Annals of vascular surgery最新文献

{"title":"Rationale for Adding Occlusive Liquid Polymers to Coils When Embolizing the Pelvic Reservoir in Pelvic Venous Disorders","authors":"Romaric Loffroy","doi":"10.1016/j.avsg.2025.02.006","DOIUrl":"10.1016/j.avsg.2025.02.006","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"115 ","pages":"Pages 1-2"},"PeriodicalIF":1.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584416","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":"Ruptured Popliteal Aneurysms: A Case Series and Systematic Review.","authors":"Aseel Abuduruk, Adel Abdallah, Philip Stather, Wissam Al-Jundi","doi":"10.1016/j.avsg.2025.01.038","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.01.038","url":null,"abstract":"<p><strong>Background: </strong>Ruptured popliteal artery aneurysm (rPAA) is a rare event that represents 2.5% of operated cases of PAA. Many patients present with unilateral leg pain and swelling, therefore often get referred through a variety of pathways, such as DVT clinic.</p><p><strong>Objectives: </strong>To evaluate the relationship between the initial diagnosis pathway of rPAA and its influence on outcomes including limb loss and mortality.</p><p><strong>Method: </strong>Patients referred to vascular surgery and had a final diagnosis of rPAA between 2007 to 2023 were reviewed. Data related to initial diagnosis, time to final diagnosis, limb loss and amputation free survival was recorded. A systematic review was undertaken according to PRISMA guidelines to evaluate reported cases of rPAA.</p><p><strong>Results: </strong>Between 2007 and 2022, 40 cases of complicated popliteal artery aneurysms (PAA) requiring intervention were identified in our institute amongst which 6 had rPAA (15%). Initial diagnosis of DVT was suspected in 2 patients with therapeutic anticoagulation commenced prior to vascular evaluation, delaying the diagnosis by up to 6 days. Two patients had early major limb amputations within 90 days of presentation and another 2 had an in-hospital mortality, resulting in a 33.3% amputation free survival. Literature search identified 134 cases of rPAA including case reports and case series. The diagnosis of rPAA was missed in up to 78.89% of the recorded cases and an initial impression of DVT, Baker's cyst rupture, or anticoagulation induced hematoma was made. Mortality was 13.22% within 30 days and almost doubled to 27.68 in 90 days. Amputation free survival was 80% and 72% at 30 and 90 days of follow up, respectively.</p><p><strong>Conclusion: </strong>Misdiagnosis of rPAA is not uncommon; this will delay diagnosis and proper surgical intervention. Mortality and major amputation are high in this cohort of patients so identification of risk factors and clinical criteria of this cohort can help early diagnosis and proper timely intervention.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584418","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 Perception of Virtual Interviews and Associations of Virtual Engagement with Vascular Surgery Culture and Community","authors":"Margaret A. Reilly ,&nbsp;Christina L. Cui ,&nbsp;Leanne E. Grafmuller ,&nbsp;Joshua S. Eng ,&nbsp;Eric B. Pillado ,&nbsp;Ruojia Debbie Li ,&nbsp;Kathryn L. DiLosa ,&nbsp;Allan M. Conway ,&nbsp;Guillermo A. Escobar ,&nbsp;Palma M. Shaw ,&nbsp;Yue-Yung Hu ,&nbsp;Karl Y. Bilimoria ,&nbsp;Malachi G. Sheahan III ,&nbsp;Dawn M. Coleman","doi":"10.1016/j.avsg.2025.02.008","DOIUrl":"10.1016/j.avsg.2025.02.008","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the vascular surgery community has increased the utilization of virtual interviews and virtual engagement or use of online technologies for educational, networking, and mentorship activities. This study evaluates trainee preferences of virtual interviews and associations of virtual engagement with wellness.</div></div><div><h3>Methods</h3><div>Deidentified data were collected from a confidential, voluntary survey of residents and fellows in vascular surgery programs administered following the 2023 Vascular Surgery In-Training Examination (VSITE). A 5-point Likert scale measured resident perceptions of virtual interviews and virtual interactions. Multivariable logistic regression modeling was used to compare factors associated with preference of virtual interviews and virtual engagement.</div></div><div><h3>Results</h3><div>Of 521 trainees who participated in the survey (78.2% response rate), 60.8% were male, 48.8% were non-White, and there was a relatively equal distribution among training years. Only 41.2% of the trainees reported they would have preferred virtual interviews in retrospect. These trainees were more likely to be non-White and in postgraduate years one or 2 (<em>P</em> = 0.03 and <em>P</em> &lt; 0.001, respectively). Overall, 83.5% of trainees were classified as virtually engaged. These trainees were more likely to be male (86.5% vs. 78.9%, <em>P</em> = 0.033) and had 2.8 increased odds of satisfaction with time for their personal lives (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>While most trainees surveyed reported a preference for in-person interviews, trainees report that virtual interviews are reflective of program culture. Additionally, trainees who were virtually engaged were more likely to report satisfaction with their time for their personal lives. Our study supports continued hybrid approaches to interviews and trainee engagement.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"114 ","pages":"Pages 219-227"},"PeriodicalIF":1.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584444","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":"Preoperative History of Gabapentinoids Use is Associated with Longer Length of Hospital Stay in Patients Undergoing Lower Extremity Bypass Surgery for Severe Peripheral Artery Disease","authors":"Fadi Samaan ,&nbsp;Elizabeth Lavanga ,&nbsp;Leana Dogbe ,&nbsp;Ahsan Zil-E-Ali ,&nbsp;Faisal Aziz","doi":"10.1016/j.avsg.2025.02.011","DOIUrl":"10.1016/j.avsg.2025.02.011","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the association of preoperative gabapentinoids (GBP) use with the postoperative length of stay for patients undergoing peripheral artery lower extremity bypass (LEB) surgery for lifestyle-limiting claudication and chronic limb-threatening ischemia at a tertiary care hospital.</div></div><div><h3>Methods</h3><div>Patients undergoing LEB surgery during the period between 2000 and 2020 at Penn State Health Milton S. Hershey Medical Center were stratified into 2 groups based on the preoperative use of prescribed GBPs (GBPs versus no GBPs). Patients' preoperative characteristics, comorbidities and medications were assessed, and the outcomes of interest were analyzed in univariate analysis, stratified analysis, and by multivariable regression models. Primary outcomes were 30-day mortality and length of stay. The secondary outcomes included readmissions, unplanned return to the operating room, amputation, myocardial infarction, cerebrovascular accident, pneumonia, pulmonary embolism, urinary tract infections, wound complications, acute congestive heart failure exacerbation and nonhome discharge. A <em>P</em> value of &lt;0.05 was considered significant for all the analyses.</div></div><div><h3>Results</h3><div>The study cohort comprised 359 patients. The GBPs group comprised 125 patients with a mean (standard deviation) age of 61.6 (±10.2) years and the no-GBPs group consisted of 234 patients with a mean (standard deviation) age of 64.6 (±12.2) years. Patients in GBPs group were likely to be younger (<em>P</em> = 0.014), undergo LEB for chronic limb-threatening ischemia (<em>P</em> = 0.039), and have insulin-dependent diabetes mellitus (<em>P</em> &lt; 0.001) than the no-GBPs group. In terms of outcomes, the patients in the GBPs group were more likely to have longer postoperative length of stay (9.3 ± 11.1 vs. 6.4 ± 5.0 days no GBPs, <em>P</em> = 0.008). In multivariable analysis, the patients in the GBPs group had 92% (adjusted odds ratio 1.92 [1.16, 3.18], <em>P</em> = 0.01) increase in the odds of having a length of stay above 6-day calculated median in comparison to the no-GBPs group.</div></div><div><h3>Conclusion</h3><div>This retrospective analysis of patients undergoing LEB at a tertiary care hospital shows a significant association between preoperative GBPs use and the longer postoperative length of stay. This study bridges a gap in the current body of knowledge regarding the association of GBP use with the postoperative outcomes in patients undergoing LEB for severe peripheral artery disease.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"114 ","pages":"Pages 251-259"},"PeriodicalIF":1.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584415","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":"Management of Infectious Aortic Aneurysms: Short- and Mid-TermOutcomes","authors":"Simon Frisch ,&nbsp;Nicla Settembre ,&nbsp;Rabie Ali Belkorissat ,&nbsp;Philippe Guerci ,&nbsp;Damien Mandry ,&nbsp;Abdulrahman AlblowI ,&nbsp;Lucas Lalevee ,&nbsp;Benjamin Lefevre ,&nbsp;Serguei Malikov","doi":"10.1016/j.avsg.2025.01.042","DOIUrl":"10.1016/j.avsg.2025.01.042","url":null,"abstract":"<div><h3>Background</h3><div>Infectious aortic aneurysms are a rare but life-threatening condition due to their rapid development. Their management is multidisciplinary. The main purpose of this study was to evaluate the mortality of patients treated for infectious aortic aneurysm (IAA) by different types of treatments. Secondary objectives were to evaluate infectious recurrences and the factors influencing mortality with this management.</div></div><div><h3>Methods</h3><div>Between September 2009 and October 2023, all the patients with an IAA confirmed by the clinical, biological, microbiological, radiological, and nuclear medicine data were included. Standard treatment included preoperative and postoperative antibiotics and open radical surgery with reconstruction using biological material. Endovascular treatment was used in patients with contraindication to open surgery. An alternative “bridge” technique was proposed in emergencies and consisted of the placement of a covered stent graft followed by secondary open surgical reconstruction. The clinical, biological, bacteriological, and imaging data were collected in the Retrospective and Prognostic Registry of Aortic Infections registry, with a 30-day, 1-year, and 3-year evaluation. Infectious recurrences were studied.</div></div><div><h3>Results</h3><div>The IAA diagnosis was confirmed in 47 patients with a mean age of 67 ± 10.8 years. Aneurysms were located in the arch (4%), the descending thoracic aorta (21%), the thoracoabdominal aorta (30%), the juxta-renal (4%), and the infrarenal abdominal (41%) aorta. The involved microorganisms were methicillin-sensitive <em>S. aureus</em> (43%), <em>Salmonella</em> (13%), <em>E. coli</em> (9%), and other species (35%). Radical surgery was performed in 27 patients (57.4%): bovine pericardial tubular xenografts and cryopreserved allografts were used in 22 and 3 cases, respectively. Endovascular treatment was performed in 12 patients (25.5%) Medical treatment only was used in 8 cases (17%). The overall 30-day, 1-year, and 3-years survival rates were 78.7%, 52.4%, and 44.4%, respectively. In the radical surgery group, survival rates were 84%, 75.6%, and 60.6%, respectively, vs. 91.7%, 41.7%, and 20.8% in the endovascular group. In the medical group with persistent infection, survival rates were 37.5% and 0%. The average length of antibiotic treatment was 8 days preoperatively and 3 months postoperatively. Periaortic infectious recurrence was observed in 1 patient.</div></div><div><h3>Conclusion</h3><div>The combination of medical treatment and radical open surgery is effective in the treatment of IAA. Endovascular treatment yields acceptable results. Medical treatment alone should only be reserved for patients who are inoperable due to a very high short-term mortality.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"115 ","pages":"Pages 197-205"},"PeriodicalIF":1.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584412","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":"Moderate-to-Severe Preoperative Anemia is Associated with Increased Postoperative Myocardial Infarction and Mortality in Patients Undergoing Transcarotid Artery Revascularization","authors":"Heepeel Chang ,&nbsp;Karan Garg ,&nbsp;Frank J. Veith ,&nbsp;Craig Basman ,&nbsp;Jae S. Cho ,&nbsp;Muhammad Zeeshan ,&nbsp;Romeo B. Mateo ,&nbsp;Mikaiel Ebanks ,&nbsp;Caron B. Rockman","doi":"10.1016/j.avsg.2025.02.010","DOIUrl":"10.1016/j.avsg.2025.02.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;While preoperative anemia is prevalent among surgical patients, its impact on patients undergoing transcarotid artery revascularization (TCAR) remains poorly understood. This study aims to assess the relationship between the severity of preoperative anemia and outcomes following TCAR.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective analysis of the Vascular Quality Initiative database (2016–2021) was performed to identify patients who underwent TCAR for carotid stenosis. Anemia was defined according to World Health Organization guidelines as a hemoglobin (Hb) level &lt;12 g/dL in females and &lt;13 g/dL in males. The severity of anemia was further classified as mild (Hb: 10–11.9 g/dL in females and 11–12.9 g/dL in males) or moderate to severe (Hb &lt; 10 g/dL in females and &lt;11 g/dL in males). Patients were stratified into three cohorts as follows, based on the presence and severity of preoperative anemia: no anemia, mild anemia, and moderate-to-severe anemia.&lt;/div&gt;&lt;div&gt;The primary outcome was 30-day mortality. Secondary outcomes included in-hospital stroke, in-hospital death, myocardial infarction (MI), and prolonged postoperative hospitalization (&gt;1 day). Univariable and multivariable logistic regression analyses were conducted to evaluate the association between the severity of preoperative anemia and clinical outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 21,648 patients who underwent TCAR, 4,240 (19.8%) had mild anemia, and 3,401 (15.8%) had moderate-to-severe anemia preoperatively. After adjusting for relevant clinical factors and confounders, moderate-to-severe preoperative anemia was associated with significantly increased odds of in-hospital MI (adjusted odds ratio [aOR], 2.39; 95% confidence interval [CI]: 1.53–3.74; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), in-hospital death (aOR, 2.65; 95% CI: 1.62–4.34; &lt;em&gt;P&lt;/em&gt; &lt; 0.001), and 30-day mortality (aOR, 1.89; 95% CI: 1.32–2.72; &lt;em&gt;P&lt;/em&gt; &lt; 0.001) compared to nonanemic patients. Among patients with moderate-to-severe anemia, factors such as a history of chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), urgent or emergent procedures, and symptomatic carotid stenosis were the strongest predictors of 30-day mortality. In contrast, mild anemia was not associated with increased odds of adverse postoperative outcomes compared to the nonanemic cohort. Preoperative anemia, regardless of severity, was not associated with an increased risk of postoperative stroke following TCAR. However, the severity of preoperative anemia was associated with a stepwise increase in the adjusted odds of prolonged hospitalization (aOR, 1.19 [mild anemia] and 1.57 [moderate-to-severe anemia]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;In this multi-institutional retrospective study of patients undergoing TCAR, moderate-to-severe preoperative anemia was independently associated with higher adjusted odds of in-hospital MI, in-hospital death, and 30-day morta","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"115 ","pages":"Pages 43-52"},"PeriodicalIF":1.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571868","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":"An 8-Year Experience of Robot-Assisted Laparoscopic Surgical Management of Median Arcuate Ligament Syndrome","authors":"Aaron Litvak ,&nbsp;Joshua Geiger ,&nbsp;Benjamin Ford ,&nbsp;Matthew M. Byrne ,&nbsp;Neilesh Parikh ,&nbsp;Luke Schoeniger ,&nbsp;Adam Doyle","doi":"10.1016/j.avsg.2025.01.039","DOIUrl":"10.1016/j.avsg.2025.01.039","url":null,"abstract":"<div><h3>Background</h3><div>Due to the rarity of median arcuate ligament syndrome (MALS), surgical approaches to median arcuate ligament release (MALR) have been understudied. This series aimed to review robot-assisted laparoscopic MALR from a quaternary care center.</div></div><div><h3>Methods</h3><div>This is a single-center cohort study of adult patients who underwent robot-assisted laparoscopic MALR between March 2015 and June 2023. Clinicopathologic data were abstracted from the electronic medical record for patients with at least 30 days of follow-up. Our primary outcome was symptom improvement, which was assessed via review of the medical record from postoperative patient visits with a provider. Bivariate analyses were performed using Fisher's exact test.</div></div><div><h3>Results</h3><div>Twenty patients were identified. The mean age of patients at the time of surgery was 41.65 (±16.02), and 16 (80%) of the patients were female. Many patients had concomitant diagnoses of gastrointestinal illnesses, including Crohn's or irritable bowel syndrome (IBS) (40%) and gastroesophageal reflux disease (GERD) (35%). Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) psychiatric illnesses were diagnosed in 13 (65%) patients. The most frequently encountered preoperative chronic symptoms included postprandial pain (90%), chronic abdominal pain (85%), and unintended weight loss (85%). Postoperatively, 10 patients experienced complete resolution of unintended weight loss (<em>P</em> = 0.0031) and significant improvement in chronic MALS symptoms, including abdominal pain, postprandial pain, nausea, and unintended weight loss. The median follow-up time was 1.63 (0.97–2.69) years. Operative characteristics include the mean operative time of 133.25 ± 25.91 minutes, median estimated blood loss of 20 (8.75–25.00) mL, and no significant changes in inspiratory or expiratory celiac artery peak systolic velocity between measurements before and after robot-assisted laparoscopic median arcuate ligament release (R-MALR). Patients had a median length of stay of 2 (1–3) days. 2 of 20 patients (10%) experienced a return to the operating room for an injury to the gastroesophageal junction and pseudoaneurysm of the left gastric artery. There were no mortalities within 30 days of operation.</div></div><div><h3>Conclusion</h3><div>Our single-institution experience offers evidence that R-MALR release can be a safe and effective option for medium-term relief of MALS symptoms.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"114 ","pages":"Pages 212-218"},"PeriodicalIF":1.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571855","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":"Engineering Approach to Study the Effect of TEVAR on the Cardiovascular System: A Systematic Review","authors":"Marco Magliocco ,&nbsp;Michele Conti ,&nbsp;Bianca Pane ,&nbsp;Giovanni Pratesi ,&nbsp;Marco Canepa ,&nbsp;Sara Seitun ,&nbsp;Simone Morganti ,&nbsp;Antonio Salsano ,&nbsp;Giovanni Spinella","doi":"10.1016/j.avsg.2025.01.036","DOIUrl":"10.1016/j.avsg.2025.01.036","url":null,"abstract":"<div><h3>Background</h3><div>To study the effect of endovascular treatment of the thoracic aorta on cardiac geometry and evaluate the effects of stent placement on hemodynamics and cardiovascular biomechanics.</div></div><div><h3>Methods</h3><div>Articles were selected through the use of online databases such as PubMed, Scopus, and Web of Science, investigating the use of engineering methods (computational analysis and simulations using three-dimensional models of cardiovascular structures obtained from medical imaging) to study the effects of pretreatment and posttreatment Thoracic Endovascular Aortic Repair (TEVAR) in terms of left ventricular mass variation and assessment of fluid dynamics parameters such as Wall Shear Stress (WSS), flow variations, and velocity. The quality of the included studies was assessed using the Newcastle-Ottawa scale.</div></div><div><h3>Results</h3><div>A total of 11 studies were considered: 3 reported data on left ventricular mass variation, 5 reported flow and velocity variations, and 6 provided information on WSS. A high discrepancy in results and methodology for conducting the analyses was observed. Overall, an increase in left ventricular mass was observed in patients undergoing TEVAR, while an improvement in flow conditions and stress was noted following the exclusion of the pathological aortic zone.</div></div><div><h3>Conclusions</h3><div>To summarize, TEVAR can result in changes in vascular structures. However, the current literature on this topic is limited and the analysis methods used vary in terms of methodology, treated pathology, and follow-up duration. To successfully integrate computational simulations and engineering evaluations of medical images into clinical practice, it is crucial to standardize the analysis methods.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"114 ","pages":"Pages 183-191"},"PeriodicalIF":1.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volumetric Abdominal Aortic Aneurysm Analysis in Post EVAR Surveillance Settings","authors":"Kathryn Simmons ,&nbsp;David Weiss ,&nbsp;Mariam Aboian ,&nbsp;MingDe Lin ,&nbsp;Khaled Bousabarah ,&nbsp;Daniel Renninghoff ,&nbsp;Wolfgang Holler ,&nbsp;Cornelius Deuschl ,&nbsp;Uwe Fischer ,&nbsp;Edouard Aboian","doi":"10.1016/j.avsg.2025.02.009","DOIUrl":"10.1016/j.avsg.2025.02.009","url":null,"abstract":"<div><h3>Background</h3><div>Early detection of abdominal aortic aneurysms (AAA) is a mainstay of diagnosis, with endovascular aneurysm repair (EVAR) emerging as the primary mode of repair. Maximum diameter measurement remains central to risk assessment; however, recent studies suggest AAA volumetric analysis may be more sensitive to true size changes. We compare the utility of volume and diameter in AAA size assessment and further investigate related clinical factors.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all patients who underwent EVAR at our institution between August 2017 and March 2023 with available pre and postoperative computed tomography (CT) angiograms. AAA total aneurysm and lumen volume were measured using semiautomatic segmentations. The maximum diameter and clinical variables were extracted from the medical record. The direct comparison of volume to diameter was completed using percent change from baseline. A subgroup of patients with long-term follow-up (LTFU) data (&gt;231 days between scans) were used for additional analyses.</div></div><div><h3>Results</h3><div>Of 116 patients, 69 (59.5%) were included in the long-term patient cohort. Postintervention, percent change volume and percent change diameter had a moderate positive correlation (r_s = 0.6662), and average AAA percent change did not differ between volume and diameter (1.5% vs. −1.8%, respectively; <em>P</em> = 0.1654). Volumetric analysis was more likely to detect aneurysm sac enlargement (<em>P</em> = 0.0315). On univariable analysis, increase in volume and diameter was associated with older age and endoleak. A diameter decrease was associated with metformin therapy.</div></div><div><h3>Conclusion</h3><div>Aneurysm volume is more likely to detect AAA enlargement than diameter. The benefit of early detection of high-risk aneurysms may translate to changes in surveillance and ultimately decrease aneurysm-related mortality.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"114 ","pages":"Pages 241-250"},"PeriodicalIF":1.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571874","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":"Cerebral Hyperperfusion Syndrome after Carotid Revascularization; Predictors and Complications","authors":"Ahmed Abdelkarim ,&nbsp;Mohammed Hamouda ,&nbsp;Marcos Real ,&nbsp;Sina Zarrintan ,&nbsp;Gregory A. Magee ,&nbsp;Mahmoud B. Malas","doi":"10.1016/j.avsg.2025.02.001","DOIUrl":"10.1016/j.avsg.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication following carotid artery revascularization. Considering the varying rates observed among carotid endarterectomy (CEA), Transfemoral Carotid Artery Stenting (TFCAS), and Transcarotid Artery Revascularization (TCAR), identifying the predictors and complications of CHS is essential for improving patient outcomes. This study utilizes a national database to investigate the predictors and complications of CHS following carotid revascularizations.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of all patients undergoing CEA, TFCAS, and TCAR for carotid artery stenosis in the Vascular Quality Initiative database from 2020 to 2023. Multivariate logistic regression was applied to identify CHS predictors, which were used to develop a risk score calculator. Moreover, we compared the stroke and mortality rates following CHS among the 3 revascularization techniques.</div></div><div><h3>Results</h3><div>The final cohort in our study included 59,130 (53%) CEAs, 14,064 (13%) TFCAS’s, and 37,565 (34%) TCARs. There were 281 cases of CHS (0.25%), and TFCAS was associated with the highest rate of CHS (0.78% vs. 0.22% vs. 0.15%; <em>P</em> &lt; 0.001). After adjusting for potential confounders, TFCAS was associated with almost 3-fold higher risk compared to CEA (adjusted odds ratio (aOR) = 2.87 [95% confidence interval (CI): 1.65–4.9] <em>P</em> &lt; 0.001). On the other hand, TCAR was comparable to CEA. Other predictors of CHS included uncontrolled hypertension, insulin-dependent diabetes, symptomatic status, prior carotid procedure, urgent intervention, and postoperative blood pressure medication. These predictors were used to develop an interactive CHS risk calculator (C-statistic = 0.8). Among patients who developed CHS, TFCAS was associated with a 70% higher risk of inhospital stroke (aOR = 1.7 [95% CI: 1.4–2] <em>P</em> &lt; 0.001) and almost triple the risk of inhospital death (aOR = 2.9 [95% CI: 2.3–3.8] <em>P</em> &lt; 0.001). TCAR and CEA were comparable except for a slight risk of inhospital stroke after TCAR (aOR = 1.2 [95% CI: 1–1.3] <em>P</em> = 0.03).</div></div><div><h3>Conclusion</h3><div>In this multi-institutional national study, we have demonstrated that the type of carotid revascularization significantly influences the risk of CHS and subsequent stroke and mortality, with TFCAS associated with the highest risk. Uncontrolled hypertension was associated with a 2-fold increased risk of CHS, underscoring the importance of tight blood pressure control. We were able to provide a prediction model for CHS based on preoperative factors. Prospective use of this risk calculator might benefit in postoperative monitoring.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"115 ","pages":"Pages 13-22"},"PeriodicalIF":1.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565850","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}