Annals of vascular surgery最新文献

{"title":"Mortality Trends for Aortic Aneurysm Rupture in the United States, 1999–2020: A Population-Based Observational Study Using CDC WONDER","authors":"Muhammad Shaheer Ahmad ,&nbsp;Sarmad Imran ,&nbsp;Ahmed Abdul Rab ,&nbsp;Warda Shahzad ,&nbsp;Iqra Nawaz ,&nbsp;Abdul Hannan ,&nbsp;Mohammedsadeq A. Shweliya MD","doi":"10.1016/j.avsg.2025.12.034","DOIUrl":"10.1016/j.avsg.2025.12.034","url":null,"abstract":"<div><h3>Background</h3><div>Ruptured aortic aneurysm (rAA) is a life-threatening vascular emergency, often fatal before reaching medical care. Despite advances in screening, endovascular repair, and cardiovascular risk control, mortality from rAA remains high. This study aimed to evaluate national trends and disparities in rAA-related mortality among the US adults from 1999 to 2020.</div></div><div><h3>Methods</h3><div>A retrospective population-based analysis was performed using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for adults aged ≥25 years. Deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision codes I71.1, I71.3, I71.5, and I71.8. Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 US standard population. Temporal trends were assessed with Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with 95% confidence intervals.</div></div><div><h3>Results</h3><div>rAA led to 118,211 deaths in the United States from 1999 to 2020. The overall AAMR was 2.50 per 100,000, declining from 4.87 in 1999 to 1.15 in 2020 (AAPC = −6.51%). Mortality was higher in men (3.70) than women (1.62) and in rural (3.04) compared to urban areas (2.37). Non-Hispanic (NH) Whites had the highest rates (2.74), while NH Asians showed the steepest decline (AAPC = −7.02%). Regionally, the Midwest recorded the highest AAMR (2.94), whereas the Northeast showed the fastest decline (AAPC = −6.83%). Mortality increased sharply with age, peaking in adults ≥85 years.</div></div><div><h3>Conclusion</h3><div>The US mortality due to rAA has decreased significantly over a period of 20 years, although the underlying factors for this decline cannot be determined from mortality data alone. Nevertheless, this reduction was not even, as women, older adults, and rural residents continue to face disproportionately higher mortality. Ongoing surveillance and targeted efforts to address disparities in access to care are needed to maintain and extend these gains.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"126 ","pages":"Pages 116-127"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987628","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":"Systemic Heparin Use in Upper Extremity Arteriovenous Access Maintenance for Dialysis: A Meta-Analysis of Randomized Studies","authors":"Rafael Andrade Rego ,&nbsp;Eren Çetinel ,&nbsp;Andressa Frankowski Dagostin ,&nbsp;Mostafa Labib ,&nbsp;Him Shun KEI ,&nbsp;Ghislain Irakoze Habiyambere ,&nbsp;Dario Madera","doi":"10.1016/j.avsg.2025.12.041","DOIUrl":"10.1016/j.avsg.2025.12.041","url":null,"abstract":"<div><h3>Background</h3><div>A significant proportion of arteriovenous fistulas (AVFs) and grafts for hemodialysis fail due to early thrombosis, necessitating reintervention. The role of systemic heparinization in improving perioperative patency remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of perioperative systemic heparin on the patency of upper-limb vascular access creations (fistulas or grafts placement).</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane databases for randomized trials comparing heparinization versus standard care in adults undergoing arm AVF or graft placement. Data were pooled using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. All statistical analyses were conducted using Review Manager 5.4.</div></div><div><h3>Results</h3><div>Six studies comprising 1,265 patients were included, of whom 731 (58%) underwent heparinization. Systemic heparinization significantly reduced the odds of early patency loss compared to standard care (OR: 0.58; 95% CI: 0.37–0.92; <em>P</em> = 0.02; I² = 14%). However, heparin was associated with an increased risk of bleeding complications (OR: 4.24; 95% CI: 1.13–15.9; <em>P</em> = 0.13; I² = 47%).</div></div><div><h3>Conclusion</h3><div>Perioperative systemic heparinization significantly improves early patency rates for hemodialysis vascular access in adults undergoing arm fistulization or graft placement; however, there is a risk of increased bleeding events. Heparin may be considered a viable preventive strategy against early thrombosis, though its use should be balanced against individual patient bleeding risk and surgical considerations.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"126 ","pages":"Pages 100-105"},"PeriodicalIF":1.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987840","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":"Targeting High-Risk Populations for Abdominal Aortic Aneurysm Screening: A Sex-Stratified Analysis in an Ethnicity Diverse Cohort Incorporating Machine Learning Tools","authors":"Maysam Shehab ,&nbsp;Ziad Arow ,&nbsp;Lior Ben Hemo ,&nbsp;Adi R. Bachar ,&nbsp;Sharon Yalov-Handzel ,&nbsp;Tzipi Hornik-Lurie","doi":"10.1016/j.avsg.2025.12.010","DOIUrl":"10.1016/j.avsg.2025.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is usually asymptomatic, but rupture carries up to 90% mortality. Ultrasound screening reduces rupture-related mortality in ever-smoking men older than 65. Women have 4-fold lower prevalence but worse outcomes and were markedly underrepresented in major AAA trials. We analyzed a nationwide database to identify high-risk subgroups.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed individuals aged ≥50 years who underwent ultrasound screening for AAA from the nationwide Clalit-Health-Services database (2013–2023). Sex-stratified logistic regression and machine learning models were applied to identify high-risk groups.</div></div><div><h3>Results</h3><div>A total of 70,149 individuals underwent screening, including 32,269 (46%) of Middle Eastern or North African descent and 24,776 (35.3%) women. AAA prevalence was 9.5% in men and 3.2% in women. In women, AAA was associated with age &gt;75 (odds ratio [OR]: 2.22, 95% confidence interval: 1.74–2.84, <em>P</em> &lt; 0.001), ever smoking (OR: 3.08, 2.63–3.60, <em>P</em> &lt; 0.001), and high CHA₂DS₂-VASc &gt;4 (OR: 3.27, 2.25–4.74, <em>P</em> &lt; 0.001). In men, age &gt;75 (OR: 1.93, 1.71–2.18, <em>P</em> &lt; 0.001), smoking (OR: 1.52, 1.38–1.67, <em>P</em> &lt; 0.001), and high CHA₂DS₂-VASc (OR: 1.84, 1.65–2.06, <em>P</em> &lt; 0.001) were significant. Ethnicity modestly increased AAA odds in men. Consistent with logistic regression, machine learning-based probability curves demonstrated higher predicted AAA risk with advancing age, higher CHA₂DS₂-VASc scores, smoking, and peripheral arterial disease, particularly among women &gt;75 years.</div></div><div><h3>Conclusion</h3><div>Our findings indicate that AAA screening should consider age, smoking status and cardiovascular risk factors, including in women, where higher ORs were observed.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 73-83"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800420","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":"Midterm Outcomes of Preemptive Side Branch Embolization Aimed for Total Branch Embolization During Endovascular Aneurysm Repair","authors":"Yu Nosaka,&nbsp;Masahiro Ikeda,&nbsp;Teruaki Ushijima,&nbsp;Hirofumi Takemura","doi":"10.1016/j.avsg.2025.12.009","DOIUrl":"10.1016/j.avsg.2025.12.009","url":null,"abstract":"<div><h3>Background</h3><div>We performed preemptive side branch embolization (PBE) during endovascular aneurysm repair (EVAR) to prevent type 2 endoleak (T2EL). Our aggressive PBE (A-PBE) strategy aims to embolize all patent side branches of abdominal aortic aneurysm (AAA) identified on preoperative computed tomography (CT). This study evaluated midterm clinical outcomes for that strategy.</div></div><div><h3>Methods</h3><div>Participants comprised 140 of 163 patients who underwent primary EVAR between 2015 and 2024. A total of 33 patients received A-PBE based on age, comorbidities, and activities of daily living (A-PBE group). The remaining 107 patients were assigned to the O group. Outcomes examined were changes in aneurysm sac diameter, reintervention rates, and T2EL incidence.</div></div><div><h3>Results</h3><div>The mean follow-up was 3.0 ± 2.3 years for the A-PBE group and 4.0 ± 2.6 years for the O group. The incidence of sac shrinkage was significantly higher in the A-PBE group (63.6% vs. 37.4%, <em>P</em> = 0.0078). The incidences of sac enlargement and T2EL were significantly lower in the A-PBE group (6.1% vs. 28.0%, <em>P</em> = 0.0086; 15.2% vs. 36.4%, <em>P</em> = 0.031, respectively). Sixteen patients in the O group (15.0%) required reintervention for sac enlargement, compared to none in the A-PBE group. Total embolization was achieved in 57.6% of A-PBE cases, with only one sac enlargement and T2EL due to incomplete embolization. Operative and fluoroscopy times and contrast agent usage were higher in the A-PBE group, but no postoperative complications or new dialysis occurred.</div></div><div><h3>Conclusion</h3><div>A-PBE effectively promotes sac shrinkage and reduces T2EL and sac enlargement, potentially improving long-term EVAR outcomes in selected patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 54-61"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800365","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":"Three-Dimensional Assessment of Renal Artery Aneurysm Growth Using Vascular Deformation Mapping","authors":"Drew J. Braet ,&nbsp;Beckett Peterson ,&nbsp;Luciano Delbono ,&nbsp;Chris Johnson-Harwitz ,&nbsp;Peter K. Henke ,&nbsp;Dawn M. Coleman ,&nbsp;C. Alberto Figueroa ,&nbsp;James C. Stanley ,&nbsp;Nicholas S. Burris","doi":"10.1016/j.avsg.2025.12.012","DOIUrl":"10.1016/j.avsg.2025.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Risk factors for renal artery aneurysm (RAA) growth are poorly understood. Vascular deformation mapping (VDM) is known to accurately depict 3-dimensional (3D) growth patterns of aortic aneurysms. This study investigates the feasibility of VDM to accurately define 3D growth of RAAs and the relationship of RAA diameter alone to 3D growth.</div></div><div><h3>Methods</h3><div>Fifty-five RAAs having ≥2 computed tomography angiograms with ≤2.5 mm slice thickness, ≥2 months apart, were studied. RAAs were segmented and their volumes (including calcium, thrombus, lumen, and total) were determined. Change in RAA diameter (ΔDiameter) and volume (ΔVolume) over time were calculated. VDM was used to quantify 3D growth. ΔVolume and mean 3D growth were compared between RAAs having stable diameters and those with increased diameters (≥0.1 cm ΔDiameter) and the relationship between ΔDiameter, ΔVolume, and 3D growth was examined.</div></div><div><h3>Results</h3><div>Twenty-five of the 55 RAAs studied had successful VDM analyses. The affected patients’ mean age was 60.1 ± 8.7 years and 56% were female. One RAA was symptomatic, with no ruptures. The overall ΔDiameter was 0.86 ± 1.25 mm/year (mean CT interval of 43.1 months). Nine (36.0%) RAAs exhibited diameter increases, and when compared to the 16 stable RAAs, there were no differences in ΔVolume or 3D growth. There was no correlation of ΔDiameter with 3D growth or ΔVolume (<em>r</em> &lt; 0.4, <em>P</em> &gt; 0.05). RAA 3D growth strongly correlated with ΔTotal Volume (<em>r</em> = 0.653, <em>P</em> &lt; 0.001) and ΔLumen Volume (<em>r</em> = 0.695, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>VDM is an accurate method for assessing RAA growth, yields additional metrics not provided by diameter alone, and provides a more comprehensive assessment of RAA morphology changes that correlate with ΔVolume.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 23-32"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802945","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 Wound, Ischemia, and Foot Infection Classification Stratifies Amputation Risk but Not Patient Experience in Chronic Limb-Threatening Ischemia","authors":"Shiwen Song,&nbsp;Ping Li","doi":"10.1016/j.avsg.2025.12.004","DOIUrl":"10.1016/j.avsg.2025.12.004","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 11-12"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780145","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":"Building Advanced Endovascular Aortic Programs","authors":"Fernando Motta ,&nbsp;Mark A. Farber","doi":"10.1016/j.avsg.2025.12.016","DOIUrl":"10.1016/j.avsg.2025.12.016","url":null,"abstract":"<div><h3>Abstract</h3><div>This article will discuss key aspects of building and maintaining an advanced endovascular aortic program.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 289-295"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145853319","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 Database Evaluation of Endovascular versus Open Surgical Approaches for Iliac Vessel Injuries","authors":"Gabriela Santos-Revilla ,&nbsp;Alejandro Pizano ,&nbsp;Mehmet Alagoz ,&nbsp;Elisa Szydziak ,&nbsp;Nwe Oo Mon ,&nbsp;Sara Cardozo-Stolberg ,&nbsp;Sarah Alamprese ,&nbsp;L.D. George Angus ,&nbsp;Anantha Ramanathan","doi":"10.1016/j.avsg.2026.01.007","DOIUrl":"10.1016/j.avsg.2026.01.007","url":null,"abstract":"<div><h3>Background</h3><div>Iliac vessel injuries are linked to a high mortality rate in trauma surgery. Endovascular repair of these injuries has gained recognition as a less invasive alternative, with possibly better outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the National Trauma Data Bank was performed of all iliac vessel injuries for the year 2022. The endpoint was the in-hospital mortality rate. Secondary outcomes included in-hospital and critical care unit lengths of stay, complications, and major amputation rates.</div></div><div><h3>Results</h3><div>Out of a total of 2,300 patients with iliac vessel injuries, 74.4% were male with an average age of 46 years (±20.1 years). The majority (68.9%) had blunt trauma, while 31.1% had penetrating trauma. Treatment modalities included endovascular procedures (41.9%), open surgery (25.1%), and nonoperative management (33.0%). Endovascular treatment was associated with lower mortality rates (18%) than open surgery (26%) and nonoperative management (19.4%) (<em>P</em> &lt; 0.05). Patients undergoing endovascular interventions were older and had higher Injury Severity Scores (<em>P</em> &lt; 0.05). Complex iliac injuries had higher rates of complications and mortality than isolated injuries (<em>P</em> &lt; 0.05). Factors associated with increased mortality included age over 55 (odds ratio [OR] 2.33), higher Injury Severity Scores (OR 1.07), and penetrating mechanism of injury (OR 2.82) (<em>P</em> &lt; 0.001). Endovascular intervention was associated with a significantly lower odds of in-hospital mortality than open vascular treatment in penetrating trauma (adjusted OR 0.067, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Our results underscore the increasing role of endovascular intervention in managing iliac trauma and suggest a mortality benefit in specific injury pattern scenarios.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 270-281"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958304","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":"Abdominal Aortic Aneurysm in Women and Men: A Systematic Review of Sex-Specific Outcomes in the United Kingdom","authors":"Gemma Pace ,&nbsp;Martin Hossack ,&nbsp;Francesco Torella ,&nbsp;Jillian Madine ,&nbsp;Riaz Akhtar","doi":"10.1016/j.avsg.2025.12.011","DOIUrl":"10.1016/j.avsg.2025.12.011","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Abdominal aortic aneurysm (AAA) is less common in women than in men; however, when present, women appear to follow a more aggressive disease course, rupturing at smaller diameters and experiencing worse operative outcomes. The United Kingdom provides a unique environment in which to evaluate sex-specific outcomes, as national screening invitations are extended to men only and National Institute for Health and Care Excellence guidance applies a uniform 5.5 cm threshold for elective repair irrespective of sex.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, EMBASE, and the Cochrane Library were searched to September 2025. Eligible studies reported sex-stratified outcomes for AAA in the United Kingdom. Gray literature was included through review of the National Vascular Registry, National Health Service AAA Screening Program reports, and National Institute for Health and Care Excellence guidance. Where sex-stratified numerators and denominators were available, crude odds ratios (ORs) were calculated and pooled using Der Simonian–Laird random-effects models. A separate adjusted-effects meta-analysis was performed using the generic inverse-variance method for studies reporting multivariable-adjusted ORs (adjORs).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Five peer-reviewed studies met inclusion, supported by national reports. Women had significantly higher perioperative mortality after elective endovascular repair (pooled OR 1.61, 95% confidence interval [CI] 1.31–1.97) and elective open repair (pooled OR 1.37, 95% CI 1.16–1.63). After ruptured repair, mortality was similar between sexes following endovascular aneurysm repair (EVAR) (pooled OR 1.11, 95% CI 0.89–1.39), but higher in women after open surgery (pooled OR 1.53, 95% CI 1.24–1.89), although with substantial heterogeneity. Adjusted-effects synthesis confirmed higher mortality for women after elective EVAR (summary adjOR ≈1.55, 95% CI 1.25–1.80) and open repair (adjOR 1.39, 95% CI 1.25–1.56). Women were less likely to undergo surgery following rupture, more likely to be readmitted after elective EVAR, had longer hospital stays, and higher long-term aortic-related mortality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Women with AAA in the United Kingdom remain disadvantaged at every stage of care: they are less likely to be screened, rupture at smaller diameters, less often selected for repair, and when treated, face higher perioperative and long-term mortality. These disparities reflect a combination of anatomical and biomechanical differences, together with systemic factors. Current UK policy, based on male-only screening and a sex-neutral 5.5 cm threshold, does not reflect this reality. Sex-specific thresholds for repair, targeted female screening, and the development of devices optimized for female anatomy are needed to address inequity.&lt;/div&gt;&lt;/di","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 40-53"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848783","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":"Modern Physician-Modified Endograft Techniques for Renal and Mesenteric Vessel Incorporation","authors":"Rohan Basu,&nbsp;Payton Miller,&nbsp;Alexa Hughes,&nbsp;Andres Fajardo","doi":"10.1016/j.avsg.2025.12.017","DOIUrl":"10.1016/j.avsg.2025.12.017","url":null,"abstract":"<div><div>Anatomic suitability for endovascular aortic surgery has rapidly expanded to include the juxtarenal and paravisceral segment. Traditional infrarenal endovascular devices are not suitable for use in short neck, angulated, or complex aneurysms that involve the visceral-renal segment of the aorta due to lack of appropriate seal zones or coverage of visceral-renal arteries. There are few commercially available devices in the United States approved for treatment of these complex abdominal aortic aneurysms, one of which requires a 6–8 week waiting period for patient-specific custom fabrication. Physician-modified endografts (PMEGs) have been increasingly adopted as readily available solutions to offer expeditious repair of these anatomically complex aneurysms. PMEG can incorporate various modifications, including fenestrations and directional branches, to accommodate a wide range of anatomies, without need for waiting periods for device fabrication. The authors describe modern planning and technical methods for incorporation of visceral and renal arteries using PMEG created from commercially available endografts.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 91-101"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848804","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}