Annals of vascular surgery最新文献

{"title":"Development and Characterization of a Large Animal Model for Iliofemoral Deep Vein Thrombosis Secondary to Chronic Iliac Vein Stenosis.","authors":"Xicheng Zhang, Guanqiang Li, Bo Hu, Xianchen Huang, Yuan Sun","doi":"10.1016/j.avsg.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.028","url":null,"abstract":"<p><strong>Objective: </strong>To establish a large animal model of deep venous thrombosis (DVT) secondary to chronic iliac vein stenosis (IVS) that can simulate pathophysiologic processes in humans.</p><p><strong>Methods: </strong>Iliac vein stenosis models with degrees of stenosis of approximately 30%, 50%, 70%, and 90% were developed in 4 groups of 12 adult goats using a novel controllable ligation technique. Four weeks later, the stenotic lesion was evaluated by digital subtraction angiography (DSA) and optical coherence tomography (OCT), after which iliac vein thrombosis adjacent to the stenosis was induced by balloon blockade combined with thrombin injection. Three days after thrombosis, the process of clinical thrombus clearance was simulated by a rheolytic thrombectomy catheter, and the IVS was corrected by balloon angioplasty and stent implantation.</p><p><strong>Results: </strong>After controllable ligation, venography revealed iliac vein stenosis degrees of 31.39±3.09%, 48.95±1.24%, 71.34±5.12%, and 89.78±4.66% in the four groups. After 4 weeks, DSA and OCT showed obvious collateral circulation and intimal hyperplasia around stenotic lesions in Group 3, which was consistent with the secondary pathological changes in IVS in humans. The iliac veins in Groups 1 and 2 remained patent without obvious collateral circulation, while Group 4 showed complete iliac vein occlusion with extensive collaterals. Thrombosis was successfully induced in Groups 1 and 2, but Groups 3 and 4 required repeated thrombin injections and a shortened distance between the two balloons. Clinical thrombus-clearing devices removed most thrombi, and residual stenosis was corrected by balloon angioplasty and stent implantation. OCT confirmed optimal stent apposition.</p><p><strong>Conclusion: </strong>This study developed a caprine model of IVS-related thrombosis, which can facilitate research on the IVS-DVT relationship and the evaluation of thrombectomy devices and specialized stents for IVS.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135985","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 Meta-Analysis of Risk Factors for Restenosis Following Percutaneous Transluminal Angioplasty in Arteriovenous Fistulas of Maintenance Hemodialysis Patients.","authors":"Yi Fan, Xuyang Luo, Xudong Wang, Huan Luo, Jiaojiao Du, Junjie Mou, Liqin Lin, Fei Deng","doi":"10.1016/j.avsg.2025.08.033","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.033","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate risk factors for restenosis after percutaneous transluminal angioplasty (PTA) in arteriovenous fistulas (AVFs) of maintenance hemodialysis (MHD) patients.</p><p><strong>Methods: </strong>This systematic review, prospectively registered on PROSPERO (CRD420250631715), identified studies investigating factors influencing AVF patency after PTA in MHD patients. Databases including PubMed, Embase, CNKI, CBM, and the Chinese Scientific Journal Database were searched from inception to January 2025. Study quality was assessed using the Newcastle-Ottawa Scale (NOS), and meta-analyses were performed using STATA 18.0.</p><p><strong>Results: </strong>Fourteen studies involving 2,257 participants were included in the meta-analysis. The pooled results demonstrated diabetes mellitus (HR=1.18, 95% CI: 1.03∼1.36, P=0.016), upper-arm AVF location (OR=1.67, 95% CI: 1.33∼2.10, P<0.0001), stenosis length >2 cm (OR=1.50, 95% CI: 1.11∼2.02, P=0.008), and multiple stenosis lesions (OR=1.53, 95% CI: 1.24∼1.89, P<0.0001) as significant risk factors for restenosis following PTA in MHD patients.</p><p><strong>Conclusion: </strong>Age, BMI, sex and AVF vintage were not identified as significant risk factors for restenosis. However, diabetes mellitus,upper-arm AVF location, stenosis length >2 cm, and multiple stenosis lesions emerged as statistically significant predictors.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136381","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 Management Strategies for Primary Infected Abdominal Aortic Aneurysm: A Single-Center Retrospective Study.","authors":"Wenxin Zhao, Yixuan Wang, Ning Zhao, Zhiyuan Wu, Yongpeng Diao, Yongjun Li","doi":"10.1016/j.avsg.2025.08.049","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.049","url":null,"abstract":"<p><strong>Objectives: </strong>To summarize the experience of diagnosing and treating of infrarenal infected native abdominal aortic aneurysm (INAA) by reviewing the clinical characteristics, management strategies, and outcomes of patients in a single center.</p><p><strong>Methods: </strong>The clinical data of 17 patients with INAA admitted to the Department of Vascular Surgery, Beijing Hospital from April 2017 to October 2024 were retrospectively analyzed. Patient demographics, comorbidities, postoperative complications, long-term survival, re-intervention rates, treatment approaches, and follow-up outcomes were reviewed and summarized.</p><p><strong>Results: </strong>Of the 17 patients included (94.1% male, mean age 63.4 ± 7.2 years), 52.9% presented with abdominal pain and 58.8% were threatened with aneurysm rupture or fistula formation. Microbial cultures identified Gram-negative bacilli in 82.4% of cases. Four patients received conservative treatment, of whom three died (75%). Thirteen patients underwent surgery: five received open surgical repair (OSR; all survived, 100% survival rate), and eight endovascular aneurysm repairs (EVAR; three died, 62.5% survival rate). The overall mortality rate was 35.3%. The treatment modality may have contributed to the observed differences in survival.</p><p><strong>Conclusions: </strong>Our results suggest that open surgical repair (OSR) may offer favorable outcomes for selected patients with INAA, while EVAR can be considered for high-risk or emergency cases. Individualized treatment strategies, based on multidisciplinary team (MDT) evaluation and patient characteristics, are essential for optimal care. Given the retrospective design, small sample size, and possible selection bias, these findings are preliminary and hypothesis-generating. Further large-scale, prospective studies are needed to confirm the optimal management of INAA.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135964","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":"Conservative treatment has a role in elderly patients with Chronic Limb-Threatening Ischemia, especially in very elderly patients (≥ 85 years).","authors":"Bob T A Schultze, Klaas H J Ultee, Matthijs G Buimer, Hans G W de Groot, Eelco J Veen, Gwan H Ho, Paul G H Mulder, Lijckle van der Laan","doi":"10.1016/j.avsg.2025.09.020","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.020","url":null,"abstract":"<p><strong>Objective: </strong>This study primarily aimed to assess mortality and amputation-free survival in elderly patients with chronic limb-threatening ischemia (CLTI) treated with conservative management, open surgical revascularization (OSR) or endovascular revascularization therapy (ERT). The secondary objective was to identify any risk factors associated with mortality in this cohort and to identify which of the survival-related variables are associated with the decision for conservative treatment.</p><p><strong>Design: </strong>A single-centre retrospective cohort study was conducted to evaluate patients aged ≥65 years diagnosed with CLTI for the first time between 2013 and 2020.</p><p><strong>Methods: </strong>Patient demographics, treatment details and outcomes up to 5 years were collected. Overall survival and amputation-free survival were analysed using Kaplan-Meier estimate curves. The estimated effects on survival and amputation-free survival were assessed with a Cox Proportional Hazards regression model.</p><p><strong>Results: </strong>A total of 743 patients were included. Conservative treatment has a role in elderly patients with CLTI and was frequently initiated (30.1%). Conservative treatment resulted in a 1-year survival of 58% and an amputation-free survival of 54%, and a 5-year survival of 14% and an amputation-free survival of 13%. In patients aged ≥85 years conservative treatment had a 1-year survival of 52%, which was a similar trend to the survival of 51% after ERT. Independent associations with mortality were found for age, preoperative haemoglobin, ASA score, Fontaine classification, femoropopliteal TASC, a history of COPD, cardiac disease and CVA, eGFR and postoperative complications (delirium, pneumonia, AMI).</p><p><strong>Conclusion: </strong>This study showed that conservative treatment should be considered as an appropriate treatment option in frail high-risk elderly patients, particularly those with a predicted survival of less than two years. The findings emphasize the significance of integrating patient specific factors into the process of treatment and shared decision making.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136330","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 Postoperative Stroke and Myocardial Infarction on One-Year Survival Following Carotid Revascularization Using the VQI Database.","authors":"Ahmed Abdelkarim, Mohammed Hamouda, Mohamed Abdalla, Sina Zarrintan, Jesse A Columbo, Mahmoud B Malas","doi":"10.1016/j.avsg.2025.09.014","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postoperative stroke and myocardial infarction (MI) are associated with devastating postoperative morbidity and mortality, therefore limiting the protective effect of carotid revascularization procedures. Moreover, there seems to be a relationship between the severity of stroke and the type of carotid revascularization technique. We aim to investigate the impact of in-hospital stroke or MI on one-year survival following carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), and transcarotid artery revascularization (TCAR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective analysis of patients undergoing CEA, TFCAS, and TCAR in the VQI database (2016-2023). Our primary outcome was one-year mortality in patients who developed in-hospital stroke or MI following carotid revascularization. Kaplan-Meier survival estimate and multivariable Cox regression analysis were applied to calculate hazard ratios (HR) after adjusting for potential confounders. Additionally, we conducted sub-analyses based on patients' symptomatic status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our study included 125,513 (61.8%) CEA, 25,875 (12.8%) TFCAS, and 51,545 (25.4%) TCAR. Compared to patients who did not have a postoperative stroke, the hazard of 1-year mortality was higher for those who did have a stroke following CEA (adjusted hazards ratio [aHR] = 5.9[95%CI:5.1-6.8] P&lt;0.001), TFCAS (aHR=4.2[95%CI:3.7-5.3] P&lt;0.001), and TCAR (aHR=5.2[95%CI:4.1-6.5] P&lt;0.001). The hazards of 1-year mortality after in-hospital MI were also higher following CEA (aHR=3.8[95%CI:3.1- 4.6] P&lt;0.001), TFCAS (aHR=3.5[95%CI:2.3- 5.5] P&lt;0.001), and TCAR (aHR=5.1[95%CI:3.6- 7.2] P&lt;0.001). This trend persisted in sub-analysis based on symptomatic status. At one year, TFCAS showed the lowest survival following an in-hospital stroke or MI. There was no significant difference in one-year mortality among patients who developed in-hospital stroke between TCAR and CEA (aHR=0.93[95%CI:0.73- 1.2] P=0.55). On the other hand, TFCAS was associated with a 50% higher mortality hazard than CEA (aHR=1.5[95%CI:1.1-2.1] P=0.003), and TCAR was associated with a 30% reduction in one-year mortality compared to TFCAS (aHR=0.7[95%CI:0.55-0.94] P=0.015) among patients who developed in-hospital stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This large multicenter study reveals critical insights into the impact of in-hospital major adverse events on one-year survival following carotid revascularization. The analysis indicates a significant increase in the hazard of one-year mortality following in-hospital stroke and MI. In patients who developed in-hospital stroke or MI, there was no significant difference in one-year survival between TCAR and CEA. On the contrary, among patients who developed in-hospital stroke or MI, TFCAS was associated with significantly higher mortality compared to CEA and TCAR. This study highlights the importance of selecting the appropriate revascularization","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145135956","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":"Propensity-matched comparison of proximal versus distal shunt insertion during eversion carotid endarterectomy of the internal carotid artery in symptomatic and asymptomatic patients.","authors":"Aleksandar Dimov, Maximilian Kreibich, Antoan Mihaylov, Andreas Harloff, Davide Turchino, Mario Lescan, Martin Czerny, Sam Brixius, Stoyan Kondov","doi":"10.1016/j.avsg.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.021","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the two intraoperative shunting techniques (proximal vs. distal) during eversion endarterectomy (EEA) of the internal carotid artery (ICA).</p><p><strong>Methods: </strong>All patients operated between January 2011 and December 2022 who received routine shunting of the ICA were enrolled in this retrospective study. Patients undergoing selective shunting, patch angioplasty of the ICA, redo surgeries or surgery performed by a resident were excluded. Intraoperative shunt placement took place after completing the eversion of the ICA. The Patients were divided into two groups based on shunt placement technique: (i) distal shunting, where the shunt was firstly inserted into the ICA and then into the CCA, and (ii) proximal shunting, where the shunt was firstly inserted into the common carotid artery (CCA) and then into the ICA. Propensity score matching was used to compare the two groups. All procedures were performed under general anesthesia, with regional cerebral oxygenation monitoring. The primary endpoint was the incidence of perioperative stroke and in-hospital mortality.</p><p><strong>Results: </strong>A total of 658 thrombendarteriectomies of the ICA using intraoperative shunt were performed during the study period. Proximal shunting was used in n=330 (50.2%) and distal shunting in n=328 (49.8%). Using the Propensity score matching 260 pairs were generated for analysis. The perioperative stroke rate was significantly higher in the proximal shunting group n=13(5%), compared to the distal shunting group n=4 (1.5%), (p<0.05). The overall in-hospital mortality incidence was 0.6% (n=3) (n= 2 in the proximal shunting group and n=1 in the distal shunting group (p=0.99).</p><p><strong>Conclusion: </strong>In the setting of an elective shunting of the ICA during eversion endarterectomy, proximal first placement of the shunt may cause a higher incidence of perioperative stroke compared to distal first placement of the stunt. A distal first shunting strategy seems reasonable when performing EEA surgery to improve patient outcomes.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111863","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 ROLE OF GENDER IN BLUNT THORACIC AORTIC INJURIES.","authors":"Ilenia D'Alessio, Nicola Monzio-Compagnoni, Greta Salinetti, Joseph DuBose, Benjamin W Starnes, Elina Quiroga, Davide Benasconi, Mario D'Oria, Sandro Lepidi, Pierantonio Rimoldi, Valerio Stefano Tolva","doi":"10.1016/j.avsg.2025.09.023","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.023","url":null,"abstract":"<p><strong>Objectives: </strong>Blunt thoracic aortic injuries (BTAIs) are the second leading cause of death in polytrauma patients. The majority of BTAIs occurs in males in the fifth decade, thoracic endovascular aortic repair (TEVAR) is the gold standard for the treatment. The role of gender in the natural history of BTAIs and in perioperative outcomes is still not clear.</p><p><strong>Methods: </strong>A retrospective multicenter cohort study was conducted using dataset of the Aortic Trauma Foundation (ATF) Global Registry. The primary outcome of this study was to determine if gender correlates with a different severity of the aortic injury. The secondary outcome was to determine if gender affects perioperative complications after TEVAR.</p><p><strong>Results: </strong>Within a total of 942 patients enrolled from February 2016 to May 2022, 623 patients met the inclusion criteria. Seventy-seven percent were males (age 44.2±17.9 years). The BTAIs grades according to the Society for Vascular Surgery (SVS) classification was: 158 (25.4%) grade I, 89 (14.3%) grade II, 310 (49.8%) grade III and 66 (10.6%) grade IV. Males showed a higher probability to develop more severe aortic lesions compared to women (OR 1.500 CI95%; p=0.035). TEVAR was performed in 384 patients and results reveal a higher risk of intra and perioperative complications in women, despite no statistical significance was demonstrated (p >0.05).</p><p><strong>Conclusions: </strong>Gender related differences in the natural history of BTAIs and in the outcomes of patients undergoing TEVAR are present. Females show a lower risk of developing more severe aortic injuries, but they seem to develop more intra and perioperative complications when treated with TEVAR.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111866","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 SUITABILITY OF LEFT SUBCLAVIAN ARTERY OFF-THE-SHELF BRANCH GRAFT IN A REAL-WORLD SETTING.","authors":"Comlan Blitti, Julien Die-Loucou, Aline Jazayeri, Olivier Bouchot, Camil-Cassien Bamde, Eric Steinmetz","doi":"10.1016/j.avsg.2025.09.029","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.029","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyze the anatomical suitability of thoracic branch endoprothesis (TBE), an \"off-the-shelf\" stent graft, in routine practice at a tertiary French hospital.</p><p><strong>Methods: </strong>This was a single center, retrospective, cross-sectional study. We included patients who underwent thoracic endovascular aortic repair (TEVAR) in zone 2, or in zone 3 with the lesion located <30 mm from the left subclavian artery (LSA), between 2010 and 2024. The morphological parameters of the aorta were measured, and eligibility for TBE (WL Gore, Phoenix, USA) placement was evaluated according to the manufacturer's instructions for use.</p><p><strong>Results: </strong>From the 210 TEVAR procedures performed during the study period, 97 patients were included. These patients were predominantly male (80.4%), with a median age of 61 years (IQR: 44.0-73.0). Emergency TEVAR was performed in 79.4% of cases. TBE placement was anatomically suitable in 82.5% (80/97) of included cases and in 38.1% (80/210) of all TEVAR procedures. The most frequent cause of anatomical unsuitability was proximal segment length (distance between the distal edge of the LSA and the mid-point of the ostium of the left common carotid artery <20 mm) in 9.3% of cases. Although the aortic and LSA diameters were smaller in patients treated for blunt traumatic thoracic aortic injury, the rate of unsuitability of TBE placement due to anatomical characteristics was similar whatever the underlying disease.</p><p><strong>Conclusions: </strong>This eligibility study highlights the interest of TBE endografts for the management of thoracic aortic lesions, demonstrating their suitability in a wide range of clinical settings. The clinical relevance of this endograft remains to be determined.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111763","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":"Atrial Fibrillation Elevates Stroke, Bleeding, and Cost in U.S. Aortic Aneurysm Admissions: Insights from the National Inpatient Sample.","authors":"Ali Salman, Areeka Irfan, Mariam Shahabi, Muteia Shakoor, Mohammad Ismail Asim, Areeba Gul, Ali Roomi Khuwaja, Muhammad Usman Baig, Shahzeb Arif Khatri, Fakiha Hussain, Muhammad Talha Maniya, Muhammad Shikaib Shabbir, Ahmed Ali Aziz","doi":"10.1016/j.avsg.2025.09.015","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.015","url":null,"abstract":"<p><strong>Background: </strong>Aortic aneurysm (AA) and atrial fibrillation (AF) frequently coexist, with emerging evidence suggesting that such patients exhibit an elevated cardiovascular risk profile. However, the impact of preexisting AF on in-hospital outcomes among patients hospitalized for AA remains poorly characterized.</p><p><strong>Methods: </strong>We analyzed data from the National Inpatient Sample (2018-2020) to identify adult hospitalizations with a primary diagnosis of AA. Patients were stratified by the presence or absence of AF. Multivariable logistic and linear regression were used to assess the association of AF with in-hospital mortality, complications, length of stay (LOS), and inflation-adjusted total hospital charges.</p><p><strong>Results: </strong>Among 147,420 weighted AA hospitalizations (mean age: 70 ±12 years), 39,030 (19.5%) had concomitant AF. After multivariable adjustment, AF was not significantly associated with in-hospital mortality (OR: 1.07 [0.90, 1.27], p=0.46). However, patients with AF had a longer median LOS (5 vs. 2 days; p<0.001) and incurred higher total charges ($160,363 vs. $129,647; p<0.001). AF was independently associated with increased odds of ischemic stroke (OR: 1.85 [1.36, 2.51], p<0.001), transient ischemic attack (OR: 1.96 [1.01, 3.80], p=0.047), acute myocardial infarction (OR: 1.58 [1.23, 2.04], p<0.001), and major (OR: 1.21 [1.01, 1.45], p=0.035) and transfusion-requiring bleeding (OR: 1.90 [1.04, 3.47], p=0.035).</p><p><strong>Conclusion: </strong>Although AF was not associated with in-hospital mortality among patients admitted for AA, it was linked to a significantly higher risk of bleeding complications, prolonged hospitalization, and greater healthcare expenditures.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111884","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 Surgical Site Infections and Antibiotic Prophylaxis During Arteriovenous Hemodialysis Access Creation.","authors":"Joanna Curry, Christian de Virgilio, Ramsey Ugarte, Kyle Wright, Maria Valadez, Mark Archie","doi":"10.1016/j.avsg.2025.09.026","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.026","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic prophylaxis is recommended in vascular surgery procedures, especially when implanting prosthetic materials. However, there is a paucity of data regarding their usage or efficacy for hemodialysis (HD) access procedures, especially when an arteriovenous fistula (AVF) is planned.</p><p><strong>Methods: </strong>A retrospective review of consecutive patients undergoing AVF for HD access between 2014 and 2019 was conducted from five safety net hospitals within the Los Angeles County Department of Health Services system. The primary endpoint was surgical site infection (SSI) at 30 days. The secondary endpoint was the usage of antibiotics and variability by surgeon and hospital.</p><p><strong>Results: </strong>There were a total of 1,404 patients, of which 1,198 (85.3%) patients received antibiotic prophylaxis. The proportion of patients receiving antibiotics decreased from 94.8% to 82.9% over the study period (nptrend<0.02). Hospital specific rates of prophylactic antibiotic use varied significantly from 77.0% to 99.2% (p<0.001). Further, there was significant variation in rates of perioperative antibiotics utilization by surgeon, ranging from 0% to 100% (mean: 84.4%, p<0.001). There was no statistically significant difference in age (p=0.119), sex (p=0.211), and BMI (p=0.888) for patients who received antibiotics and those who did not. The overall rate of SSI at 30 days was 1.1% (n=15), with no difference for patients who received antibiotic prophylaxis and those who did not (n=12, 1.0% vs. n=3, 1.5%, p=0.55).</p><p><strong>Conclusion: </strong>The present analysis identified hospital and surgeon level variability in the use of prophylactic antibiotics. Prophylactic antibiotics were no associated with a significant reduction in SSI rates.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102525","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}