Annals of vascular surgery最新文献

{"title":"Bovine Carotid Artery Grafts versus PTFE Grafts for Hemodialysis Access: A Systematic Review and Meta-Analysis","authors":"Tijmen W. Kraai ,&nbsp;Rick S. Looman ,&nbsp;Johannes W. Drouven ,&nbsp;Barzi Gareb ,&nbsp;Ben R. Saleem ,&nbsp;Clark J. Zeebregts","doi":"10.1016/j.avsg.2025.07.046","DOIUrl":"10.1016/j.avsg.2025.07.046","url":null,"abstract":"<div><h3>Background</h3><div>Arteriovenous grafts are considered for hemodialysis access in patients without a suitable vein for the creation of an arteriovenous fistula (AVF). The most commonly used synthetic polytetrafluorethylene (PTFE) graft carries a high risk of infection (6–29%) and limited biocompatibility. The bovine carotid artery graft (BCAG), a biological alternative, may address these limitations. This systemic review and meta-analysis compared the clinical outcomes of BCAG versus PTFE grafts.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and Cochrane Library were searched for eligible studies (PROSPERO, no. 607603). Studies including patients with BCAG access were included, and those studies published before 2000 were excluded. If PTFE outcomes were reported, they were pooled for comparison. The primary outcome was (graft) infection. Secondary outcomes included primary, primary assisted and secondary patency, and postoperative complications. Meta-analyses and subgroup analyses used random-effects models.</div></div><div><h3>Results</h3><div>Eleven studies (one randomized controlled trial (RCT) and 10 cohort studies) involving 1,247 patients met the inclusion criteria. Infection rates were similar between BCAG and PTFE (64 vs. 95 per 1,000 patient years; <em>P</em> = 0.43). At 12 months, BCAG showed significantly higher primary (47% vs. 29%; <em>P</em> = 0.02) and primary assisted patency (66% vs. 34%; <em>P</em> = 0.004). Secondary patency at 12 months was not significantly higher in the BCAG group (78% vs. 57%; <em>P</em> = 0.10). No differences were observed in the incidence of postoperative complications.</div></div><div><h3>Conclusion</h3><div>BCAG demonstrated superior primary and primary assisted patency compared to PTFE grafts in hemodialysis access. Other outcomes also favored BCAG but lacked statistical significance. Large-scale RCTs are warranted to further define the role of BCAG and support evidence-based decisions.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 486-500"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939286","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":"GLP-1 Receptor Agonists Associated With Improved Survival After Infrainguinal Bypass in Diabetic Patients","authors":"Elonay Yehualashet,&nbsp;Muhammad S. Mazroua,&nbsp;Estefania Narvaez,&nbsp;Marissa C. Jarosinski,&nbsp;Nathan L. Liang,&nbsp;Michael C. Madigan,&nbsp;Rabih A. Chaer,&nbsp;Natalie D. Sridharan","doi":"10.1016/j.avsg.2025.08.013","DOIUrl":"10.1016/j.avsg.2025.08.013","url":null,"abstract":"<div><h3>Background</h3><div>The American Diabetes Association recommends the use of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) (e.g., Ozempic) for patients with atherosclerotic cardiovascular disease, including peripheral artery disease. We hypothesized increasing the use of GLP1-RAs would be associated with improved outcomes after bypass.</div></div><div><h3>Methods</h3><div>Retrospective review of diabetic patients undergoing infrainguinal bypass at a multihospital institution between 2017 and 2024 was conducted, including patient characteristics, operative details, and outcomes. The primary outcome was survival. Secondary outcomes included perioperative complications, major adverse limb events, major adverse cardiovascular events (MACE), and metabolic changes. Kaplan–Meier and Cox regression evaluated outcomes.</div></div><div><h3>Results</h3><div>A total of 322 patients (62.5% male, 78.8% White, median age 68 [61–76] years) underwent 339 bypasses. GLP1-RA use increased from 8.2% to 18.8% during the study period (<em>P</em> = 0.001). Patients on a GLP1-RA (<em>n</em> = 38, 11.2%) were younger (65.5 [57.0–71.0] vs. 69.9 [62.0–77.0] years, <em>P</em> = 0.003) and had a higher body mass index (29.6 [26.9–33.3] vs. 27.2 [23.3–31.1] kg/m², <em>P</em> &lt; 0.001). Median follow-up was 18 [6–39] months. Improved survival at 2 years was seen among patients on a GLP1-RA (94.7% vs. 71.8%, <em>P</em> = 0.004). On adjusted analysis, GLP1-RA use was associated with reduced mortality (adjusted hazard ratio = 0.09, 95% confidence interval 0.01–0.66, <em>P</em> = 0.02). Freedom from MACE at 2 years was greater among patients on a GLP-1-RA (100% vs. 88.6%, <em>P</em> = 0.046). Freedom from major adverse limb events was similar between groups.</div></div><div><h3>Conclusion</h3><div>GLP1-RA use is increasingly common in patients undergoing lower extremity bypass and was associated with significantly improved postoperative survival and freedom from MACE. Further studies are required to confirm reasons for differences in outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 480-491"},"PeriodicalIF":1.6,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871091","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":"Open Superficial Venous Arterialization for Limb Salvage","authors":"Kayden Chahal ,&nbsp;Agilandiswari Arumuga Jothi ,&nbsp;Ahmed Helal ,&nbsp;Vijay Gadhvi ,&nbsp;Sandeep Patel ,&nbsp;Ankur Thapar","doi":"10.1016/j.avsg.2025.07.050","DOIUrl":"10.1016/j.avsg.2025.07.050","url":null,"abstract":"<div><h3>Background</h3><div>Patients with chronic limb threatening ischemia (CLTI) unsuitable for conventional endovascular or surgical revascularization are treated with major amputation. Superficial venous arterialization (SVA) presents an alternative option. No cases report success beyond 2 years.</div></div><div><h3>Methods</h3><div>Retrospective review of patients undergoing SVA between 2019 and 2023 by 2 surgeons in a regional vascular unit. The primary end point was limb salvage. Presentation, comorbidities, and symptom resolution were recorded. Patients were followed up clinically and with duplex ultrasound.</div></div><div><h3>Results</h3><div>Five patients underwent open lower limb SVA using the Lengua technique. Indications were tissue loss in 4 and severe ischemic rest pain in 1. Median age was 68 (range 50–71) years, 2 were female. Median follow-up was 5 months (range 1–36) with the longest ever reported follow-up at 3 years. Eighty percent were technically successful. Limb salvage rate was 40%, rest pain resolved and wounds healed in both. The other three had amputations – 2 transtibial and 1 transfemoral. Of these, one patient had a functioning graft but no benefit in perfusion or pain and requested amputation.</div></div><div><h3>Conclusion</h3><div>SVA offers an unconventional but simple option for limb salvage for younger, fitter patients with CLTI. Key technical considerations, prerequisite anatomy and reasons for failure are described.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 529-533"},"PeriodicalIF":1.6,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871092","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":"Deep Venous Thrombosis can Reveal Behçet's Disease in Young Males in Countries with High Prevalence: A Retrospective Study","authors":"Özge Karakök,&nbsp;Tuğçe Bozkurt,&nbsp;Tulin Ergun,&nbsp;Haner Direskeneli,&nbsp;Fatma Alibaz-Oner","doi":"10.1016/j.avsg.2025.08.008","DOIUrl":"10.1016/j.avsg.2025.08.008","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 477-479"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862027","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":"Salvage of Failing Abdominal Aortic Aneurysm Repairs with Fenestrated Endovascular Aortic Repair","authors":"Rohan Basu,&nbsp;Joshua Davis,&nbsp;Mackenzie Madison,&nbsp;Alexa Hughes,&nbsp;John Maijub,&nbsp;Raghu Motaganahalli,&nbsp;Andres Fajardo","doi":"10.1016/j.avsg.2025.08.015","DOIUrl":"10.1016/j.avsg.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Fenestrated endovascular aortic repair (FEVAR) can be used for salvage of failing abdominal aortic aneurysm (AAA) repairs. We describe our experience with the commercially available Zenith fenestrated (ZFEN) platform to salvage failing AAA repairs.</div></div><div><h3>Methods</h3><div>This is a retrospective review of all FEVARs performed from January 2012 until August 2019 at a tertiary academic medical center. The study compared primary FEVAR against reoperative FEVARs (RFEVAR) done for salvage of prior infrarenal aneurysm repairs with 60 months of follow-up. The primary outcome was technical success. Secondary outcomes included mortality, reintervention, and complications.</div></div><div><h3>Results</h3><div>There were 153 patients meeting inclusion criteria, with 133 primary repairs and 20 RFEVARs. Indications for repair included proximal disease progression (55%) and type IA endoleak (45%). Primary FEVARs were associated with decreased case complexity, with shorter operative time (217.6 vs. 265.6 minutes, <em>P</em> = 0.018) and number of visceral arteries stented (2.2 vs. 2.6, <em>P</em> = 0.021). Technical success was 97.7% in the primary FEVAR group, versus 95.0% in the RFEVAR group (<em>P</em> = 0.43). At 60 months, estimated survival and freedom from reintervention did not differ between groups and were 68.8% (<em>P</em> = 0.38) and 76.0% (<em>P</em> = 0.80), respectively, in the RFEVAR group.</div></div><div><h3>Conclusion</h3><div>RFEVAR using ZFEN is effective to salvage failing AAA repairs, with 60-month outcomes comparable to primary repair of AAA using FEVAR. RFEVAR is attractive over traditional open approaches as it avoids significant morbidity. These results support the long-term efficacy of ZFEN to salvage failing aortic repairs.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 446-455"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862034","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":"Evaluating the Accuracy and Reliability of Splenic Artery Aneurysm Assessment on Computed Tomography Imaging","authors":"Robert J. Leatherby ,&nbsp;ChunHei Li ,&nbsp;Adelola Oseni ,&nbsp;Rose Howroyd ,&nbsp;James Budge ,&nbsp;Peter Holt ,&nbsp;Iain Roy","doi":"10.1016/j.avsg.2025.07.040","DOIUrl":"10.1016/j.avsg.2025.07.040","url":null,"abstract":"<div><h3>Background</h3><div>Splenic artery aneurysms (SAAs) are the third most common abdominal arterial aneurysm. Several radiological features have been associated with their growth rate and rupture risk. We aim to evaluate the accuracy and reliability in assessing these features on computed tomography scans.</div></div><div><h3>Methods</h3><div>Radiological reports were searched for scans positive for SAA between 2012 and 2021 inclusive. These scans were assessed with our novel radiological proforma by 2 radiologists to determine those criteria which were reliably reported. A nonexpert was then compared against this baseline to assess the reliability of SAA assessment by nonradiologists. Pearson and Spearman rank correlation coefficients and Cohen Kappa statistics was used to assess agreement.</div></div><div><h3>Results</h3><div>A cohort of 170 scans was assessed. A high degree of agreement (correlation coefficient <em>r</em> = 0.89–0.91) was achieved by radiologists for SAA diameter measurement. A high level of agreement was also achieved for calcification (Kappa = 0.827) and previous intervention (1.0), moderate agreement for presence of SAA (0.563), calcification percentage (0.563), morphology (0.446), and presence of thrombus (0.516). Rupture and pseudoaneurysm morphology demonstrated poor agreement (Kappa &lt;0.01) but were rare events limiting interpretation. A nonexpert could achieve comparable diameter measurements (<em>P</em> &lt; 0.05) but had consistently lower kappa agreements for all aneurysm characteristics compared to radiologists.</div></div><div><h3>Conclusion</h3><div>Aneurysm diameter, calcification, and previous intervention were the only features reported with high agreement between radiologists. Other SAA characteristics only achieved moderate or poor agreement and so should be used with caution in research and clinical settings.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 438-446"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862028","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":"Patient Factors Impacting Dialysis Patency: A Tool to Guide Decision Making for Creation of Lower Extremity Arteriovenous Access","authors":"David P. Ebertz ,&nbsp;Gavin Christy ,&nbsp;Saideep Bose ,&nbsp;Jeffrey Siracuse ,&nbsp;Matthew R. Smeds","doi":"10.1016/j.avsg.2025.08.017","DOIUrl":"10.1016/j.avsg.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Lower extremity access remains a last resort for many patients needing dialysis access. We sought to identify patient factors impacting lower extremity arteriovenous fistula (AVF) and arteriovenous graft (AVG) patency and create a clinical tool to help guide decision-making in these complex patients.</div></div><div><h3>Methods</h3><div>All patients in the Vascular Quality Initiative dialysis module undergoing lower extremity access creation from 2011 to 2023 were separated into 2 cohorts based off whether the access was AVF or AVG and retrospectively analyzed. Univariate Kaplan–Meier and multivariable regression analyses were conducted with outcomes being overall survival and primary/secondary patency. Significant factors were standardized and scaled to create scores for loss of secondary patency. The model was then internally validated and imported into a clinical calculator to generate a score that was predictive of loss of patency (the Dialysis Patency Estimation score).</div></div><div><h3>Results</h3><div>In addition, 1,213 patients underwent creation of lower extremity access from 2011 to 2023 with 151 (12.45%) AVF and 1,062 (87.5%) AVG. One-year primary patency was 52.18% and secondary patency was 77.56% No difference was seen with primary patency based on access type (AVF 60.5%/AVG 50.9%, <em>P</em> = 0.068); however, AVG had worse secondary patency (AVF 88.6%/AVG 74.3%, <em>P</em> = 0.013). Factors increasing loss of secondary patency included: length of stay, age, body mass index, peripheral vascular disease, diabetes, and prior AVF/AVG. These factors were standardized and scaled to create a scoring system of 0 to 100 to predict loss of secondary patency at 1 year, with a score of &gt;56 being near 100% risk. This scoring system was separated into 4 groups to predict risk of loss of patency (0–40 = low risk, 41–50 = medium low risk, 51–55 = medium high risk, and 56–100 = high risk).</div></div><div><h3>Conclusion</h3><div>Lower extremity AVG has inferior patency compared to AVF, but are more commonly placed. We have created a risk stratification score to determine which patients may benefit from a lower extremity AVG.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 435-443"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862032","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":"Smoking Cessation Adjuncts Are Cost Effective Prior to Elective Revascularization","authors":"Hasan Nassereldine ,&nbsp;Katherine M. Reitz ,&nbsp;Mikayla Lowenkamp ,&nbsp;Michael Madigan ,&nbsp;Rabih Chaer ,&nbsp;Edith Tzeng ,&nbsp;Kenneth J. Smith ,&nbsp;Natalie D. Sridharan","doi":"10.1016/j.avsg.2025.08.016","DOIUrl":"10.1016/j.avsg.2025.08.016","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative smoking cessation can reduce adverse postoperative outcomes. Investment in smoking cessation therapies has therefore proven cost effective prior to elective interventions across numerous disciplines. Despite high rates of smoking among patients with peripheral artery disease (PAD), the cost effectiveness of smoking cessation before elective revascularization is unclear.</div></div><div><h3>Methods</h3><div>Using a Markov model, we evaluated the cost effectiveness of preoperative smoking cessation therapies (standard care, counseling, nicotine replacement therapy [NRT], varenicline, bupropion) for 65-year-old patients undergoing open or endovascular revascularization for symptomatic PAD. Local data quantified smoking cessation therapy costs. Established literature informed therapy effectiveness, postoperative outcomes (stroke, myocardial infarction, major amputation, patency, death) frequencies, and postoperative costs. Lifetime costs were quantified in US dollars and effectiveness in quality-adjusted life-years (QALYs), with a willingness-to-pay threshold of $100,000/QALY gained. Sensitivity analyses tested model robustness.</div></div><div><h3>Results</h3><div>In the base-case scenario, standard care was least expensive ($326,280) and varenicline was costliest ($333,335). However, varenicline was the most effective (7.11 QALYs), while standard care was least effective (6.43 QALYs). NRT and varenicline were the most cost-effective therapies. In the probabilistic simulation (randomly varying model parameters over 1,000 iterations), varenicline was favored in 80.3% at $100,000/QALY gained. Assuming no mortality differences by smoking status, in one-way sensitivity analyses varenicline dominated all other therapies.</div></div><div><h3>Conclusion</h3><div>Smoking cessation adjuncts are cost effective prior to PAD interventions. Varenicline and NRT were the most cost-effective smoking cessation strategies. Our results highlight the value of supplemented coverage for smoking cessation therapies among patients with PAD undergoing revascularization.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 464-473"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862035","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":"Expression of the Peroxisome Proliferators–Activated Receptors in Ex Vivo Arterial Tissue of Patients with Abdominal Aortic Aneurysms and Its Association With Wall Remodeling and Inflammatory Gene Expression","authors":"Javier E. Anaya-Ayala ,&nbsp;Ingrid A. Landero-Aguilar ,&nbsp;Brenda J. Galicia-Vega ,&nbsp;Jacqueline Mejia-Cervantes ,&nbsp;Felipe J. Rodriguez-Hernandez ,&nbsp;Brenda N. Marquina-Castillo ,&nbsp;Gabriela Aleman ,&nbsp;Adriana M. Lopez ,&nbsp;Ivan Torre-Villalvazo ,&nbsp;Carlos Serrano-Gavuzzo ,&nbsp;Carlos A. Hinojosa","doi":"10.1016/j.avsg.2025.08.021","DOIUrl":"10.1016/j.avsg.2025.08.021","url":null,"abstract":"<div><h3>Background</h3><div>The pathogenesis of abdominal aortic aneurysms (AAAs) is multifactorial, characterized by complex pathophysiological processes, including cytokine secretion and protease-mediated degradation of the arterial extracellular matrix (ECM). Peroxisome proliferators–activated receptors (PPARs) are a group of nuclear receptors that regulate the expression of genes for metabolic enzymes and cytokines. However, the molecular mechanisms of PPARs on vascular physiology are not fully evaluated. Our objective was to assess the association between the expression of PPARs in ex vivo aortic tissue and the gene expression of markers of arterial remodeling and inflammation.</div></div><div><h3>Methods</h3><div>Two aortic tissue samples were obtained from 20 patients (mean age 69 years, standard deviation 5) who underwent open AAA repair. One from the aneurysmal sac and other from the nondiseased adjacent aortic tissue. Four micrometers sections of formalin-fixed and paraffin embedded samples were stained with hematoxylin and eosin, Masson's trichrome and Verhoeff-van Gieson for histopathologic evaluation and arterial wall thickness morphometry. Total RNA was extracted and retrotranscribed to determine PPARs, matrix remodeling proteins, and cytokine gene expression by real-time polymerase chain reaction using specific forward and reverse oligonucleotides and SybrGreen master mix. Statistical analysis was conducted using the nonparametric Mann–Whitney <em>U</em>-test in Prism 8 for Mac (GraphPad, San Diego, CA, USA).</div></div><div><h3>Results</h3><div>Aneurysm biopsies demonstrated loss of smooth muscle cells, and fragmented and disorganized elastic fibers and changes in ECM composition. The expression of PPARα, PPARδ, and PPARγ was significantly lower in the aneurysmal aorta compared to the nondiseased control tissue from the same patients (59%, 61%, and 42%, respectively, <em>P</em> &lt; 0.01). The expression of the matrix metalloproteinase inhibitor tissue inhibitor of metalloproteinase 4 was significantly reduced in the aneurysmal tissue compared to control (64%), whereas that of the vascular ECM–degrading enzyme cathepsin S was 7-fold higher in the aneurysmal aortic tissue (<em>P</em> &lt; 0.01). Gene expression of monocyte chemoattractant protein-1 and the cytokines tumor necrosis factor α and interleukin-1β was significantly upregulated in the aneurysmal tissue compared to the control nondiseased tissue (20-fold, 83-fold, and 18-fold, respectively, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>These results confirm an inverse correlation between PPARs gene expression and inflammatory cytokine mRNA levels, along with an unfavorable arterial remodeling gene expression. The decrease in the expression of the three PPAR isoforms in the aortic tissue appears to promote abnormal arterial remodeling and the production of proinflammatory cytokines leading to wall thinning and AAA progression.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"122 ","pages":"Pages 543-551"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862025","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":"Comments on Open versus Endovascular Repair of Patent Popliteal Artery Aneurysms in an Elective Setting","authors":"Abdullah Abdullah,&nbsp;Muhammad Mustafa Khan,&nbsp;Abdul Saboor","doi":"10.1016/j.avsg.2025.08.009","DOIUrl":"10.1016/j.avsg.2025.08.009","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"121 ","pages":"Pages 444-445"},"PeriodicalIF":1.6,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862026","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}