Annals of vascular surgery最新文献

{"title":"Toe Brachial Indices Are an Accurate Peripheral Artery Disease Screening Tool in Vascular Deserts.","authors":"Carolina Aparicio, Clara Gomez-Sanchez, Caitlin W Hicks, Aaron Zaldana, Tomas Alamin, Leigh Ann O'Banion","doi":"10.1016/j.avsg.2025.09.034","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.034","url":null,"abstract":"<p><strong>Background: </strong>Targeted cardiovascular screening in vascular deserts (VD), defined as regions lacking vascular providers, is necessary to address issues of health literacy and poor access to care in high-risk socioeconomically disadvantaged populations. Guidelines suggest focused screening for peripheral artery disease (PAD) utilizing ankle brachial index (ABI) in appropriately selected patients, which requires skilled technicians. This study aims to evaluate toe brachial indices (TBI) as an accurate way to effectively screen this patient population.</p><p><strong>Methods: </strong>In 2023, vascular surgeons, surgical trainees, and medical students screened patients for PAD at events targeted in known VD. Demographics and risk factors for PAD were collected and assessed, and measures of lower extremity perfusion including ABI and TBI were collected. Screened patients were combined with 50 randomly selected retrospective patients seen in the vascular clinic (VC) as new consultations for a diagnosis of PAD who also underwent ABI/TBI testing. PAD was defined as an ABI <0.9 or TBI <0.7. Non-compressibility (NC) was defined as an ABI >=1.4. ANOVA and correlation analyses were used to assess relationships between ABI and TBI overall and among patients without NC, stratified by diabetes status and intermittent claudication symptoms.</p><p><strong>Results: </strong>99 patients were screened for PAD (49 VD, 50 VC). 56% were male and 54% were Hispanic with only 58% having seen a primary care provider within the last year. The mean age was 60±19 years, with 38% smokers and 36% with a previous diagnosis of diabetes or a screened HbA1c of >5.7%. 50% of patients reported symptoms of possible intermittent claudication. Of screened patients, 8% had NC ABI's, and 36% had ABI<0.9. There were significant and graded associations of TBI with ABI: among patients with ABI<0.9, mean TBI was 0.38 (95% CI 0.31, 0.45), compared to 0.90 (95% CI 0.84, 0.96) among patients with ABI between 0.9 and 1.4, and 1.33 (95% CI 1.18, 1.48) among patients with ABI>1.4 (P<0.001). There was a strong correlation between ABI and TBI (Pearson's correlation coefficient [PCC] 0.82, P<0.001) overall and among patients with measurable ABI (PCC 0.83, P<0.001), but not among patients with NC ABIs (PCC 0.38). Results were similar in subgroups stratified by diabetes status and claudication symptoms (both, P<001; ).</p><p><strong>Conclusions: </strong>Toe Brachial Indices closely mirror ankle brachial indices and are an efficient tool to screen for PAD. This method provides an accurate assessment of patients at risk for PAD, particularly those with DM and non-compressible vessels, and can provide valuable information to healthcare providers in vascular deserts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172729","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":"Trends, outcomes, and factors associated with steal syndrome following creation of arteriovenous hemodialysis access: A safety net hospital system analysis.","authors":"Joanna Curry, Christian de Virgilio, Ramsey Ugarte, Dhru Vaghashia, Maria Valadez, Mark Archie","doi":"10.1016/j.avsg.2025.09.024","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.024","url":null,"abstract":"<p><strong>Background: </strong>Steal syndrome (DASS) is a feared complication of hemodialysis (HD) access creation. There is a paucity of work investigating the relationship between preoperative factors, access type, resource utilization and DASS, particularly within a safety net hospital system.</p><p><strong>Methods: </strong>A retrospective review of arteriovenous fistula (AVF) or graft (AVG) creation between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was the development of DASS within 2 years of HD access creation. Secondary outcomes included reintervention and patency.</p><p><strong>Results: </strong>There were 1,430 patients, of which 54 (3.8%) developed DASS. The incidence of DASS decreased from 6.3% to 2.2% over the study period. The incidence of DASS was 10.6% for AVG vs 3.5% for AVF (p=0.01). DASS occurred in 5.0% of brachiocephalic and 2.6% of brachiobasilic AVFs. DASS had higher rates of access related ED visits (14.8 vs 4.7%) and reoperation (53.9 vs 12.2%; both p<0.001). Following adjustment, AVG (Adjusted Odds Ratio [AOR] 2.74, 95% Confidence interval [CI] 1.02-7.55) and brachiocephalic AVF (AOR 2.13, CI 1.01-4.52) were associated with higher odds of DASS. Finally, DASS was associated with greater odds of 30-day ED visit for access related complications (AOR 3.36, CI 1.48-7.60) and reoperation (AOR 8.18, CI 4.14-16.18), but there was no significant difference in 12-month patency.</p><p><strong>Conclusion: </strong>Within a safety net system, the incidence of DASS following AVF/AVG creation is declining. AVG, and brachiocephalic AVF were associated with higher odds of DASS. Finally, DASS was associated with an increased rate of emergency care and reoperation following access creation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172333","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":"Thoracic endovascular aortic repair for native or prosthetic aortic infection: Solution or a Bridge to Nowhere? With focus on Fistulae.","authors":"Carlos-A Mestres, Eduard Quintana, Francis E Smit","doi":"10.1016/j.avsg.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.035","url":null,"abstract":"<p><p>Vascular graft infection continues to be a highly morbid condition, still associated to high mortality. Aortoesophageal and aortobronchial fistulae are the most dreadful complications of graft infection. There is scanty related information in the literature and, due to the rarity of these communications, it is not possible to standardize the combined medical, interventional and surgical therapy. This document aims at offering an updated overview of the most recent relevant contributions on the visceral fistulous communications, summarize what actions are usually taken and respond to the question posed in the title.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147809","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":"Robotic Median Arcuate Ligament Release May Offer Superior Symptom Improvement to Laparoscopic Release.","authors":"Kayla A Fay, Jennifer A Stableford, Jesse A Columbo, David H Stone, David J Finley","doi":"10.1016/j.avsg.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.033","url":null,"abstract":"<p><strong>Introduction/objective: </strong>Median arcuate ligament syndrome (MALS) is a challenging disease process to treat. Laparoscopic ligament release can lead to early symptom improvement, but symptom recurrence is common. Recently, these MAL releases are being performed robotically at select institutions. The purpose of this study was to document symptom resolution and recurrence rates after laparoscopic and robotic MAL release (r-MALR) at our institution.</p><p><strong>Methods: </strong>We performed a retrospective review of all patients treated with minimally invasive MAL release at a single academic tertiary medical center from 2017 - 2023. We stratified patients by operative approach, laparoscopic versus robotic. Our primary outcome was symptom resolution at 6-month follow-up.</p><p><strong>Results: </strong>We identified 38 patients who underwent MAL release, 27 (71.1%) that underwent laparoscopic release, and 11 (28.9%) that underwent r-MALR. Pre-operative characteristics were similar between groups, including age (37.0 years vs. 41.1 years, p=0.45) and preoperative psychiatric diagnosis (60.0% vs. 36.4%, p=0.28). Patients who underwent a r-MALR had a higher likelihood of postoperative symptom resolution when compared to those who underwent a laparoscopic release at both 1 month (81.8% vs. 20%, p=0.001) and 6 months (54.5% vs. 4%, p=0.001). Post-operative length of stay was lower in the laparoscopic group (median 0 days vs. 1 day, p=0.03), and there were more frequent reports of new post-operative gastrointestinal symptoms after r-MALR (27.3% v. 4.0%, p=0.08).</p><p><strong>Conclusions: </strong>R-MALR was associated with improved symptom resolution at 1-month and 6-months post-operatively when compared to laparoscopic release. r-MALR should be considered for patients who have this challenging disease entity.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147649","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":"Recanalization in Large Diameter Saphenous Veins After Thermal Ablation: A Retrospective Review of Vascular Quality Initiative Data.","authors":"Vivek Pisharody, Jonathan Gunasti, Ines Garcia, Ravi R Rajani, Christopher Ramos, Manuel Garcia-Toca, Jaime Benarroch-Gampel","doi":"10.1016/j.avsg.2025.09.037","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.037","url":null,"abstract":"<p><strong>Introduction: </strong>Endovenous ablation has become the treatment of choice for saphenous venous insufficiency in recent years. There is debate as to whether veins with large diameters are more likely to recanalize. In this study, we explore the relationship between vein diameter and recanalization rates using a nationwide database.</p><p><strong>Methods: </strong>Patients undergoing thermal ablation of the great or small saphenous veins between 2015-2019 were identified from the Vascular Quality Initiative varicose vein module. Demographics, vein diameter, procedure characteristics, and post-operative course were queried from the database. Patients were divided into large (≥10mm) and small diameter vein cohorts. Multivariate logistic regression and Cox proportional hazards models were used to compare outcomes.</p><p><strong>Results: </strong>A total of 16,937 procedures were identified in 13,263 patients. Patients with large veins were more likely to develop hematomas (0.7% vs 0.4%, p=0.0195) or superficial phlebitis (1.5% vs 0.8%, p<0.001). There were no significant differences in rates of other post-operative complications. Post-intervention symptom improvement was greater in patients with large veins (-7.47 vs -7.01 on standardized Heaviness-Achiness-Swelling-Throbbing-Itching scale, p=0.001). On Cox proportional hazards modeling, large veins were not associated with worse recanalization-free survival (OR 0.74, p=0.24).</p><p><strong>Conclusions: </strong>Large vein diameter was not associated with worse recanalization after thermal ablation. Thermal ablation procedures can be considered a first line treatment for managing large veins.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147644","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 Clinical Profile of Thoracic Endovascular Aortic Repair in Blunt Thoracic Aortic Injury: A Systematic Review and Meta-analysis.","authors":"Abdelaziz O Surkhi, Matti Jubouri, Abdullah I Alsarayrah, Yousif F Jubouri, Hani M Akasheh, Rami S N Alaraj, Ahmed Al-Bunnia, Aya F Qaisi, Muhammad Nabil Rajput, Thurkga Moothathamby, Amr Abdelhaliem, Gabriele Piffaretti, Mohamad Bashir","doi":"10.1016/j.avsg.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.036","url":null,"abstract":"<p><strong>Objectives: </strong>Blunt thoracic aortic injury (BTAI) is a critical vascular emergency associated with high mortality rates. Thoracic endovascular aortic repair (TEVAR) is the gold-standard treatment for this condition. This meta-analysis seeks to comprehensively evaluate the clinical profile and outcomes associated with TEVAR in managing BTAI.</p><p><strong>Methods: </strong>A systematic review was undertaken using a rigorous methodology. This involved conducting searches across multiple electronic databases using defined search terms while adhering to stringent pre-established inclusion and exclusion criteria in accordance with the Cochrane Handbook and the PRISMA-2020 guidelines. Proportional meta-analysis was executed using Comprehensive Meta-Analysis software (version 4).</p><p><strong>Results: </strong>A total of 117 studies comprising 29,972 patients were analyzed. The mean age was 42.3 years, with 74.9% being male. The mean Injury Severity Score (ISS) was 35.9, and the distribution of BTAI SVS grades was as follows: Grade 1 at 8%, Grade 2 at 18.1%, Grade 3 at 62.3%, and Grade 4 at 14.9%. The in-hospital and 30-day mortality rate was reported at an aggregated rate of 6.2%. A meta-regression analysis investigating the relationship between mortality and delayed intervention (>24 hours) demonstrated a significant inverse correlation. The incidence of postoperative stroke and endoleak was aggregated at 3.2% and 3%, respectively. Coverage of the left subclavian artery (LSA) was noted in 37.3% of the patients. A sub-analysis was performed to examine the association between BTAI grade and 30-day mortality, which indicated a weak and non-significant correlation (Regression Coefficient: 0.455, P-value=0.2588). Additionally, a meta-regression assessing the relationship between LSA coverage and left arm symptoms did not yield a significant relationship. However, a significant inverse relationship was identified between LSA coverage and stroke incidence.</p><p><strong>Conclusion: </strong>The management of BTAI poses significant challenges due to its associated high morbidity and mortality rates. However, TEVAR has emerged as a safe and effective intervention, yielding favourable outcomes for patients. Early diagnosis and timely referral to trauma centres equipped with TEVAR capabilities are essential to enhance survival rates and overall patient prognosis.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147710","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":"Case series for Transradial Approach in Fistulograms for Arteriovenous Access.","authors":"Rahman Sayed, Agastya Vaidya, Rishab Agarwal Bsba, Yuki M Kanai, Mao Yasuhiru, Neil Patel, Rithva Ramesh, Sameer Ahmad, Jeffrey E Indes, Evan Lipsitz, Paul Lajos","doi":"10.1016/j.avsg.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.032","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional endovascular interventions for arteriovenous (AV) access procedures typically are performed with direct fistula or graft puncture. The transradial approach (TRA) offers both arterial and venous limb visualizations and therapeutic interventions through a single access point. Our objective was to assess clinical success, functional patency, flow rates, and complications in patients undergoing TRA fistulograms.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent TRA fistulograms between 2017 and 2023. Patient demographics, stenotic lesion type, and 3-month postoperative complications were analyzed. Patency and clinical success were assessed by measuring flow rates before the operation and at 1-month, 3-month, and 6-month intervals afterward. Paired t-tests were performed to compare flow rates prior to and after intervention.</p><p><strong>Results: </strong>A total of 255 patients (mean age 61.9 years, 58% male) underwent TRA fistulograms.The predominant lesion types were venous outflow (71%), juxta-anastomotic (8.6%), and mixed between the two (12.2%). The mean preoperative flow rate was 456.5 cc/s, increasing to 751, 878, and 741 after one, three, and six-months, respectively. Flow rates were significantly higher in at the one and three and 6-month intervals (p < 0.05). Technical success was observed in 94.9% of cases and complications included ruptures in 1.6% of cases, access site complications in 3.9% of cases, and AV fistula thrombosis in 6.7% of cases.</p><p><strong>Conclusions: </strong>The TRA for fistulograms offers functional patency rates that show significant improvement in those with malfunctioning AV access while offering minimal complications. This method offers a convenient alternative to traditional access, specifically for venous and juxta-anastomotic lesions through a single puncture.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147643","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":"Neighborhood Socioeconomic Deprivation Does Not Appear to Influence Selection for Lower Extremity Revascularization versus Amputation in Maryland.","authors":"Oluwasegun Akinyemi, Terhas Weldeslase, Eunice Odusanya, Temitope Ogundare, Jermaine Heath, Mallory Williams, Edward Cornwell, Kakra Hughes","doi":"10.1016/j.avsg.2025.09.038","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.038","url":null,"abstract":"<p><strong>Background: </strong>Race/ethnicity, socioeconomic status and insurance status have all been reported to have an effect not only on outcomes, but also on the likelihood of whether patients presenting with Chronic Limb Threatening Ischemia (CLTI) are more likely to undergo revascularization versus amputation. The effect of neighborhood socioeconomic deprivation is increasingly being acknowledged as having a role in these sociodemographic disparities.</p><p><strong>Objective: </strong>This study aimed to determine if neighborhood socioeconomic deprivation, as measured by the Distressed Communities Index (DCI), influences treatment selection by revascularization versus amputation for patients presenting with CLTI in the state of Maryland.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the Maryland State Inpatient Database between January 2018 and December 2020 to assess the association between DCI and the likelihood of revascularization versus amputation for patients presenting with CLTI. Multivariate logistic regression analyses were also used to determine the odds for revascularization versus amputation.</p><p><strong>Results: </strong>There were 4,537 hospitalizations for CLTI. Of these, 3,511 (77.4%) underwent revascularization, while 1,026 (22.6%) underwent major amputation. The median age was 67 years (Interquartile range 59-75) and 38.0% of the patients were female. By race/ethnicity, 56.4% identified as White, 38.5% were Black, 2.7% were Hispanic, and 2.4% identified as Other. We did not identify an association between DCI and the treatment received, i.e., revascularization versus amputation.</p><p><strong>Conclusion: </strong>The DCI was not associated with a likelihood of undergoing revascularization versus amputation for patients presenting with CLTI in this Maryland statewide database.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147731","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 Management of Chronic Mesenteric Ischemia: Technical Success and Long-Term Outcomes Over 10 Years in a UK Tertiary Centre.","authors":"N Kalam-Sakit, I Obaidat, P Neupane, M Khurram Ebir Nazir, K Ali Khan","doi":"10.1016/j.avsg.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.018","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study is to evaluate the immediate technical success, 30-day mortality, and long-term outcomes of mesenteric artery angioplasty and/or stenting performed on patients suffering from symptomatic chronic mesenteric ischemia at a single Tertiary Centre in the UK, over a ten-year period from 2012 to 2022.</p><p><strong>Methods: </strong>This retrospective study involved the collection of data from electronic hospital records. The primary outcomes assessed were early immediate technical success (defined as patent vessels with less than 30% residual stenosis after endovascular management) and (< 30 days) mortality. Secondary outcomes included symptom recurrence following the initial intervention, re-intervention rates within a two-year period, and overall mortality tracked over a ten-year timeframe.</p><p><strong>Results: </strong>A total of fifty-three patients underwent surgical treatment for sixty vessels. The primary outcomes revealed a 30-day mortality rate of 3.7% (2 /53 patients) and an immediate technical success rate of 96.2% (51/53 patients). Secondary outcomes indicated a re-intervention rate at two years of 18.9% (10/53 patients) and a symptom recurrence rate of 11% (6/53 patients) within one year. The mortality rates observed were 15.1% (8/53 patients) at two years and 37.7% (20/53 patients) at ten years. 71.6% (38/53 patients) did not require further revascularisation after two years. Among those who survived beyond one year, 71.6% (38/53 patients) demonstrated successful treatment without the necessity for further revascularization at the two-year mark.</p><p><strong>Conclusion: </strong>Endovascular management of the superior mesenteric artery (SMA) for chronic mesenteric ischemia (CMI) represent a safe therapeutic option, yielding immediate symptom relief. It has good technical success rate, and 30-day mortality is within acceptable range. The observed overall mortality associated with elective CMI procedures in this cohort appears to be more closely linked to general health decline and coexisting cardiovascular morbidities rather than the procedural interventions or mesenteric disease itself. In patients who survived beyond one year, mortality was primarily associated with respiratory ailments or malignancies.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147733","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 Carotid Endarterectomy and Transcarotid Artery Revascularization in High Cervical Lesions.","authors":"Ezra Y Koh, Hanaa Dakour-Aridi, Mackenzie Madison, Arash Keyhani, Kourosh Keyhani, Raghu L Motaganahalli, Andres Fajardo, S Keisin Wang","doi":"10.1016/j.avsg.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.031","url":null,"abstract":"<p><strong>Background: </strong>High cervical carotid lesions increase intraoperative complexity in carotid endarterectomy (CEA) due to the challenge in obtaining a clean distal clamp site. For these cases, transcarotid artery revascularization (TCAR) may offer an alternative. Our aim was to compare outcomes of CEA and TCAR in patients with high cervical lesions.</p><p><strong>Methods: </strong>Demographics and outcomes of CEA and TCAR procedures were retrospectively captured at two high-volume institutions between 2003 and 2023. Patients with high cervical lesions, defined as target clamp sites above the C2 vertebra, were included. Patients were dichotomized according to surgical procedure. Univariate analysis was performed comparing baseline characteristics and outcomes in both groups at an α < 0.05.</p><p><strong>Results: </strong>2,250 patients were reviewed, of which 106 lesions (5%) were classified as above C2, of which 73 (69%) underwent TCAR and 33 (31%) underwent CEA. TCAR patients were more likely symptomatic, whereas CEA patients were more likely to have coronary artery disease. Perioperative (30-day) morbidity was similar (ipsilateral stroke was 2.7% vs. 6.1%, p=0.406, myocardial infarction was 1.4% vs. 0%, p=0.499, cranial nerve injury was 1.4% vs. 6.1%, p=0.406, and mortality was 1.4% vs. 0%, p=0.499). Operative time and estimated blood loss were higher with CEA (72.9 ± 31.8 minutes vs. 132.5 ± 53.2 minutes, p <0.001, and 47.1 ± 57.3 mL vs. 214.2 ± 285.7 mL, p < 0.001).</p><p><strong>Conclusion: </strong>This retrospective study demonstrates similar outcomes between CEA and TCAR. However, TCAR was associated with a shorter operative time, suggesting that this may be an advantageous approach.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147728","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}