Annals of vascular surgery最新文献

{"title":"Evaluation of postoperative acute kidney injury through contrast-enhanced ultrasound in patients with aortic dissection: An observational cohort study.","authors":"Ju Tian, Lei Zhang, Liang Li, Yiran Zhang, Tianning Pu, Chao Zheng, Jingjing Fu, Yun Wei, Mingyue Wang, Yao Wang, Zhonghua Sun, Qiang Yong, Lei Xu","doi":"10.1016/j.avsg.2025.05.035","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.035","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) is a common postoperative complication in patients with aortic dissection (AD). Contrast-enhanced ultrasound (CEUS) quantitatively evaluates kidney microvascular perfusion, but its significance in patients undergoing AD surgery remains unclear. This study examined the correlation between preoperative CEUS parameters and postoperative AKI in patients with AD.</p><p><strong>Methods: </strong>This observational cohort study included 90 patients with AD who underwent kidney CEUS and AD surgery. CEUS was performed before surgery, with peak intensity (PI), time-to-peak (TTP), and mean transit time (MTT) derived from the time-intensity curve. The occurrence of postoperative AKI was assessed using the criteria of Improving Global Outcomes in kidney disease. Receiver-operating characteristic curves were plotted to determine the predicting value of CEUS parameters for postoperative AKI. Logistic regression analysis was conducted to identify potential risk factors for postoperative AKI in AD patients.</p><p><strong>Results: </strong>The CEUS parameters TTP (P = 0.001) and MTT (P = 0.010) were significantly longer in the AKI group(n=30) than in the non-AKI group(n=60). The area under the ROC curve for TTP and MTT was 0.717 and 0.667 in predicting postoperative AKI, respectively. Multivariate analysis revealed that TTP > 5.75 s and MTT > 21.35 s were independent risk factors for postoperative AKI in AD patients.</p><p><strong>Conclusions: </strong>The CEUS parameters TTP and MTT are independent risk factors for predicting postoperative AKI in patients with AD. CEUS could be used as a valuable tool for identifying patients with AD at risk of developing postoperative AKI and for monitoring the renal perfusion.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180554","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":"Single Stage Endovascular Treatment of Combined Iliac and Infrainguinal peripheral arterial disease through brachial access.","authors":"Mohammed Hassan Abdelaty, Amr Mohammad El-Mahallawy","doi":"10.1016/j.avsg.2025.05.042","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.042","url":null,"abstract":"<p><strong>Objective: </strong>Combined inflow and outflow disease has become a common pattern in patients with chronic limb threatening ischemia. Patients with tissue loss require simultaneous correction of inflow and outflow disease to prevent amputation. However, those patients are usually unfit for open surgical or hybrid procedures due to having multiple comorbidities. The aim of this study was to evaluate the safety and effectiveness of combined iliac and infrainguinal endovascular revascularization via brachial access in a single session.</p><p><strong>Patients and methods: </strong>A prospective study conducted on 45 patients with tissue loss. In case of failure to cross the infrainguinal lesions, a secondary femoral access was used.</p><p><strong>Results: </strong>Technical success was achieved in 75.6% of the patients using brachial access alone and in 20% using secondary femoral access. Only one patient required right brachial access (2.2 %), while the remaining 44 patients were treated via left brachial access. Access complications were recorded in 11.1% but only 4.4% required surgical repair of brachial artery. No perioperative mortality and no cerebrovascular events were recorded. At 1 year, the overall and amputation-free survival rates were 93.33% and 84.4% respectively. Crural artery occlusion was significantly associated with failure of brachial access (P <0.001). Brachial access related complications were significantly associated with using larger (7 Fr) sheaths (P = 0.019).</p><p><strong>Conclusion: </strong>Endovascular treatment of combined iliac and infrainguinal disease can be safely delivered via brachial access. Patients with crural artery occlusion may need secondary femoral access to successfully restore direct blood flow to the foot. Higher rate of access complications was associated with using larger arterial sheaths.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179775","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":"National Trends in Trainee Operative Exposure to Upper Extremity Fasciotomy Support a Multidisciplinary Approach.","authors":"Christina L Cui, Crystal Jing, Daemar Jones, Young Kim","doi":"10.1016/j.avsg.2025.05.043","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.043","url":null,"abstract":"<p><strong>Background: </strong>Acute limb ischemia (ALI) of the upper extremity is an uncommon but emergent clinical scenario, in which both revascularization and decompressive fasciotomy may be indicated to optimize patient outcomes. The purpose of this study was to examine operative exposure to upper extremity fasciotomy among surgical trainees across different specialties.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education (ACGME) national data reports were reviewed for operative volumes as reported by vascular surgery integrated residents (VSR), vascular surgery fellows (VSF), orthopedic surgery residents (OSR), and hand surgery fellows (HSF). Data were analyzed via univariate tests and linear regression analysis for trends.</p><p><strong>Results: </strong>From 2013 to 2022, HSF graduates performed a mean of 51.7±6.4 upper extremity fasciotomy procedures, and OSR graduates performed 6.0±0.7 fasciotomy procedures (p<0.0001 vs HSF). Over the same time period, both VSF and VSR reported zero upper extremity fasciotomy procedures performed at time of graduation (p<0.0001 each vs HSF). OSR graduates also reported 42.7±7.9 carpal tunnel release procedures, with an annual increase of 2.5±0.3 cases on linear regression analysis (R²=0.89, p<0.0001). Neither OSR (annual trend, 0.1±0.1 cases/yr, R²=0.18, p=0.18) nor HSF groups (annual trend, 0.0±0.1 cases/yr, R²=0.01, p=0.83) experienced a decline in upper extremity fasciotomy operations performed over the ten-year study period. Revascularization procedures were performed by VSR (4.3±0.7 cases), VSF (3.5±0.6 cases), and HSF (15.1±1.2 cases) groups. ACGME data reports did not report data on upper extremity revascularization procedures performed by OSR graduates.</p><p><strong>Conclusions: </strong>Vascular operations of the upper extremity remain an integral component of surgical training across multiple specialties, however, vascular surgical trainees have minimal operative exposure to upper extremity fasciotomy. These data underscore the importance of a multidisciplinary approach to patients presenting with ALI of the upper extremity.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179845","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 mechanism of matrilin-2 inhibiting the progression of in-stent restenosis for lower-extremity arteriosclerosis obliterans via TGF-β/Smad signaling pathway.","authors":"Mintao Li, Chao Ma, Kangli Yin, Feng Lu, Zilin Lu, Ning Wang, Le Zhang, Yubin He, Jian Dong","doi":"10.1016/j.avsg.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.030","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate differential expression of matrilin-2/TGF-β/Smad signaling pathway components and downstream targets in primary atherosclerotic plaques versus in-stent restenosis (ISR) lesions of femoropopliteal arteries in lower extremity arteriosclerosis obliterans (LEASO) patients, and to explore the mechanistic role of this pathway in regulating vascular smooth muscle cell (VSMC) phenotypic modulation for preventing post-interventional restenosis.</p><p><strong>Methods: </strong>Femoropopliteal intimal tissues were collected from 20 primary LEASO patients and 20 ISR patients with matched baseline characteristics. Western blot quantified matrilin-2, TGF-β, contractile (TAGLN) versus synthetic (MYH10) VSMC markers, and Smad phosphorylation levels. Lentiviral transduction was used to overexpress matrilin-2 in human aortic VSMCs (HA-VSMCs). Subsequent analyses included TGF-β/p-Smad signaling activation, VSMC phenotypic marker expression, and functional assessments of proliferation/migration.</p><p><strong>Results: </strong>ISR lesions exhibited significantly reduced matrilin-2, TGF-β, and p-Smad levels compared to primary lesions, alongside elevated MYH10 and reduced TAGLN expression. Matrilin-2 overexpression upregulated TGF-β, TAGLN, and p-Smad, while suppressing VSMC proliferation and migration. Smad inhibition reversed these effects, increasing MYH10 and enhancing proliferative/migratory capacities.</p><p><strong>Conclusion: </strong>ISR lesions demonstrate predominant synthetic VSMC phenotypes compared to primary LEASO plaques. Matrilin-2 inhibits the phenotypic transition from contractile to synthetic VSMC by upregulating TGF-β/Smad signaling, thereby attenuating post-interventional restenosis in LEASO.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179875","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":"Towards Standardization: proposal of a Novel Index for evaluating Hostile Aortic Neck.","authors":"Rocco Cangiano, Antonio Marzano, Luca di Marzo, Wassim Mansour","doi":"10.1016/j.avsg.2025.05.033","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.033","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179835","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":"Preliminary study of noncontrast-enhanced magnetic resonance imaging for the diagnosis and management iliac venous compression syndrome.","authors":"Zhu Wang, Jiahao Zhu, Mengxin Jiang, Xiaofei Zhong, Yongjia Cheng, Gang Chen, Yuguo Sheng, Jian Wu, Jianwei Gao, Wenming Wang, Yingjiang Xu","doi":"10.1016/j.avsg.2025.05.026","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.026","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the technical feasibility and safety of noncontrast-enhanced magnetic resonance imaging (MRI) in the diagnosis and management of iliac vein compression syndrome (IVCS) compared with 3D rotational venography (3D-RV).</p><p><strong>Methods: </strong>The general epidemiological data (including age, gender), clinical manifestations (including major symptom, affected extremity, CEAP classification, comorbidity, stenosis rate,Valletta score), and intra-operative findings (collateral vessels present or absent) of 39 IVCS patients who were assessed by underwent both noncontrast-enhanced MRI and 3D-RV between January 2018 to January 2022 were obtained and analyzed.</p><p><strong>Results: </strong>The iliac vein stenosis rate determined by noncontrast-enhanced MRI and 3D-RV was 79.09±1.57% vs 80.06±1.62%, respectively (p=0.13). With the aggravation of Villalta score, the detection rate of both noncontrast-enhanced MRI and 3D-RV for collateral vessels present increased significantly. Compared with 3D-RV, noncontrast-enhanced MRI is more sensitive for the detection of collateral vessels present in early chronic venous disease (p=0.03). All of these patients, 20 patients were treated with MR images fusion navigation, and 19 patients were treated with 3D venography images fusion navigation during endovascular management. Significant differences were observed between the noncontrast-enhanced MRI and 3D-RV groups concerning X-ray dose (1695±36.01 mGy vs. 2820±23.06 mGy; p<0.001) and contrast agent dosage (49.25±1.02 mL vs. 83.79±2.75 mL; p<0.001).</p><p><strong>Conclusion: </strong>Noncontrast-enhanced MRI is a quick, efficient, and accurate non-invasive technique for the evaluation and diagnosis of IVCS. In addition to providing the required anatomic information to make the diagnosis of IVCS, it also provides all this intraoperative\"roadmap\"for possible endovascular management of IVCS.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180678","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":"Nonfatal Firearm-Related Vascular Injuries: Clinical and Financial Implications in Trauma Care.","authors":"Melanie Jones, Katharine Tracy, George Liu, Vishaal Motla, Ryan Langston, Amanda Schaefer, Jack Yu, Gautam Agarwal, Erika Mabes","doi":"10.1016/j.avsg.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Gun violence is a growing public health crisis, with firearm-related vascular injuries leading to significant morbidity, mortality, and healthcare costs. Survivors of these injuries often experience severe complications, including limb loss, nerve damage, and prolonged hospital stays, contributing to long-term disability and economic burden. Vascular injuries, particularly those involving significant vessels such as the abdominal aorta, inferior vena cava, and femoral arteries, require complex surgical interventions and extensive postoperative care. These cases are associated with increased resource utilization, including longer intensive care unit stays, multiple operations, and higher hospital readmission rates. This study examines the cost, length of stay, and surgical burden associated with nonfatal firearm injuries (NFI) involving vascular trauma. Given the growing interest in endovascular techniques as a less invasive alternative to open surgery, we also explore their potential role in reducing complications and costs. Understanding the financial and clinical impact of vascular firearm-related injuries is essential for optimizing treatment strategies and reducing the burden on both patients and healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A single-center retrospective trauma registry was reviewed at a level-one academic trauma center between 2019 to 2021. The inclusion criteria were all patients with NFI. IBM SPSS 29.0 was used for descriptive analysis and independent samples T-tests. Further descriptive analysis was performed on patients suffering vascular injuries caused by NFI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of all 359 patients in the study, 104 (29%) suffered vascular injury. Of these patients, the mean age was 32 years (SD 12.4), with 87.5% (n=91) males and 12.5% (n=13) females. Black race was the most common at 79.8% (n= 83), White race at 17.3% (n=18), and Multiracial at 2.9% (n=3). Of the 77 patients for which the intention was known, 68.8% (n=53) of the injuries were due to assault, 6.5% (n=5) accidental self-harm, 9.1% (n=7) intentional self-harm, 14.3% (n=11) unintentional, and 1.3% (n=1) from law enforcement. The mean total cost of stay for vascular injuries was significantly higher than injuries without vascular involvement ($49,050 vs $31,763, p=.006). The mean length of stay was increased considerably at 10.88 days (vs 7.68, p=.012), and the total number of trips to the operating room was also significantly increased at 2.53 (vs. 1.61, p=.013). Though nonsignificant, these patients attended a mean of 3.86 follow-up appointments compared to 2.94 appointments for non-vascular injury patients (p=.056).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Given the high resource utilization associated with vascular injuries, optimizing trauma management is essential. Traditional open surgical repair remains the standard of care; however, emerging evidence suggests that endovascular techniques may provide a ","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179606","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":"Safety and Efficacy of Spontaneous Carotid Artery Dissection Management with Transfemoral Carotid Artery Stenting (TFCAS) and Transcarotid Artery Revascularization (TCAR): A Multi-Institutional Study.","authors":"Ahmed Abdelkarim, Mikayla Kricfalusi, Isibor J Arhuidese, Ali Azizzadeh, Raghu Motaganahalli, Mahmoud B Malas","doi":"10.1016/j.avsg.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.018","url":null,"abstract":"<p><strong>Background: </strong>Carotid artery dissection (CD) could lead to stroke, particularly in younger patients. Most studies assessing the safety of carotid artery stenting have excluded patients with dissections. We aim to fill that knowledge gap by evaluating and comparing the outcomes of transfemoral carotid artery stenting (TFCAS) and transcarotid artery revascularization (TCAR) in the management of spontaneous CD using a national database.</p><p><strong>Methods: </strong>This is a retrospective analysis of all patients who underwent either TFCAS or TCAR for spontaneous carotid dissection in the VQI database (2016-2024). The primary outcomes were 30-day mortality and in-hospital major adverse cardiovascular events (MACEs), including stroke, death, and myocardial infarction (MI). Multivariate logistic regression models were employed to adjust for potential confounders.</p><p><strong>Results: </strong>There were 458 patients treated with TFCAS (310; 67.9%) or TCAR (148; 32.1%) for CD. TCAR patients were older with more medical comorbidities, while TFCAS patients were more likely to be symptomatic. Two-stent usage was similar between the two groups (20.3%TCAR vs. 26.3%TFCAS; P=0.08). In all CAS cases, 30-day mortality was 2.4%, with 1.7% in-hospital deaths, 2% strokes, and 0.7% MIs. Stroke/death occurred in 3.7%, MACEs in 4.4%, access site complications in 4%, and technical failure was rare at 0.2%.TCAR was associated with lower 30-day mortality (1.2% vs. 2.9%), stroke (0.7% vs. 2.7%), MACEs (2% vs. 5.5%), technical failure (0% vs. 0.3%), and access site complications (2% vs. 4.8%) compared to TFCAS. However, these differences were not statistically significant (P>0.05).</p><p><strong>Conclusions: </strong>In this multi-institutional national study, both procedures showed acceptable stroke and death rates. Although not statistically significant, TCAR is associated with better technical success and peri-procedural outcomes in CD management.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172444","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 Use of Thrombin Generation as a Predictor of Thrombosis in Peripheral Artery Disease.","authors":"Mounika Naidu Boya, Isabella F Cieri, Adriana Araceli Rodriguez Alvarez, Shiv Patel, Deborah Tinlin, Jessica Cardenas, Anahita Dua","doi":"10.1016/j.avsg.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.021","url":null,"abstract":"<p><strong>Objectives: </strong>Thrombosis of stents or bypass grafts is the major cause of amputation in Peripheral Artery Disease (PAD) patients post-revascularization. Calibrated Automated Thrombography (CAT) is a global coagulation assay that measures thrombin generation and has been used to evaluate bleeding risk. However, its utility in PAD has not been investigated. This study aims to evaluate if CAT can predict thrombotic events in PAD patients.</p><p><strong>Methods: </strong>Seventy-nine PAD patients who underwent revascularization at our single tertiary care institute were prospectively enrolled and followed from 2022 to 2024. Patients were stratified based on the thrombotic events during follow-up. CAT parameters including lag time, peak thrombin generation, rate of thrombin generation, and endogenous thrombin potential (ETP) were measured at 1 week, 1,2,3,6, and 9 months and compared between the groups. Groups were statistically compared using Mann-Whitney U tests. Receiver operating characteristic (ROC) curves were generated.</p><p><strong>Results: </strong>In our cohort of 79 patients, thrombotic events occurred in 20 patients (25.3%). Thrombosed patients demonstrated significantly higher peak thrombin generation (246.2 vs 169.2, p=0.045) and thrombin generation rate (87.62 vs 50.76, p=0.005) when compared to the non-thrombotic group. ROC analysis revealed that peak thrombin generation showed a modest predictive value (AUC=0.650, 95% CI: 0.518-0.782, p=0.046) with an optimal cutoff value of >172 nM (sensitivity 80.0%, specificity 50.8%). The rate of thrombin generation demonstrated better discriminatory ability (AUC=0.708, 95% CI: 0.578-0.837, p=0.006) with an optimal cutoff value >57.44 nM/min (sensitivity 80.0%, specificity 57.6%).</p><p><strong>Conclusion: </strong>Peak thrombin generation and thrombin generation rate may serve as potential indicators for thrombosis in PAD patients.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172447","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":"Venous Thoracic Outlet Syndrome (vTOS): may surgery be a solution in chronic form?","authors":"Giuseppe Mangiameli, Alberto Italiani, Giovanna Rizzardi, Corrado Lodigiani, Efrem Civilini, Debora Brascia, Giuseppe Marulli, Luigi Bortolotti","doi":"10.1016/j.avsg.2025.05.025","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.05.025","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic venous thoracic outlet syndrome (vTOS) is characterized by persistent compression of the subclavian vein (SCV) for >3 months after the initial primary upper extremity deep vein thrombosis event often resulting in significant morbidity and post-thrombotic syndrome (PTS). While treatment algorithms for acute vTOS are well-defined, management of chronic vTOS remains non-standardized and underexplored. This study aims to assess outcome of thoracic outlet decompression in patients with chronic vTOS, providing insights into optimal management.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients with chronic vTOS who underwent surgical decompression at Humanitas Gavazzeni Hospital between January 2013 and April 2024. Diagnosis was based on clinical presentation and imaging studies. Preoperatively, patients were stratified into three groups according to the extent of venous recanalization: Group I (complete recanalization), Group II (partial recanalization and/or collateral circulation), and Group III (persistent occlusion with collateral compression). All patients underwent first-rib resection through a transaxillary approach. Postoperative outcome, including symptoms relief and imaging findings, were assessed through follow-up visits.</p><p><strong>Results: </strong>A total of 83 patients were included, with an 8% postoperative complication rate. Group I showed the most favorable outcome, with 89% achieving full symptoms resolution, while Group II patients benefited from adjunctive balloon angioplasty, improving venous function in 61% of cases. In Group III, decompression improved collateral circulation despite persistent SCV occlusion, resulting in significant symptomatic relief. Across groups, 83% of patients reported substantial improvement in symptoms, facilitating a return to daily activities and cessation of anticoagulation. All patients in Groups I and III were able to definitively discontinue anticoagulant therapy.</p><p><strong>Conclusion: </strong>Decompressive surgery through transaxillary first-rib resection significantly relieves symptoms in chronic vTOS and decision should be guided by preoperative imaging characteristics and objective clinical analyses. Stratification by recanalization and compression severity can help predict surgical success and guide postoperative management, including the use of adjunctive endovascular interventions.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140975","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}