Annals of vascular surgery最新文献

{"title":"Commentary on: Inflammatory Biomarker-Based Risk Prediction Model for Endovascular Reconstruction in Acute Limb Ischemia: A Multicenter Development and Validation Study Risk Assessment for Endovascular Repair in Acute Limb Ischemia","authors":"Laiba Saher, Sahar Haseeb","doi":"10.1016/j.avsg.2025.09.003","DOIUrl":"10.1016/j.avsg.2025.09.003","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 597-598"},"PeriodicalIF":1.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032601","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":"12 Months Outcomes of Polymer-Free Amphilimus Eluting Stent Nitides in Patients With Complex Femoropopliteal Arterial Disease - A Single Center Experience","authors":"Katerina Sidiropoulou,&nbsp;Konstantinos Tigkiropoulos,&nbsp;Danai Chatziathanasiou,&nbsp;Georgios Chatziantoniou,&nbsp;Alexandros Apostolou,&nbsp;Kyriakos Stavridis,&nbsp;Dimitrios Karamanos,&nbsp;Nikolaos Saratzis","doi":"10.1016/j.avsg.2025.08.038","DOIUrl":"10.1016/j.avsg.2025.08.038","url":null,"abstract":"<div><h3>Background</h3><div>Nitides (Alvimedica, Istanbul, Turkey) is a novel polymer-free stent, which elutes Amphilimus; a combination of sirolimus and long chain fatty acids. Aim of this prospective single-center study is to assess the efficacy and 12-months outcomes of patients with femoropopliteal arterial disease, who underwent successful angioplasty with implantation of Amphilimus-eluting stent Nitides.</div></div><div><h3>Methods</h3><div>Patients with peripheral arterial disease who underwent angioplasty of the femoropopliteal segment with DES Nitides from August 2021 to February 2024 were included in the study. Primary endpoints included in-stent restenosis verified by Duplex ultrasound or computed tomography angiography of the lower limbs at 12 months. Secondary endpoints included major amputation, clinically driven target lesion revascularization (CD-TLR) and cardiovascular mortality during follow-up.</div></div><div><h3>Results</h3><div>A total of 61 angioplasties in 58 consecutive patients were performed. 82.7% were male patients with a mean age of 64.26 years. Fifty-six angioplasties were performed in the superficial femoral artery and in 5 patients in the p1 segment of the popliteal artery. Mean lesion length was 145.74 mm. A total of 72.1% of the lesions were chronic total occlusions, Tasc C and Tasc D lesions were 36.1% and 34.4%, respectively. Technical success was 100%. Primary patency was 91.2% (<em>n</em> = 52) and freedom from CD-TLR rate was 96.5% (<em>n</em> = 55) at 12 months. One patient underwent major amputation at 11 months (1.75%) and cardiovascular related mortality was 6.89% (<em>n</em> = 4).</div></div><div><h3>Conclusion</h3><div>This monocentric prospective study demonstrated that Amphilimus-eluting stent Nitides is safe, with good patency outcomes in complex femoropopliteal lesions and high rates of freedom from CD-TLR.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 564-571"},"PeriodicalIF":1.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032546","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 Mobility of Arm Score: A Short and Side-Specific Tool to Assess Functional Impairment in Patients with Suspected Thoracic Outlet Syndrome","authors":"Simon Lecoq ,&nbsp;Gabriel Davoise ,&nbsp;Samir Henni ,&nbsp;Eva Deveze ,&nbsp;Pierre Abraham ,&nbsp;Jeanne Hersant","doi":"10.1016/j.avsg.2025.08.040","DOIUrl":"10.1016/j.avsg.2025.08.040","url":null,"abstract":"<div><h3>Background</h3><div>Thoracic outlet syndrome (TOS) is characterized by the positional compression of the brachial plexus and/or subclavian vessels in the cervico-thoraco-brachial region, unilaterally or bilaterally. The functional impact is currently assessed by questionnaires that do not allow side-specific assessments. The Mobility of Arm Score (MASC) questionnaire was designed to be short and assess the functional impact of suspected TOS, emphasizing dynamic tasks and side-specific evaluations.</div></div><div><h3>Methods</h3><div>We prospectively recruited 200 patients referred to the vascular medicine department of the University Hospital of Angers for suspected TOS. They completed the Disability of Arm, Shoulder, and Hand (DASH) and MASC questionnaires. Feasibility was evaluated by comparing the rates of scorable questionnaires using the McNemar test. Pearson correlation coefficients were calculated to examine the relationship between MASC from the most affected arm and the DASH and Quick-DASH (Q-DASH) scores.</div></div><div><h3>Results</h3><div>The rate of scorable questionnaires was significantly higher for the MASC (98.5%) than for the DASH (90.5%; <em>P</em> &lt; 0.001) or Q-DASH (94%; <em>P</em> &lt; 0.001). Pearson correlation coefficients between the MASC score for the most affected arm and the DASH and Q-DASH scores were 0.835 (<em>P</em> &lt; 0.001) and 0.825 (<em>P</em> &lt; 0.001), respectively.</div></div><div><h3>Conclusion</h3><div>The MASC questionnaire demonstrated excellent feasibility and a strong correlation with the DASH and Q-DASH questionnaires. It offers valuable insights into the laterality of the symptoms in patients with suspected TOS. Future research should explore the sensitivity to changes of the MASC in the longitudinal follow-up of treated patients to validate these preliminary findings.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 599-607"},"PeriodicalIF":1.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022790","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 Treatment Protocol for Ruptured Abdominal Aortic Aneurysm: Ten-Year Experience","authors":"Grace Carvajal Mulatti ,&nbsp;Tayrine Mazotti de Moraes ,&nbsp;Eduardo Corvello Teixeira ,&nbsp;Priscilla Matos Cunha ,&nbsp;Taina Gomes Curado de Barros ,&nbsp;Ana Beatriz Madeira Boffa ,&nbsp;Dilson Pimentel-Junior ,&nbsp;Guilherme Baumgardt Barbosa Lima ,&nbsp;André Brito-Queiroz ,&nbsp;Pedro Puech-Leão ,&nbsp;Nelson De Luccia","doi":"10.1016/j.avsg.2025.09.002","DOIUrl":"10.1016/j.avsg.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>To investigate whether endovascular repair of ruptured abdominal aortic aneurysm (RAAA), performed whenever anatomically feasible, would be superior in a real-world registry.</div></div><div><h3>Methods</h3><div>Retrospective analysis of consecutive RAAA patients treated at the emergency department of a single hospital from January 2011 to December 2023, after implementation of protocol-based care. The variables of interest were hemodynamic stability, proximal neck length, and type of intervention. The outcomes were 30-day mortality and long-term survival. Statistical analyses were conducted using the chi-square test, Student's <em>t</em>-test, and Pearson correlation. Logistic regression was used to construct a propensity score for matching, and survival rates were illustrated using Kaplan–Meier curves.</div></div><div><h3>Results</h3><div>Among 209 treated patients, anatomical location included infrarenal, isolated iliac, and juxta-renal aneurysms. Endovascular repair was performed in 121 patients (57.9%), with a significant difference in proximal neck length compared to the open repair group (median 19.7 mm vs. 7.9 mm, <em>P</em> &lt; 0.001). Hemodynamic instability was present in 39% at admission. The overall 30-day mortality rate was 44%; endovascular repair was associated with lower mortality (34.7%, <em>P</em> = 0.001, 95% confidence interval: 0.263–0.431) before matching. Factors such as kidney failure, hemodynamic stability, proximal neck length, and morphology were significantly associated with mortality outcomes. However, propensity score matching (PSM, 42 pairs) revealed no statistical superiority of either technique.</div></div><div><h3>Conclusion</h3><div>While initial analysis indicated lower 30-day mortality in the endovascular group, PSM revealed no significant difference in either 30-day or long-term mortality between endovascular and open repair when anatomically feasible. Intervention choices should be tailored based on individual anatomical circumstances, the expertise of the medical team, and the resources at hand. Our propensity score analysis was the first to consider anatomical features; nevertheless, endovascular repair demonstrated no clear superiority to open repair.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 586-596"},"PeriodicalIF":1.6,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022802","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":"Ultrasound-Guided Percutaneous Electrocoagulation of Pathological Perforating Veins in the Treatment of Advanced Chronic Venous Insufficiency of the Lower Extremities: A Retrospective Cohort Study","authors":"Zhiruo Zhou,&nbsp;Zhanfeng Sun,&nbsp;Zhan Xu,&nbsp;Jiaji Bai,&nbsp;Decai Chi,&nbsp;Haitao Wang","doi":"10.1016/j.avsg.2025.08.030","DOIUrl":"10.1016/j.avsg.2025.08.030","url":null,"abstract":"<div><h3>Background</h3><div>To assess the efficacy and safety of ultrasound-guided electrocoagulation for pathological perforating veins in advanced lower extremity chronic venous insufficiency.</div></div><div><h3>Methods</h3><div>This study enrolled 455 patients (497 affected limbs) with venous insufficiency. Pathological perforating veins (diameter ≥3.5 mm, reflux duration &gt;500 ms) underwent ultrasound-guided percutaneous trocar-assisted electrocoagulation, while the main trunk of great saphenous vein was treated with endovenous radiofrequency ablation under tumescent anesthesia or local anesthesia. Comparative evaluation of preoperative and postoperative parameters, including Venous Clinical Severity Score (VCSS), ulcer healing status, cutaneous induration, inflammatory markers, pain intensity, and compliance with therapeutic compression therapy, was performed to validate the safety and efficacy of the surgical procedure.</div></div><div><h3>Results</h3><div>The VCSS of patients at 3, 12, and 24 months postoperatively were (10.30 ± 4.57) points, (4.52 ± 2.00) points and (1.38 ± 1.31) points, respectively, showing a continuous decline compared to the preoperative score of (16.09 ± 6.63) points, with statistically significant differences (<em>P</em> &lt; 0.001). In addition, statistically significant differences were observed in the comparisons between the VCSS at 3 months and 12, 3, and 24 months as well as 12 and 24 months postoperatively (<em>P</em> &lt; 0.001). All patients with lower limb ulcers achieved complete ulcer healing. Four patients experienced ankle pain while walking, which resolved within 2 weeks. No cases of deep vein thrombosis, hematoma, saphenous nerve injury, arterial ischemia, or infection were observed.</div></div><div><h3>Conclusion</h3><div>Through a retrospective cohort analysis incorporating duplex ultrasonography and standardized clinical outcome metrics, significant improvements in hemodynamic parameters and ulcer healing rates were observed. Ultrasound-guided cannular electro- coagulation of pathological perforating veins demonstrates encouraging safety and efficacy profiles in the management of severe chronic lower extremity venous insufficiency.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 673-681"},"PeriodicalIF":1.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013724","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":"Outcomes of the safety and efficacy of covered stents versus bare-metal stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Single-Center Experience.","authors":"Rafael de Athayde Soares, Gabriel Souza Lorenzoni, Victor Galvão Pinheiro, Flávio Augusto Peixoto Aleixo, Teresa Cristina Alves Duarte, Valdeno Brito Neto, Edson Takamitsu Nakamura, Roberto Sacilotto","doi":"10.1016/j.avsg.2025.08.026","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.026","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this paper was to compare the efficacy of covered stents (CSs) and bare metal stents (BMSs) in treating all types of aortoiliac occlusive disease (AIOD) and subsequently to analyze the risk factors associated with restenosis, limb salvage, and patency.</p><p><strong>Methods: </strong>This prospective cohort study included consecutive patients with AIOD who underwent aortoiliac angioplasty, and two groups of patients were evaluated: patients with AIOD submitted to endovascular treatment with the use of covered stents and bare metal stents. Patients with critical limb ischemia or incapacitating claudication who underwent aortoiliac angioplasty during the index period were eligible for the study.</p><p><strong>Results: </strong>In total, 103 aortoiliac angioplasties were performed in 103 patients, with an initial technical success rate of 100%. Analyses were performed at 1800 days. Two groups of patients were evaluated: 33 patients (32%) submitted to endovascular treatment with covered stents and 70 patients (68%) with bare metal stents. The estimated primary patency rates at 1800 days were better for the covered stents group ( 91.7%) than the bare metal stents group (58.8%, p = 0.001). Moreover, the time freedom from reintervention rates at 1800 days were better for the covered stents group (90%) than the bare metal stents group (58.4%, p = 0.003). The limb salvage rates at 1800 days were 100% in the covered stents group and 85.3% in the bare metal stents group, p = 0.07. A Cox regression revealed that the primary patency rate was significantly worse in patients of the bare metal stents group (HR = 2,50, CI = 1.51-9.38, p = 0.019), conversely, concomitant common femoral endarterectomy was a protector factor for primary patency (HR = 0.906, CI = 0.022-0.754, p = 0.023). Moreover, arterial hypertension was associated with reduced survival rates at the Cox regression analysis (HR = 2.61, CI = 1.005-6.806, p = 0.049).</p><p><strong>Conclusions: </strong>Based on the results of this study, we conclude that endovascular treatment with covered stents for AIOD has better outcomes regarding primary patency and freedom from reintervention rates than bare metal stents. Moreover, concomitant common femoral endarterectomy is a protective factor for better primary patency. Another important finding of this cohort is that arterial hypertension is associated with reduced survival rates.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013713","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":"Thirty-Day Outcomes of Infrainguinal Bypass Surgery in Patients With Disseminated Cancer","authors":"Renxi Li ,&nbsp;Tugce Erguven ,&nbsp;Anton N. Sidawy ,&nbsp;Salim Lala ,&nbsp;Bao-Ngoc H. Nguyen","doi":"10.1016/j.avsg.2025.09.004","DOIUrl":"10.1016/j.avsg.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Disseminated cancer can complicate the decision-making for major surgery, as patients can be poor surgical candidates and have potentially limited life expectancy. This study aimed to evaluate the 30-day postoperative outcomes of infrainguinal bypass in patients with disseminated cancer using a large-scale national database.</div></div><div><h3>Methods</h3><div>Adult patients with and without disseminated cancer who underwent infrainguinal bypass were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2023. A 1:5 propensity-score matching was used to balance the preoperative factors. Thirty-day postoperative outcomes were compared. A separate multivariable analysis was also conducted.</div></div><div><h3>Results</h3><div>There were 25,200 patients who underwent infrainguinal bypass, where 120 (0.48%) patients had disseminated cancer, who were matched to 596 patients with no disseminated cancer. Patients with disseminated cancer had higher risks of mortality (13.33% vs. 6.21%, <em>P</em> = 0.01) and untreated loss of patency (5.83% vs. 1.34%, <em>P</em> = 0.01). Other 30-day outcomes, including major amputation (5.41% vs. 4.24%, <em>P</em> = 0.61), cardiac complications (4.17% vs. 5.54%, <em>P</em> = 0.66), stroke (0.83% vs. 0.84%, <em>P</em> = 1.00), pulmonary complications (2.50% vs. 6.71%, <em>P</em> = 0.09), and renal complications (0.83% vs. 2.35%, <em>P</em> = 0.49), were comparable between patients with and without disseminated cancer. Multivariable analysis confirmed higher mortality and untreated loss of patency among disseminated cancer patients, while deep vein thrombosis was also found to be higher in this group (4.17% vs. 0.96%, adjusted odds ratio 3.763, 95% confidence interval 1.507–9.399, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Disseminated cancer patients demonstrated more than twice the 30-day mortality risk and over 4 times the risk of untreated loss of patency. As such, infrainguinal bypass should be considered a high-risk procedure for disseminated cancer patients, and the clinical decision for surgery should be made with caution. Deep vein thrombosis (DVT) was also found to be higher among disseminated cancer patients after multivariable analysis, suggesting DVT prophylaxis among these patients may need to be optimized. Future studies should focus on the long-term prognosis, particularly limb outcomes, in disseminated cancer patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 633-641"},"PeriodicalIF":1.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013690","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":"Letter to the Editor: Primary Subclavian Venous Thrombosis—Multidisciplinary Collaboration Improves Early Identification and Frequency of Surgical Intervention","authors":"Fredrik Sartipy ,&nbsp;Klara Milles Schalling ,&nbsp;Victor Mill ,&nbsp;Peter Gillgren ,&nbsp;Jonas Malmstedt","doi":"10.1016/j.avsg.2025.08.032","DOIUrl":"10.1016/j.avsg.2025.08.032","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 613-615"},"PeriodicalIF":1.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008105","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":"Effectiveness of Incisional Negative Pressure Wound Therapy in the Prevention of Post-Amputation Complications: Systematic Review and Meta-Analysis","authors":"Ahmed Altaweel ,&nbsp;Amr Meselhi ,&nbsp;Hamza Marzouk ,&nbsp;Hatim N. Shahin ,&nbsp;Moustafa Salim ,&nbsp;Alaa M. Mohamed ,&nbsp;Ismail M. Khataybeh ,&nbsp;Ahmed T. Seif ,&nbsp;Ahmed Elbataa ,&nbsp;Eslam Metwalli ,&nbsp;Anas Elgenidy","doi":"10.1016/j.avsg.2025.08.027","DOIUrl":"10.1016/j.avsg.2025.08.027","url":null,"abstract":"<div><h3>Background</h3><div>Negative pressure wound therapy (NPWT) is an advanced therapy utilizing sub-atmospheric pressure at the wound site to generate a controlled environment that promotes blood flow and stabilizes the wound area. However, its effectiveness in diminishing surgical site complications remains unproven effectively. We aim to assess the impact of incisional NPWT (iNPWT) on the reduction of surgical wound complications, mortality rate, and improvement of healing rate following lower limb amputation.</div></div><div><h3>Methods</h3><div>An extensive search was executed in several databases for relevant studies evaluating iNPWT following lower limb amputation. We used RevMan to calculate pooled risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence interval (95% CI). The outcomes of our analysis were the assessment of overall post-intervention wound complications, surgical site infection, need for revision surgery, seroma or hematoma formation, 30-day mortality, subsequent amputation, readmission, and the time taken for complete healing.</div></div><div><h3>Results</h3><div>Ten studies, including a total of 1,003 patients, were included in our analysis. The findings indicate a significant reduction in the risk of overall post-intervention wound complications (RR, 0.41; 95% CI 0.20, 0.84) and a shorter time to complete healing (MD, −1.76 weeks; 95% CI −2.66, −0.86 weeks) compared to the control group. No significant difference was found in wound infection, seroma or hematoma formation, readmission, and mortality rates between the iNPWT and the control groups.</div></div><div><h3>Conclusion</h3><div>iNPWT significantly reduces overall post-intervention wound complications and shortens the time required for complete healing.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 616-632"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005831","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":"Upper Extremity Arteriovenous Grafts are Less Likely to be Abandoned Compared to Autogenous Fistulas Despite a Higher Reintervention Rate","authors":"Nyah Patel ,&nbsp;Alik Farber ,&nbsp;Elizabeth King ,&nbsp;Mahmoud Malas ,&nbsp;Andrea Alonso ,&nbsp;Vipul Chitalia ,&nbsp;Saran Lotfollahzadeh ,&nbsp;Jesse A. Columbo ,&nbsp;Philip P. Goodney ,&nbsp;Jeffrey J. Siracuse ,&nbsp;Vascular Quality Initiative, Vascular Implant Surveillance and Interventional Outcomes Network","doi":"10.1016/j.avsg.2025.08.036","DOIUrl":"10.1016/j.avsg.2025.08.036","url":null,"abstract":"<div><h3>Background</h3><div>Upper-extremity arteriovenous (AV) access often requires reintervention. However, the frequency of reinterventionsand subsequent access failure is not well-characterized. Our goal was to evaluate the frequency and type of reinterventions, risk-factors, and outcomes after AV access creation.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of index upper extremity AV access creations (2017–2019) within the VQI Medicare-linked Vascular Implant Surveillance and Interventional Outcomes Network dataset for patients on hemodialysis (HD). Reinterventionswere defined as open or endovascular procedures on the access occurring at 1 day or more after access creation. Access abandonment was defined as any new access creation, peritoneal dialysis, kidney transplant, or death following index access creation. Univariable, multivariable, Kaplan-Meier, and Cox regression analyses were performed.</div></div><div><h3>Results</h3><div>There were 2,551 patients with an index AV graft (AVG) (19.5%) or AV fistula (AVF) (80.5%). Patients who underwent an AVG were more likely older, female sex, of non-White race, nonambulatory, not living at home, and to undergo the procedure as an inpatient (<em>P</em> &lt; 0.05). Reintervention rates were 1.64/person-year for AVG and 1.17/person-year for AVF. On Kaplan-Meier analysis, freedom from new AV access creation at 3 years was 72% for AVG and 78% for AVF (<em>P</em> &lt; 0.001). Freedom from tunneled dialysis catheter (TDC) placement at 3 years was 66% for AVG and 71% for AVF (<em>P</em> = 0.19). On multivariable analysis, undergoing placement of an AVG was independently associated with an increased risk of any reintervention compared to AVF (rate ratio (RR) 1.40 95% confidence interval (CI) 1.3–1.6; P = &lt;0.001). TDC placement was increasingly associated with each subsequent reintervention but did not vary by access type. There was an elevated risk of access abandonment with subsequent reinterventions; however, long-term access abandonment was lower with an AVG compared to an AVF (RR 0.82 95% CI 0.7–0.96; <em>P</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>Reinterventions to support HD access are common, and more than 60% of patients required at least one procedure within the first year of access placement. While patients with AVG require more reinterventions, they also have a lower rate of long-term access abandonment and similar rates of TDC placement compared to patients who receive an AVF.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 654-663"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005897","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}