Jiaqi Zhu, Hanfei Tang, Yong Ding, Tonglei Han, Dong Yan, Tianlun Shen, Xiao Tang, Daqiao Guo","doi":"10.1016/j.avsg.2026.09.064","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.064","url":null,"abstract":"<p><strong>Background: </strong>The role of calcification in carotid atherosclerosis before and after carotid artery stenting (CAS) remains controversial. This study assessed the association between the extent of calcification in target carotid plaques and outcomes after CAS.</p><p><strong>Methods: </strong>A total of 292 subjects with carotid stenosis who underwent CAS were retrospectively enrolled. Follow-up for major adverse cardiovascular events (MACEs) was conducted via outpatient visits and telephone. Ultimately, 211 subjects completed 2-year follow-up. Superficial calcification clusters were counted on CTA. Subjects with ≥4 superficial calcification clusters (n=24) were matched in a 1:4 ratio to those with <4 superficial calcification clusters (n=96). Sensitivity analysis was performed based on the matched cohort.</p><p><strong>Results: </strong>Over a median follow-up of 1.92 years, 14 MACEs occurring more than 30 days after discharge were recorded. In univariate Cox analysis, symptom status (P= 0.0116), alcohol abuse (P= 0.0091), total number of calcification clusters (P= 0.0428), and number of superficial calcification clusters (P= 0.0022) were significantly associated with MACEs. In bivariate analyses, the number of superficial calcification clusters maintained a reasonably good association with MACEs. In sensitivity analysis, superficial calcification clusters remained significantly associated with MACE when loss to follow-up was classified as MACE (P= 0.0256, HR= 1.2548, 95% CI 1.0281-1.5315) or as no MACE (P= 0.0265, HR= 1.4948, 95% CI 1.0479-2.1323).</p><p><strong>Conclusion: </strong>The number of superficial calcification clusters may independently serve as a prognostic risk factor in patients with carotid atherosclerosis undergoing CAS.</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":"149179127","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":"Distinct Temporal Patterns of Limb Loss and Mortality After Transcatheter Arterialization of the Deep Veins for No-Option CLTI.","authors":"Swechha Bhatt, Aseman Bagheri Sheshdeh, Radha Bansal, Shezan Fouzdar, Fauzia Hollangel, Shiv Patel, Prajakta Lokhande, Valeria Robayo, Vanessa Sauer, Anahita Dua","doi":"10.1016/j.avsg.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.002","url":null,"abstract":"<p><strong>Objective: </strong>No-option chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral arterial disease, characterized by exhausted revascularization options and substantial systemic comorbidity. Contemporary registry data have reported amputation-free survival (AFS) as low as approximately 37% at 1 year with standard care alone. Deep venous arterialization (DVA) has emerged as a limb-salvage strategy for these patients by arterializing the venous circulation to restore perfusion to the distal extremity. Although early trial data have been encouraging, the durability of Transcatheter Arterialization of the Deep Veins (TADV) in routine clinical practice beyond the trial setting remains incompletely defined. We evaluated 2-year technical and clinical outcomes following TADV in a single-center cohort.</p><p><strong>Methods: </strong>We performed a retrospective, single-center cohort study of 29 consecutive patients with no-option CLTI who underwent TADV, with follow-up extending up to 2 years. Outcomes assessed included technical success, 30-day circuit patency, major amputation, limb salvage, all-cause mortality, and amputation-free survival (AFS). Kaplan-Meier methods were used to estimate time-to-event outcomes, and univariable Cox regression was used to identify baseline factors associated with AFS and mortality.</p><p><strong>Results: </strong>Technical success was achieved in all 29 patients (100%). During the follow-up, limb salvage was maintained in 22 of 29 patients (75.9%) (Table 2). The Kaplan-Meier limb-salvage curve plateaued after approximately 7 months, with no major amputations observed among patients who remained amputation-free beyond this point (Figure 1). All-cause mortality was 41.4% (12 of 29 patients) and increased throughout follow-up (Table 2). Older age was significantly associated with mortality (median, 77 vs 71 years; P = .047), and congestive heart failure showed a nonsignificant trend toward increased mortality risk (83.3% vs 47.1%; P = .064) (Table 3).</p><p><strong>Conclusions: </strong>In this cohort of patients with no-option CLTI, TADV achieved durable limb preservation in approximately three-quarters of patients through 2 years of follow-up, with amputation occurring almost exclusively within the first several months after the procedure. All-cause mortality remained substantial throughout follow-up, consistent with the comorbidity burden of this population. These findings support TADV as a limb-salvage option for patients with no-option CLTI who would otherwise face major amputation, although larger multicenter studies are needed to confirm long-term durability.</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":"149179129","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":"Severity-dependent patterns of hemodynamic change in symptomatic carotid stenosis during the waiting period before endarterectomy.","authors":"Maarten E Bodegom, Rutger J Hissink, Barzi Gareb, Clark J Zeebregts","doi":"10.1016/j.avsg.2026.09.067","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.067","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the rate of hemodynamic change after a symptomatic carotid event differs between moderate and severe stenosis.</p><p><strong>Methods: </strong>Serial duplex examinations in symptomatic patients awaiting carotid endarterectomy were analyzed with a linear mixed-effects model, using an extended, prospectively maintained database. Maximum internal carotid artery peak systolic velocity (ICA PSV) was modeled as a linear function of time from the index event interacting with baseline severity (moderate 125-229, severe ≥230 cm/s), with a random intercept per patient. The rate of change (cm/s per day) and the moderate-severe difference were the principal outcomes. Categorical interval comparisons and paired within-patient changes, including distal common carotid artery (CCA) PSV, were secondary analyses.</p><p><strong>Results: </strong>The time course of maximum ICA PSV differed by baseline severity (interaction p = .006). The modeled rate of change was +1.20 cm/s per day (95% CI 0.28 to 2.12) in moderate and -0.21 cm/s per day (95% CI -0.58 to 0.17) in severe stenosis (difference 1.41 cm/s per day, 95% CI 0.42 to 2.40; p = .005). Secondary analyses were consistent: moderate stenosis accelerated with stable inflow, whereas severe stenosis showed no further ICA acceleration but a fall in distal CCA PSV (-3.0 cm/s; p < .001).</p><p><strong>Conclusion: </strong>The rate of hemodynamic change during the waiting period depends on baseline severity: moderate stenosis accelerates, whereas severe stenosis shows little further ICA acceleration, consistent with behavior near a velocity ceiling. Maximum ICA PSV and distal CCA PSV are best read as separate, time-sensitive variables rather than as a single ratio.</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":"149179161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-General Anesthesia for Endovascular Aneurysm Repair: A Systematic Review and Meta-analysis of Clinical Outcomes and Robustness of Evidence.","authors":"Fulvio Nisi, Roberto Piscopo, Fabrizio Aurelli, Giulio Calgaro, Massimo Meco, Enrico Giustiniano, Federico Piccioni, Sandro Lepidi, Mario D'Oria","doi":"10.1016/j.avsg.2026.09.068","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.068","url":null,"abstract":"<p><strong>Background: </strong>The optimal anesthetic strategy for endovascular aortic aneurysm repair (EVAR) remains debated. While recent meta-analyses suggested potential benefits for non-general anesthesia (Non-GA), available evidence is observational, and the robustness of pooled estimates remains uncertain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of comparative observational studies (2015-2025) was conducted across PubMed, MEDLINE, Embase, and Scopus. Primary outcomes were 30-day and in-hospital mortality. Secondary outcomes included length of stay (LOS) and postoperative complications. Random-effects models utilized the Paule-Mandel estimator with Hartung-Knapp adjustment, prediction intervals, and prespecified influence diagnostics.</p><p><strong>Results: </strong>Twenty-two studies comprising >150,000 EVAR procedures were analyzed. Non-GA was not associated with reduced 30-day mortality compared with general anesthesia (RR 0.90, 95% CI 0.54-1.52; I²≈86%; wide prediction interval). Influence diagnostics identified one influential study; its exclusion yielded a lower mortality for Non-GA (RR 0.72, 95% CI 0.59-0.87; I²≈1%). Non-GA was associated with a modest reduction in hospital LOS (mean difference -0.53 days, 95% CI -1.02 to -0.03), but no consistent differences were observed in ICU stay or major complications. The overall certainty of evidence was judged very low (GRADE).</p><p><strong>Conclusions: </strong>Non-GA for EVAR does not increase 30-day mortality risk compared to general anesthesia. However, survival estimates are sensitive to study-level characteristics and procedural complexity. Current observational evidence supports individualized anesthetic selection rather than proving superiority or equivalence of either technique.</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":"149179141","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":"Comparative Outcomes of Endovascular and Open Surgical Repair for Extracranial Carotid Artery Aneurysms: A Systematic Review and Meta-analysis.","authors":"Mayara Leite Coutinho, Celso Ricardo Bregalda Neves, Inez Ohashi Torres, Lucas Monteiro Delgado, Mario D'Oria, Antonio Eduardo Zerati, Pedro Puech Leão","doi":"10.1016/j.avsg.2026.09.065","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.065","url":null,"abstract":"<p><strong>Background: </strong>Extracranial carotid artery aneurysms (ECAAs) are rare lesions managed by open surgical repair (OpR) or endovascular repair (ER). We compared the perioperative and long-term outcomes of both strategies.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review and meta-analysis, registered in PROSPERO, was performed. Comparative studies were pooled using random-effects models, and separate single-arm meta-analyses were conducted for OpR and ER.</p><p><strong>Results: </strong>Twenty-six retrospective studies involving 707 patients and 725 procedures were included (574 OpR and 151 ER). Six comparative studies (228 procedures) showed no significant differences between ER and OpR in 30-day mortality (OR, 2.58; 95% CI, 0.53-12.52), 30-day stroke (OR, 1.08; 95% CI, 0.30-3.91), late stroke, reintervention, or primary patency. In the single-arm analyses, pooled 30-day mortality and stroke rates after OpR were 1.18% and 4.29%, respectively. No 30-day deaths and one stroke were reported after ER, yielding a pooled stroke rate of 1.25% (95% CI, 0.18-8.34). Primary patency was high after both OpR (98.44%) and ER (94.50%).</p><p><strong>Conclusions: </strong>Observational evidence suggests similar perioperative outcomes and similar observed late event rates for ER and OpR in ECAAs, although heterogeneous follow-up and the absence of time-to-event analyses limit formal comparison of long-term durability. Both approaches were associated with low mortality, stroke, reintervention rates, and excellent primary patency. Open repair remains supported by a larger body of evidence and longer follow-up, whereas evidence for ER remains comparatively limited. Because treatment allocation in the available studies was influenced by patient characteristics, anatomical complexity, and surgical risk, the observed similarity in outcomes should not be interpreted as evidence of therapeutic equivalence. Given the observational design and the predominantly moderate to serious risk of bias of the included studies, these findings should be interpreted with caution.</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":"149179131","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":"Anatomic Level as a Modifier of Racial/Ethnic Disparities in Chronic Limb-Threatening Ischemia: Outcomes After First-Time Endovascular Revascularization.","authors":"Adarsh Mallepally, Daniel Komorowski, Daniel H Newton","doi":"10.1016/j.avsg.2026.09.055","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.055","url":null,"abstract":"<p><strong>Purpose: </strong>Racial and ethnic disparities in chronic limb-threatening ischemia (CLTI) outcomes are well documented, but whether these disparities vary by anatomic level of endovascular intervention remains unclear. We evaluated racial and ethnic differences in limb outcomes following endovascular revascularization for CLTI stratified by intervention level.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the TriNetX US Collaborative Network, including adults undergoing first-time lower extremity endovascular revascularization for CLTI between 2015-2024. Patients were stratified by intervention level: iliac, femoropopliteal, tibioperoneal, or combined femoropopliteal and tibioperoneal (multilevel). Propensity score matching balanced demographics and comorbidities across racial/ethnic cohorts. The primary outcomes were rates of 1-year major amputation and amputation-free survival (AFS). Outcome comparisons were reported as risk ratios (RR).</p><p><strong>Results: </strong>Among 14,786 patients, there were 3,071 iliac, 5,178 femoropopliteal, 2,363 tibioperoneal, and 3,718 multilevel interventions. After matching, Black patients demonstrated increased major amputation risk following iliac intervention (RR: 1.80, 95% CI: 1.13-2.88, p=0.012) and femoropopliteal intervention (RR: 1.83, 95% CI 1.39-2.41, p<0.001) compared with White patients. No significant differences in amputation were observed following tibioperoneal or multilevel interventions. Hispanic patients exhibited increased amputation risk only in the multilevel cohort (RR: 1.57, 95% CI: 1.02-2.40, p=0.037). Despite differences in amputation, AFS remained similar across racial and ethnic groups.</p><p><strong>Conclusions: </strong>Racial and ethnic disparities in CLTI outcomes following endovascular revascularization varied by anatomic intervention level. Disparities were most pronounced after proximal interventions and attenuated in distal disease, suggesting anatomic disease pattern may modify inequities in limb outcomes after revascularization.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179172","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}