Annals of vascular surgery最新文献

{"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":"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}

{"title":"The Axillary-Bi-Profunda Femoris Artery Bypass is Linked to a Higher Long-Term Risk of Amputation Compared to the Axillary-Bi-Common Femoral Artery Bypass.","authors":"Raquel Vicario-Feliciano, Ahsan Zil-E-Ali, Faisal Aziz","doi":"10.1016/j.avsg.2025.08.047","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.047","url":null,"abstract":"<p><strong>Objective: </strong>Axillofemoral bypass to treat aortoiliac occlusive disease is an extra-anatomic bypass which is an alternative to aortobifemoral bypass in patients deemed to be unfit to undergo an aortic operation. Distal anastomosis is usually sewn to the common femoral artery. However, in patients with occluded common femoral and superficial femoral arteries, profunda femoris artery can be used as the outflow. This study compares the outcomes of axillary to bilateral common femoral (Ax-Bi-CFA) and axillary to bilateral profunda femoris artery (Ax-Bi-PFA) bypasses.</p><p><strong>Methods: </strong>1,358 patients were included in the study from VQI registry data (1,194 patients: axillary to bilateral common femoral artery (Ax-Bi-CFA) bypass and 164 patients: axillary to bilateral profunda femoral artery (Ax-Bi-PFA) bypass). The primary outcomes studied were minor and major amputation as well as mortality at 30-days and at 1-year follow up. A p-value <0.05 was considered statistically significant across all analyses. Significant variables from the univariate analysis were further evaluated using multivariate logistic regression. Ax-Bi-CFA bypass was considered the reference group for the multivariable models.</p><p><strong>Results: </strong>Male patients were more likely to undergo an Ax-Bi-PFA bypass (n=106, 64.63%) compared to female patients (n=58, 35.37%). Patients with history of hypertension (n=152, 92.68%), CABG/PCI (n=67, 44.97%), prior arterial bypass (n=49, 29.88%), and prior history of smoking (n=80, 49.08%) were more likely to undergo an Ax-Bi-PFA bypass (p<0.05). Univariate analysis showed that patients with Ax-Bi-PFA bypass had relatively higher risk of major amputation at 30-days (9.76% in Ax-Bi-PFA vs. 4.36% in Ax-Bi-CFA, p=0.003) and at 1-year follow-up compared to patients who underwent Ax-Bi-CFA bypass (15.9% in Ax-Bi-PFA vs. 6% in Ax-Bi-CFA, p<0.05). There was no significant difference in mortality. On multivariate logistic regression, Ax-Bi-PFA bypass had a significantly higher risk of major amputation compared to patients who underwent Ax-Bi-CFA bypass at 1-year follow up (OR 2.44, 95% CI 1.39-4.28, p<0.05). There was no statistically significant difference observed at the 1-year time-endpoint (p=0.09).</p><p><strong>Conclusion: </strong>Patients with Ax-Bi-PFA bypass have increased risk of major amputation at 30-day and at 1-year follow up compared to patients with Ax-Bi-CFA bypass. After the risk adjustment, the odds of major amputation were observed to be significantly higher for Ax-Bi-PFA bypass as compared to patients in the other group.</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":"145058293","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 of the Preloading Coil-In-Plug Method for Internal Iliac Artery Embolization","authors":"Nagi Hayashi,&nbsp;Junji Yunoki,&nbsp;Atsuhisa Tanaka,&nbsp;Keijiro Shigetomi,&nbsp;Kouhei Baba,&nbsp;Masahide Shichijo,&nbsp;Kouki Jinnouchi,&nbsp;Hiroyuki Morokuma,&nbsp;Manabu Itoh,&nbsp;Keiji Kamohara","doi":"10.1016/j.avsg.2025.09.008","DOIUrl":"10.1016/j.avsg.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>During endovascular aneurysm repair (EVAR), embolization of the internal iliac artery (IIA) is sometimes necessary. The preloading coil-in-plug (P-CIP) technique allows high-density embolization within a confined area. This retrospective study at our institution evaluated the efficacy of the P-CIP technique and compared it with conventional coil embolization (CE).</div></div><div><h3>Methods</h3><div>Between January 2015 and December 2023, 201 patients underwent EVAR. Seventy-three patients underwent IIA trunk embolization. Patients who underwent embolization using only an Amplatzer vascular plug (AVP) or P-CIP using an AVP2 were excluded. Fifty-six patients (mean age, 76.7 years; 11 female patients) were categorized into the P-CIP (25 patients) and CE (31 patients) groups.</div></div><div><h3>Results</h3><div>The embolization site vessel diameter (8.08 ± 1.9 mm vs 8.01 ± 2.2 mm; <em>P</em> = 0.85), procedure time (36.4 ± 3.1 minutes vs 34.0 ± 3.1 minutes; <em>P</em> = 0.45) and incidence of type 2 endoleaks (0 [0%] vs. 1 [3.2%]; <em>P</em> = 0.27) of both groups were not significantly different. Compared to the CE group, the P-CIP group required fewer coils (3.36 ± 0.26 vs 4.30 ± 0.24; <em>P</em> = 0.037) and had a significantly higher complete occlusion rate (19 [76.0%] vs 10 [32.3%]; <em>P</em> &lt; 0.002). Compared to the CE group, the P-CIP group had a significantly smaller embolization range (20.1 ± 5.46 mm vs. 31.7 ± 7.2 mm; <em>P</em> &lt; 0.001); however, the buttock claudication incidence was not significantly different (13 [52.0%] vs 13 [41.9%]; <em>P</em> = 0.45). All patients experienced full recovery of buttock claudication within 1 year postoperatively.</div></div><div><h3>Conclusion</h3><div>The P-CIP technique enabled effective and reliable embolization of the IIA trunk and demonstrated advantages over conventional CE.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 627-634"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058257","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":"Diagnostic Features of Infective Native Aortic Aneurysms:a Case-Control Study.","authors":"Zhengkunx Huo, Xuejun Wu","doi":"10.1016/j.avsg.2025.08.048","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.048","url":null,"abstract":"<p><strong>Background: </strong>Infective native aortic aneurysm (INAA) is a highly lethal disease that poses great challenges for the diagnosis. The Delphi consensus is the first consensus document and offered the diagnostic criteria of INAA. The previous research mainly compared INAA with published data. This case-control study aimed to compare clinical characteristics of INAA and non-infective aortic aneurysms (NIAA) to provide external verification of the diagnostic algorithm of INAA.</p><p><strong>Methods: </strong>INAA patients between 2013 and 2022 were extracted and were further reviewed with the criteria of the consensus. NIAA patients were assigned to the randomly selected (RS) group at a ratio of 2:1 and the propensity score-matched (PSM) group at a ratio of 1:1. A case-control study was performed. A nomogram diagnostic model was constructed with the result of logistic regression.</p><p><strong>Results: </strong>87 cases were identified as INAA (6.6%). Mean age of INAA was 67.1 years (SD 9.8), younger than those with NIAA (P=.009). There was no significant difference in multiple aneurysms between INAA and NIAA (P=.12). Mural thrombus (n=45 versus 148) and calcification (n=36 versus 148) were negatively correlated with INAA. The sensitivity of the diagnostic algorithm was 98.9%, and the specificity was 75.9%. The area under curve of the diagnostic model was 0.97 and the concordance index was 0.97.</p><p><strong>Conclusion: </strong>The diagnostic criteria in the Delphi consensus had a high sensitivity, while its specificity was not ideal. Whether multiple aneurysms can support the diagnosis of INAA remains to be further discussed. Mural thrombus and calcification can be the negative predictive factors of INAA. A new diagnostic model was proposed, and the nomogram model can identify INAA with high accuracy and discriminative ability.</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":"145058229","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":"Endoleak Repair Using Transfemoral Retrograde Embolization Outside the Graft during Endovascular Abdominal Aortic Repair","authors":"Zhe Zhang,&nbsp;Lishan Lian,&nbsp;Hai Feng,&nbsp;Xueming Chen","doi":"10.1016/j.avsg.2025.08.041","DOIUrl":"10.1016/j.avsg.2025.08.041","url":null,"abstract":"<div><h3>Background</h3><div>To preliminarily explore the efficacy and safety of retrograde embolization outside the stent graft via the femoral artery for endoleak repair during endovascular abdominal aortic repair.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 13 patients from our center who underwent retrograde endovascular embolization via the femoral artery for endoleak repair during endovascular abdominal aortic repair from December 2021 to March 2024. Nine patients had a type I endoleak, and 4 patients had a type II endoleak. All endoleaks were treated by endovascular coil embolization alone or combined with liquid embolic agents. All patients received regular follow-up with computed tomography angiography postoperatively.</div></div><div><h3>Results</h3><div>Coil embolization alone was used in 10 patients, coil embolization combined with fibrin glue or thrombin in 2 patients, and fibrin glue embolization alone in 1 patient. Intraoperative angiography revealed complete elimination of the endoleak in 10 patients and significant reduction in 3 patients. During the operation, ectopic embolization of the fibrin glue occurred in 1 patient, with no complications reported in the other patients. During the postoperative follow-up period ranging from 6 to 24 months (10.4 ± 5.4 months), follow-up computed tomography angiography results showed no definite endoleaks and no increase in aneurysm diameter; the aneurysm diameter decreased in 8 patients and did not change in 5 patients. No reoperations or deaths occurred during the follow-up period, resulting in a short-term success rate of 100%.</div></div><div><h3>Conclusion</h3><div>Retrograde embolization outside the stent graft via the femoral artery can be an alternative method to repair type I or II endoleaks during EVAR, with satisfactory short-term outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 646-655"},"PeriodicalIF":1.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058270","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":"The Role of EndoAnchors in Enhancing Proximal Sealing: A Call for Standardized Measurement and Prospective Validation","authors":"Xinyang Li,&nbsp;Shiwen Song","doi":"10.1016/j.avsg.2025.09.006","DOIUrl":"10.1016/j.avsg.2025.09.006","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 572-573"},"PeriodicalIF":1.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051879","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":"Endovascular-Based Treatment Compared To Frozen Elephant Trunk For Patients With Non-A Non-B Aortic Dissection: A Systematic Review And Meta-Analysis.","authors":"Carlos B M De Melo Neto, Mariana K Obara, Miguel Godeiro Fernandez, Dilson S Pimentel Junior, Milena Monteiro Mastra, Enrico P Bertolino, Denise Filippini, Grace Carvajal Mulatti","doi":"10.1016/j.avsg.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.09.001","url":null,"abstract":"<p><strong>Objectives: </strong>We performed a systematic review and meta-analysis to compare endovascular-based treatments (EBT) to surgical repair with Frozen Elephant Trunk (FET) in patients with non-A non-B aortic dissection and evaluate which of these approaches yields better outcomes.</p><p><strong>Methods: </strong>The systematic search was conducted using PubMed, Embase, and Cochrane Central databases up to January 2025. Articles were analysed following the Cochrane Collaboration Handbook and the PRISMA guidelines. The outcomes evaluated were all-cause mortality, 30-day mortality, aortic-related reintervention, length of hospital stay, and adverse aortic-related events. In addition, we performed a meta-regression analysis for all the outcomes to assess for any interaction with the following characteristics: prevalence of hypertension, prevalence of diabetes mellitus, aortic arch diameter, median follow-up period, and proportion of repairs in the acute phase of dissection.</p><p><strong>Results: </strong>The search yielded 942 results, of which 3 studies met the inclusion criteria. A total of 309 patients were included. No statistical difference was observed regarding all-cause mortality, 30-day mortality, length of hospital stay, and adverse aortic-related events. However, EBT revealed a significant increase in aortic-related reintervention compared to FET (RR 1.93; 95% CI 1.67 - 2.22; p < 0.01; I² = 0%). Prespecified meta-regressions showed no significant interactions.</p><p><strong>Conclusion: </strong>This meta-analysis reveals that FET has an improved outcome compared to endovascular-based treatments for patients with non-A non-B aortic dissection. Furthermore, a definitive recommendation for either surgery or endovascular therapy can not be made because of the limitations inherent to an analysis of a small population with heterogeneous anatomical presentation.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038927","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}