Annals of vascular surgery最新文献

{"title":"Mid-Term Outcomes of Percutaneous Decannulation for Venoarterial Extracorporeal Membrane Oxygenation Weaning: A Single-Centre Experience.","authors":"Dushan Miladinovic, Luca Borruso, Kiana Chan, David A Robinson, Timothy Shiraev","doi":"10.1016/j.avsg.2026.09.051","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.051","url":null,"abstract":"<p><strong>Objective: </strong>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an established therapy for severe cardiac failure, but femoral decannulation remains associated with significant morbidity. Percutaneous decannulation has emerged as an alternative to surgical cutdown; however, published experience remains limited. This study evaluates a fully percutaneous VA-ECMO decannulation strategy using the Abbott ProStyle vascular closure device compared with open surgical cutdown.</p><p><strong>Methods: </strong>A retrospective single-centre matched cohort study identified all patients undergoing intended percutaneous VA-ECMO decannulation between November 2023 and January 2026 and matched them to a surgical cutdown cohort according to age and sex. Outcomes were assessed by intention-to-treat, with technically successful cases evaluated secondarily.</p><p><strong>Results: </strong>Twenty-eight patients underwent intended percutaneous VA-ECMO decannulation. Technical success was achieved in 82% (n = 23), with five conversions to open cutdown. On intention-to-treat analysis, procedural duration was shorter (94.1 ± 26.3 vs 121.7 ± 46.9 minutes, p = .063) and groin wound complications were less frequent (7.1% vs 25.0%, p = .077), although neither reached statistical significance. Among technically successful percutaneous decannulations, procedural duration was significantly shorter (88.0 ± 28.7 vs 120.8 ± 50.0 minutes, p = .020) and groin wound complications significantly lower (4.3% vs 30.4%, p = .047). Survival to discharge was similar between groups (p = .78).</p><p><strong>Conclusion: </strong>Percutaneous VA-ECMO decannulation achieved 82% technical success, with numerically shorter procedural duration and fewer groin wound complications on intention-to-treat analysis. Among technically successful cases, both outcomes were significantly improved compared with surgical cutdown.</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":"149179118","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":"Preoperative white matter lesions and functional recovery after revascularization for chronic limb-threatening ischemia.","authors":"Tsutomu Doita, Shinsuke Kikuchi, Eijiro Hikasa, Hirofumi Jinno, Naoya Kuriyama, Kazuki Takahashi, Seima Ohira, Keisuke Kamada, Mio Shikota, Nanami Hosoya, Keisuke Miyake, Shigeru Miyagawa, Tetsuo Ota, Nobuyoshi Azuma","doi":"10.1016/j.avsg.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.10.004","url":null,"abstract":"<p><strong>Objective: </strong>Restoring ambulation is an important goal of revascularization for chronic limb-threatening ischemia (CLTI), but predictors of functional recovery remain limited. We investigated whether preoperative white matter lesion (WML) burden was associated with ambulatory recovery after revascularization.</p><p><strong>Methods: </strong>This single-center retrospective cohort included 196 patients with CLTI, tissue loss, Wound, Ischemia, and foot Infection (WIfI) ischemia grade 2 or 3, and brain magnetic resonance imaging (MRI) within 3 months before revascularization. Preoperative brain MRI was routinely obtained in patients considered for open surgical revascularization for cerebrovascular risk assessment. Periventricular and deep subcortical white matter hyperintensities were graded using the Fazekas scale; a total score of 3 or greater defined high-grade WML burden. The primary outcome was achievement of a Functional Ambulation Category score of 3 or greater within 180 days. Associations were evaluated using multivariable Cox models.</p><p><strong>Results: </strong>High-grade WML burden was present in 120 patients. Six-month ambulatory recovery was lower in the high-grade group than in the low-grade group (63.1% vs 82.4%; P = .019). High-grade WML burden was independently associated with slower ambulatory recovery (adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.43-0.96; P = .032) and delayed final discharge (adjusted HR, 0.63; 95% CI, 0.43-0.92; P = .017), but not with wound healing or wound-free functional limb achievement.</p><p><strong>Conclusions: </strong>High-grade WML burden was associated with impaired ambulatory recovery and delayed discharge after CLTI revascularization. When preoperative brain MRI is available, WML assessment may complement limb staging and help anticipate rehabilitation and discharge needs.</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":"149179197","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 variations of the circumflex femoral arteries: a systematic review and meta-analysis of their prevalence and new classification of risk for surgical management.","authors":"Juan José Valenzuela-Fuenzalida, Fernanda Danés-López, Anggie Ortiz Domínguez, Víctor Bastías Monsalve, Cristóbal Díaz-Palominos, Jessica Paola Loaiza-Giraldo, Mathias Orellana-Donoso, Andrés Sebastián Riveros, María Paz Moya Daza, Gloria Cifuentes-Suazo, Glen James Paton, María Piagkou, George Triantafyllou, Marko Konschake, Shahed Nalla, Juan Sanchis-Gimeno","doi":"10.1016/j.avsg.2026.09.059","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.059","url":null,"abstract":"<p><strong>Background and introduction: </strong>The femoral circumflex arteries (FCAs), arising from the femoral and profunda femoris arterial system, exhibit substantial anatomical variability and are clinically relevant due to their role in supplying the femoral head and proximal thigh musculature. These variations may affect surgical, vascular, reconstructive, and anaesthetic procedures in the femoral region. The objective of this study is to systematically evaluate the prevalence of FCA anatomical variants, characterize their patterns, and assess their clinical and surgical implications.</p><p><strong>Methods: </strong>A systematic search was performed across PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS up to July 2025. Studies describing morphological or branching variants of the medial or lateral FCA were included. Methodological quality was assessed using the Anatomical Quality Assurance (AQUA) tool. A random-effects model estimated pooled prevalences and subgroup differences. Thirty-six studies met the eligibility criteria, of which twenty-nine contributed data to the quantitative meta-analysis.</p><p><strong>Results: </strong>The global pooled prevalence of FCA variations was 56% (95% CI: 46%-66%) with high heterogeneity (I² = 99.5%). No significant laterality predominance was observed. Regional subgroup analysis demonstrated higher prevalence in European populations (33%, 95% CI: 25%-42%) relative to Asian populations (28%, 95% CI: 20%-36%). Sex-specific analysis showed a greater prevalence in females (72%, 95% CI: 59%-84%) than in males (42%, 95% CI: 29%-54%). Variations primarily involved origin, branching pattern, and course of the FCAs.</p><p><strong>Conclusions: </strong>Anatomical variations of the femoral circumflex arteries (FCA) are common and exhibit significant geographic and sexual variability. Based on this, we have proposed a classification of the probability of iatrogenic injury according to FCA variant and its relationship to the main surgical approaches to the hip.</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":"149179124","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":"Laparoscopic Left Renal Vein Transposition for Nutcracker Syndrome: A Single-Center Case Series.","authors":"Paulina Mizera, Jacek Cywiński, Michał Pająk, Mirosław Stelągowski, Zbigniew Pasieka, Mateusz Jęckowski","doi":"10.1016/j.avsg.2026.09.052","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.052","url":null,"abstract":"<p><strong>Background: </strong>Nutcracker syndrome is a rare vascular compression disorder caused by entrapment of the left renal vein, most commonly between the aorta and the superior mesenteric artery. Surgical treatment is reserved for patients with persistent and debilitating symptoms; however, evidence regarding minimally invasive approaches remains limited. This study aimed to evaluate the outcomes of laparoscopic left renal vein transposition in patients with symptomatic nutcracker syndrome.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of nine consecutive patients who underwent laparoscopic left renal vein transposition for symptomatic nutcracker syndrome between 2019 and 2024 at a single tertiary vascular center. Diagnosis was established using contrast-enhanced computed tomography demonstrating significant left renal vein compression. Perioperative outcomes, complications, length of hospital stay, and clinical symptom resolution during follow-up were assessed.</p><p><strong>Results: </strong>The study group included seven women (77.8%) and two men (22.2%), aged 20-52 years. The most common presenting symptom was left flank or lumbar pain. All procedures were completed laparoscopically without conversion to open surgery. Operative time ranged from 180 to 375 minutes, with a median hospital stay of 4 days. One patient experienced major perioperative bleeding requiring transfusion and pleural drainage (Clavien-Dindo IIIb). Most patients achieved complete or substantial symptom relief during follow-up. One patient developed late anastomotic occlusion with symptom recurrence requiring reoperation and venous bypass reconstruction.</p><p><strong>Conclusions: </strong>Laparoscopic left renal vein transposition appears to be a safe and effective treatment option for selected patients with symptomatic nutcracker syndrome. The minimally invasive approach provides favorable clinical outcomes with acceptable perioperative morbidity; however, long-term follow-up remains essential because of the risk of anastomotic occlusion and symptom recurrence. Further multicenter studies with larger patient cohorts are required to better define optimal treatment strategies.</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":"149179143","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 Simple Vascular Quality Initiative Frailty Score on Outcomes of Venous Leg Ulcer Healing and Recurrence.","authors":"Joseph P Hart, Mona Li, Mark G Davies","doi":"10.1016/j.avsg.2026.09.053","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.053","url":null,"abstract":"<p><strong>Objective: </strong>Up to 1% of patients with chronic venous disease will present with a primary venous Leg Ulcer (VLU). This study aimed to analyze the impact of frailty as measured by the Simple Vascular Quality Initiative-Frailty Score (sVQI-FS) on the outcomes of patients undergoing treatment for a VLU.</p><p><strong>Methods: </strong>Between 2012 and 2024, all patients presenting with a VLU were analyzed. Inclusion criteria were an active VLU, in the presence of superficial truncal venous incompetence, and without total deep venous incompetence (classified as involving all 18 named venous segments) on duplex imaging. Frailty was assessed by the sVQI-FS (congestive heart failure, renal impairment, chronic obstructive pulmonary disease, not living at home, not ambulatory, anemia, and underweight status with a BMI of less than 18.5). An sVQI-FS score of 0.3 or greater was considered frail. Demographics and interventions to effect healing were recorded. The primary outcomes were ulcer healing at 24 weeks and VLU recurrence within one year.</p><p><strong>Results: </strong>534 patients (61% female, age 67 ± 9 years, mean ± SD) presented with an active VLU. 43% of patients were classified as frail by the sVQI-FS. 31% had their ulcer for >12 months. Frail patients were more likely to have longer ulcer duration (7.1 ± 0.9 vs. 4.7 ± 1.1 months; Frail vs. Non-Frail; Mean ± SD; p=0.001) and have a longer interval before referral compared to non-frail patients (5.6 ± 1.2 vs. 3.9 ± 1.1 months, mean ± SD; p=0.001). Frailty was associated with more severe ulcers as measured by wound bed scores (11 ± 3 vs. 15 ± 5; Non-Frail vs. Frail; Mean ± SD; Frail vs. Non-Frail; p=0.001). The intensity of therapy, as measured by the sum of scheduled and unscheduled clinic visits and all interventions, was 1.8 times higher in the frail group than in the Non-Frail group (p = 0.001). Initial VLU healing was 26 ± 2% and 16 ± 2% at 12 weeks for Non-Frail and Frail, respectively (mean ± SEM; p=0.001). By 24 weeks, initial VLU healing was 67 ± 4% and 38 ± 4%, for Non-Frail and Frail, respectively (p=0.003). Freedom from VLU recurrence was 59 ± 4% and 36 ± 5% at 1 year (mean ± SEM; p=0.002). and 30 ± 6%, and 18 ± 7% at 3 years for Non Frail and Frail, respectively (p=0.002).</p><p><strong>Conclusions: </strong>Frailty significantly affects early referral for VLU care, is associated with more severe ulcers, and impacts both VLU healing rates and recurrence rates. Intervening to identify and ameliorate frailty is necessary to enhance VLU care.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164973","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 Leg Venous Reflux and Fluid Accumulation Assessed by Bioelectrical Impedance Analysis: A Generalized Estimating Equation Analysis.","authors":"Toshiya Nishibe, Tsuyoshi Iwasa, Masayasu Nishibe","doi":"10.1016/j.avsg.2026.09.040","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.040","url":null,"abstract":"<p><strong>Purpose: </strong>Leg edema is common in chronic venous disease, but its relationship with venous reflux remains unclear. This study investigated the association between the venous filling index (VFI) and the extracellular water-to-total body water ratio (ECW/TBW).</p><p><strong>Methods: </strong>We analyzed 140 patients with saphenous varicose veins (280 limbs). ECW/TBW was measured using bioelectrical impedance analysis and VFI using air plethysmography. Generalized estimating equations (GEE) were used to account for within-patient correlation. The primary outcome was ECW/TBW (%) analyzed using GEE linear regression, and the secondary outcome was edema (ECW/TBW ≥0.390) analyzed using GEE logistic regression.</p><p><strong>Results: </strong>The mean age was 64.0 years, and 58.6% of patients were female. Mean ECW/TBW was 0.392 and mean VFI was 2.94 mL/s. In multivariable GEE linear regression, VFI was independently associated with higher ECW/TBW (%) (β=0.045 percentage points per 1 mL/s increase; 95% CI, 0.018-0.072; P<0.001). In multivariable GEE logistic regression, VFI was independently associated with edema (OR, 1.47; 95% CI, 1.22-1.76; P<0.001).</p><p><strong>Conclusion: </strong>Greater venous reflux was independently associated with fluid accumulation and edema. ECW/TBW may provide an objective measure of venous-related fluid accumulation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134913","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":"Efficacy and safety of artificial intelligence-assisted image-guided navigation in complex endovascular aortic repair: a systematic review and meta-analysis.","authors":"Judson C S Neri Júnior, Fernando C Batista, Raíssa V A Estevam, Bethânia C Heredia, Juliana A Tinoco, Gabriela V M M de Azevedo, Cristina R Riguetti-Pinto","doi":"10.1016/j.avsg.2026.09.039","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.039","url":null,"abstract":"<p><strong>Background: </strong>Complex endovascular aortic repair exposes patients and operators to substantial radiation, contrast, and long procedures. Artificial intelligence (AI)-assisted image-guided navigation, based on cloud-based three-dimensional image fusion, has been proposed to improve intraoperative guidance, but its comparative benefit is uncertain.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, the Cochrane Library, and Web of Science (last search July 2025) for studies comparing AI-assisted image-guided navigation with conventional fluoroscopy and digital subtraction angiography during complex endovascular aortic repair. No navigation platform was prespecified. Random-effects meta-analyses yielded mean differences (MD) with 95% confidence intervals (CI); heterogeneity was quantified with I². Risk of bias was assessed with ROBINS-I and certainty with GRADE.</p><p><strong>Results: </strong>Three retrospective cohorts (332 patients; 189 AI, 143 control), all evaluating one cloud-based platform (Cydar EV), were eligible. AI-assisted navigation was associated with a lower radiation dose (2 studies, 216 patients; MD -1435.85 mGy, 95% CI -2208.84 to -662.86; I² = 0%). No significant differences were found in fluoroscopy time (MD -11.04 minutes, 95% CI -25.37 to 3.29; I² = 65%), operative time (MD -16.39 minutes, 95% CI -37.21 to 4.42; I² = 0%), or contrast volume (MD -30.59 mL, 95% CI -73.95 to 12.76; I² = 94%). Mortality and major adverse events (single studies) did not differ significantly.</p><p><strong>Conclusions: </strong>Cydar EV-assisted navigation may reduce radiation dose during complex endovascular aortic repair, but evidence is limited to retrospective studies of a single platform and does not establish a class effect for other AI-assisted navigation systems. Prospective comparative studies across platforms are needed.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134858","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":"Symptomatic popliteal artery entrapment syndrome: a challenging diagnosis and treatment.","authors":"Toon Kuypers, Kim Daenens, Hozan Mufty, Eveline Claus, Sabrina Houthoofd, Inge Fourneau","doi":"10.1016/j.avsg.2026.09.027","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.027","url":null,"abstract":"<p><strong>Objective: </strong>We analysed the diagnostic accuracy, patient selection, and postoperative outcomes of patients surgically treated for popliteal artery entrapment syndrome (PAES).</p><p><strong>Methods: </strong>All patients diagnosed with PAES in our hospital between January 2019 and March 2025 were included. Diagnosis was made on the positive triad of symptoms, decreased ankle-brachial index (ABI) and compression on angiography. Conservative and operative treatments were offered to all patients. Retrospective analysis of demographic, clinical, and surgical data was performed.</p><p><strong>Results: </strong>Thirty-two patients were diagnosed with PAES with a total of 57 affected legs. Thirty-five legs in 21 patients underwent surgical decompression. Functional success was achieved in 60.0% and technical success in 85.7% of the operated legs. Positive evolution in the ABI is seen with prolonged follow up. Fourteen legs experienced no functional improvement after surgery, despite evidence of technical success in nine legs (25.7%). Five patients were postoperatively diagnosed with other causal pathologies than PAES and two patients experienced symptom relieve with botulinum toxin infiltration postoperatively.</p><p><strong>Conclusion: </strong>PAES is a pathology with a broad differential diagnosis. The difference between postoperative functional and technical success in patients with popliteal artery compression indicates that other pathologies may be responsible for the patient's symptoms and that the popliteal compression may be an asymptomatic coincidence. PAES should be considered a diagnosis of exclusion in a multidisciplinary setting when the positive triad is present, to maximize the postoperative functional success. To determine technical success, prolonged ABI follow-up is recommended, as improvement may occur over time.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126454","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 of Race and Socioeconomic Status with Hemodialysis Arteriovenous Access Outcomes.","authors":"Keivan Ranjbar, Jeongin Jang, Rahul Rodrigues, Gautam Bulusu, Muhammad Atiq, Prashanth Palvannan, Shivani Kumar, Jeffrey Siracuse, Payam Salehi","doi":"10.1016/j.avsg.2026.09.034","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.034","url":null,"abstract":"<p><strong>Objectives: </strong>Arteriovenous access is essential for long-term hemodialysis. The creation and maintenance of arteriovenous fistula (AVF) or arteriovenous graft (AVG) are critical for effective dialysis and minimizing complications. However, the influence of race and social determinants of health on presentation, management, and outcomes has not been well evaluated. This study uses the Vascular Quality Initiative (VQI) database to evaluate disparities in vascular access outcomes by race and community-level disadvantage.</p><p><strong>Methods: </strong>We conducted a retrospective study using the VQI database to identify adults who underwent AVF or AVG creation for hemodialysis between 2016 and 2023. The Area Deprivation Index (ADI), a validated measure of neighborhood socioeconomic disadvantage incorporating income, education, employment, and housing quality, was categorized into quartiles from least (Q1) to most disadvantaged (Q4). Patients without follow-up data, recorded complications, or ADI information were excluded. Predisposing factors and postoperative outcomes considering race and ADI were analyzed. Group comparisons were performed using chi-square tests and t-tests. Multivariable logistic regression adjusted for demographic and clinical covariates was used to assess associations. All analyses were conducted using SPSS version 30.</p><p><strong>Results: </strong>A total of 77,544 patients were included (mean age 62.2 years, 43.4% female). White patients represented the largest racial group (51.5%, n=39,959), and 29.5% (n=22,850) were from the most disadvantaged ADI quartile. AVF maturation was more delayed in White vs Black patients (adjusted OR 1.43, 95% CI: 1.21-1.70, p<0.001). Immediate postoperative bleeding was less common in White vs Black patients (0.6% vs 0.9%; OR 0.58,0.43-0.79, p<0.001) and less frequent in Q4 vs Q1 (0.5% vs 1.2%; OR 0.36, 0.25-0.53, p<0.001). At 9 months, access patency was lower in Black vs White patients (86.4% vs 88.2%, p=0.003) and varied by ADI (p<0.001), with Q1 achieving the highest patency (88.7%). Nine-month mortality was highest in White patients (28% vs 21% in Black, p<0.001 unadjusted); however, only Asian race remained independently protective after adjustment (OR 0.41, 0.35-0.47, p<0.001 vs Black). Patients in Q4 had significantly higher 9-month mortality compared to Q1 (adjusted OR 1.56, 1.46-1.67, p<0.001).</p><p><strong>Conclusions: </strong>Significant disparities in hemodialysis access outcomes exist by race and socioeconomic status. Patients in disadvantaged areas experienced higher rates of maturation delay and mortality. Black and American Indian/Alaskan Native patients had worse patency and greater AVG use. Structural and social factors strongly influence vascular access outcomes, underscoring the need for targeted interventions to improve equity in hemodialysis care.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103214","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":"Development and Internal Validation of the Si-AAA Prognostic Score for Five-Year Overall Survival after Endovascular Aneurysm Repair in Patients with Asymptomatic Abdominal Aortic Aneurysm.","authors":"Tossapol Prapassaro, Natwadee Jitcharoen, Khamin Chinsakchai, Sasima Tongsai, Kiattisak Hongku, Chumpol Wongwanit, Nuttawut Sermsathanasawadi, Suteekhanit Hahtapornsawan, Nattawut Puangpunngam, Kanin Pruekprasert, Tiwa Chaisongrit, Chanean Ruangsetakit","doi":"10.1016/j.avsg.2026.09.038","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.038","url":null,"abstract":"<p><strong>Background: </strong>Although endovascular aneurysm repair is widely used for the treatment of asymptomatic abdominal aortic aneurysm, long-term survival is influenced by patient comorbidities and aneurysm-related characteristics. This study aimed to develop and internally validate a prognostic scoring system for predicting 5-year overall survival after endovascular aneurysm repair.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in patients with asymptomatic abdominal aortic aneurysm undergoing endovascular aneurysm repair. Candidate predictors included demographic, clinical, aneurysm-related, and laboratory variables. Multivariable Cox proportional hazards regression was used to identify independent predictors of 5-year mortality. Continuous predictors were categorized using clinically interpretable thresholds derived from time-dependent receiver operating characteristic analysis, and a simplified point-based score was constructed from regression coefficients. Model performance was assessed using Harrell's concordance index, and internal validation was performed using 1,000 bootstrap resamples to obtain an optimism-corrected concordance index. Calibration was evaluated using bootstrap-based calibration plots.</p><p><strong>Results: </strong>A total of 445 patients were screened, and 443 complete cases were included in the final analysis. During follow-up, 133 deaths (30.0%) occurred. The estimated 5-year overall survival rate was 62.8% (95% CI, 57.8%-68.0%). Independent predictors of 5-year mortality included age >70 years (adjusted hazard ratio [aHR] 1.66, 95% CI 1.06-2.62; P = .029), chronic obstructive pulmonary disease (aHR 1.70, 95% CI 1.08-2.69; P = .023), unfit status (aHR 2.32, 95% CI 1.58-3.39; P < .001), serum albumin ≤3.5 g/dL (aHR 2.80, 95% CI 1.97-3.98; P < .001), and abdominal aortic aneurysm diameter ≥7 cm (aHR 1.59, 95% CI 1.07-2.38; P = .023). The final score ranged from 0 to 7. The apparent concordance index was 0.721, with an optimism-corrected concordance index of 0.713 after bootstrap validation. Risk stratification showed clear separation between low-, intermediate-, and high-risk groups (5-year overall survival: 82.5%, 53.4%, and 23.8%, respectively; log-rank P < .001).</p><p><strong>Conclusions: </strong>A simple prognostic scoring system incorporating age, chronic obstructive pulmonary disease, unfit status, serum albumin, and aneurysm diameter demonstrated acceptable discrimination and good calibration for predicting 5-year overall survival after endovascular aneurysm repair. This tool may assist in risk stratification and long-term clinical decision-making. As this score was derived and internally validated in a single-center cohort, external validation in independent cohorts is required before routine clinical implementation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102860","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}