Annals of vascular surgery最新文献

{"title":"Health-Related Quality of Life After Open and Endovascular Revascularization for Aortoiliac Occlusive Disease: A Prospective Cohort Study.","authors":"Francesco Squizzato, Elda Chiara Colacchio, Sabrina Menara, Mirko Menegolo, Franco Grego, Michele Piazza, Michele Antonello","doi":"10.1016/j.avsg.2026.09.024","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.024","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of open (OR) and endovascular repair (ER) on Health-Related Quality of Life (HRQOL) in patients treated for Aortoiliac Occlusive Disease (AIOD).</p><p><strong>Methods: </strong>We conducted a single-center prospective observational cohort study on consecutive patients treated by OR and ER for AIOD between January 2020 and July 2025. HRQOL was assessed using the 36-Item Short Form Health (SF-36) questionnaire at baseline, 1, 6, and 12 months. Physical (PCS) and Mental (MCS) Component Summary scores were compared between treatment groups using linear mixed-effects models with fixed effects for time, treatment, and their interaction. Linear regression models were used to assess factors associated with baseline HRQOL, while Firth's penalized logistic regression was used to evaluate factors associated with changes in HRQOL during follow-up.</p><p><strong>Results: </strong>Eighty-one patients were included: 20 (24.7%) underwent OR and 61 (75.3%) ER, for claudication (74.1%), rest pain (13.6%), or tissue loss (12.3%). No postoperative mortality occurred. Baseline PCS was associated with higher Rutherford class (p = .033) and TransAtlantic Inter-Society Consensus (TASC) lesion complexity (p = 0.02), while baseline MCS was associated with disease severity (p = .018) and comorbidities (p = .048). PCS improved significantly over time (p < 0.001), with a faster early improvement in the ER group (p for interaction= .005) especially within the first month from the procedure (p = .011). MCS also improved over time (p = .005), with no differences between groups. Early reintervention (p = .049 for PCS), late complications (p = .018 for PCS; p = .031 for MCS), chronic kidney disease (CKD) (p = .012 for PCS), coronary artery disease (CAD) (p = .014) and limb loss (p = .049 for PCS) were associated with reduced likelihood scores of HRQOL improvements at follow-up.</p><p><strong>Conclusions: </strong>Both OR and ER were associated with significant improvements in HRQOL. ER provided faster early physical recovery, whereas mental health outcomes were comparable between treatment strategies. Patient characteristics and postoperative adverse events had a greater influence on HRQOL recovery than the revascularization strategy itself.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102963","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":"Inflammatory and Hemostatic Biomarker Response After Endovenous Laser Ablation Versus High Ligation and Stripping: A Randomized Controlled Trial.","authors":"Elisa H S Zampieri, Carlos D R Centellas, Heitor F Amorim, Fabíola L A C Mestriner, Maria C Jordani, Christiane Becari, Mauricio S Ribeiro","doi":"10.1016/j.avsg.2026.09.048","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.048","url":null,"abstract":"<p><strong>Objective: </strong>This randomized controlled trial aimed to evaluate and compare perioperative inflammatory response, primary hemostasis, and coagulation cascade activation between endovenous laser ablation (EVLA) and high ligation and stripping (HLS) in patients with great saphenous vein (GSV) incompetence.</p><p><strong>Methods: </strong>This prospective randomized trial included 39 patients with unilateral GSV incompetence (CEAP C2-C6), randomized to EVLA using a 1470-nm radial fiber (n=21) or conventional HLS (n=18). Blood samples were collected at baseline, 8 hours, 7 days, and 30 days postoperatively to assess inflammatory cytokines, adhesion molecules, and acute-phase markers. The primary endpoint was differences in biomarker levels between techniques over time.</p><p><strong>Results: </strong>The EVLA group demonstrated significantly earlier return to daily activities compared to HLS (17 vs 30 days, p<0.0001). Distinct inflammatory patterns were observed: EVLA showed increased P-selectin at 1 week and elevated IL-1, TNF-α, and IL-6 at 1 month, indicating a delayed inflammatory response. In contrast, HLS demonstrated higher von Willebrand factor levels at 1 week, suggesting earlier endothelial activation. No cases of deep vein thrombosis or endovenous heat-induced thrombosis were observed.</p><p><strong>Conclusions: </strong>EVLA and HLS exhibit distinct temporal patterns of inflammatory and hemostatic activation. EVLA is associated with a delayed pro-inflammatory response, whereas HLS demonstrates earlier endothelial activation. Despite these differences, both techniques showed similar safety profiles. These findings may contribute to individualized thrombotic risk stratification and perioperative management strategies in venous surgery.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103030","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":"Early Results of Shape Memory Polymer Embolization for Endoleak Treatment after Thoracoabdominal Fenestrated/Branched Endovascular Aneurysm Repair.","authors":"David P Kuwayama, Prashanth Vallabhajosyula, Cassius Iyad Ochoa Chaar, Sarah Loh, Jonathan Cardella, Roland Assi, Edouard Aboian, David Strosberg, Matthew Williams","doi":"10.1016/j.avsg.2026.09.030","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.030","url":null,"abstract":"<p><strong>Background: </strong>Endoleaks after thoracoabdominal fenestrated/branched endovascular aneurysm repair (TA-F/BEVAR) may require multimodal treatment, including sac access and cavity filling. Shape memory polymer (SMP) is a self-expanding porous scaffold that promotes organized thrombus, is radiolucent, exerts low radial force, and biodegrades. We evaluated SMP embolization to fill endoleak cavities after TA-F/BEVAR.</p><p><strong>Methods: </strong>Retrospective review of all patients treated at a single center with IMPEDE-FX Embolization Plugs for endoleak after TA-F/BEVAR (July 2024-June 2026). Outcomes were endoleak resolution, change in sac diameter and volume, complications, and endoleak-related reintervention.</p><p><strong>Results: </strong>Ten patients (8 male; median age 70) underwent 12 procedures. Median preoperative endoleak volume was 25 mL (range, 3-148 mL); 6 had prior endoleak-directed reintervention. A median 114 plugs were implanted per procedure (range, 29-297). No procedural complications occurred. At a median of 34 days, 5 patients (50%) had complete resolution, 3 (30%) near-complete resolution (residual 1.3-2.0 mL), and 2 (20%) partial resolution (residual 25-32 mL); both of the latter underwent a second SMP procedure achieving near-complete resolution. At last follow-up (median 155 days; range, 30-761 days) no new endoleaks were identified. Sacs regressed in 6 patients and were stable in 4; none expanded.</p><p><strong>Conclusion: </strong>SMP embolization was safe and effective for significant endoleak after TA-F/BEVAR, despite large endoleak volumes and frequent prior failed intervention. All patients achieved substantial endoleak reduction or resolution; most sacs regressed and none expanded. Longer follow-up is needed to establish durability.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102826","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":"Bridge Endovascular Aneurysm Repair Followed by Delayed Open Reconstruction for Infected Native Abdominal Aortic Aneurysm.","authors":"Jung Won Kwak, Sung Bum Cho, Hyo Kee Kim, Young Ju Oh, Cheol Woong Jung, Heungman Jun","doi":"10.1016/j.avsg.2026.09.049","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.049","url":null,"abstract":"<p><strong>Objectives: </strong>Infected native abdominal aortic aneurysm (INAA) is a life-threatening condition for which emergency open repair may carry substantial physiologic risk. This study evaluated a staged strategy using endovascular aneurysm repair (EVAR) for initial aneurysm exclusion, followed by prolonged antimicrobial therapy and delayed definitive open reconstruction.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive patients with INAA treated at a single tertiary referral center between January 2020 and December 2025. Patients undergoing bridge EVAR followed by delayed EVAR explantation and open reconstruction after infection control were included. Clinical characteristics, operative details, postoperative complications, infection-related outcomes, and survival were assessed descriptively.</p><p><strong>Results: </strong>Nine patients were diagnosed with INAA, of whom eight underwent staged treatment. Mean age was 68.1 years, five patients (62.5%) were male, and blood cultures were positive in six (75.0%). The median interval from EVAR to definitive reconstruction was 79.5 days (range, 55-105 days). Seven patients underwent in situ prosthetic graft reconstruction after infection control; one patient with persistent infection underwent autologous femoral vein reconstruction. During a median follow-up of 20.5 months (range, 1-39 months), two patients died. Estimated overall survival was 87.5% at 1 year and 65.6% at 3 years. No recurrent infection, graft infection, or graft-related reintervention was observed among surviving patients.</p><p><strong>Conclusions: </strong>In this small cohort managed with a staged institutional strategy, bridge EVAR followed by prolonged antimicrobial therapy and delayed open reconstruction was feasible and achieved durable infection control among survivors. This strategy may provide time for infection control and physiologic recovery before definitive reconstruction; larger comparative studies are required.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103225","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":"Proximal Neck Diameter Changes Following Zone 0 TEVAR With or Without Ascending Aortic Wrapping.","authors":"Takayuki Shijo, Kazuo Shimamura, Koichi Maeda, Yoshiki Watanabe, Takashi Shirakawa, Toru Ide, Fumio Yamana, Satoshi Sakakibara, Mitsuyoshi Takahara, Shigeru Miyagawa","doi":"10.1016/j.avsg.2026.09.033","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.033","url":null,"abstract":"<p><strong>Background: </strong>In zone 0 thoracic endovascular aortic repair (TEVAR), ascending aortic wrapping for a moderately dilated ascending aorta may stabilize the proximal landing zone. This study evaluated serial changes in proximal aortic diameter after zone 0 TEVAR and explored the potential stabilizing effect of ascending aortic wrapping.</p><p><strong>Methods: </strong>This retrospective, single-center study included 108 patients with degenerative aortic arch aneurysms who underwent zone 0 TEVAR between 2008 and 2022. Thirty patients received concomitant ascending aortic wrapping (group W) and 78 underwent TEVAR without wrapping (group N). We assessed serial changes in ascending aortic diameter at the proximal neck.</p><p><strong>Results: </strong>Preoperative proximal neck diameter was larger in group W (median 39 mm [IQR 38-41]) than in group N (34 mm [IQR 32-36]; p < .001), and it decreased to 30 mm [IQR 28-31] after wrapping. In group W, diameter increased significantly during the first postoperative year (2.5 mm/year; 95% CI 1.9-3.0; p < .001), then slowed yet showed a continued upward trend (0.17 mm/year; 95% CI 0.04-0.31; p = .018). In group N, the growth rate was 0.57 mm/year (95% CI 0.21-0.92; p = .002) in year one and 0.42 mm/year (95% CI 0.18-0.67; p = .001) thereafter. At 5 years, cumulative incidence of late type Ia endoleak was 0% in group W versus 14% (95% CI 5-31%) in group N.</p><p><strong>Conclusions: </strong>Ascending aortic wrapping during zone 0 TEVAR may attenuate proximal neck enlargement.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103061","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":"Failure Modes of Endovascular Therapy for Spontaneous Isolated Superior Mesenteric Artery Dissection.","authors":"Jianping Xiong, Shilu Zhao, Qichen Feng, Qijia Liu, Guangxin Yang, Jinman Zhuang, Tianrun Li, Changming Wang, Jingyuan Luan","doi":"10.1016/j.avsg.2026.09.045","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.045","url":null,"abstract":"<p><strong>Background: </strong>Mechanisms of failure after endovascular stenting for symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD) remain poorly characterized. We analyzed device- and procedure-related failure modes in a 17-year single-center cohort.</p><p><strong>Methods: </strong>We reviewed 117 consecutive patients with SISMAD (2008-2025). Patients stented for persistent or escalating pain despite conservative management formed the cohort; catheter-infusion and open-surgery patients were analyzed separately. Lesions were classified by Yun morphology. Failure modes were classified a priori as Type I (intraprocedural technical failure), Type II (thrombotic events occurring after the procedure), and Type III (in-stent restenosis or intimal hyperplasia at ≥6 months). Patency and reinterventions were recorded.</p><p><strong>Results: </strong>Thirty-two patients underwent endovascular therapy (28 stenting, 4 catheter-directed infusion). In the stent cohort, uncomplicated technical success was 82.1% (23/28). Type I failures occurred in 17.9% (5/28), dominated by false-lumen deployment (10.7%) clustered in Yun III occlusions (50.0% vs 9.1%; P = .050). Type II events (3 weeks; 24 months) were rescued by reintervention. Type III events developed in 22.7% (5/22), confined to multi-stent constructs (45.5% vs 0%; P = .035). Primary patency was 81.8% (18/22) at a median 19-month imaging follow-up; secondary patency was 100% after 3 reinterventions. Greater baseline true-lumen stenosis and Yun III morphology predicted composite events. No patient died; the only bowel resection preceded secondary stenting.</p><p><strong>Conclusions: </strong>Endovascular therapy for SISMAD fails in characteristic, morphology-dependent patterns. The proposed three-type classification is exploratory and requires validation in larger cohorts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102895","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":"Pediatric Abdominal Vascular Compression Syndromes: Clinical Presentation, Comorbidities, and Outcomes Following Surgical Correction.","authors":"David S Mahan, Benjamin Brandeis, Khanjan H Nagarsheth","doi":"10.1016/j.avsg.2026.09.044","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.044","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this case series was to characterize the clinical presentation, comorbidities, and postoperative outcomes of pediatric patients who underwent surgical repair for Median Arcuate Ligament Syndrome (MALS) and/or Nutcracker Syndrome (NCS).</p><p><strong>Methods: </strong>We conducted a retrospective chart review of 17 pediatric patients who underwent open surgical repair for MALS and/or NCS at a single academic center from 2021-2025.</p><p><strong>Results: </strong>The most common comorbidities included postural orthostatic tachycardia syndrome (POTS), hypermobile Ehlers-Danlos syndrome (hEDS), gallbladder pathology, and additional vascular compressions. All 17 patients presented with abdominal pain, and more than half reported postprandial pain and/or nausea. Open surgical repair provided patient-reported symptomatic improvement in all patients. A subset experienced recurrent pain at longer-term follow-up.</p><p><strong>Conclusion: </strong>Pediatric patients with MALS and/or NCS demonstrate consistent clinical features, including abdominal pain and overlapping comorbidities. In this highly selected surgical cohort, open repair was associated with early and intermediate-term patient-reported improvement in compression-related pain, though symptom recurrence was observed in a subset.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103048","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":"Procedural and early postoperative pain after treatment of varicose veins using endovenous laser ablation with or without phlebectomy and cyanoacrylate closure.","authors":"Peter Balaz, Slavomir Rokosny, Adam Whitley","doi":"10.1016/j.avsg.2026.09.026","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.026","url":null,"abstract":"<p><strong>Objectives: </strong>To compare procedural and early postoperative pain after endovenous laser ablation (EVLA), EVLA with concomitant phlebectomy, and cyanoacrylate closure (VenaSeal).</p><p><strong>Methods: </strong>Consecutive patients undergoing EVLA, EVLA with phlebectomy, or cyanoacrylate closure between January 2024 and January 2025 were included. Pain was assessed using a numerical rating scale (NRS, 0-10) immediately after the procedure and at telephone follow-up 10-14 days postoperatively. Multivariable linear regression was used to adjust for baseline differences between groups.</p><p><strong>Results: </strong>A total of 392 patients were analysed (EVLA: n=190; EVLA with phlebectomy: n=109; cyanoacrylate closure: n=93). Pain scores were low across all groups, both immediately after the procedure (mean NRS 1.52) and at follow-up (mean NRS 1.43), with no significant differences between treatment modalities before or after adjustment. Concomitant phlebectomy did not increase pain. Clinical outcomes and complication rates were comparable.</p><p><strong>Conclusions: </strong>EVLA, EVLA with phlebectomy, and cyanoacrylate closure are associated with an equally low pain burden. Pain should not be a decisive factor when selecting among established endovenous treatment modalities.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103054","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":"Decoding the Aneurysm Thrombus: Radiomic Signatures of Sac Shrinkage After EVAR.","authors":"Laura Rascio, Luca Boldrini, Edda Boccia, Huong Elena Tran, Teresa Lodico, Alessandro Posa, Daniele Perla, Roberto Iezzi, Ottavia Borghese, Yamume Tshomba","doi":"10.1016/j.avsg.2026.09.025","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.025","url":null,"abstract":"<p><strong>Background: </strong>Aneurysm sac shrinkage after endovascular aortic repair (EVAR) is a surrogate marker of effective aneurysm exclusion and favorable outcomes. Radiomics enables quantitative imaging analysis beyond visual assessment and is increasingly applied in cardiovascular imaging. Analysis of intraluminal thrombusmay may provide additional information for identifying patients with different patterns of sac remodeling after EVAR.</p><p><strong>Methods: </strong>This single-center retrospective study assessed whether radiomic features of the intraluminal thrombus extracted from preoperative computed tomography angiography (CTA), alone and in combination with clinical and anatomical variables, were associated with aneurysm sac shrinkage after EVAR. Patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm were included and stratified according to sac shrinkage at 12-month follow-up. Preoperative arterial-phase CTA scans were analyzed. The aneurysm sac was manually segmented using 3D Slicer, and the intraluminal thrombus was selected as the region of interest. A total of 530 radiomic features were extracted using PyRadiomics with Laplacian of Gaussian filtering. Features were standardized and evaluated using the Wilcoxon-Mann-Whitney test, Pearson correlation filtering, and Akaike Information Criterion-based feature selection. Predictive performance was compared among combined clinical-radiomic, radiomic-only, and clinical-only models.</p><p><strong>Results: </strong>Among 94 patients, 29 showed aneurysm sac shrinkage. Two radiomic features were significantly associated with shrinkage. Younger age (p=0.02), larger aneurysm diameter (p=0.02), and homogeneous thrombus texture were associated with shrinkage, while the absence of COPD was associated with lack of shrinkage. None of the other evaluated clinical or anatomical variables showed a significant association with sac shrinkage. The combined clinical-radiomic model achieved the best performance (AUC 0.76, sensitivity 0.70, specificity 0.75, accuracy 0.73).</p><p><strong>Conclusion: </strong>Preoperative thrombus radiomic features were associated with subsequent sac shrinkage and provided complementary information when integrated with clinical variables. These findings support the potential role of thrombus radiomics in the characterization of sac remodeling after EVAR and warrant validation in larger cohorts.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103220","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":"Assessment of Dressing Method (Self-dressing vs. Nurse-led dressing) on Healing Outcomes in Diabetic Foot Ulcers: A Prospective Comparative Study.","authors":"Islam Badry Mohammed, Abdelrahman Magdy Farrag, Mohamed Hatem Emara, Amr Abdelghaffar Mahmoud","doi":"10.1016/j.avsg.2026.09.035","DOIUrl":"https://doi.org/10.1016/j.avsg.2026.09.035","url":null,"abstract":"<p><strong>Background: </strong>Diabetic foot ulcers (DFUs) are a major cause of morbidity and amputation. Professional wound care is standard, but patient self-dressing could be an alternative in resource-limited settings. Direct comparisons between self-dressing and nurse-led dressing are lacking. We compared their effects on healing outcomes in DFUs.</p><p><strong>Methods: </strong>This prospective, randomized, controlled trial enrolled 60 adults (≥18 years) with type 1 or type 2 diabetes and Wagner grade 1-2 DFUs, ankle-brachial index ≥0.7, sufficient cognitive and motor skills for self-care, and ability to attend follow-up. Patients were randomized 1:1 to either a structured self-dressing protocol after standardized training (group A, n=30) or nurse-led dressing (group B, n=30). All received standardized offloading, debridement, and a sodium hyaluronate dressing changed every 2-3 days. The primary outcome was time to complete healing (weeks). Secondary outcomes included healing rate, infection, amputation, and number of dressing days. Follow-up for healing outcomes was 14 weeks. Analysis used intention-to-treat, with post-hoc logistic regression adjusting for baseline imbalances.</p><p><strong>Results: </strong>Baseline characteristics were similar except for higher chronic kidney disease prevalence and foot infection score in the self-dressing group (P<0.05). After adjusting for these factors, the dressing type remained independently associated with complete healing (adjusted OR 0.12, 95% CI 0.02-0.68, P=0.016). Healing of surface area and wound volume was significantly slower in the self-dressing group at all time points from 2 to 14 weeks (P<0.001). Complete healing occurred in 80.0% (24/30) of the self-dressing group vs. 100% (30/30) of the nurse-led group (P=0.032). Time to complete healing was longer with self-dressing (mean 17.7±4.1 vs. 9.8±2.1 weeks; P<0.001). Dressing days (124.8±28.2 vs. 67.7±15.3; P<0.001), infection rate (23.3% vs. 0%; P=0.011), and minor amputations (17.9% vs. 0%; P=0.021) were significantly higher in the self-dressing group. Limb salvage and major amputations did not differ significantly.</p><p><strong>Conclusions: </strong>In patients with uncomplicated DFUs, nurse-led dressing achieved faster healing, fewer infections, and fewer minor amputations compared with structured patient self-dressing. Self-dressing cannot be recommended as a substitute for professional wound care in this population.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103266","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}