Annals of vascular surgery最新文献

{"title":"Inflammatory biomarker-based risk prediction model for endovascular reconstruction in acute limb ischemia: A multicenter development and validation study.","authors":"Sai Xiang, KaiPing Lu, Zhi Yu, Tao Jin, Xiaodong Wang","doi":"10.1016/j.avsg.2025.06.049","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.06.049","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory markers are associated with poor prognosis of peripheral vascular diseases. We aim to determine the relationship between inflammatory markers and the prognosis of acute lower limb ischemic disease and to construct and verify a prognostic model based on inflammatory indicators.</p><p><strong>Methods: </strong>We evaluated 295 patients with a diagnosis of acute lower limb ischemia (ALI) from multiple centers between 2020 and 2023.The association between baseline disease characteristics with length of stay and half-year cut-off results were determined using SPSS software and R language, respectively. We identified predictive factors and built a nomogram to predict 30-day amputation rate in patients with ALI after endovascular surgery.</p><p><strong>Results: </strong>In the training cohort, 34 patients underwent amputation within 30-day after endovascular surgery. Atrial fibrillation, diabetes, Rutherford grade IIb, higher neutrophil-to-lymphocyte ratio (NLR), higher platelet-to-lymphocyte ratio (PLR), lower hemoglobin (Hb), higher low-density lipoprotein (LDL), and higher triglycerides (TG) were independently associated with 30-day amputation. Pre-operative NLR, PLR and LDL presented a good discriminative ability (NLR: AUC=0.927; PLR: AUC=0.839; LDL: AUC=0.724). Five independent risk factors, diabetes, Rutherford grade, NLR, PLR, LDL, were screened from the results of the multivariate logistic analysis of the training cohort and included in the nomogram. The calibration curve also proved that the nomogram predicted outcomes were close to the ideal curve and the decision curve analysis (DCA) curve showed that all patients could benefit with threshold probability within 0-95%.</p><p><strong>Conclusions: </strong>A nomogram for postoperative endovascular reconstruction of ALI was constructed with good predictive performance, which can be used as an auxiliary diagnosis of the potential risk factors and assist surgeon in making a personalized diagnosis and treatment for patients.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615953","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 Pedal Acceleration Time for the Assessment of Perfusion in Patients with Chronic Limb Threatening Ischemia.","authors":"Guistinna Tun, Curtis Woodford, Colleen Flanagan, Peter A Schneider, Michael S Conte, Clara M Gomez-Sanchez","doi":"10.1016/j.avsg.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.014","url":null,"abstract":"<p><strong>Objective: </strong>Accurate hemodynamic assessment of perfusion is critical in managing patients with chronic limb threatening ischemia (CLTI). Traditional methods such as ankle-brachial index (ABI) and toe pressures (TP) may be inadequate due to arterial calcification and toe amputations. Pedal acceleration time (PAT), a novel technique, aims to address these limitations. The objective of this study was to further validate this technique.</p><p><strong>Methods: </strong>A retrospective review was conducted in patients with CLTI who underwent PAT measurement during clinical evaluations. PAT measurements were correlated with ABI, TP, pedal calcification, limb staging (WIfI), and major amputation. Correlations were compared between highest, lowest, and average PAT values, as well as occlusive and angiosomal patterns to identify predictive thresholds.</p><p><strong>Results: </strong>41 patients with 51 limbs were included. Highest PAT positively correlated with WIfI wound grade (p=0.04). Additionally, highest and average PAT values demonstrated significant correlations with ischemia grade based on TP (p<0.001 for both). Lowest also correlated with TP but less strongly. Incompressible ankle pressures were present in 61% of patients; highest PAT did not correlate with ABI (p=0.08). Average PAT was higher in the dorsal metatarsal and medial plantar arteries of patients with hallux or 2^nd digit wounds (p=0.04) and arcuate and deep plantar arteries of patients with digits 3-5 wounds (p=0.02) compared to those without wounds in the respective angiosomes.</p><p><strong>Conclusions: </strong>PAT is a valuable adjunct for assessing perfusion in patients with calcified, incompressible ankle vessels, particularly when TP is unavailable. Highest and average PAT values are the most predictive of ischemia severity, and PAT measurements correlate anatomically with wound location.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616029","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":"Revisiting the Gold Standard: Supera Stent Performance in Common Femoral Artery Lesions, Medium-to Long-Term Results","authors":"Mohammed Al-Nejar,&nbsp;Carmen Schoonjans,&nbsp;Karen Wustenberghs,&nbsp;Benoit Thomas,&nbsp;Roderik Deleersnijder","doi":"10.1016/j.avsg.2025.07.015","DOIUrl":"10.1016/j.avsg.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, disease of the common femoral artery (CFA) has been treated with open endarterectomy. However, advances in endovascular techniques—particularly with the Supera stent (Abbott Vascular Inc. CA, USA), a flexible, fracture-resistant nitinol device—offer a less invasive alternative.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 33 patients treated with Supera stenting for symptomatic CFA disease at 3 institutions between January 2021 and June 2023. Patient characteristics, procedural details, and clinical outcomes were reviewed. Primary endpoints included stent patency at 1, 2, and 3 years; need for reintervention, amputation, or mortality.</div></div><div><h3>Results</h3><div>Most patients (88%) presented with intermittent claudication; the remainder had critical limb ischemia. Stent deployment was successful in all patients; most procedures were performed via a crossover approach. At 1, 2, and 3 years, primary patency rates were 88%, 83%, and 79%, respectively. Accounting for successful interventions in cases of restenosis, primary-assisted patency reached 100% at 3 years among patients with full follow-up. No amputations or device failures were observed.</div></div><div><h3>Conclusion</h3><div>Supera stenting appears to be a safe, effective alternative to open surgery for CFA disease. While open surgery remains the gold standard, we believe Supera stenting should be considered more routinely, especially in patients at increased surgical risk, pending further evidence from ongoing randomized trials.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"120 ","pages":"Pages 302-308"},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615958","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":"Osteosarcopenia-aneurysm score predicts long-term survival following endovascular repair for abdominal aortic aneurysm.","authors":"Hirotsugu Ozawa, Takao Ohki, Kota Shukuzawa, Soichiro Fukushima, Eisaku Ito, Koki Nakamura","doi":"10.1016/j.avsg.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.012","url":null,"abstract":"<p><strong>Introduction: </strong>Estimated prognosis plays an important role in the operative decision-making process in the management of abdominal aortic aneurysms (AAAs). We aimed to develop a composite score to predict overall survival following endovascular aneurysm repair (EVAR) for AAAs based on bone mineral density (BMD) and psoas muscle index (PMI).</p><p><strong>Methods: </strong>This was a single-center, retrospective cohort study of 237 patients undergoing primary EVAR for AAA between 2016 and 2019. BMD was assessed by measuring the Hounsfield units (HUs) of the 11th thoracic vertebra on preoperative computed tomography; a BMD value of <110 HU was considered osteoporosis. The PMI was used in the diagnosis of sarcopenia.</p><p><strong>Results: </strong>A multivariable analysis showed that age (hazard ratio [HR], 1.07, 95% confidence interval [CI], 1.04-1.11; P < 0.001), aneurysm diameter (HR, 1.05, 95% CI, 1.02-1.08; P = 0.001), osteoporosis (HR, 1.69, 95% CI, 1.12-2.55; P = 0.013), and sarcopenia (HR, 2.20, 95% CI, 1.34-3.60; P = 0.002) were found to be independent risk factors for all-cause mortality. Osteosarcopenia-aneurysm score (OSAS) was defined as the sum of the following factors: elderly (≥ 80 years), large aneurysm (≥ 55 mm), osteoporosis, and sarcopenia. In a receiver-operating characteristic analysis in predicting of 5-year mortality, the area under the curve (AUC) for the OSAS was comparable to that for the Glasgow Aneurysm Score (GAS) (AUC for OSAS: 0.75, 95% CI, 0.69-0.82 vs. AUC for GAS: 0.74, 95% CI, 0.67-0.81; P = 0.69).</p><p><strong>Conclusion: </strong>We believe that the OSAS is applicable to predict long-term survival following EVAR.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615955","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":"Paraplegia events and follow-up results after thoracic endovascular aortic repair.","authors":"Zhenchun Ji, Chengkai Su, Biwen Yang, Yunsheng Yu, Wenxue Ye, Yihuan Chen, Haoyue Huang, Zhenya Shen","doi":"10.1016/j.avsg.2025.06.039","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.06.039","url":null,"abstract":"<p><strong>Objective: </strong>To retrospectively investigate the clinical characteristics, risk factors, and prognosis of paraplegia complications after thoracic endovascular aortic repair (TEVAR).</p><p><strong>Methods: </strong>A total of 420 patients with Stanford type B acute aortic dissection who underwent TEVAR between December 2015 and December 2020 were divided into a non-paraplegic (403 patients) or paraplegic group (17 patients) according to the presence or absence of paraplegia. Logistic regression analysis was used to identify the risk factors for paraplegia. The patients were followed up for a median of 38 months (interquartile range[IQR]: 24-50 months), and the clinical outcomes of the patients in the two groups were assessed. The primary endpoint was death from any cause. The Kaplan-Meier estimation was applied to determine the time to the primary endpoint, while the log-rank test was employed to compare group survival rates. Additionally, Cox regression analysis was used to detect the factors influencing the survival rate of the two groups.</p><p><strong>Results: </strong>The overall incidence of paraplegia after TEVAR was 4.05% (17/420 patients). The paraplegic and non-paraplegic groups were significantly different in terms of hypertension, false lumen thrombosis, perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (p < 0.1). One-way logistic regression analysis of these factors showed that hypertension, false lumen thrombosis,perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were significant risk factors for paraplegia (p < 0.1). Further, multivariate logistic regression analysis demonstrated significant differences in perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis (P < 0.01). The Kaplan-Meier curves revealed significant differences in all-cause mortality between the paraplegic and non-paraplegic groups (hazard ratio [HR], 11.57; 95% confidence interval [CI], 2.58-51.76; P = 0.00). Moreover, Cox regression analysis indicated that paraplegia was an independent risk factor for all-cause mortality after TEVAR (HR, 3.05; 95% CI, 1.20-7.79; P= 0.01).</p><p><strong>Conclusion: </strong>The overall incidence of concomitant paraplegia after TEVAR was 4.05%. Perioperative hypotension, distance from the stent end to the ostia of celiac axis, and the rate of distal true lumen stenosis were independent risk factors for the postoperative occurrence of paraplegia. During a median follow-up of 38 months, a significant difference in survival rate was found between the patients in the paraplegic and non-paraplegic groups. Furthermore, paraplegia was an independent risk factor for all-cause mortality in patients after endovascular aortic repair.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of an Office Based Interventional Lab on Resident and Fellow Training at a University Vascular Surgery Program.","authors":"William Duong, Jesus Ulloa, Juan Carlos Jimenez, Karen Woo, John Rollo, Steven Farley, David Rigberg, Jessica O'Connell, Brian DeRubertis, Vincent Rowe, Hugh Gelabert","doi":"10.1016/j.avsg.2025.06.047","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.06.047","url":null,"abstract":"<p><strong>Objective: </strong>Office-based interventional labs (OBLs) are a well-established site for vascular procedures in vascular surgical practices. Safe and effective performance of interventions in this setting requires careful patient selection and methodology specific to this particular practice environment. Most university-based vascular surgery training programs do not offer an OBL training experience as part of their educational curriculum. Our study goal was to describe the impact of an OBL experience on the case volume and training environment of vascular surgery trainees at an academic vascular surgery program.</p><p><strong>Methods: </strong>Resident training logs were reviewed from 2004 to 2023. Two 10-year time periods were compared: before the OBL was established (Period 1, from 2004-2013) and after the OBL (Period 2, from 2014-2023). A registry of cases performed in our OBL with trainee involvement were reviewed for number and types of cases and then compared to self-reported training logs.</p><p><strong>Results: </strong>Over the 20-year study period, a total of 44,816 open and endovascular resident training vascular cases were logged, with 17,431 in Period 1 and 27,385 in Period 2. This represented a 57% increase in cases (p=0.02). Trainees logged a total of 17,930 endovascular cases, with 7,039 cases in Period 1 and 10,891 cases in Period 2. This represented an increase of 55% (p=0.03). Trainees logged an average of 476 cases per trainee over the entire study, with an average of 444 cases in Period 1 and an average of 496 in Period 2 (p>0.05). Overall endovascular cases represented 40% of total cases, of which 16% were performed in the OBL. Out of 1,892 total OBL cases, only 4 (0.21%) emergency transfers to the main hospital were required.</p><p><strong>Conclusion: </strong>The establishment of an OBL within an academic vascular surgery program was associated with an 57% increase in overall trainee case volume from Period 1 to Period 2. This increased case volume allowed for expansion of our training program without compromising case volume. Trainees learned the elements of an OBL in clinical practice. Clinical experience in an OBL as part of vascular surgery training offers experience absent from most traditional educational paradigms and is directly applicable to modern vascular surgery practice.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615979","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":"Anatomical factors influencing catheterization time in FEVAR procedures (KT-FEVAR study).","authors":"Thibaud Hamelin, Cindy Vannier, Jade Hollier-Ben Turkia, Remy Pascot, Antoine Lucas, Adrien Kaladji","doi":"10.1016/j.avsg.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.002","url":null,"abstract":"<p><strong>Introduction: </strong>Catheterization of the target vessel (TV) during fenestrated endovascular aortic repair (FEVAR) can be challenging and contributes to significant radiation exposure and procedural time. The objective of this study was to investigate the link between the anatomical features of the TVs on CT-scan and procedural time.</p><p><strong>Materiel and method: </strong>This prospective single-center study included patients who underwent FEVAR procedure between May 2020 and April 2022. Patients with branched, mixed (branched and fenestrated), off-the-shelf, or brachial access were excluded. Variables measured on CT-scan (EndoSize, Therenva Inc.) included, for each TV, its diameter, aortic diameter at the TV level, angulations with the aorta, and degree of ostial stenosis (>50%). The catheterization method was the same for all patients: femoral approach, short then long sheath, use of a catheter (no steerable sheath), and a soft then stiff guidewire. Catheterization time was defined as the fluoroscopy time from insertion of the soft guidewire in the short sheath until the placement of the non-expanded covered stent protected by the introducer. Each anatomical parameter was then correlated with this time interval using both uni- and multivariate analyses.</p><p><strong>Results: </strong>40 patients were included, and 132 TVs were catheterized. All procedures were guided by image fusion. The median catheterization time for renal arteries was 7±6.9 minutes, 4.5±3.1 minutes for the superior mesenteric artery, and 13±13.9 minutes for the celiac trunk (CT). There were 16% of TV with ostial stenosis . Of the 24 stented CTs, 5 had an arcuate ligament. The two variables significantly correlated with catheterization time in univariate analysis were the angulation of the TV (the more the artery is oriented downwards, the longer the time, p=0.01) and the presence of ostial stenosis in the TV (p<0.0001). In multivariate analysis, these two parameters remained significantly correlated (p=0.04 for angulation and p=0.0001 for the presence of ostial stenosis).</p><p><strong>Conclusion: </strong>The presence of ostial stenosis and/or a very downward orientation of the TVs are independently correlated with catheterization time and should be considered when planning FEVAR procedures, either by proposing a brachial approach or using a steerable sheath.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615976","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":"Survival Benefit of Deceased Donor Kidney Transplantation among Patients with Peripheral Artery Disease.","authors":"Li Ting Tan, Amber B Kernodle, Sile Yu, Katherine McDermott, Midori White, Courtenay M Holscher, Ying Wei Lum, Dorry L Segev, Allan B Massie, Elizabeth A King, James H Black, Caitlin W Hicks","doi":"10.1016/j.avsg.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.07.010","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral artery disease (PAD) is a common comorbidity among patients waitlisted for deceased donor kidney transplant (DDKT). However, some centers consider PAD a contraindication for transplant given the higher risk of post-operative complications. We aimed to examine the survival benefit of DDKT among patients with and without PAD.</p><p><strong>Methods: </strong>We used data from the Scientific Registry of Transplant Recipients (SRTR) from January 2003 to December 2022 to identify all DDK waitlist candidates. Kaplan-Meier survival estimates and multivariable Cox proportional hazards models were used to compare patient mortality for those who received a DDKT versus those remaining on the waitlist, stratified by PAD status.</p><p><strong>Results: </strong>506,785 candidates were listed for adult kidney-only transplant during the study period, of which 8.7% had PAD and 36.0% received a DDKT. After a median follow-up time of 3.21 years from waitlist activation [interquartile range 1.11-7.03 years], mortality varied significantly according to DDKT and PAD status. After adjusting for baseline differences, DDKT was associated with a significantly lower hazard of death compared to remaining on the waitlist, regardless of PAD status [adjusted hazards ratio (aHR) 0.45-0.60, P<0.001]. Further stratifying by sex, race and ethnicity, and diabetes status did not substantially alter these results.</p><p><strong>Conclusion: </strong>PAD includes a spectrum of diseases with varying mortality risks. As captured and dichotomized in the SRTR database, DDKT conferred a similar long-term benefit relative to remaining on the waitlist for candidates with and without PAD. Therefore, PAD should not be an absolute contraindication to DDKT.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616028","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":"Factors Affecting the Decrease in Psoas Muscle Area 1 Year After Thoracic Aortic Replacement in Older Patients","authors":"Naoya Araki,&nbsp;Kosuke Nakata,&nbsp;Takafumi Hirota,&nbsp;Hideaki Hidaka,&nbsp;Tatsuya Horibe,&nbsp;Jun Takaki,&nbsp;Takashi Yoshinaga,&nbsp;Toshihiro Fukui","doi":"10.1016/j.avsg.2025.06.042","DOIUrl":"10.1016/j.avsg.2025.06.042","url":null,"abstract":"<div><h3>Background</h3><div>To investigate the rate of change in the psoas muscle area (PMA) from the preoperative period to 1 year postoperatively in patients aged ≥65 years undergoing elective thoracic aortic replacement and identify factors influencing PMA decrease at 1 year.</div></div><div><h3>Methods</h3><div>In this single-center retrospective study, PMA was measured in 73 patients (median age, 75 years; 25 women) preoperatively and 1 year postoperatively. Factors affecting PMA decreased after thoracic aortic replacement were identified using univariate and multivariate analyses. Patients were divided into 2 groups based on whether their PMA had decreased 1 year after thoracic aortic replacement compared to the preoperative value.</div></div><div><h3>Results</h3><div>The decrease and nondecrease groups comprised 38 and 35 patients, respectively. From the univariate logistic regression analysis results, male sex (<em>P</em> = 0.004), preoperative body mass index (BMI) (<em>P</em> = 0.020), and failure of postoperative 6-min walk distance (6 MWD) to recover to the preoperative value (<em>P</em> = 0.012) were selected for the multivariate analysis. Multivariate logistic regression analysis identified male sex (odds ratio (OR) = 5.019, 95% confidence interval (CI) = 1.527–16.499, <em>P</em> = 0.008), preoperative BMI (OR = 1.190, 95% CI = 1.004–1.410, <em>P</em> = 0.045), and failure of postoperative 6 MWD to recover to the preoperative value (OR = 9.617, 95% CI = 1.590–58.152, <em>P</em> = 0.014) as independent predictors of PMA decrease.</div></div><div><h3>Conclusion</h3><div>Male sex, preoperative BMI, and failure of postoperative 6 MWD to recover to the preoperative value were independent factors influencing the decrease in PMA 1 year after thoracic aortic replacement.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 333-342"},"PeriodicalIF":1.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615978","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":"Preliminary Experience of Protocol for Digital Subtraction Angiography Using Diluted Contrast Medium during Endovascular Aneurysm Repair","authors":"Ayaka Yu ,&nbsp;Naoki Fujimura ,&nbsp;Kyosuke Hosokawa ,&nbsp;Takahiro Shoji ,&nbsp;Kenji Suzuki ,&nbsp;Kentaro Matsubara ,&nbsp;Hirohisa Harada","doi":"10.1016/j.avsg.2025.06.038","DOIUrl":"10.1016/j.avsg.2025.06.038","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the efficacy of digital subtraction angiography (DSA) using low-concentration contrast medium (LC-DSA) during endovascular aneurysm repair (EVAR).</div></div><div><h3>Methods</h3><div>An LC-DSA protocol for EVAR using the Infinix Celeve-i angiography system (Canon Medical Systems Corporation, Tochigi, Japan) was developed through an ex vivo experiment. Seventeen patients undergoing EVAR using the LC-DSA protocol between October 2018 and November 2019 were prospectively analyzed. A historical cohort that underwent EVAR using a normal contrast medium between November 2017 and May 2018 was included as the control group (<em>n</em> = 11).</div></div><div><h3>Results</h3><div>Contrast medium use was significantly lower in the LC-DSA group (15.8 mL vs. 64.6 mL, <em>P</em> &lt; 0.001). There were no significant differences between the groups in clinical outcomes, including technical success (<em>P</em> = 0.44) and perioperative complications (<em>P</em> = 0.35). However, the quality of the DSA image was significantly inferior in the LC-DSA group (contrast noise ratio; 35.2 vs. 53.8, <em>P</em> = 0.01), and the radiation dose was significantly higher in the LC-DSA group (1290.0 mGy vs. 393.7 mGy, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>The LC-DSA protocol for EVAR can reduce the amount of contrast medium used without affecting the clinical outcomes. However, this is associated with inferior image quality and a significant increase in radiation exposure, warranting further improvements.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"120 ","pages":"Pages 311-319"},"PeriodicalIF":1.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615957","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}