Annals of vascular surgery最新文献

{"title":"Added Diagnostic Value of Intravascular Ultrasound over Venography in “High Risk for Dialysis Circuit Vascular Access Failure” ESRD Patients","authors":"Mia Zivkovic ,&nbsp;Sasan Partovi ,&nbsp;Levester Kirksey ,&nbsp;Abraham Levitin ,&nbsp;Sean P. Lyden ,&nbsp;Jon G. Quatromoni ,&nbsp;Israel Cohen ,&nbsp;Efrat Keren Gilat ,&nbsp;Cassandra Kovach ,&nbsp;Patrick Ghibes ,&nbsp;Daniel Raskin","doi":"10.1016/j.avsg.2025.08.034","DOIUrl":"10.1016/j.avsg.2025.08.034","url":null,"abstract":"<div><h3>Background</h3><div>As a two-dimensional modality, venography has limitations in its capacity to measure lumen caliber and to assess stenotic disease accurately. This has implications in the management of end-stage renal disease (ESRD) patients “no-option” candidates access for arteriovenous fistula (AVF) or graft (AVG) creation secondary to high risk of vascular access failure. The incremental diagnostic and clinical impact of intravascular ultrasound (IVUS) was quantified in this tunneled dialysis catheter-dependent ESRD cohort.</div></div><div><h3>Methods</h3><div>From January 2024 to February 2025, 14 consecutive “high risk for dialysis circuit vascular access failure” ESRD patients (mean age 56 ± 13 years; 8 male) underwent same-session venography and IVUS. For each interrogated vein, IVUS and venography were compared regarding stenosis grade, venous wall pathology (chronic thrombus, elastic recoil, trabeculae/web formation), and patent central venous outflow. Primary endpoints were IVUS–venography discordance and subsequent change in patient management based on the combined IVUS–venography results. Secondary end points included successful surgical vascular access creation, access maturation at 3–6 months, contrast volume, fluoroscopy time, and procedure-related morbidity.</div></div><div><h3>Results</h3><div>IVUS was discordant with venography in 7/14 patients (50%): stenosis severity was upgraded in 4 (29%) and downgraded in 3 (21%) based on findings in IVUS. IVUS revealed or confirmed appropriate venous outflow for future vascular access creation in 5/14 patients (36%). Eight of the 14 patients (57%) ultimately underwent AVF/AVG creation after IVUS-guided central venous mapping. At 6 months, 5/8 accesses (63%) were functional for dialysis (4 fistulas, 1 graft). Two accesses (25%) had not been used at the time of analysis, and one fistula (12%) was ligated secondary to infectious complications. Median contrast volume was 51 mL (range 25–127) and median fluoroscopy time was 7.6 min (range 3.0–20.3). No intraprocedural complications during dedicated central venous mapping occurred, and specifically no complications related to IVUS usage were recorded. Two delayed complications occurred in patients who received vascular access as a result of IVUS assessment, and both were managed successfully with endovascular procedures.</div></div><div><h3>Conclusion</h3><div>In no-option ESRD patients, IVUS revealed changes in stenosis severity in half of the cases compared to standard two-dimensional venography, resulting in permanent dialysis circuit vascular access creation in more than half of the assessed patients, with 63% of these patients reaching vascular access maturation. Routine incorporation of IVUS into salvage central venous mapping may expand durable vascular access options and reduce dialysis catheter dependency.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 587-594"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005839","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":"Balloon-Expandable Versus Self-Expandable Stent Grafts for Endovascular Repair of Aorto-Iliac Aneurysms with Iliac Branch Devices: A Systematic Review and Meta-Analysis","authors":"Dilson Pimentel-Junior ,&nbsp;Milena Monteiro Mastra ,&nbsp;Enrico Prajiante Bertolino ,&nbsp;Miguel Godeiro Fernandez ,&nbsp;Denise Filippini ,&nbsp;Mariana K. Obara ,&nbsp;Carlos BM. De Melo Neto ,&nbsp;Guilherme B. Lima ,&nbsp;Nelson De Luccia ,&nbsp;Grace Carvajal Mulatti","doi":"10.1016/j.avsg.2025.08.037","DOIUrl":"10.1016/j.avsg.2025.08.037","url":null,"abstract":"<div><h3>Background</h3><div>To compare the results of internal iliac artery (IIA) incorporation using balloon-expandable stent grafts (BESGs) versus self-expandable stent grafts (SESGs) while using iliac branch devices (IBDs) for endovascular repair of aorto-iliac artery aneurysms.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis was conducted. PubMed, Embase, and Cochrane databases were searched for studies up to December 2024 that compared BESG and SESG for IBD during endovascular repair of aorto-iliac aneurysms. A total of 1,107 articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. End points included a composite of all endoleaks, types 1b, 1c, and 3 endoleaks, buttock claudication, IIA occlusion, and IBD-related reinterventions during follow-up.</div></div><div><h3>Results</h3><div>Four cohort studies met the eligibility criteria with 684 patients treated with 711 IBDs. 460 (64.7%) BESGs and 251 (35.3%) SESGs were used in the target IIAs. Both groups had similar demographics and cardiovascular risk factors. The median age of patients was 71.1 years and 88.7% were male. A composite of all endoleaks (odds ratio [OR]: 5.53; 95% confidence interval [CI]: 1.15 to 26.63; <em>P</em> = 0.03; I² = 0) was significantly less common in patients treated with SESG compared to BESG. Type 1b (OR: 4.62; 95% CI: 0.18–116.16; <em>P</em> = 0.35), type 1c (OR: 1.52; 95% CI: 0.09–25.03; <em>P</em> = 0.77), type 3 endoleaks (OR: 5.25; 95% CI: 0.58–47.47; <em>P</em> = 0.14), buttock claudication (OR: 0.38; 95% CI: 0.06–2.58; <em>P</em> = 0.32; I² = 0%), IIA occlusion (OR: 0.40; 95% CI: 0.06–2.57; <em>P</em> = 0.34; I² = 0%), and IBD-related reinterventions (OR: 1.62; 95% CI: 0.84–3.11; <em>P</em> = 0.15; I² = 0%) were not significantly different between groups.</div></div><div><h3>Conclusion</h3><div>SESG for IIA was associated with a lower incidence of all types of endoleaks when compared to BESG during endovascular repair of aorto-iliac aneurysms using IBD. However, types 1b, 1c, and 3 endoleaks; buttock claudication; IIA occlusion; and IBD-related reinterventions were similar among SESG and BESG. BESG is more versatile to adjust to challenging anatomical conditions.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 552-563"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005888","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":"Litigation Trends in Vascular Surgery in the UK: A Retrospective Analysis of NHS Resolution Data and Impact of the COVID-19 Pandemic","authors":"Porya Hassan Abadi ,&nbsp;Behrad Barmayehvar ,&nbsp;Andrew Thompson ,&nbsp;Kaji Sritharan","doi":"10.1016/j.avsg.2025.08.039","DOIUrl":"10.1016/j.avsg.2025.08.039","url":null,"abstract":"<div><h3>Background</h3><div>Vascular surgery (VS) is a high-risk specialty, with complex procedures and multimorbid patients. Medicolegal claims offer insight into recurring clinical vulnerabilities. We aimed to analyze litigation trends in VS over the past decade in England and the potential impact of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>A retrospective review of VS-related claims submitted to NHS Resolution between 2014/15 and 2023/24 was conducted following a Freedom of Information request. The trends in claim volumes, alleged causes, injuries, and costs were analyzed.</div></div><div><h3>Results</h3><div>A total of 1,288 claims were reviewed; 814 resulted in damages costing £205 million. The most common causes for claims were failure/delay in treatment (427 claims; 36.6%), failure/delay in diagnosis (138 claims; 10.7%), and inappropriate treatment (84 claims; 6.5%). Lower limb amputation was the most frequent injury (436 claims; 33.8%), followed by fatality (174 claims; 13.5%). Litigation costs rose in the post-COVID-19 pandemic years (2019–24) compared to prepandemic (2014–19) by 30.8% (£88 to £116 million), with a 33% and 50% increase in claims related to delays in diagnosis (59–79) and delays in performing operations (20 to 30), respectively. Average cost per closed claim was £239,680 in 2014/15, peaking at £386,038 in 2021/22 and closing at £174,922 in 2023/24.</div></div><div><h3>Conclusion</h3><div>Treatment delays and amputations account for the majority of VS claims. The COVID-19 pandemic exacerbated pre-existing systemic pressures, contributing to rising costs. Targeted efforts to improve time to treatment, documentation, and communication are essential to reducing litigations. Ongoing review of litigation data could help inform policy and enhance outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 595-602"},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005886","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":"Interpretable Machine Learning Approaches for Identification Acute Aortic Dissection in Chest Pain Patients.","authors":"Shuangshuang Li, Kaiwen Zhao, Wen Li, Qingsheng Lu, Jian Zhou, Jia He","doi":"10.1016/j.avsg.2025.08.028","DOIUrl":"https://doi.org/10.1016/j.avsg.2025.08.028","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is using interpretable machine learning methods to construct models by combing routine laboratory examination biomarkers and clinical characteristics to identify acute aortic dissection (AAD) patients from other sudden chest pain patients referring to acute myocardial infarction (AMI), acute pulmonary embolism (APE) and abdominal aortic aneurysm (AAA).</p><p><strong>Methods: </strong>The research encompassed a cohort of 832 individuals, with 515 of them diagnosed as acute aortic dissection patients. Patients were randomly assigned to training and test groups for model development and evaluation, with data collected from medical records and validated by study physicians. LASSO regression was used for variable selection in the study, which utilized nine machine learning algorithms for model development. The DeLong test compared AUC values among models. Optimal parameters were found through grid search on the training set with 5-fold cross validation. The SHAP method ranks input feature importance and explains model outcomes to address model opacity.</p><p><strong>Results: </strong>Utilizing the LASSO regression technique, eight variables were pinpointed for their nonlinear significance. Evaluation of these models using test set data yielded area under the curve (AUC) values between 0.72 and 0.77, suggesting promising utility in differential diagnosis. The Random Forest method demonstrated noteworthy sensitivity, specificity, and F1 Score. The internal validation set consistently yielded results with an area under the curve (AUC) ranging from 0.71 to 0.77. The SHAP method was utilized to assess the influence of features on the model, identifying N.L and age as the most significant variables.</p><p><strong>Conclusion: </strong>In this prognostic study, a machine learning model was created to assist in differentiating patients with aortic dissection from those presenting with chest pain. The use of interpretable machine learning techniques allows for the prioritization of key features, showcasing significant potential for application in supporting the prompt diagnosis and treatment of aortic dissection differentials.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005846","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":"Effects of a 3-week Inpatient Rehabilitation for Neurogenic Thoracic Outlet Syndrome on Strength, Pain, and Function: A Prospective Study","authors":"Alban Fouasson-Chailloux ,&nbsp;Pauline Daley ,&nbsp;Pierre Menu ,&nbsp;Sandrine Quiguer ,&nbsp;François Quatrevaux ,&nbsp;Anita Orrieux ,&nbsp;Noémie Labre ,&nbsp;Véronique Rouzioux ,&nbsp;Michel Merle ,&nbsp;Germain Pomares ,&nbsp;Marc Dauty","doi":"10.1016/j.avsg.2025.08.024","DOIUrl":"10.1016/j.avsg.2025.08.024","url":null,"abstract":"<div><h3>Background</h3><div>Neurogenic thoracic outlet syndrome (NTOS) is due to the compression of the brachial plexus and is responsible for upper limb pain, strength loss and fatigability, which are responsible for daily life impairment. We assessed prospectively the effect of a 3-week inpatient rehabilitation on upper limb strength and endurance, and to assess pain and function in patients with NTOS.</div></div><div><h3>Methods</h3><div>Among patients with NTOS, 220 addressed to rehabilitation were included. Patients performed a shoulder isokinetic testing of the rotator cuff and an isometric hand strength measurement, at the beginning and the end of the rehabilitation, and at 24 weeks. Patients completed a QuickDASH questionnaire, and pain was evaluated with a numeric rating scale (NRS). Sick leave rate was also assessed.</div></div><div><h3>Results</h3><div>Out of 220 patients, 182 performed the 3 evaluations: 78% were female, mean age was 40.7 ± 9.7 years. Initially, symptomatic upper limbs had significantly less strength than asymptomatic upper limbs. At 24 weeks, the rotators strength had increased from 13 to 18% on symptomatic shoulders, and from 4 to 12.5% on asymptomatic shoulders; the rotators endurance increased from 35% to 39% on symptomatic shoulders and from 20% to 22% on asymptomatic shoulders (<em>P</em> ≤ 0.001). The grip and key-pinch measures increased by 22% and 13%, on symptomatic hands, respectively, and by 12% and 8%, on asymptomatic hands, respectively (<em>P</em> ≤ 0.001). The QuickDASH decreased from 57 ± 14% to 30 ± 19% (<em>P</em> ≤ 0.001) and the NRS from 5.6 ± 1.8 to 2.4 ± 2.0 (<em>P</em> ≤ 0.001). The sick leave rate decreased from 66 to 43% (<em>P</em> ≤ 0.0001).</div></div><div><h3>Conclusion</h3><div>Three weeks of inpatient rehabilitation for NTOS permitted to recover significant bilateral upper limb strength and endurance, both on hands and shoulders, with a maintenance of the results at 24 weeks. These results were associated to a significant reduction of pain and impairment.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 603-612"},"PeriodicalIF":1.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999489","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":"Complications Following Early Thoracic Endovascular Aortic Repair for Type B Aortic Dissection: A Pathophysiological Deepening","authors":"Antonio Manenti,&nbsp;Gianluca Pagnoni,&nbsp;Aurora Vicenzi,&nbsp;Francesca Coppi","doi":"10.1016/j.avsg.2025.08.023","DOIUrl":"10.1016/j.avsg.2025.08.023","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 555-556"},"PeriodicalIF":1.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939903","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":"Use of Cryopreserved Arterial Allografts as a Reconstruction Strategy in Peripheral Sarcoma Surgery","authors":"Valérie Lacroix ,&nbsp;Anaïs Metonga Wiwili ,&nbsp;Pierre-Louis Docquier ,&nbsp;Xavier Banse ,&nbsp;Robin Evrard ,&nbsp;Arnaud Colle ,&nbsp;Maxime Elens ,&nbsp;Thomas Schubert","doi":"10.1016/j.avsg.2025.08.004","DOIUrl":"10.1016/j.avsg.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Complete resection of lower limb soft tissue sarcoma may require vascular resection and reconstruction. While prosthetic grafts and autologous saphenous veins are commonly employed, superior patency has been described for autologous veins. However, their use implies harvesting, mostly on the contralateral limb. Limited data exist on the use of cryopreserved arterial allografts for such vascular replacement.</div></div><div><h3>Methods</h3><div>We report a retrospective series of 11 patients with locally aggressive extremity sarcomas undergoing 20 vascular resections and reconstructions with cryopreserved arterial allografts over a 5-year period. A total of 10 arteries and 10 veins were reconstructed. The mean tumor length on resected specimen was 15.4 cm, with the thigh being the most frequent site of resection. Six patients required additional osseous reconstruction with mega-implants or bone allograft.</div></div><div><h3>Results</h3><div>Limb salvage was achieved in 91% of patients. One amputation was necessary because of untreatable infection following fracture of a bone allograft in an irradiated area. The 1-year secondary arterial patency was 78%, with one graft requiring revision due to a mechanical friction on a mega-implant. The 1-year venous patency was 69%.</div></div><div><h3>Conclusion</h3><div>Our series represents the first homogeneous cohort treated with cryopreserved arterial allografts for vascular reconstruction in sarcoma surgery, showing favorable outcomes despite extensive resection characteristics. Their use avoids contralateral limb morbidity and offers promising patency and limb-salvage outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 536-542"},"PeriodicalIF":1.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939970","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 Venous Drainage Disorders: A Potential Missing Piece in Thoracic Outlet Syndrome","authors":"Joseph Karam","doi":"10.1016/j.avsg.2025.08.022","DOIUrl":"10.1016/j.avsg.2025.08.022","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 534-535"},"PeriodicalIF":1.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939753","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 Two-Decade Experience of Oncovascular Reconstruction in Patients with Retroperitoneal Sarcoma","authors":"Anita Zahiri ,&nbsp;Arash Fereydooni ,&nbsp;Emily Eshraghian ,&nbsp;Milan Ho ,&nbsp;Daniel Delitto ,&nbsp;Byrne Lee ,&nbsp;George A. Poultsides ,&nbsp;Jeffrey A. Norton ,&nbsp;E. John Harris ,&nbsp;Elizabeth L. George","doi":"10.1016/j.avsg.2025.08.014","DOIUrl":"10.1016/j.avsg.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection remains the cornerstone of sarcoma treatment; however, tumor involvement of major vasculature presents challenges. Multidisciplinary approaches incorporating vascular surgery have expanded feasibility of resection, yet long-term outcome data remain limited.</div></div><div><h3>Methods</h3><div>We performed a retrospective review of patients with retroperitoneal sarcomas who underwent resection with vascular reconstruction at a tertiary referral center from 2001 to 2024. Data included demographics, tumor characteristics, operative details, and outcomes including mortality, graft patency, and reinterventions.</div></div><div><h3>Results</h3><div>A total of 263 vascular procedures were performed in 101 patients (median age 59 years; 52% female). Prior sarcoma resection occurred in 36.3%, 53.5% received chemoradiation, and 41.7% had stage IV disease. The most common histology was leiomyosarcoma (34.7%). Concurrent procedures included nephrectomy (53.5%) and colectomy (36.3%). Thirty-day mortality was 5%, with a 64.4% Clavien-Dindo grade II + complication rate. Median overall survival was 5.9 years. Vascular reintervention occurred in 11.9% of cases. One-year vascular reintervention-free survival was 90.5%, with no 1-year survival difference between patients with (93.3%, <em>n</em> = 84) and without reconstruction thrombosis (81.7%, <em>n</em> = 16; <em>P</em> = 0.454). Univariate analysis associated thrombosis with diabetes, dual antiplatelet therapy, anticoagulation with antiplatelet therapy, iliac vein reconstruction using cryopreserved grafts, and 90-day readmission. On multivariate analysis, only use of cryopreserved grafts for iliac vein reconstruction remained significantly associated with thrombosis (odds ratio (OR) 12.75, 95% confidence interval (CI) 1.68–18.93; <em>P</em> = 0.019).</div></div><div><h3>Conclusion</h3><div>Over two decades, vascular reconstructions facilitated complex sarcoma resections with favorable long-term outcomes. Iliac vein reconstructions using cryopreserved grafts carry higher thrombosis risk. Despite the complexity of these cases, the outcomes reflect the effectiveness of multidisciplinary management.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 543-554"},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939965","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":"Comparison of Long-Term Results According to Localization of Stenosis and Occlusion in Patients Undergoing Atherectomy for Infrainguinal Peripheral Arterial Disease","authors":"Onur Emre Satilmis,&nbsp;Gulsum Turkyilmaz,&nbsp;Hasan Toz,&nbsp;Yusuf Kuserli,&nbsp;Saygin Turkyilmaz,&nbsp;Ali Aycan Kavala","doi":"10.1016/j.avsg.2025.07.038","DOIUrl":"10.1016/j.avsg.2025.07.038","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular treatment is an effective treatment option for peripheral arterial disease, which is a common disease with an increasing incidence rate. The importance of vessel preparation methods in endovascular treatment is well understood, and atherectomy, one of these methods, is frequently used to treat patients with peripheral arterial disease. In this study, we aimed to compare the primary patency rates and long-term outcomes of patients who underwent atherectomy for infrainguinal peripheral arterial disease according to lesion location.</div></div><div><h3>Methods</h3><div>In the Department of Cardiovascular Surgery at Tertiary Academic Center, 120 patients who underwent atherectomy due to infrainguinal peripheral arterial disease between January 2014 and December 2018 were retrospectively examined. Demographic data, claudication distance, Rutherford classification, ankle/brachial index (ABI), lesion length and localization were noted. The patients were divided into three groups on the basis of lesion location: superficial femoral artery (SFA), popliteal, or infrapopliteal. All patients underwent rotational atherectomy and subsequent balloon angioplasty. The ABI, Rutherford classification, and Doppler ultrasonography results were recorded at the 1-, 2- and 5-year follow-ups after the procedure.</div></div><div><h3>Results</h3><div>There were a total of 120 patients in the study. The mean age of the patients was 68.75 ± 7.44 years. Acute technical success was achieved in 115 (95.83%) of the 120 patients. The rates of patients with &lt;50% noncritical stenosis based on Doppler ultrasonography control were 100.0% in the SFA group, 100.0% in the popliteal group, and 88.9% in the infrapopliteal group at the first year; 95.0%, 93.0%, and 80.6% at the second year; and 89.2%, 84.0%, and 75.0% at the fifth year, respectively. The rate of &lt;50% noncritical stenosis in all patients was 96.5% at the first year, 89.6% at the second year, and 82.8% at the fifth year.</div></div><div><h3>Conclusion</h3><div>Vessel preparation methods should be considered in the endovascular treatment of infrainguinal peripheral arterial disease. We can conclude that the technical success rates of atherectomy and subsequent complementary drug-coated balloon angioplasty are high, and the restenosis rates and complication rates due to peripheral arterial disease are at an acceptable level with the preservation of lifestyle changes and the regular application of medical treatment after the procedure.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939773","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}