Annals of vascular surgery最新文献

{"title":"Response to the Letter Regarding “A Wider Grip Endoanchors Increase Proximal Sealing Surface During Endovascular Aneurysm Repair”","authors":"Giulio Accarino, Davide Esposito, Marco Campolmi, Raffaele Serra, Umberto Marcello Bracale","doi":"10.1016/j.avsg.2025.09.012","DOIUrl":"10.1016/j.avsg.2025.09.012","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 608-609"},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085040","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":"Iliac Artery Stenting versus Open Surgical Reconstruction for Complex Unilateral Iliac Lesions: a Randomized Trial.","authors":"Shoraan Saaya, Alexander Gostev, Olesia Osipova, Vladimir Starodubtsev, Pavel Ignatenko, Vyacheslav Mitrofanov, Cheban Aleksey, Emin Valiev, Andrey Karpenko, Alexander Chernyavskiy","doi":"10.1016/j.avsg.2025.08.046","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.046","url":null,"abstract":"<p><p>The aim of this study was to compare the safety and effectiveness of endovascular treatment (ET) and open surgical reconstruction (OR) in patients with complex unilateral iliac lesions sparing the common femoral artery.</p><p><strong>Materials and methods: </strong>From August 2015 till November 2020, eligible patients presenting with steno-occlusive iliac lesions (TASC types C, D) were randomized to either ET or OR. The prespecified primary outcomes were technical success, 30-day primary and secondary patency, and complication rates. Secondary outcomes were major adverse limb events, primary and secondary patency all at 36 months.</p><p><strong>Results: </strong>Of the 450 patients evaluated, 202 were randomized (101 in the ET group and 101 in the OR group). The average length of hospital stay was shorter in the ET (p<.001). The 30-day postoperative complication rate was 3.96% in the ET group and 15.84% in the OR group (p = .005). The primary patency rates at 36 months were 88.12% in the OR group and 75.25 % in the ET group (HR 0.44, 95% CI 0.22; 0.89, p=.022). Secondary patency at 36 months was 99.01% and 95.05% (HR 0.19, 95% CI 0.02;1.69, p=.13). Amputation free survival at 36 months were 84.16% and 85.15% in OR and ET (HR 1.17, 95% CI 0.54; 2.53, p=.68).</p><p><strong>Conclusions: </strong>This randomized trial found that ET was associated with a significantly shorter hospital stay and lower rates of postoperative complications, while secondary patency rates up to 3 years were not different. However, the primary patency at 36 months was significantly higher after OR.</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":"145085003","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":"Two-Year Outcomes of the French Multicentric Registry on LUMINOR Drug-Eluting Balloon for Superficial Femoral and Popliteal Arteries (LUMIFOLLOW)","authors":"Caroline Caradu ,&nbsp;Claire Webster ,&nbsp;Bahaa Nasr ,&nbsp;Jonathan Sobocinski ,&nbsp;Nicolas Louis ,&nbsp;Benjamin Thévenin ,&nbsp;Gilles Goyault ,&nbsp;Yann Goueffic ,&nbsp;Eric Ducasse","doi":"10.1016/j.avsg.2025.09.011","DOIUrl":"10.1016/j.avsg.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Drug-coated balloon (DCB) technology is demonstrating increasing potential in lower limb revascularization; 1-year results demonstrate acceptable levels of safety and efficacy and quality of life improvements. This follow-up study assessed whether these advantages persisted over 2 years with the Luminor DCB.</div></div><div><h3>Methods</h3><div>The LUMIFOLLOW registry enrolled 542 patients with 580 lesions across 15 centers. It included both <em>de novo</em> and restenotic lesions and calcified and/or long occlusions. Primary endpoints were medical safety (freedom from periprocedural death, index limb amputation, and/or all-cause mortality) and efficacy (primary patency defined as freedom from target lesion revascularization (f-TLR) and/or restenosis). Secondary endpoints included device, procedural and clinical success, major adverse events, and functional assessments.</div></div><div><h3>Results</h3><div>The mean age was 71.2 years, with 67.2% men; 23.8% were Rutherford classification (RC) 2, 43.2% were RC 3, 16.8% RC were 4, and 16.2% were RC 5; 57.5% of lesions were in the superficial femoral artery (SFA), 42.5% extended to the popliteal artery, with 24.2% restenosis and 44.3% total occlusions. Mean lesion length was 140.55 ± 99.42 mm. Provisional stenting was required in 43.1%. Acute clinical success was 93.5%. By 2 years, 351 of 542 (64%) patients remained in the study group, 48 patients had died. Estimated primary patency was 73.9% (95% CI: 69.3–77.9%); f-TLR was 92.0% (95% CI: 88.7–94.4%). Subgroup analyses showed no differences between f-TLR and primary patency rates between disease severity (TASC classification), <em>de-novo</em> versus in stent restenosis, and lesion location. Improvements in quality of life (QOL) were 63.1% improved mobility, 60.2% reduced pain, and 40.2% enhanced usual activities. Walking Impairment Questionnaire scores demonstrated sustained improvements (61.2 ± 30.0, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Luminor DCBs are safe and effective for femoropopliteal interventions, with equity in results in severe arterial disease, restenosis, SFA, and popliteal territories Significant improvement in QOL, walking ability, high primary patency, and low complication rates underscore the benefits of Luminor DCBs in real-world settings.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 656-668"},"PeriodicalIF":1.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079476","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":"Emerging Perspectives on Biomarker Panels in Deep Vein Thrombosis: The Combined Roles of D-Dimer, P-Selectin, and Microparticles.","authors":"Sisira Joy, Kaliyamurthi Venkatachalam, Ambika Binesh","doi":"10.1016/j.avsg.2025.08.050","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.050","url":null,"abstract":"<p><p>Deep vein thrombosis (DVT) is a severe vascular illness with high morbidity and mortality, especially when it develops as pulmonary embolism. Early and accurate diagnosis, as well as efficient risk stratification, is necessary for a prompt intervention and avoiding complications. Through D-dimer finds extensive application in everyday practice because of its very high sensitivity, its poor specificity emphasizes the requirement for more supportive diagnostic methods. Current developments have pointed to the value of muti-biomarker strategies that combine different pathophysiologic features of thrombosis, such as coagulation, platelet activation, and endothelial dysfunction. The review aims to give a complete picture of major biomarkers involved in DVT and focuses on D-dimer, P-selectin, and circulating microparticles. We review their separate biological functions, their diagnostic and prognostic value, and the limitations faced by their use alone. In addition, we discuss the rationale and forthcoming evidence in favour of combined biomarker panels, which can potentially provide better diagnostic accuracy and facilitate the process of developing personalized medicine strategies in DVT management. Muti-marker approaches incorporation is a promising horizon in bettering clinical outcomes for thrombotic disorder patients.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063343","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":"E-STABILISE Technique: A Solution for Postdissection Thoracic Aortic Aneurysm Repair: The Association of Transcatheter Electosurgical Septotomy with the STABILISE Technique","authors":"Mauro Fresilli ,&nbsp;Fabio Massimo Oddi ,&nbsp;Alessia Di Girolamo ,&nbsp;Arnaldo Ippoliti ,&nbsp;Eugenio Martelli","doi":"10.1016/j.avsg.2025.08.044","DOIUrl":"10.1016/j.avsg.2025.08.044","url":null,"abstract":"<div><h3>Background</h3><div>Postdissection thoracic aortic aneurysm (PD-TAA) treatment represents one of the most challenging scenarios in vascular surgery, and has led to the development of various techniques. This is a retrospective single-center study aiming to show the early results of patients affected by PD-TAA treated by Transcatheter Electrosurgical Septotomy, followed by endovascular remodeling using the STent-Assisted Balloon-Induced intimaL dISruption and rElamination (STABILISE) in aortic dissection repair technique.</div></div><div><h3>Methods</h3><div>From January 2023 to December 2024, 10 patients were treated for PD-TAA using this technique. Aneurysmal degeneration involved both the aortic arch and thoracic aorta in 6 cases, while in the remaining 4 cases, only the descending thoracic aorta was involved.</div><div>After endovascular repair of the aortic arch, when needed, and electrosurgical septotomy of the dissection lamella in the thoraco-abdominal tract, the procedure was completed by thoracic graft and dissection aortic stent placement, followed by aortic ballooning, performed in the same fashion as the STABILISE technique.</div></div><div><h3>Results</h3><div>Technical success and clinical success were achieved in 100% of cases.</div><div>No intraoperative and 24-h death and aorta-related complications were recorded.</div><div>No 30-day mortality was recorded. No aorta-related complication at 30 days was recorded in 9 cases. In one case, a type IB endoleak was recorded and was treated with a branched thoraco-abdominal endograft.</div></div><div><h3>Conclusion</h3><div>These preliminary results suggest that the combination of the Transcatheter Electrosurgical Septotomy (TES) with the STABILISE technique is promising in a selected cohort of patients. Further studies are necessary to confirm these results.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 610-617"},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063288","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":"Guideline-Adherent Care is Associated with Higher Rates of Symptom Relief in Claudicants with Surgical Intervention","authors":"Richard Shi,&nbsp;Nicholas Bulatao,&nbsp;Rebecca Oyetoro,&nbsp;Rupak Mukherjee,&nbsp;Adam Tanious","doi":"10.1016/j.avsg.2025.08.045","DOIUrl":"10.1016/j.avsg.2025.08.045","url":null,"abstract":"<div><h3>Background</h3><div>Surgical guidelines recommend intervention in claudicants with severe lifestyle limiting symptoms that have failed optimal medical therapy (OMT) and supervised exercise therapy. We investigate the rate of complete guideline-adherent care in claudicants and assess its impact on postsurgical symptom relief.</div></div><div><h3>Methods</h3><div>A single institution retrospective cohort study was performed on claudicants with an endovascular/open surgical intervention from 2014 to 2023. Guideline adherence was defined as: lifestyle limitation documentation, OMT adherence (composite of single antiplatelet agent, lipid-lowering therapy, smoking cessation), and exercise therapy completion. The primary outcome was symptom relief at 1 year, defined as an improvement in walking distance or impact on activities of daily living. Statistical analysis included independent sample t-tests, Pearson χ2 tests, Kaplan-Meier analysis, and logistic regression modeling.</div></div><div><h3>Results</h3><div>Of 258 claudicants with surgical intervention, 19% were guideline-adherent. Lifestyle limitation documentation was found in 62.4% of patients, 65.1% were on OMT, and 31% completed exercise therapy. One-year symptom relief was found in 87.8% of guideline-adherent patients, compared to 67.0% of guideline-nonadherent patients (<em>P</em> = 0.01). On multivariable logistic regression analysis, guideline-adherence (odds ratio [OR]: 3.31 [1.30, 8.42], <em>P</em> = 0.01), 5-factor modified frailty index &gt;2 (OR: 0.48 [0.27, 0.87], <em>P</em> &lt; 0.02), and prior peripheral vascular intervention (OR: 0.27 [0.13, 0.59], <em>P</em> &lt; 0.01) were predictors of 1-year symptom relief.</div></div><div><h3>Conclusion</h3><div>Guideline-directed care in claudicants remains low, despite its association with 1-year symptom relief. There is increasing need for initiatives to qualitatively characterize and improve adherence rates of guideline-directed care in claudicants.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 618-626"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058286","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":"Prediction of Chronic Limb Threatening Ischemia by Clinical Data: The PREDICCMI Study","authors":"Carine Boulon ,&nbsp;Loubna Dari ,&nbsp;Julien Asselineau ,&nbsp;Edouard Lhomme ,&nbsp;Juliette Picot ,&nbsp;Lucie Chastaingt ,&nbsp;François-Xavier Lapebie ,&nbsp;Philippe Lacroix ,&nbsp;Alessandra Bura-Riviere ,&nbsp;Joël Constans","doi":"10.1016/j.avsg.2025.09.005","DOIUrl":"10.1016/j.avsg.2025.09.005","url":null,"abstract":"<div><h3>Background</h3><div>The main objective was to develop a clinical model to predict critical lower limb ischemia (CLI). Secondary objectives were to assess the reproducibility of clinical data and to create a predictive score for major amputation.</div></div><div><h3>Methods</h3><div>Prediction de l'ischémie critique des membres inférieurs was a French multicenter prospective observational study that included patients suspected of chronic limb threatening ischemia (CLTI). The first end point was hemodynamic confirmation of CLI according to the European consensus and Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II definitions. We created models from clinical data to predict CLTI and major amputation or vascular death at 1 year based on CLI classifications and clinical and hemodynamic data.</div></div><div><h3>Results</h3><div>Five hundred seventy-four patients were included. After a median follow-up of 22.3 months (Q1-Q3 10.8–34.7), 243 patients (42%) had died and 96 patients (16%) had undergone at least one major amputation. The clinical model poorly predicted objectively confirmed CLI (c index 0.610 [0.560–0.630]). However, a combination of clinical data and systolic toe pressure predicted the risk of major amputation (area under the curve 0.710 [0.647–0.760]).</div></div><div><h3>Conclusion</h3><div>Classical classifications of CLI are not adequately predicted by clinical parameters. While purely clinical models also poorly predict vascular outcome, a model including clinical data and systolic toe pressure seems to predict major amputation or vascular death satisfactory.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 669-681"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051850","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":"Influence of Diabetes Mellitus on Outcomes of Patients Undergoing Carotid Artery Stenting: A Systematic Review and Meta-Analysis","authors":"Eren Çetinel ,&nbsp;Rafael Andrade ,&nbsp;Mostafa Labib ,&nbsp;Andressa Frankowski Dagostin ,&nbsp;Ghislain Irakoze Habiyambere ,&nbsp;Him Shun Kei ,&nbsp;Dario Madera","doi":"10.1016/j.avsg.2025.09.007","DOIUrl":"10.1016/j.avsg.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Diabetes mellitus is a well-known risk factor for adverse vascular events, yet its specific influence on carotid artery stenting (CAS) outcomes remains unclear. This study aims to determine if diabetes increases perioperative risks after CAS.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis compared diabetic versus nondiabetic CAS patients. We searched PubMed, Embase, Scopus, and Cochrane Library for English cohort studies reporting outcomes by diabetic status. Primary outcome was perioperative stroke; secondary included transient ischemic attack (TIA), myocardial infarction (MI), death, restenosis, and stroke/death composite. Data were pooled using random-effects models. Heterogeneity was quantified by I², and publication bias was assessed with Egger regression.</div></div><div><h3>Results</h3><div>Twelve cohort studies (22,226 patients; 7,415 diabetic) were included. Meta-analysis found diabetes was not significantly associated with increased risk of perioperative stroke (risk ratio [RR] 1.16; 95% confidence interval [CI] 0.79–1.69), TIA (RR 1.42; 95% CI 0.98–2.06), MI (RR 1.60; 95% CI 0.87–2.94), all-cause mortality (RR 0.90; 95% CI 0.61–1.32), and stroke/death composite (RR 1.07; 95% CI 0.79–1.45). However, diabetes significantly increased long-term target-vessel restenosis risk (RR 2.10; 95% CI 1.18–3.73; I² = 37%). Heterogeneity was low (I² 0%–37%). Sensitivity analyses confirmed stability. Funnel plots were symmetric; the Egger test was nonsignificant (<em>P</em> = 0.383).</div></div><div><h3>Conclusion</h3><div>In carefully selected patients, diabetes does not elevate the short-term risks of stroke, TIA, MI, or death following CAS. However, it is associated with a significantly higher long-term risk of restenosis. These results support the safe use of CAS in diabetic patients but underscore the need for enhanced long-term surveillance to manage restenosis risk.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 635-645"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058288","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":"Trainee Autonomy is Associated with Well-being.","authors":"Christina L Cui, Margaret A Reilly, Eric B Pillado, Ruojia Debbie Li, Joshua S Eng, Yue Jiang, Leanne E Grafmuller, Kathryn L DiLosa, Allan M Conway, Guillermo A Escobar, Palma M Shaw, Yue-Yung Hu, Karl Y Bilimoria, Malachi G Sheahan, Dawn M Coleman","doi":"10.1016/j.avsg.2025.09.010","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.010","url":null,"abstract":"<p><strong>Introduction: </strong>Progressive entrustment is critical to reaching independent practice. Concerns around progressive entrustment during clinical training have grown in the past decade, especially with the evolution of the vascular surgery training pipeline. The purpose of this study is to evaluate vascular surgery trainee perceptions of autonomy and its associations with their well-being and learning environment.</p><p><strong>Methods: </strong>Data was collected through a confidential, voluntary survey administered after the 2020-2024 VSITEs as an adjunct to the vascular arm of the SECOND trial. Autonomy was defined by operative autonomy, clinical autonomy, and operative time. Trainees ranked their degree of satisfaction with each component on a Likert scale, which was subsequently dichotomized. Univariable logistic regression was used to evaluate the association between autonomy and well-being outcomes. Multivariable logistic regression was used to evaluate learning environment factors associated with trainee dissatisfaction with autonomy.</p><p><strong>Results: </strong>A total of 3,272 survey results were collected from 2020-2024. Approximately 3.9% (n=117) of survey responses reported dissatisfaction with operative autonomy, 2.0% (n=52) of responses reported dissatisfaction with clinical autonomy, and 4.2% (n=93) of responses reported dissatisfaction with the amount of time spent in the operating room. These rates did not change over time (p>0.05). Within 2024 responses, the only statistically significant difference in demographic variables between trainees who were dissatisfied with autonomy and those who were satisfied was gender (dissatisfaction: 12% females versus 5% males, p=0.016). In comparison, all learning environment factors were statistically significantly different between groups (p<0.001). On adjusted analysis, dissatisfaction with autonomy was driven by trainee perceptions of faculty engagement (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 1.9-12, p<0.001) and efficiency and program resources (aOR 10.9, 95%CI 4.4-26.8, p<0.001). Perceptions of autonomy also had significant associations with well-being metrics. Trainees who reported dissatisfaction with their autonomy were also more likely to report burnout, thoughts of attrition, suicidal ideation, professional dissatisfaction, and personal dissatisfaction.</p><p><strong>Conclusion: </strong>A minority of vascular trainees expressed dissatisfaction with their autonomy. Those who did had higher odds of adverse training experiences, including burnout, work-life conflict, thoughts of attrition, and suicidal ideation. Program monitoring of trainee autonomy and operative time may mitigate this risk.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058245","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":"Long-Term Outcomes and Risk Factors after Hybrid Thoracic Endovascular Aortic Repair with Landing in Zones 1 and 2","authors":"Tomoaki Kudo,&nbsp;Toru Kuratani,&nbsp;Tomohiko Sakamoto,&nbsp;Junki Yokota,&nbsp;Yuki Oga,&nbsp;Yoshiki Sawa","doi":"10.1016/j.avsg.2025.08.043","DOIUrl":"10.1016/j.avsg.2025.08.043","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to examine the outcomes of zones 1 and 2 landing hybrid thoracic endovascular aortic repair (TEVAR) and to examine risk factors associated with poor outcomes.</div></div><div><h3>Methods</h3><div>From April 2014 to March 2024, 96 patients underwent zones 1 and 2 landing hybrid TEVAR for aortic arch pathologies (median age: 78 years). The primary endpoint was major adverse aorta-related events (late rupture/dissection and/or aorta-related reintervention). The secondary endpoint was type 1a endoleak. Outcomes were analyzed by Kaplan–Meier and log-rank tests; risk factors by Cox regression. Median follow-up was 3.0 years.</div></div><div><h3>Results</h3><div>The 30-day mortality rate was 2.1% and the stroke rate was 4.2%. The aortic events rate at 7 years was 38.1%. In multivariate analysis, age (hazard ratio [HR] 1.06; 95% confidence interval [CI], 1.00–1.12; <em>P</em> = 0.023) and early era (HR 5.59; 95% CI, 1.23–25.3; <em>P</em> = 0.025) were significant risk factors for aortic events. Type 1a endoleak rates were significantly lower in the late-era group than in the early-era group (<em>P</em> = 0.003). The diameter of proximal landing zone in the early-era group was larger than that in the late-era group (<em>P</em> &lt; 0.001); however, the oversizing rate of proximal stent grafts in the early-era group was smaller than that in the late-era group (<em>P</em> &lt; 0.001). The aortic events and type 1a endoleak rates were significantly lower in the late-era group than in the early-era group (<em>P</em> = 0.003 and <em>P</em> = 0.011).</div></div><div><h3>Conclusion</h3><div>To prevent type 1a endoleak and aortic events, strict patient selection including preoperative measurement and surgeon skill are required. Hybrid TEVAR should be performed in an experienced facility.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 574-585"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058247","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}