Annals of vascular surgery最新文献

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A Multimodal Approach for Limb Preservation of Dehisced Amputations with Bone Exposure. 骨外露性骨折断肢的多模态保肢方法。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.019
Ioannis Tsouknidas, Garrett Tibbets, Athanasios Angistriotis, George Koullias
{"title":"A Multimodal Approach for Limb Preservation of Dehisced Amputations with Bone Exposure.","authors":"Ioannis Tsouknidas, Garrett Tibbets, Athanasios Angistriotis, George Koullias","doi":"10.1016/j.avsg.2025.09.019","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.019","url":null,"abstract":"<p><strong>Purpose: </strong>The prevalence of non-traumatic amputations continues to rise annually. The length of the preserved limb is directly associated with the success of ambulation. Wound infections after lower extremity amputations are very common, and reoperation is necessary in up to 61%. When dehisced stumps are complicated by bone exposure and osteomyelitis, more proximal amputation is traditionally performed.</p><p><strong>Methods: </strong>A retrospective chart review of the electronic medical records from 2016 to 2024 was conducted at our institution, and dehisced amputated stumps with and bone exposure were included for final analysis. All cases were treated with a novel seven-step treatment algorithm, incorporating aggressive revascularization, standard and advanced wound care modalities. Data collection included patient characteristics, treatment details and follow-up outcomes.</p><p><strong>Results: </strong>A total of 22 dehisced stumps with osteomyelitis, from 19 patients (73.7% male, 26.3% female), with an average wound size of 27.4 cm<sup>2</sup> were included. Fourteen revascularization procedures were performed. Negative pressure wound therapy, collagen products, and amniotic or acellular matrix dressings were used in 54.5%, 68.2% and 72.7% of the stumps, respectively. Complete healing was achieved in all patients with an average healing time of 171.8 days. Wound recurrence occurred in two stumps. The mean wound-free period was 323.9 days.</p><p><strong>Conclusions: </strong>The proposed treatment algorithm enables successful closure of dehisced stumps with bone exposure in selected patients. Adherence to the treatment and close follow-up are essential for optimal outcomes.</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":"145102483","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}
引用次数: 0
Association of Age and Frailty with the Development of Adverse Events Following Carotid Endarterectomy in Asymptomatic Patients. 年龄和虚弱与无症状患者颈动脉内膜切除术后不良事件发生的关系。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.013
Kevin Tabibian, Amulya Vadlakonda, Aboubacar Cherif, Jeffrey Balian, Oh Jin Kwon, Daniel Tabibian, Troy Coaston, Peyman Benharash, Christian de Virgilio
{"title":"Association of Age and Frailty with the Development of Adverse Events Following Carotid Endarterectomy in Asymptomatic Patients.","authors":"Kevin Tabibian, Amulya Vadlakonda, Aboubacar Cherif, Jeffrey Balian, Oh Jin Kwon, Daniel Tabibian, Troy Coaston, Peyman Benharash, Christian de Virgilio","doi":"10.1016/j.avsg.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.013","url":null,"abstract":"<p><strong>Background: </strong>As carotid endarterectomy (CEA) is increasingly utilized for older adults, identification of risk factors in this cohort is critical. Frailty is increasingly recognized as a significant predictor of adverse surgical outcomes, yet contemporary associations with CEA outcomes in asymptomatic patients remains underexplored on a national scale.</p><p><strong>Methods: </strong>All adults (≥18) with asymptomatic carotid artery stenosis undergoing elective CEA were identified from the 2013-2022 National Surgical Quality Improvement Program Participant Use Files. Frailty was defined using the validated 5-factor modified frailty index (dependent functional status, diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure), with patients scoring ≥2 classified as Frail (others: non-Frail). Multivariable logistic regression models examined associations of age and frailty status with major adverse events (MAE: death, stroke, or myocardial infarction) within 30 days, prolonged length of stay (≥2 postoperative days), non-home discharge, and unplanned readmission within 30 days.</p><p><strong>Results: </strong>Of 18,887 CEA patients, 7,207 (38.2%) were Frail. Frail patients demonstrated increased MAE rates (3.5% vs. 1.9%, P<0.001) and greater resource use. After adjustment, frailty was linked with increased odds of MAE (AOR 1.60, 95% CI 1.29-1.98), prolonged length of stay (AOR 1.31, CI 1.21-1.41), non-home discharge (AOR 1.83, CI 1.40-2.39), and unplanned readmission (AOR 1.64, CI 1.41-1.92). Following marginal analysis of age and frailty, frailty remained associated with a higher risk-adjusted probability of major adverse events.</p><p><strong>Conclusion: </strong>Irrespective of age, frail patients exhibited concerning rates of major adverse events. If future studies confirm these findings, prophylactic CEA in this vulnerable population should be carefully reconsidered.</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":"145102541","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}
引用次数: 0
Outcomes of Percutaneous Aspiration Thrombectomy in Acute Thrombosis of Arteriovenous Access. 急性动静脉通道血栓形成经皮穿刺取栓的疗效。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.025
Sellers Boudreau, Anthony Grzeda, Adam Hicks, Jessica Schucht, Erik Wayne, Amit Dwivedi, Abindra Sigdel
{"title":"Outcomes of Percutaneous Aspiration Thrombectomy in Acute Thrombosis of Arteriovenous Access.","authors":"Sellers Boudreau, Anthony Grzeda, Adam Hicks, Jessica Schucht, Erik Wayne, Amit Dwivedi, Abindra Sigdel","doi":"10.1016/j.avsg.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.025","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine outcomes after percutaneous aspiration thrombectomy of acutely thrombosed arteriovenous dialysis access.</p><p><strong>Methods: </strong>A retrospective review of 78 patients undergoing a total of 146 percutaneous aspiration thrombectomies of arteriovenous dialysis access between 2016 to 2020 were reviewed to evaluate outcomes. The CAT-D Suction Thrombectomy Device (Penumbra; Alameda, CA) was the device used to restore arteriovenous access patency in this study. Outcomes measured include rates of successful thrombectomy, primary patency rates, and cumulative patency rates were determined via chart review. Secondary analysis was conducted to determine factors that may affect post procedure patency.</p><p><strong>Results: </strong>Seventy-eight patients undergoing a total of 146 percutaneous aspiration thrombectomies were studied. There was a technical success rate of 98.6% with 95.9% subsequently undergoing dialysis successfully. There were no procedural related deaths or clinically apparent pulmonary embolism. Primary patency at 30, 90, and 180 days was 58.2%, 35.6%, and 23.3% with an average primary patency of 104.5 days. Cumulative patency rates at 30, 90, and 180 days were 80.8%, 64.4%, and 54.8% with an average cumulative patency rate of 232.5 days.</p><p><strong>Conclusions: </strong>The use of percutaneous aspiration thrombectomy in acutely thrombosed arteriovenous access is associated with high technical and clinical success rates while maintaining a low risk of complications. This study demonstrated a primary and cumulative patency rate that was lower than prior literature, but this may have been secondary to our study population consisting of greater numbers of patients with known risk factors for early access thrombosis.</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":"145102511","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}
引用次数: 0
Drug-coated balloon angioplasty (DCB) versus percutaneous transluminal angioplasty (PTA) for below-the-knee (BTK) interventions in chronic limb-threatening ischemia (CLTI) patients - systematic review and meta-analysis. 药物包被球囊血管成形术(DCB)与经皮腔内血管成形术(PTA)在慢性肢体威胁缺血(CLTI)患者膝下(BTK)干预中的对比——系统评价和荟萃分析
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.022
Kush Modi, Tony Joseph, Ruhi Shah, Raghav Ranga, Lawrence Markel
{"title":"Drug-coated balloon angioplasty (DCB) versus percutaneous transluminal angioplasty (PTA) for below-the-knee (BTK) interventions in chronic limb-threatening ischemia (CLTI) patients - systematic review and meta-analysis.","authors":"Kush Modi, Tony Joseph, Ruhi Shah, Raghav Ranga, Lawrence Markel","doi":"10.1016/j.avsg.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.022","url":null,"abstract":"<p><strong>Background: </strong>Drug-coated balloon angioplasty (DCB) is an emerging alternative to percutaneous transluminal angioplasty (PTA) for below-the-knee (BTK) revascularization in patients with chronic limb-threatening ischemia (CLTI). DCBs deliver antiproliferative agents to reduce neointimal hyperplasia, but results are mixed. This review assessed the clinical outcomes of DCB vs. PTA in BTK interventions for CLTI.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was registered with PROSPERO (CRD420251073999). PubMed and CENTRAL were searched for randomized controlled trials and clinical trials comparing DCB and PTA in adult CLTI patients undergoing BTK intervention. Studies until June 2025 were included in the review. Outcomes included clinically driven target lesion revascularization (CD-TLR), major amputation, all-cause mortality, primary patency, and late lumen loss (LLL). Risk of bias was assessed using the Cochrane RoB 2 tool, with most studies judged to have low or some concerns but no critical sources of bias. Random-effects model was used to calculate pooled odds ratios (ORs) and standardized mean differences (SMDs).</p><p><strong>Results: </strong>Ten studies were included in the review; seven were eligible for meta-analysis. DCB significantly reduced CD-TLR compared to PTA at 12 months (OR: 0.39; 95% CI: 0.04-0.73), but not at 5 years. No significant differences were observed in major amputations or all-cause mortality at 12 months or 5 years, though mortality trended lower with DCB in the long term (OR: 0.57; 95% CI: 0.13-1.01). No significant differences between DCB and PTA were found for 6-month primary patency or LLL.</p><p><strong>Conclusion: </strong>DCB reduces early revascularization compared to PTA, but shows no significant long-term benefit in amputation or mortality. DCB may be selectively useful in certain patients at high risk of restenosis. Further long-term, risk-stratified studies are needed to optimize DCB use in CLTI management.</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":"145102464","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}
引用次数: 0
A Case Series of Ruptured Fungal Mycotic Pseudoaneurysms in Renal Transplant Patients. 肾移植患者真菌性假性动脉瘤破裂一例。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.027
Mennatalla Hegazi, Daniel Delgadillo, Samuel L Chen, Nii-Kabu Kabutey, Roy M Fujitani, Anthony H Chau
{"title":"A Case Series of Ruptured Fungal Mycotic Pseudoaneurysms in Renal Transplant Patients.","authors":"Mennatalla Hegazi, Daniel Delgadillo, Samuel L Chen, Nii-Kabu Kabutey, Roy M Fujitani, Anthony H Chau","doi":"10.1016/j.avsg.2025.09.027","DOIUrl":"10.1016/j.avsg.2025.09.027","url":null,"abstract":"<p><p>Mycotic pseudoaneurysms (MPs) occur in <1% of renal transplant patients, with rupture being even rarer. We present clinical symptoms, surgical techniques, and postoperative courses of four transplant patients with MPs who presented with acute bleeding. All patients presented within 3 weeks of transplant. All patients underwent immunosuppression induction with rabbit anti-thymocyte globulin and high-dose steroids, and following transplant, were managed with a triple therapy immunosuppression regimen of mycophenolate sodium, a prednisone taper, and tacrolimus, as well as an infection prophylaxis regimen of valganciclovir, clotrimazole, and sulfamethoxazole-trimethoprim. All patients presented with bleeding originating from the iliac or transplant renal artery. Despite the antifungal prophylaxis, all four patients were found to have candida infections at the transplant site. Hemorrhage control was obtained using different techniques in each case, including open and endovascular techniques. Endovascular balloon occlusion was used for immediate stabilization, followed by open arterial resection, extra-anatomic bypass, or patch repair. One allograft was salvaged while three required nephrectomy. MPs in immunocompromised transplant patients may not present with infectious symptoms before rupture, but infection should be considered in acutely bleeding transplant patients. Open and endovascular approaches can be employed to control hemorrhage; however, infection risk must be considered with prosthetics.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"682-687"},"PeriodicalIF":1.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102559","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}
引用次数: 0
Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment. 开窗和分支血管内主动脉修复的结果比较窄流腔与标准流腔的内脏旁主动脉段。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.016
Kathryn DiLosa, Rohini J Patel, Asma Mathlouthi, Sina Zarrintan, Mahmoud Malas, Omar Al-Nouri, Andrew Barleben
{"title":"Outcomes in Fenestrated and Branched Endovascular Aortic Repair Comparing Patients with Narrow Flow Lumen versus Standard Flow Lumen of the Paravisceral Aortic Segment.","authors":"Kathryn DiLosa, Rohini J Patel, Asma Mathlouthi, Sina Zarrintan, Mahmoud Malas, Omar Al-Nouri, Andrew Barleben","doi":"10.1016/j.avsg.2025.09.016","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.016","url":null,"abstract":"<p><strong>Objectives: </strong>Fenestrated/branched endovascular aortic repair (F/BEVAR) with commercially available devices require a paravisceral segment >20 mm. We compared commercial and physician modified F/BEVAR outcomes in a narrowed flow lumen (NFL, <20 mm) to a standard flow lumen (SFL, ≥20 mm).</p><p><strong>Methods: </strong>We conducted a retrospective review of F/BEVAR repairs between 2016-2024. Primary outcome was technical success and secondary endpoints were target vessel stability, type 1/3 endoleaks requiring reintervention, and major adverse events (MAE).</p><p><strong>Results: </strong>A total of 136 patients underwent 138 repairs (75% male, 74±10 years), 35 repairs (25%) were in NFL and 103 (75%) in SFL. Median visceral segment diameter was 24 mm (IQR 19-29; 16mm, IQR 15-18 in NFL; 28mm, IQR 23-30 in SFL, p<.001). We observed 99% technical success. Mean fenestrations per repair was higher in NFL (3.1 vs 1.5, p<.001), and mean branches was higher in SFL (2.1 vs 0.7, p<.001). There were 24 (17%; 2 in NFL, 22 in SFL, p=.035) MAEs. There were nine branch vessel occlusions (three in NFL, six in SFL, p=.463) at a median follow up of 516 days. Target vessel stability (86% in NFL vs 84% in SFL, p=.757) and rate of reinterventions (2, 6% in NFL, 14, 14% in SFL, p=.209) did not differ significantly.</p><p><strong>Conclusions: </strong>Custom F/BEVAR offers equivalent outcomes in complex anatomy with narrowed paravisceral flow lumens compared to on-label branched and fenestrated repairs in standard flow lumens. Early results demonstrate reasonable target vessel stability and freedom from reintervention, though additional follow up is needed.</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":"145102539","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}
引用次数: 0
Peripheral Artery Disease Diagnosis Is an Independent Predictor Factor For Reduced Long-Term Survival Post Fenestrated/Branched Endovascular Aortic Repair. 外周动脉疾病诊断是开窗/分支血管内主动脉修复术后长期生存率降低的独立预测因素。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-18 DOI: 10.1016/j.avsg.2025.09.017
Mohammad Alsarayreh, Mark A Farber, Vivian Carla Gomes, Luigi Pascarella, Jacob Wood, Ehsan Benrashid, Federico Ezequiel Parodi
{"title":"Peripheral Artery Disease Diagnosis Is an Independent Predictor Factor For Reduced Long-Term Survival Post Fenestrated/Branched Endovascular Aortic Repair.","authors":"Mohammad Alsarayreh, Mark A Farber, Vivian Carla Gomes, Luigi Pascarella, Jacob Wood, Ehsan Benrashid, Federico Ezequiel Parodi","doi":"10.1016/j.avsg.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.017","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) patients comparing individuals with and without a prior diagnosis of peripheral artery disease (PAD) METHODS: A single-center retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms treated with a F/BEVAR procedure. The diagnosis of PAD was determined by an ankle-brachial index <0.9 or a toe-brachial index <0.7 in non-diabetic and diabetic patients, respectively. The ischemia grade of the WIFi classification was applied to categorize PAD patients into \"mild PAD\" (grades 0 and 1) and \"severe PAD\" (grades 2 and 3), and both groups were compared with the non-PAD cases. The primary outcomes were 30- day and 5-year survival. Secondary outcomes included 30-day major adverse events (ischemic colitis, acute kidney injury [AKI], spinal cord ischemia [SCI]), long-term major complications such as myocardial infarction [MI], stroke, and kidney function deterioration, and aneurysm-related adverse events.</p><p><strong>Results: </strong>Four-hundred-one patients (72.3% males; mean age,71.7±8.9 years) who underwent a F/BEVAR procedure between July/2012 and October/2023 were included in the study, 95 of which (24%) presented a prior diagnosis of PAD (73 mild;22 severe). In terms of demographics, aneurysm extent, aneurysm maximal diameter, and comorbidities, no significant difference was observed across the three groups, except for the history of tobacco use (P =.033) and prior diagnosis of diabetes (P =.036) that were significantly higher amongst the patients with severe PAD. The 30-day survival (P =.483) and 30-day major adverse events such as MI (P =.237), stroke (P = .222), AKI (P =. 566), and SCI(P=.183) were not significantly different across the groups. Ischemic colitis seemed to be more frequent among mild PAD patients (P=0.036), but the etiology might be multifactorial. Time-to-event analysis demonstrated that patients with severe PAD have a lower long-term survival when compared to the ones without this diagnosis (Log-rank P = .035). Cox regression analysis demonstrated that a prior diagnosis of severe PAD is associated with a significant increase in the probability of death at 5 years post F/BEVAR (HR:2.15, P=0.04). As for the aneurysm-related adverse events, there was no significant difference in terms of types I, II, and III endoleaks, access complications, target vessel occlusions, and freedom from secondary interventions across the groups.</p><p><strong>Conclusions: </strong>Significantly lower 5-year survival is observed in the F/BEVAR cases with a preoperative diagnosis of PAD and severe ischemic component. In addition, patients with PAD might present higher incidence of ischemic colitis post F/BEVAR, but the origin of this adverse event might be multifactorial.</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":"145102523","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}
引用次数: 0
Diagnostic accuracy of elastic deformation for detecting high aneurysm sac pressure after endovascular aneurysm repair. 血管内动脉瘤修复后弹性变形检测高动脉瘤囊压力的诊断准确性。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-17 DOI: 10.1016/j.avsg.2025.08.042
K van Rijn, O S van Genderen, H Putter, J P Eiberg, R C van Wissen, J F Hamming, J van Schaik, J R van der Vorst
{"title":"Diagnostic accuracy of elastic deformation for detecting high aneurysm sac pressure after endovascular aneurysm repair.","authors":"K van Rijn, O S van Genderen, H Putter, J P Eiberg, R C van Wissen, J F Hamming, J van Schaik, J R van der Vorst","doi":"10.1016/j.avsg.2025.08.042","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.042","url":null,"abstract":"<p><strong>Objectives: </strong>Elastic deformation (ED) is a novel non-invasive follow-up modality after endovascular aortic repair (EVAR). ED is defined as the percentage of diameter change of the aneurysm sac after application of a controlled ultrasound transducer pressure. It is hypothesized that low aneurysm sac deformation indicates high sac pressure. The current study aims to determine the ideal cut-off value of ED and analyze the corresponding diagnostic accuracy.</p><p><strong>Methods: </strong>A prospective cohort study was performed at a single-center tertiary university hospital. ED measurements were performed during regular follow-up in all patients after endovascular aortic repair between August 2020 and December 2024. The reference test was subsequent aneurysm sac growth. Generalized estimating equations evaluated the association between ED and aneurysm sac growth. Receiver operating characteristic curve was used to assess the discriminatory ability.</p><p><strong>Results: </strong>203 ED measurements (in 100 post-EVAR patients) were analyzed. Aneurysm growth occurred in 12 patients. An odds ratio of 0.857 (95% CI 0.772-0.952) for aneurysm sac growth was calculated. ROC curve analysis revealed an AUC of 0.711 (95%CI 0.587-0.836, p=0.014). Optimal cut-off value according to the highest Youden index was estimated at 10.5% (sensitivity 92%, specificity 45%). A lower cut-off value of 6.5% also had significant discriminatory ability and was associated with higher specificity (sensitivity 58%, specificity 74%).</p><p><strong>Conclusions: </strong>An ultrasound-based elastic deformation of 6.5% provides a straightforward and non-invasive method to predict post-EVAR aneurysm sac growth with high specificity. Further validation, including reproducibility testing between patients and operators, is needed before clinical implementation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090944","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}
引用次数: 0
Outcomes Of Interventions To Salvage The Jailed Profunda Femoris In Recurrent Limb-threatening Critical Ischemia. 挽救囚禁股深肌复发性肢体严重缺血的干预效果。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-17 DOI: 10.1016/j.avsg.2025.08.051
Joseph P Hart, Mark G Davies
{"title":"Outcomes Of Interventions To Salvage The Jailed Profunda Femoris In Recurrent Limb-threatening Critical Ischemia.","authors":"Joseph P Hart, Mark G Davies","doi":"10.1016/j.avsg.2025.08.051","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.051","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Crossover stent placement across the profunda femoris artery (PFA) ostium (jailed profunda femoris) during superficial femoral artery (SFA) stenting is increasing, but currently, little is known about the long-term consequences of interventions on jailed PFA when recurrent CLTI occurs. This study aimed to analyze the outcomes of interventions to salvage the jailed profunda femoris in recurrent chronic limb-threatening ischemia (CLTI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between 2010 and 2024, all patients undergoing an intervention for a jailed profunda femoris in the setting of recurrent chronic limb-threatening ischemia (CLTI) secondary to crossover superficial femoral artery (SFA) stent placement were analyzed. Common femoral artery (CFA) stents and PFA ostia with less than 50% stenosis were excluded. Two groups were identified: those presenting with an occluded PFA ostium and those with a stenosed PFA ostium (stenosis&gt;50%). Amputation-free survival (AFS; survival without major amputation) and freedom from major adverse limb events (MALE; Above ankle amputation of the index limb, endovascular intervention, or major open re-intervention) were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred and twelve patients (64% female, 69 ± 6 years, mean ± SD) presented with recurrent Rutherford stage 4 and 5 disease. All had crossover SFA stent placement with currently occluded SFA stents: 67 had a stenosed PFA ostium, and 45 had an occluded PFA ostium with a patent distal PFA. Patients had a median of 4 prior endovascular procedures (range 2-6). Time from initial crossover SFA stent placement was 3.6±0.6 vs. 1.1±0.3 (mean ± SD, yrs; p=0.01) for stenosed and occluded ostia groups, respectively. Sixty-four percent of patients underwent CFA endarterectomy with excision of the stent and patch angioplasty over the PFA ostium, and the remainder received an interposition graft from the proximal CFA to the PFA. 67% required concomitant ipsilateral iliac stenting for significant disease in the common and external iliac arteries, and this was significantly more common in the stenosed group. 26% required an infra-inguinal bypass, with no difference between the two groups. There was no significant difference in 30-day outcomes between patients with stenosed and occluded PFA ostia (MACE: 2% vs. 2%; MALE: 4% vs. 4%; Major Amputation: 2% vs. 2%; stenosed vs occluded PFA ostia, respectively). At 5 years, freedom from MALE (63±4% vs. 51±5%, mean ± SEM; p=0.03) and AFS (69±3% vs. 59±4%; p=0.01; stenosed vs. occluded PFA ostia, respectively) were significantly lower in occluded compared to stenosed PFA ostia groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Revascularization of the jailed PFA due to crossover SFA stenting in recurrent CLTI can be achieved with acceptable short-term outcomes and long-term patency. Management of inflow is common, and the need for infra-inguinal bypass is low. There is no difference in outcomes between a stenosed or ","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090973","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}
引用次数: 0
Comparative Safety and Efficacy of Transcarotid Artery Revascularization (TCAR) Versus Transfemoral Carotid Artery Stenting (TFCAS): A Systematic Review and Meta-analysis. 经颈动脉血管重建术(TCAR)与经股颈动脉支架植入术(TFCAS)的安全性和有效性比较:一项系统综述和meta分析。
IF 1.6 4区 医学
Annals of vascular surgery Pub Date : 2025-09-16 DOI: 10.1016/j.avsg.2025.08.052
Atef A Hassan, Sherif Alaa Sharaby, Elsayed Elesheshtawy Elbosraty, Mohamed Ibrahim Abdo, Ahmed Attia Shaban, Fouad Mohammed Awad, Reda Othman Abbas, Mohamed A Khalafallah, Mohamed Ibrahim Hammoda, Haytham Yousef Aboelsaad
{"title":"Comparative Safety and Efficacy of Transcarotid Artery Revascularization (TCAR) Versus Transfemoral Carotid Artery Stenting (TFCAS): A Systematic Review and Meta-analysis.","authors":"Atef A Hassan, Sherif Alaa Sharaby, Elsayed Elesheshtawy Elbosraty, Mohamed Ibrahim Abdo, Ahmed Attia Shaban, Fouad Mohammed Awad, Reda Othman Abbas, Mohamed A Khalafallah, Mohamed Ibrahim Hammoda, Haytham Yousef Aboelsaad","doi":"10.1016/j.avsg.2025.08.052","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.052","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery stenosis is a significant cause of ischemic stroke. Transcarotid artery revascularization (TCAR), a newer technique utilizing dynamic flow reversal, has emerged as a potentially safer alternative to transfemoral carotid artery stenting (TFCAS). This systematic review and meta-analysis aimed to compare TCAR and TFCAS in patients undergoing carotid revascularization.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane CENTRAL, Scopus, and Web of Science through June 2025 for comparative studies evaluating TCAR vs TFCAS. Primary outcomes included 30-day and in-hospital mortality, stroke, and composite stroke/death. Secondary outcomes assessed myocardial infarction (MI), transient ischemic attack (TIA), procedural times, and periprocedural complications. Risk ratios (RRs) and mean differences (MDs) were pooled using random-effects models.</p><p><strong>Results: </strong>Thirteen studies involving 142,032 patients were included in the analysis. TCAR significantly reduced 30-day mortality (RR 0.45; p<0.001), in-hospital mortality (RR 0.45; p<0.001), 30-day stroke (RR 0.66; p<0.001), and composite 30-day stroke/death (RR 0.57; p<0.001). TIA (RR 0.72; p<0.001) and stroke/TIA (RR 0.66; p<0.001) were also lower with TCAR. MI rates were similar overall, though asymptomatic patients had a higher 30-day MI risk with TCAR. TCAR reduced reperfusion injury (RR 0.38; p<0.001) and hospital stay length (RR 0.76; p<0.001), but had slightly longer operative times. Long-term data from two large cohorts confirmed TCAR's durable stroke risk reduction up to 3 years.</p><p><strong>Conclusion: </strong>This meta-analysis of current observational data demonstrates that TCAR is associated with superior perioperative outcomes compared to TFCAS, with significantly lower rates of stroke and death. These findings support TCAR as a preferred endovascular treatment for eligible patients with carotid artery stenosis.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085000","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}
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