Annals of vascular surgery最新文献

{"title":"Single or Dual Antiplatelet Therapy Improves One-Year Arteriovenous Graft Patency and Overall Survival","authors":"David P. Ebertz ,&nbsp;Saideep Bose ,&nbsp;Armando De Valle ,&nbsp;Satinderjit Locham ,&nbsp;Mahmoud B. Malas ,&nbsp;Matthew R. Smeds","doi":"10.1016/j.avsg.2024.11.006","DOIUrl":"10.1016/j.avsg.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Following new dialysis access creation there is no consensus on the optimal use of anti-thrombotic therapy. Recent studies have suggested that single antiplatelet therapy may improve hospital mortality as well as patency. The aim of this study was to assess the role of different antiplatelet and anticoagulation therapies on outcomes following dialysis access creation.</div></div><div><h3>Material and Methods</h3><div>A retrospective study was conducted utilizing patients from the Vascular Quality Initiative who underwent AV fistula (AVF) and AV graft (AVG) creation from 2011–2023. Patients who were antiplatelet and anticoagulation naive were separated into 4 cohorts: no antiplatelet (No APT), single antiplatelet (SAPT), dual antiplatelet (DAPT), and aspirin with anticoagulation (ASA + AC). Univariate Kaplan-Meier (KM) and multivariable regression analyses were conducted to assess overall survival, primary patency, and secondary patency.</div></div><div><h3>Results</h3><div>49,980 patients with AVF creation and 12,688 patients with AVG creation were identified. AVG patients had improved 1-year primary patency with SAPT compared to No APT (48% vs. 44%, <em>P</em> = 0.03) on KM analysis. No difference on KM analysis was observed for AVF. Regression analysis showed decreased risk of loss of primary patency for AVF (HR 0.90, CI 0.83–0.97, <em>P</em> = 0.009). AVG with SAPT showed decreased risk of mortality (HR 0.80, CI 0.64–1.00, <em>P</em> = 0.05) and decreased risk of loss of primary patency (HR 0.80, CI 0.67–0.94, <em>P</em> = 0.009). DAPT also showed decreased risk of loss of primary patency for AVG (HR 0.64, CI 0.43–0.95, <em>P</em> = 0.028). Survival was worse for both AVF and AVG patients on ASA + AC on KM analysis.</div></div><div><h3>Conclusions</h3><div>Single antiplatelet therapy following access creation improves primary patency for both AVF and AVG, as well as overall survival for those with AVG. DAPT may further improve primary patency in those with AVG. The use of anticoagulation shows no clear benefit and may be harmful, however is more likely to reflect higher risk patients with other co-morbidities. These results suggest that following an AVF one should consider discharging patients on SAPT, and following an AVG one should consider SAPT or DAPT.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 367-385"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765839","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":"Endovascular Treatment of Abdominal Aortic Aneurysm with Hostile Artery Access: A Multi-Center Retrospective Study","authors":"Xingyi Tang ,&nbsp;Jiaxuan Feng ,&nbsp;Yubin Li ,&nbsp;Shun Xiao ,&nbsp;Heng Zhang ,&nbsp;Wenjing Huang ,&nbsp;Mingyuan Liu ,&nbsp;Junjun Liu ,&nbsp;Mingjin Guo","doi":"10.1016/j.avsg.2024.10.008","DOIUrl":"10.1016/j.avsg.2024.10.008","url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study is to document our experience using low-profile endografts for the endovascular repair of abdominal aortic aneurysms (AAAs) in cases where access arteries are challenging, commonly referred to as hostile access arteries.</div></div><div><h3>Methods</h3><div>Data regarding patients with narrow or tortuous access arteries who underwent endovascular aortic repair (EVAR) using low-profile endografts at 3 tertiary medical centers between January 2020 and December 2022 were retrospectively collected and analyzed. A total of 76 patients were enrolled in the study. The primary endpoints included technical success, occurrence of endoleaks, endograft occlusion, and any device- or procedure-related major adverse events. Secondary endpoints were assessed for endograft migration, endograft fracture, access site complications, and aneurismal sac shrinkage.</div></div><div><h3>Results</h3><div>The mean follow-up duration was 28.1 ± 9.0 months (range, 14.0–54.0). Among the patients, 32 (42.1%) had narrow artery access (diameter ≤6.0 mm), 29 (38.2%) had access arteries characterized by tortuosity, and 15 (19.7%) patients presented with both narrow and tortuous access arteries. Technical success was achieved in 73 (96.1%) cases. A total of 4 (5.2%) patients received reintervention due to endograft occlusion. During follow-up, a total of 8 (10.5%) type II endoleaks were observed during follow-up without intervention, and the endoleak disappeared in the follow-up period. Abdominal aortic aneurysm-sac shrinkage and stability were observed in 25 (32.9%) and 51 (67.1%) cases, respectively. The overall survival rate was 98.7%. The perioperative and follow-up outcomes for the groups categorized by ‘Narrow arteries’, ‘Tortuous arteries’, and ‘Narrow and Tortuous arteries’ did not show statistically significant differences when compared to each other.</div></div><div><h3>Conclusions</h3><div>This preliminary investigation indicates that the use of low-profile endografts is associated with safety and effectiveness within the observed period.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 92-101"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695147","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":"Impact of Age Differences in Chronic Limb-Threatening Ischemia Outcomes in Octogenarians","authors":"Sai Sashank Jagannath Wunnava ,&nbsp;Krishna Ravulapalli ,&nbsp;Tamer El-Sayed ,&nbsp;Ashwin Sivaharan ,&nbsp;Sarah Sillito ,&nbsp;Miles Witham ,&nbsp;Sandip Nandhra","doi":"10.1016/j.avsg.2024.11.010","DOIUrl":"10.1016/j.avsg.2024.11.010","url":null,"abstract":"<div><h3>Background</h3><div>The aging population is a growing challenge for healthcare services and as such multimorbidity and associated aging are the focus of research programs. Chronic limb-threatening ischemia (CLTI) in the older patient is perceived to be associated with high morbidity and mortality but a potentially contentious area with limited evidence.</div></div><div><h3>Methods</h3><div>Retrospective review of all consecutive CLTI admissions to a UK tertiary vascular during 2020. Analysis included descriptive statistics and comparisons by age. The primary outcome was survival (by Kaplan–Meier) with secondary outcomes being major adverse limb and cardiovascular events.</div></div><div><h3>Results</h3><div>One hundred eighty-three patients with a median age of 72 of which 55 (30%) were octogenarians. Fewer octogenarians were diabetic (38.2% vs. 58.6%, <em>P</em> = 0.015), but comorbidities such as previous stroke (25.5% vs. 10.9%, <em>P</em> = 0.015) and atrial fibrillation (36.4% vs. 16.4%, <em>P</em> = 0.004) were increasingly common. 87.3% of octogenarians had moderate or severe frailty compared to 57.8% in those &lt;80 (<em>P</em> = 0.001) (by electronic frailty index). Median survival time was 30 months with no significant difference between groups (<em>P</em> = 0.406). Major adverse cardiovascular event (10.9% vs. 7.81%, <em>P</em> = 0.504) and major adverse limb event (34.5% vs. 24.2% <em>P</em> = 0.261) were comparable between groups. Octogenarians were less likely to have open surgery (10.9% vs. 25.8%, <em>P</em> = 0.024).</div></div><div><h3>Conclusions</h3><div>Octogenarians have similar cardiovascular, limb, and survival outcomes following intervention despite being increasingly frail and comorbid. Holistic assessment, perioperative optimization, and risk stratification are important in this group.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 212-224"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715136","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":"Assessing the Predictive Value of the Neutrophil-to-Lymphocyte Ratio for Post-Thrombotic Syndrome following Iliofemoral Deep Venous Thrombosis","authors":"Anthony G. DeMartino ,&nbsp;Devina Chatterjee ,&nbsp;Laura De Ravin ,&nbsp;Olivia Babick ,&nbsp;Anahita Shiva ,&nbsp;Nisarg Shah ,&nbsp;Khanjan Nagarsheth","doi":"10.1016/j.avsg.2024.11.015","DOIUrl":"10.1016/j.avsg.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Post-thrombotic syndrome (PTS) is a common complication of deep vein thrombosis (DVT) that occurs in 20–50% of patients and results in a decreased quality of life. Even with the progressive identification of PTS risk factors, clinically useful predictors of PTS continue to be limited, unobjective, and ill-defined. The neutrophil-to-lymphocyte ratio (NLR) is an emerging prognostic biomarker used in a variety of diseases that reflects acute systemic inflammation. This pilot study aimed to evaluate the utility of the NLR at the time of iliofemoral DVT diagnosis in predicting PTS incidence in patients.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed on patients identified with iliofemoral DVT at the University of Maryland Medical Center between 2020 and 2022. Patients with at least one follow-up visit between 3 and 6 months after initial DVT diagnosis were included. Diagnosis of PTS was determined based on Villalta Score. The Youden index with receiver operating characteristic curve analysis was used to determine the NLR cut-off value that may be predictive of PTS. A multivariable logistic regression model was then performed to assess the utility of this NLR cut-off value and other common clinical markers in predicting the presence of PTS symptoms.</div></div><div><h3>Results</h3><div>Four hundred and eighteen patients with positive iliofemoral DVT venous duplex ultrasounds were screened for eligibility. One hundred and eighteen patients were eligible with a mean age of 53.18 ± 15.45 years. A total of 43 patients (36.44%) were found to have PTS. An NLR cut-off of 7.71 was determined with an area under the receiver operating characteristic curve (area under the curve) of 0.63 (<em>P</em> = 0.046). When the NLR was assessed jointly with other clinical markers at the time of DVT diagnosis, NLR was a statistically significant positive predictor, measured using odds ratio (1.83; 95% confidence interval, 1.20–2.78; <em>P</em> = 0.005).</div></div><div><h3>Conclusions</h3><div>Our study found that when stratified by a determined cutoff value, the NLR at the time of DVT diagnosis was significantly associated with the development of PTS in patients with iliofemoral DVT. This result is consistent with one prior research finding yet is novel in its specificity for iliofemoral DVTs and its acute lab collection for NLR calculation. The NLR should be further investigated as a potential inexpensive prognostic tool to aid in the improvement of treatment and prophylactic strategies for PTS.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 393-401"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765832","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 Incidence and Significance of Iliac Vein Stenosis in Patients with Deep Vein Thrombosis","authors":"Sahar Ali ,&nbsp;Shin Mei Chan ,&nbsp;Anand Brahmandam ,&nbsp;Yunshan Xu ,&nbsp;Yanhong Deng ,&nbsp;Ahmed Elbadawy ,&nbsp;Alfred Lee ,&nbsp;Cassius Iyad Ochoa Chaar","doi":"10.1016/j.avsg.2024.11.016","DOIUrl":"10.1016/j.avsg.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The role of iliac vein stenosis (IVS) in the development of deep vein thrombosis (DVT) is poorly understood. This study determines the incidence of IVS in patients diagnosed with DVT and assesses its impact on presentation and outcomes. Our hypothesis is that the presence of IVS increases the risk of long-term ipsilateral DVT recurrence.</div></div><div><h3>Methods</h3><div>A retrospective study of the electronic medical records of consecutive adult patients treated for lower extremity DVT was performed. Only patients with cross-sectional imaging (computed tomography or magnetic resonance with intravenous contrast) were included. Patient and DVT characteristics were recorded. Cross-sectional imaging was reviewed for the presence or absence of ipsilateral IVS (≥50%). Patients were divided into 2 groups based on the presence or absence of IVS to compare characteristics and outcomes. Subgroup analyses on patients with provoked DVT, cancer-related DVT, and unprovoked DVT were performed.</div></div><div><h3>Results</h3><div>There were 548 patients with DVT and 32% had evidence of ipsilateral IVS on cross-sectional imaging. There were no significant differences in baseline characteristics or treatment methods between the 2 groups. There was a trend toward patients with IVS having less incidence of pulmonary embolism on presentation (22.9% vs. 29.7%, <em>P</em> = 0.1) but that difference did not reach statistical significance in the overall comparison. Subgroup analysis in patients with cancer-related DVT (<em>n</em> = 227) showed that patients with IVS were significantly more likely to develop ipsilateral recurrent DVT compared to patients with no IVS (12.9% vs. 4.5%, <em>P</em> = 0.045). Patients with unprovoked DVT with IVS had significantly lower pulmonary embolism on presentation than patients with unprovoked DVT without IVS (24.2% vs. 39.8%, <em>P</em> &lt; 0.03).</div></div><div><h3>Conclusions</h3><div>Ipsilateral ≥50% IVS is present in approximately a third of patients presenting with DVT. The presence of IVS seems to play a differential role in ipsilateral DVT recurrence and prevention of pulmonary embolization in different groups of patients presenting with DVT.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 310-318"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765843","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":"Association of Iliofemoral Calcium Score and Major Vascular Complications within the First Year after Lower Limb Endovascular Revascularization","authors":"Raul Devia-Rodriguez ,&nbsp;Maikel Derksen ,&nbsp;Mostafa El Moumni ,&nbsp;Kristian de Groot ,&nbsp;Issi R. Vedder ,&nbsp;Clark J. Zeebregts ,&nbsp;Reinoud P.H. Bokkers ,&nbsp;Robert A. Pol ,&nbsp;Jean-Paul P.M. de Vries ,&nbsp;Richte C.L. Schuurmann","doi":"10.1016/j.avsg.2024.11.009","DOIUrl":"10.1016/j.avsg.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>The accumulation of calcium load in peripheral lower extremity arteries has been associated with increased severity of peripheral artery disease (PAD) and mortality. While calcium scores are commonly calculated from non-contrast computed tomography (CT) scans, patients with PAD often undergo contrast-enhanced CT scans. This study aims to explore the association between a length-adjusted calcium score (LACS) of the iliofemoral arteries, determined through pre-intervention contrast-enhanced CT, and major adverse events in patients with chronic limb-threatening ischemia (CLTI).</div></div><div><h3>Methods</h3><div>A cohort of CLTI patients subjected to endovascular revascularization between 2005 and 2017 at a tertiary referral center were categorized into 2 groups. The complication group experienced one of the composite outcomes (reintervention, above-the-ankle amputation, and/or all-cause mortality within 1 year of the primary endovascular procedure), while control patients did not encounter this composite endpoint. Patients from the complication group were matched one-to-one with controls based on sex and Fontaine classification. LACS was calculated (Ca volume[mm³]/length[cm]) at 3 arterial segments; 1. the common iliac artery (CIA), 2. the external iliac artery and common femoral artery (EIA + CFA), and 3. the superficial femoral artery plus the popliteal artery (SFA + PA). Binary logistic regression analysis was conducted to investigate the association between LACS in the different arterial segments and the occurrence of the composite binary outcome (complication and control) and LACS of the different segments, adjusting influences of age, sex, BMI &gt;25, Fontaine classification, diabetes mellitus type 1 &amp; 2, chronic kidney disease stage, and hemodialysis treatment.</div></div><div><h3>Results</h3><div>Sixty-four CLTI patients were included in this study (complication group [<em>n</em> = 32], and control group [<em>n</em> = 32]). A significant difference (higher LACS was found for the complication group in the CIA, the SFA + PA, as well as the total trajectory. CLTI patients with high LACS in the SFA + PA or the total trajectory were more likely to suffer adverse events (SFA + PA: OR: 1.010, 95% CI: 1.000–1.020, <em>P</em> = 0.04; Total LACS: OR: 1.008, 95% CI: 1.000–1.017, <em>P</em> = 0.05).</div></div><div><h3>Conclusions</h3><div>Patients with a high calcium load in the ilio-femoral arteries are at increased risk of major adverse events during 1 year after endovascular revascularization. The calcium score, derived from contrast-enhanced CT scans, holds potential utility in decision making for CLTI patients.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 290-298"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Negative Pressure Wound Therapy on Groin Surgical Site Infection After Lower Extremity Bypass for Chronic Limb-Threatening Ischemia","authors":"Young Kim,&nbsp;Christina L. Cui,&nbsp;Hana S. Shafique,&nbsp;E. Hope Weissler,&nbsp;Adam P. Johnson,&nbsp;Dawn M. Coleman,&nbsp;Kevin W. Southerland","doi":"10.1016/j.avsg.2024.10.020","DOIUrl":"10.1016/j.avsg.2024.10.020","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are a common cause of patient morbidity, hospital readmission, and reoperation after lower extremity bypass (LEBs) surgery for chronic limb-threatening ischemia (CLTI). Recent studies on the use of incisional negative pressure wound therapy (NPWT) in LEB surgery have reported conflicting results. In this single-center study, we examined our experience on the impact of NPWT on groin SSI rates after LEB surgery.</div></div><div><h3>Methods</h3><div>We retrospectively queried electronic medical records for all LEB operations performed for CLTI. Multivariate logistic regression analysis was used to identify risk factors associated with postoperative SSI. Using these risk factors, subset analysis was performed to determine whether NPWT was associated with reduced SSI in high-risk patients.</div></div><div><h3>Results</h3><div>From 2018 to 2022, a total of 367 patients underwent LEB surgery for CLTI. Mean patient age was 66 years. Postoperative groin SSI was diagnosed in 22.9% (<em>n</em> = 84) of patients. Patients suffering SSI were more frequently morbidly obese (6.0% vs 1.8%, <em>P</em> = 0.03) and had higher rates of chronic obstructive pulmonary disease (35.7% vs 23.3%, <em>P</em> = 0.02). Other comorbidities and demographic data were similar between groups. NPWT was utilized in 19.6% (<em>n</em> = 72) of patients, with no baseline differences between SSI and no SSI cohorts (15.5% vs 20.9%, <em>P</em> = 0.28). On multivariate analysis, female sex (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.06–3.35, <em>P</em> = 0.03), white race (OR 2.17, 95% CI 1.23–3.82, <em>P</em> = 0.007), morbid obesity (OR 3.67, 95% CI 0.93–14.4, <em>P</em> = 0.05), and active smoking (OR 4.07, 95% CI 1.20–13.8, <em>P</em> = 0.02) were independently associated with postoperative SSI. Subset analysis among patients at increased risk of SSI did not reveal any differences in wound infection with NPWT usage.</div></div><div><h3>Conclusions</h3><div>In our experience, NPWT does not appear to be more effective than standard dressings in preventing groin SSI after LEB surgery for CLTI, even among populations at heightened risk for wound infection.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 143-150"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Updated Review on Arterial Stiffness Measurement Techniques and Arterial Stiffness Alterations After Aortic Aneurysm Repair","authors":"Michail Tsotsios ,&nbsp;Athanasios Katsargyris ,&nbsp;Konstantinos G. Moulakakis ,&nbsp;Evangelos Oikonomou ,&nbsp;Vasiliki Tsigkou ,&nbsp;Natasha Hasemaki ,&nbsp;Gerasimos Siasos ,&nbsp;Chris Klonaris","doi":"10.1016/j.avsg.2024.11.018","DOIUrl":"10.1016/j.avsg.2024.11.018","url":null,"abstract":"<div><h3>Background</h3><div>Studies over the last years have revealed the possible impact of endovascular repair of abdominal or thoracic aortic aneurysms on the arterial stiffness and secondary on the cardiac function and the central hemodynamics.</div></div><div><h3>Methods</h3><div>A literature search was conducted to collect data on current methods of arterial stiffness assessment and the induced changes in arterial stiffness after endovascular or open surgical repair of abdominal or thoracic aortic aneurysms.</div></div><div><h3>Results</h3><div>Seventeen studies were analyzed. In most of these studies, arterial stiffness, either assessed by pulse wave velocity or augmentation index, was found to be increased after aortic aneurysm repair. Factors that increase arterial stiffness seem to be endovascular repair of the aneurysm and the proximity of the stent graft to the heart. The clinical implications of increased arterial stiffness are left ventricular hypertrophy, coronary arteries malperfusion and potential end-organ damage.</div></div><div><h3>Conclusions</h3><div>Both endovascular and open aortic aneurysm repair can alter arterial stiffness, with endovascular repair having a greater effect. Future research is essential, particularly in exploring the impact of aortic aneurysm repair methods on vital organs and cardiac function. Extended follow-up studies are proposed to gain a better understanding of the long-term cardiovascular consequences of both endovascular and open surgical repair outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 299-309"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765826","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":"Artificial Intelligence to Enhance Future Clinical Trials in Vascular Surgery","authors":"Sebastien Goffart,&nbsp;Andréa Chierici,&nbsp;Lisa Guzzi,&nbsp;Hervé Delingette,&nbsp;Ahmed Alouane,&nbsp;Fabien Lareyre,&nbsp;Juliette Raffort","doi":"10.1016/j.avsg.2024.11.019","DOIUrl":"10.1016/j.avsg.2024.11.019","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 331-335"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765829","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":"Carotid Ultrasound Assessment Prior to Coronary Artery Bypass Grafting – An Irish Cardiac Surgery Center's Experience","authors":"John David Kehoe ,&nbsp;Amber Downes ,&nbsp;Aoife Feeley ,&nbsp;Sean Barrett ,&nbsp;Carl Vaughan ,&nbsp;Tara Ni Dhonnchu","doi":"10.1016/j.avsg.2024.10.012","DOIUrl":"10.1016/j.avsg.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Carotid stenosis is a risk factor for cerebrovascular accident (CVA) following coronary artery bypass grafting (CABG). Guidelines recommend selective preoperative screening with Doppler ultrasound (US) but nonselective application is commonplace. Recent data has questioned the efficacy of perioperative carotid intervention, challenging the value of this practice. We thus aimed to analyze the utility of carotid US assessment prior to CABG in our institution.</div></div><div><h3>Methods</h3><div>This was a retrospective review of all patients over 18 that underwent a nonemergency CABG in a single Irish cardiac surgery center from January 2019 to December 2022.</div></div><div><h3>Results</h3><div>1161 subjects were included. 1084/1161 (93.36%) underwent US assessment. 41/1084 (3.8%) had ≥70% stenosis and 189/1084 (17.5%) had ≥50% stenosis. 32/1084 (2.95%) underwent confirmatory imaging and 7/1084 (0.64%) underwent carotid intervention. Postoperative CVA occurred in 18/1161 (1.55%) and ≥70% (<em>P</em> = 0.024) and ≥50%(<em>P</em> &lt; 0.001) carotid stenosis were associated with same.</div><div>Chronic kidney disease (odds ratio [OR] = 1.66,<em>P</em> = 0.01), decreasing hemoglobin (OR = 1.13,<em>P</em> = 0.019), increasing age (OR = 1.03,<em>P</em> = 0.011) and being a current (OR = 3.21,<em>P</em> &lt; 0.001) or ex-smoker (OR = 1.82,<em>P</em> = 0.004) were risk factors for ≥50% carotid stenosis on logistic regression. Multivessel coronary artery disease (CAD) was not associated with carotid stenosis (<em>P</em> = 0.563).</div><div>Of those that underwent carotid intervention, 0/7 (0%) suffered a CVA, but this protective effect failed to reach statistical significance for those with ≥70% (<em>P</em> = 1) or ≥50% (<em>P</em> = 1) carotid stenosis.</div></div><div><h3>Conclusions</h3><div>Carotid US screening altered the management of only a small proportion of CABG patients despite near universal application, challenging the effectiveness of this practice. Multivessel CAD was not associated with carotid stenosis despite European guidelines listing it as screening criteria. Predictive models must be developed using identified risk factors to enable targeted preoperative screening.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 176-186"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708931","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}