Annals of vascular surgery最新文献

{"title":"Retrospective Cohort Study: Supraceliac Cross Clamping Does Not Affect Early Outcomes After Juxtarenal Aneurysm Repair","authors":"Simon Roisin ,&nbsp;Simon Soudet ,&nbsp;Mage Adriane ,&nbsp;Florent Briffa ,&nbsp;Marie-Albane Bensussan ,&nbsp;Thierry Reix","doi":"10.1016/j.avsg.2025.12.005","DOIUrl":"10.1016/j.avsg.2025.12.005","url":null,"abstract":"<div><h3>Objectives</h3><div>Supraceliac clamping may be required during repair of short-neck or juxtarenal abdominal aortic aneurysms (AAAs). Its use remains controversial, mainly due to potential renal risks. This study reports the outcomes of its routine use in the surgical management of these complex aneurysms.</div></div><div><h3>Methods</h3><div>Between January 2008 and December 2024, 207 patients underwent open repair of short-neck or juxtarenal AAAs. Data were retrospectively analyzed, including demographic variables, aneurysm characteristics, intraoperative details, and early morbidity and mortality outcomes. The primary end point was postoperative acute kidney injury (AKI) according to the Risk, Injury, Failure, Loss, End-stage kidney disease classification. Secondary end points included early morbidity and mortality, as well as overall survival at 1 and 5 years.</div></div><div><h3>Results</h3><div>During the study period, 114 patients required an infrarenal clamp and 93 a supraceliac clamp. The median age was 67 years. Early morbidity and mortality outcomes were compared between the infrarenal and supraceliac clamping groups. No increased risk of postoperative AKI was observed (23% vs. 32%, <em>P</em> = 0.22). The 30-day mortality rate was 2% and did not differ according to clamp level. In multivariate analysis, preexisting chronic kidney disease, greater blood loss, and the presence of atheroma in the proximal neck were independently associated with postoperative AKI (odds ratio 7.0, <em>P</em> = 0.01).</div></div><div><h3>Conclusion</h3><div>Routine use of supraceliac clamping for the repair of short-neck or juxtarenal AAAs appears to be an efficient and rapid technique, without increasing short-term morbidity or mortality, particularly regarding renal outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 282-288"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826794","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":"Comparative Outcomes of Infusion Catheter-Directed Thrombolysis and Ultrasound-Enhanced Catheter-Directed Thrombolysis in Acute Limb Ischemia: A 10-Year Single Institution Retrospective Analysis","authors":"Zackery Aldaher,&nbsp;Michelle Patel,&nbsp;Sweta Munagapati,&nbsp;Bhargav Doddala,&nbsp;Gautam Agarwal,&nbsp;William Jordan,&nbsp;Omar El Shazly","doi":"10.1016/j.avsg.2025.12.013","DOIUrl":"10.1016/j.avsg.2025.12.013","url":null,"abstract":"<div><h3>Background</h3><div>Standard catheter-directed thrombolysis (CDT) (S-CDT) is widely accepted as a safer alternative to open surgery for acute limb ischemia (ALI), but data on ultrasound-enhanced CDT (UE-CDT) for limb salvage are limited. This study compares outcomes of UE-CDT versus S-CDT.</div></div><div><h3>Methods</h3><div>A 10-year single institution retrospective review identified 68 adult patients who underwent 93 CDT events for ALI, including 62 with UE-CDT and 22 with S-CDT. Following intervention, inpatient, 30 day, and 90 day outcomes were compared; one outcome for comparison was major adverse limb events (MALEs) defined as amputation of any type.</div></div><div><h3>Results</h3><div>No significant differences were observed between UE-CDT and S-CDT in hospital stay (5.6 vs. 7.1 days, <em>P</em> = 0.31), intensive care unit stay (2.5 vs. 2.9 days, <em>P</em> = 0.26), or duration of thrombolysis (24.2 vs. 29.6 hours, <em>P</em> = 0.39). Technical success was achieved in 92% of UE-CDT cases and 95% of S-CDT cases. At 30 days, UE-CDT patients had significantly fewer MALEs compared to S-CDT (6.5% vs. 31.8%; <em>P</em> = 0.01). However, when amputation type was stratified between digit amputation versus above/below knee amputation, there was only a significant difference between digit amputations in the S-CDT compared to UE-CDT at 30 days (<em>P</em> = 0.004). Otherwise, there was no significant difference between the groups at 30 and 90 days when comparing rates of above ankle amputations.</div></div><div><h3>Conclusion</h3><div>UE-CDT and S-CDT for ALI show similar hospital and procedural outcomes. However, UE-CDT is associated with lower 30-day MALE, driven by reduced digit amputations, and becomes nonsignificant when stratifying by above ankle amputations.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 33-39"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809033","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":"Corrigendum to Uncomplicated Type B Aortic Dissection: A European Multicentre Cross-Sectional Evaluation [Ann Vasc Surg 2025; 114: 340–349]","authors":"Mohamad Bashir ,&nbsp;Matti Jubouri ,&nbsp;Abdelaziz O. Surkhi ,&nbsp;Ian M. Williams ,&nbsp;Lazar B. Davidovic ,&nbsp;Igor Koncar ,&nbsp;Tomas Baltrūnas ,&nbsp;Giovanni Pratesi ,&nbsp;Aysegul Kunt ,&nbsp;Ömer Tanyeli ,&nbsp;Maria José Alcaraz García ,&nbsp;Joaquin Perez-Andreu ,&nbsp;Murat Ugur ,&nbsp;Giovanni Rossi ,&nbsp;Marie-Elisabeth Stelzmueller ,&nbsp;Arjan W.J. Hoksbergen ,&nbsp;Vincent Jongkind ,&nbsp;Luca Bertoglio ,&nbsp;Sergio Zacà ,&nbsp;Wassim Mansour ,&nbsp;Heinz Jakob","doi":"10.1016/j.avsg.2026.01.002","DOIUrl":"10.1016/j.avsg.2026.01.002","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 142-143"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016813","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":"Reflection of the Impact of COVID-19 Infection on Vascular Surgery Outcomes: A Multicenter Analysis of Peripheral Vascular Interventions and Infrainguinal Bypass","authors":"Sabrina Straus ,&nbsp;Nadin Elsayed ,&nbsp;William P. Robinson ,&nbsp;Mahmoud Malas","doi":"10.1016/j.avsg.2025.12.038","DOIUrl":"10.1016/j.avsg.2025.12.038","url":null,"abstract":"<div><h3>Background</h3><div>The impact of COVID-19 on vascular surgery patients remains incompletely understood. Emerging evidence suggests that individuals with vascular disease are at an increased risk for complications. This study aimed to describe postoperative outcomes and 1-year survival in COVID-19 patients undergoing vascular procedures using a multicenter real-world dataset.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing peripheral vascular interventions (PVIs) and infrainguinal bypass procedures in the Vascular Quality Initiative (2020-2022). Multivariable logistic regression assessed in-hospital adverse events; Kaplan–Meier and Cox regression analyses assessed 1-year survival.</div></div><div><h3>Results</h3><div>Among the 16,608 PVI patients and 10,460 infrainguinal bypass patients, urgent/emergent procedures were more common in COVID-19 patients (PVI: 50.9%; bypass: 40%). COVID-19 patients undergoing PVI had higher in-hospital mortality (10.9% vs. 1.8%, odds ratio [OR]: 4.9, 95% confidence interval [CI]: 3.2–7.9), ipsilateral amputation (17.7% vs. 10.6%, OR: 1.8, 95% CI: 1.2–2.5), renal complications (4.1% vs. 1.8%, OR: 1.9, 95% CI: 1.1–3.5), and pulmonary complications (6.8% vs. 1.2%, OR: 4.9, 95% CI: 3.0–7.9) compared with non-COVID patients. COVID-19 infrainguinal bypass patients had higher rates of ipsilateral amputation (OR: 1.6, 95% CI (1.0–2.6), <em>P</em> = 0.049). One-year mortality was higher in COVID-19 PVI patients (hazard ratio: 2.1, 95% CI: 1.5–2.9). There was no effect of COVID-19 infection on 1-year mortality in bypass patients.</div></div><div><h3>Conclusion</h3><div>COVID-19 patients undergoing PVI faced significantly increased risks of renal and pulmonary complications, limb loss, and mortality. Those undergoing infrainguinal bypass also had higher limb loss risk. Surgeons should ensure optimal medical optimization, close monitoring, and consider deferring elective procedures to minimize morbidity and mortality.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 144-151"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984298","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":"Long-Term Outcomes of Type B Aortic Dissections in Younger (<55 years) Patients","authors":"Bliss Jaggers,&nbsp;Charles Shirley,&nbsp;Oleksiy Gudz,&nbsp;Mohammed Moursi","doi":"10.1016/j.avsg.2025.11.144","DOIUrl":"10.1016/j.avsg.2025.11.144","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to review all type B aortic dissection (TBAD) cases treated at a single institution to identify any significant differences in clinical outcomes during long-term follow-up between younger (&lt;55) and older (≥55) patients.</div></div><div><h3>Methods</h3><div>Data were collected from patients admitted to a single center with a diagnosis of TBAD over a 10-year period 2012 to 2022. Data collected included demographics, comorbidities (e.g. genetic conditions, smoking, drug abuse, diabetes, renal disease, hyperlipidemia, and hypertension), level of entry tear, treatment type, and patient outcomes. Major end points included survival, progression of dissection or aneurysmal degeneration, and need for follow-up intervention.</div></div><div><h3>Results</h3><div>One hundred seventy-five TBAD patients were identified (&lt;55, <em>n</em> = 71; ≥55, <em>n</em> = 104). Patients aged ≥55 years had a significantly higher prevalence of chronic obstructive pulmonary disease (30.6% vs. 16.9%, <em>P</em> = 0.0394), while younger (&lt;55) patients more frequently reported drug abuse (22.1% vs. 8.7%, <em>P</em> = 0.0131). No significant difference in overall survival was noted between age groups. The survival curves are similar for the first three to 4 years following dissection, with the younger cohort having improved survival rates over the next several years, until the curves meet again at 10 years following dissection. However, among patients &lt;55 years, those treated with thoracic endovascular aortic repair (TEVAR) had significantly higher survival compared with those treated conservatively (<em>P</em> = 0.0365).</div></div><div><h3>Conclusion</h3><div>In this retrospective cohort, TEVAR—used selectively for symptomatic or high-risk TBAD—was associated with better long-term survival in younger (&lt;55-year) patients compared with medical therapy alone. These hypothesis-generating data suggest that early endovascular repair may be beneficial in carefully selected young patients but do not justify broad prophylactic expansion of TEVAR indications; prospective studies are required.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 62-69"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802996","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":"Efficacy of Bioresorbable Vascular Scaffolds in Below-the-Knee Arterial Disease: A Single-Arm Systematic Review and Meta-Analysis","authors":"Hong-Jie Cui ,&nbsp;Meng-Long Li ,&nbsp;Ying-Feng Wu","doi":"10.1016/j.avsg.2025.12.027","DOIUrl":"10.1016/j.avsg.2025.12.027","url":null,"abstract":"<div><h3>Background</h3><div>Below-the-knee (BTK) lesions in peripheral artery disease (PAD) are associated with high restenosis rates and poor limb outcomes. Bioresorbable vascular scaffolds (BVS) have emerged as temporary vessel support that may overcome the limitations of balloon angioplasty and metallic stents. However, their efficacy and safety in BTK revascularization remain uncertain.</div></div><div><h3>Methods</h3><div>A systematic review and single-arm meta-analysis were performed by searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus from inception to October 2025. Studies reporting at least 1-year outcomes after BVS implantation in BTK lesions were included. Primary efficacy end points were 1-year patency, freedom from target lesion revascularization (TLR), and clinical remission; safety end points included all-cause mortality and perioperative complications. Random- or fixed-effects models were applied according to heterogeneity.</div></div><div><h3>Results</h3><div>Eleven studies with 591 patients were included (1 randomized, 3 prospectives, 6 retrospectives, and 1 conference abstract). The average lesion length across included studies ranged from 20.1 mm to 43.8 mm. The pooled 1-year patency, freedom from TLR, and clinical remission rates were 90% (95% confidence interval (CI): 0.85–0.95, I² = 63.8%), 94% (95% CI: 0.92–0.96, I² = 0.0%), and 83% (95% CI: 0.79–0.86, I² = 0.0%), respectively. The pooled perioperative complication and 1-year mortality rates were 3% and 9%. Sensitivity analysis confirmed the robustness of pooled estimates, while heterogeneity remained moderate for patency. The overall quality of evidence was low due to the observational design of most studies.</div></div><div><h3>Conclusion</h3><div>BVS demonstrate favorable short-term safety and efficacy in BTK revascularization. However, as this single-arm meta-analysis lacks comparator data and includes mostly small, nonrandomized studies, the results should be interpreted as exploratory. Larger, randomized controlled trials with long-term follow-up are warranted to validate these findings and define the role of BVS in BTK arterial disease.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 206-217"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916729","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":"Two-Stage Open Ascending Aorta Replacement Followed by Total Aortic Arch Repair Using a Double-Fenestrated Physician-Modified Endograft for Patients with an Aortic Arch Aneurysm and an Aneurysmal Ascending Aorta","authors":"Christoph Bacri ,&nbsp;Baptiste Durant ,&nbsp;Kheira Hireche ,&nbsp;Pierre Alric ,&nbsp;Thomas Gandet ,&nbsp;Ludovic Canaud","doi":"10.1016/j.avsg.2025.11.143","DOIUrl":"10.1016/j.avsg.2025.11.143","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study is to report the feasibility and outcomes of a two-stage open ascending aorta replacement followed by total aortic arch repair using a double-fenestrated physician-modified endograft for aortic arch and ascending aorta aneurysm.</div></div><div><h3>Methods</h3><div>All consecutive patients presenting with an aortic arch aneurysm and treated between 2020 and 2024 were reviewed. Inclusion criteria included arch aneurysm with aneurysmal ascending aorta compromising the proximal landing zone. Study endpoints were technical success, 30-day outcomes, and mid-term follow-up analysis of mortality, morbidity, and reinterventions.</div></div><div><h3>Results</h3><div>Ten patients met the inclusion criteria. The median age was 68.5 years. Half had post-type B dissections, half had degenerative aneurysms. No patients died or experienced a stroke following open repair. All patients successfully underwent both procedures. The median interval between the two surgeries was 70 days. Technical success of the endovascular procedure was 100%. One patient required early reintervention after open surgery for hemostasis, and another required reintervention after the endovascular procedure for a false aneurysm at the brachial puncture site. One patient experienced a regressive stroke on postdischarge day 10 due to a sylvian artery occlusion. During mid-term follow-up, no patient died from aortic-related causes. One patient required a left subclavian artery stent extension for a type 1c endoleak 2 years after the procedure. No patients exhibited impaired renal function.</div></div><div><h3>Conclusion</h3><div>Two-staged open ascending aortic repair followed by endovascular arch repair using a double-fenestrated physician-modified endograft is a feasible, safe, and promising option that avoids the need for circulatory arrest.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 1-10"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800067","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 on Survival After Acute Type A Aortic Dissection Repair","authors":"Justin C. Wang ,&nbsp;Xander Jacquemyn ,&nbsp;Ibrahim Sultan ,&nbsp;Derek Serna-Gallegos ,&nbsp;Danial Ahmad ,&nbsp;Johannes Bonatti ,&nbsp;David Kaczorowski ,&nbsp;Danny Chu ,&nbsp;Takuya Ogami ,&nbsp;Irsa Hasan","doi":"10.1016/j.avsg.2025.12.024","DOIUrl":"10.1016/j.avsg.2025.12.024","url":null,"abstract":"<div><h3>Background</h3><div>Acute Type A aortic dissection (ATAAD) remains a surgical emergency with high morbidity and mortality despite improvements in operative management. The influence of age on outcomes among patients undergoing surgical repair remains incompletely characterized.</div></div><div><h3>Methods</h3><div>Using the Nationwide Inpatient Sample (2010–2018, 2020), we identified adult hospitalizations with a primary diagnosis of ATAAD who underwent surgical repair. Patients were stratified into 3 age groups (&lt;65, 66–75, and &gt;75 years). Weighted analyses compared demographics, comorbidities, hospital characteristics, and outcomes across groups. Multivariable logistic regression identified independent predictors of in-hospital mortality, adjusting for comorbidities and hospital factors.</div></div><div><h3>Results</h3><div>Among 32,798 weighted admissions, 48.1% were aged &lt;65 years, 23.3% were 66–75 years, and 28.6% were &gt;75 years (median age 65 years). Overall, in-hospital mortality was 11.9%, increasing from 8.9% in younger patients to 17.1% in those &gt;75 years (<em>P</em> &lt; 0.001). Older adults had greater comorbidity burden (with most comorbidities differing significantly), shorter median length of stay (5 vs. 6 days, <em>P</em> &lt; 0.001), and lower total hospital charges (<em>P</em> &lt; 0.001). On multivariable analysis, age remained an independent predictor of mortality in patients 66–75 years old (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.34–1.63; <em>P</em> &lt; 0.001) and in patients &gt;75 years (OR, 2.29; 95% CI, 2.10–2.5; <em>P</em> &lt; 0.001). Larger hospitals demonstrated modestly higher adjusted mortality, while hospital teaching status was not independently associated with outcomes.</div></div><div><h3>Conclusion</h3><div>Advancing age substantially increases in-hospital mortality after ATAAD repair. These findings emphasize the need for individualized operative decision-making, early referral to experienced centers, and system-level strategies to optimize outcomes for older adults with ATAAD.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 102-111"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892186","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 Impact of Common Thromboprophylactic Regimens on Thrombin Generation in Patients with Peripheral Artery Disease Postrevascularization","authors":"Shria Bucha ,&nbsp;Isabella Ferlini Cieri ,&nbsp;Adriana A. Rodriguez ,&nbsp;Mounika Naidu Boya ,&nbsp;Shiv Patel ,&nbsp;Anahita Dua","doi":"10.1016/j.avsg.2025.12.026","DOIUrl":"10.1016/j.avsg.2025.12.026","url":null,"abstract":"<div><h3>Background</h3><div>Antithrombotic therapy reduces thrombotic risk in patients with peripheral artery disease (PAD) by targeting thrombin generation, a key hypercoagulability factor. However, the specific effects of different antithrombotic combinations on thrombin generation dynamics remain poorly understood. This study uses calibrated automated thrombogram (CAT) to objectively measure and compare patient responses to various common thromboprophylactic regimens.</div></div><div><h3>Methods</h3><div>We prospectively enrolled patients with PAD aged 60+ years who underwent revascularization between January 2021 and December 2022. Whole blood samples were collected preoperatively and at 1, 3, and 6 months postintervention, with 1-year clinical follow-up. Analysis focused on 1-month samples using CAT to quantify thrombin generation parameters: lag time, peak thrombin concentration, endogenous thrombin potential, and thrombin generation rate. Patients were stratified by antithrombotic regimen: mono antiplatelet therapy (MAPT), dual antiplatelet therapy (DAPT), MAPT + direct oral anticoagulant (DOAC), and DAPT + DOAC. Statistical analysis used Mann–Whitney <em>U</em> and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>Among 56 PAD patients analyzed, DOAC addition produced notable thrombin generation changes, with more pronounced effects in patients on MAPT. MAPT + DOAC showed significant reductions in thrombin generation rate (−38.2 nM/min, <em>P</em> = 0.014), increased lag time (+5.4 min, <em>P</em> = 0.019), and decreased peak thrombin (−111 nM, <em>P</em> = 0.013). DAPT + DOAC produced smaller, nonsignificant reductions. One-year adverse events occurred in 38.5% of DAPT patients, 20.0% DAPT + DOAC, 17.6% MAPT + DOAC, and 0% MAPT patients. Large standard deviations indicated substantial interpatient variability.</div></div><div><h3>Conclusion</h3><div>PAD patients demonstrate marked thrombin generation variability, with DOAC addition to MAPT producing the most significant thrombin generation changes. These findings highlight biological response heterogeneity in PAD and support individualized antithrombotic strategies.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 112-121"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931535","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":"Early Outcomes of Off-the-Shelf Thoracoabdominal Multibranch Endoprosthesis for Type IA Endoleak from Failed Infrarenal and Complex Endovascular Aortic Repairs","authors":"Kenneth Han ,&nbsp;Ariela Zenilman ,&nbsp;Alyssa J. Pyun,&nbsp;Zachary Rengel,&nbsp;Miju Bae,&nbsp;Sukgu M. Han","doi":"10.1016/j.avsg.2026.01.004","DOIUrl":"10.1016/j.avsg.2026.01.004","url":null,"abstract":"<div><h3>Background</h3><div>The Thoracoabdominal Multibranch Endoprosthesis (TAMBE) is the first off-the-shelf four-vessel inner-branched endograft to obtain commercial approval for complex abdominal and thoracoabdominal aortic aneurysms. While off-label TAMBE has been applied to type IA endoleak from failed endovascular aortic repair (EVAR), there is paucity of data regarding outcomes involving this construct. Here, we present early outcomes on rescue TAMBE for type IA endoleak from failed infrarenal and complex EVARs.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who received TAMBE at a single institution from April 2020 to February 2025 was performed. Baseline characteristics, intraoperative metrics, and 30-day outcomes were examined.</div></div><div><h3>Results</h3><div>Ten patients who received rescue TAMBE for failed EVAR were included. The median interval between failed EVAR and TAMBE was 7 years. Three patients underwent previous attempts at type IA endoleak repair. Overall average age was 80.6 years and maximum aneurysm diameter was 86 mm. Pararenal aneurysms were the most common aneurysm type. Failed previous EVAR devices included infrarenal EVAR (8), single snorkel EVAR (1), and three-vessel Zenith fenestrated (1). Intraoperative metrics included operative time of 259 min, fluoroscopy time of 59.8 min, and contrast usage of 109 mL. Technical success was 100% with no perioperative mortalities. Thirty-day reintervention rate was 10%. This patient required right renal artery angioplasty and stenting due to branch occlusion.</div></div><div><h3>Conclusion</h3><div>TAMBE is a promising option for rescue aortic repair of previously failed infrarenal and complex EVAR, with excellent procedural and perioperative outcomes. Longer-term follow-up and larger studies are ongoing to define its durability and broader applicability.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 152-158"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984231","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}