Vascular and endovascular surgery最新文献

{"title":"Total Laparoscopic Inferior Mesenteric Artery Clipping for Persistent Type II Endoleak Following EVAR: A Case Report and Review of Surgical Strategy.","authors":"Mahmoud Badawi Hassan, T F Browne, Ioannis Prionidis","doi":"10.1177/15385744261441978","DOIUrl":"https://doi.org/10.1177/15385744261441978","url":null,"abstract":"<p><p>BackgroundType II endoleak is the most common complication following endovascular aneurysm repair (EVAR), typically due to retrograde flow from collateral arteries, most notably the inferior mesenteric artery (IMA). Although usually low-pressure, persistent leaks associated with sac expansion warrant intervention.Case PresentationWe describe an 87-year-old male presenting with progressive aneurysm sac enlargement due to a persistent Type II endoleak post-EVAR. Initial management with <b>intra-sac thrombin injection</b>. Subsequently, a total laparoscopic IMA clipping was performed with intraoperative ultrasound verification of immediate endoleak cessation. Early postoperative duplex demonstrated reduction in endoleak volume.ConclusionTotal laparoscopic IMA clipping is a feasible minimally invasive option for refractory type II endoleak. Intra-operative ultrasound can provide real-time physiological confirmation of flow cessation. Long-term cross-sectional follow-up imaging was unavailable.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261441978"},"PeriodicalIF":0.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for Type 2 Endoleak Requiring Embolization: Large Inferior Mesenteric Artery, Multiple Lumbar Arteries, and Anticoagulation.","authors":"Camila Esquetini Vernon, Houssam Farres, Camilo Polania Sandoval, Charles Ritchie, Christopher Jacobs, Beau Toskich, Ricardo Paz Fumagalli, Young Erben","doi":"10.1177/15385744261450590","DOIUrl":"https://doi.org/10.1177/15385744261450590","url":null,"abstract":"<p><p>IntroductionEndovascular abdominal aortic aneurysm repair (EVAR) is the primary treatment for abdominal aortic aneurysm (AAA). Despite favorable early outcomes, lifelong surveillance is essential as endoleaks remain a major cause of reintervention. Among these, type II endoleaks (T2E) remain controversial regarding optimal management. This study aimed to identify factors associated with intervention for T2E using time-to-event analysis and predefined anatomic thresholds. Secondary objectives included comparing outcomes between T2E patients with (intT2E) and without (nointT2E) intervention.MethodsA retrospective review of EVAR procedures from 2011-2024 was performed. Patients with newly diagnosed or persistent T2E were identified on completion and follow-up CT angiography. Patients were categorized as intT2E or nointT2E. Multivariable Cox regression evaluated time to first intervention, and logistic regression served as sensitivity analysis. Kaplan-Meier curves assessed freedom from intervention by inferior mesenteric artery (IMA) size.ResultsAmong 207 EVAR patients, 78 (37.6%) developed T2E over a mean 3.4 ± 2.4 years. Nineteen (24.3%) required intervention. IntT2E patients were younger (74.9 ± 6.8 vs 78.3 ± 7.9 years, <i>P</i> = 0.02), had more frequent anticoagulation use (47.4% vs 20.3%, <i>P</i> = 0.02), larger IMAs (4.2 ± 0.6 vs 3.3 ± 0.7 mm, <i>P</i> < 0.01), and more lumbar arteries (6.0 ± 1.2 vs 5.0 ± 1.3, <i>P</i> = 0.02). IMAs >4 mm occurred in 68.4% of intT2E vs 8.5% of nointT2E (<i>P</i> < 0.01). Mean sac growth was greater in intT2E (9.7 ± 5.3 mm vs -1.9 ± 6.5 mm, <i>P</i> < 0.01). Thirty-day complications following the index EVAR procedure, mid-term reinterventions, and overall mortality were similar between groups. Post-embolization, T2E resolved in 36.9%, with sac regression in 63.1%. Among embolized patients, 26.3% required a second embolization and one patient required 3 attempts without achieving resolution. IMA >4 mm independently predicted intervention (HR 7.18, 95% CI 1.97-26.16, <i>P</i> < 0.01). Logistic regression confirmed IMA >4 mm (OR 23.4, 95% CI 6.17-88.6, <i>P</i> < 0.01), >6 lumbar arteries (OR 4.2, 95% CI 1.10-15.98, <i>P</i> = 0.02), and anticoagulation (OR 3.4, 95% CI 1.17-10.6, <i>P</i> = 0.02) as predictors.ConclusionsApproximately one-quarter of T2E patients required embolization. IMA >4 mm was the strongest predictor of intervention, while anticoagulation and increased lumbar artery number also increased risk. Management should prioritize risk-stratified surveillance and selective intervention.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261450590"},"PeriodicalIF":0.7,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Single Antiplatelet Therapy With Prasugrel in Carotid Artery Stenting.","authors":"Yuki Kinoshita, Satoru Takahashi, Sakyo Hirai, Kyohei Fujita, Hikaru Wakabayashi, Bongguk Kim, Yusuke Kobayashi, Hirotaka Sagawa, Mariko Ishikawa, Shoko Fujii, Kazutaka Sumita","doi":"10.1177/15385744251395138","DOIUrl":"10.1177/15385744251395138","url":null,"abstract":"<p><p>BackgroundDual antiplatelet therapy (DAPT) is used peri-operatively as standard care for patients who undergo carotid artery stenting (CAS). Nonetheless, this regimen is associated with several problems, including ischemic complications due to antiplatelet resistance, as well as hemorrhagic complications. This study investigated the feasibility of single antiplatelet therapy (SAPT) with prasugrel for CAS.MethodsRecords of consecutive patients who underwent elective CAS between January 2015 and December 2024 were reviewed. Patients administered SAPT with prasugrel and those administered DAPT with aspirin and clopidogrel were compared. The P2Y12 reaction unit (PRU) was measured using VerifyNow System. Effectiveness and safety outcomes were defined as ischemic and hemorrhagic complications within 3 months of CAS.ResultsA total of 146 patients were included in this analysis. The absolute PRU value was significantly lower in the SAPT group than in the DAPT group (128.5 vs 163.0, <i>P</i> < 0.01). The rate of ischemic events within 3 months did not significantly differ (SAPT vs DAPT, 0.0% vs 3.7%, <i>P</i> = 0.53). The rate of hemorrhagic complications also showed no significant difference (SAPT vs DAPT, 5.3% vs 0.9%, <i>P</i> = 0.34). Four patients in the SAPT group and twelve patients in the DAPT group regularly took anticoagulants, and the rate of bleeding events did not significantly differ between them.ConclusionsPrasugrel ensured an adequately low PRU value compared with clopidogrel. SAPT with prasugrel may be an alternative to DAPT in patients undergoing CAS without increasing the risk of complications. This regimen may be used safely, even in patients who regularly use anticoagulants.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"316-324"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unique Case of a 6 centimetre Ruptured Popliteal Artery Aneurysm Causing Thigh Compartment Syndrome.","authors":"Dushan Miladinovic, Timothy Shiraev","doi":"10.1177/15385744251398906","DOIUrl":"10.1177/15385744251398906","url":null,"abstract":"<p><p><b>Purpose:</b> This case highlights a rare and unique sequela following a popliteal artery aneurysm (PAA) rupture. The development of thigh compartment syndrome with haemodynamic instability as a consequence is exceptionally rare, as PAA rupture typically face resistance to rapid haemodynamic instability due to surrounding musculofascial and bony structures. To date, only 1 other published case report has documented a similar sequence of events.<b>Case Summary:</b> An 81-year-old male with a history of ischaemic heart disease, atrial fibrillation, and type 2 diabetes mellitus, but a lifelong non-smoker, presented in significant hemodynamic compromise due to a ruptured PAA. On examination, the affected extremity was swollen and tense, with sensory deficits distal to the knee, absent power in the hallux and ankle, and a faint dorsalis pedis pulse, but without evidence of acute distal ischemia. Computed tomography angiography (CTA) revealed a peripherally calcified ruptured right PAA, measuring 64 × 44 mm, accompanied by a substantial hematoma surrounding the aneurysm within the posterior thigh compartment. The patient underwent urgent endovascular repair followed by fasciotomies to manage the rupture and prevent further complications.<b>Conclusion:</b> This case demonstrates endovascular repair with a covered stent as a safe and effective alternative to open surgery in high-risk, unstable patients, allowing rapid aneurysm exclusion, limb salvage, and hemodynamic stabilisation. The patient provided informed consent for treatment and for the use of his clinical information in this case report.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"366-369"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Common Carotid Artery Pseudoaneurysm Secondary to Penetrating Trauma by Firearm, Resolved via Open Surgical Repair With Graft Interposition.","authors":"Esaú Nefthaly Torres Cisneros, David González Villordo, José Flores Almanza, Karla Rocío Barraza Zambada","doi":"10.1177/15385744251398917","DOIUrl":"10.1177/15385744251398917","url":null,"abstract":"<p><p>Common carotid artery pseudoaneurysm is the formation of a hematoma outside the vessel wall resulting from a transmural rupture. Its causes include open or blunt trauma, infections, or previous surgical procedures. These lesions usually present with a wide range of symptoms due to mass effect, and the diagnosis relies on a high index of suspicion and imaging methods. Treatment remains controversial; however, surgical management-either open or endovascular-is generally preferred. This report presents the case of a 19-year-old patient with a history of gunshot wound in neck. Imaging revealed a pseudoaneurysm of the right common carotid artery, which was surgically treated through resection and interposition of an ePTFE graft. This article discusses the etiology, diagnosis, and treatment of post-traumatic carotid artery pseudoaneurysm, with the aim of increasing awareness of this condition and its clinical presentations, thereby promoting timely diagnosis and appropriate therapeutic intervention to prevent fatal outcomes.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"361-365"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: Clinical Outcomes From a Single Center Experience.","authors":"Zachary T AbuRahma, Adrian Santini, Ali F AbuRahma, Amanda Malnikoff, Christina Veith, Emma Umstot, Mitchell Laton, Scott Dean, Elaine Mattox","doi":"10.1177/15385744251398904","DOIUrl":"10.1177/15385744251398904","url":null,"abstract":"<p><p>BackgroundFew single center studies with small sample size have been published showing clinical benefits of endovascular intervention specifically using mechanical suction thrombectomy for P.E. without systemic/catheter lytic therapy. This study will analyze our initial experience and clinical outcomes in the treatment of P.E. using Inari FlowTriever thrombectomy device.Patient Population/MethodsA single center retrospective study of 50 consecutive patients with acute P.E. were treated with the INARI FlowTriever device between January 2019 to June 2023. All patients were submassive P.E. with right ventricular strain (RV/LV ratio >0.9) and requiring oxygen therapy or having increase in oxygen therapy from baseline. Procedural and clinical success (Improvement in intraoperative pulmonary artery pressures and oxygen therapy) were evaluated along with in hospital procedural related complications with a mean follow up of 8 months (range 1-22.5 months).ResultsAll patients were stratified as intermediate high-risk PE with a mean age of 68 years. Right ventricular dilation was present in 100% of patients with a mean RV/LV ratio of 1.55 (range 0.9-2.7). Mean pre-op Troponin was 434 (median 318, range 6-2332) and mean BNP was 352 (median 154, range 60-1787). Procedural success as defined by SIR guidelines was achieved in 100% of patients. There was 0% hospital mortality, device related mortality, or complications including bleeding, and acute kidney injury (AKI). Significant improvement in FiO2 was noted when comparing the mean pre-procedural FiO2 of 40.6% (range of 21%-100%) to a mean of FiO2 of 28.3% (range of 21%-52%) at 24 h post procedure (<i>P</i> < .0001). Proportion of patients on room air increased from 0% pre procedure to 94% at 48 h. The mean pre-op pulmonary artery pressure improved from 47 mm Hg (range 20-74) to mean post pulmonary artery pressure of 34 mm Hg (range 19-65) <i>P</i> < .0001. 97% of patients had a decrease in their pre-op pulmonary pressures intraoperatively.In late follow-up when evaluating pre to post intervention 36/38 (94.4%) of our patients were back to baseline with regards to oxygen requirement. Proportion of patients on room air increased from 0% pre procedure to 94.4% post procedure. 34/38 (89%) of patients reported they were back to baseline in regard to physical activity and 37/38 (97%) of patients reported their breathing status was back to baseline from prior to procedure. Using the modified Medical Research Council Dyspnea Score, 93% of patients reported a pre-op score of four (highest) while 70% reported scores of zero (normal) and or score of one post intervention with 100% showing improvement at 8 month follow up.ConclusionOur study demonstrates both safety and effectiveness in using the INARI FlowTriever for patients with submassive acute pulmonary embolism.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"325-330"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous Thrombosis Prophylaxis after Endovenous and Open Surgery for Varicose Veins: A Systematic Review and Network Meta-Analysis.","authors":"Shuhua Ye, Jingjing Chen, Jianjie Ju, Limei Yang","doi":"10.1177/15385744251410004","DOIUrl":"10.1177/15385744251410004","url":null,"abstract":"<p><p>BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.MethodsA comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.ResultsA total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, <i>P</i> < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, <i>P</i> = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"348-357"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Digital Patient Education on Interventional Venous Diseases and Interventions.","authors":"Som P Singh, Mensur Koso, Aarya Ramprasad, Kiera G Borthwick, Mina S Makary","doi":"10.1177/15385744251395366","DOIUrl":"10.1177/15385744251395366","url":null,"abstract":"<p><p>BackgroundDigital educational resources have transformed patient care as a powerful tool for clinicians to assist patients in their medical decision-making. However, a significant degree of online educational materials is unstandardized in terms of the quality, readability, and transparency of the information provided to patients. The objective of this study was to evaluate the accuracy, quality, and readability of publicly available digital patient education materials addressing patient questions on venous diseases and image-guided interventions.Materials and MethodsA cross-sectional study addressed the objective of this study by utilizing Rothwell's Classification of Questions, readability scores, and Brief DISCERN.ResultsThe digital educational materials extracted from the methodology of this study were mostly found to be from \"Academic Institutions\" at 41.3%. (n = 186) and \"Medical Practices\" at 30.2% (n = 136). Readability scores indicate that most articles on venous diseases or procedures are considered either \"fairly difficult\" or \"difficult\" to read. According to the Brief DISCERN assessment, educational materials on venous disease topics generally received higher quality scores compared to those on venous interventions.ConclusionsThe findings revealed a potential discrepancy in the quality of patient education articles between those related to venous diseases and those related to venous interventions. Articles about venous diseases generally scored higher in quality according to the Brief DISCERN assessment. This may suggest that a more substantial amount of high-quality information is available in this area. In terms of readability, these educational articles generally fell short of recommended grade reading levels.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"309-315"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the ExoSeal Vascular Closure Device in Patients With Peripheral Artery Disease: Risk Analysis of Deployment Failure and Prolonged Hemostasis.","authors":"Ryo Okusako, Taira Kobayashi, Takanobu Okazaki, Masaki Hamamoto, Shinya Takahashi","doi":"10.1177/15385744251409971","DOIUrl":"10.1177/15385744251409971","url":null,"abstract":"<p><p>ObjectivesEndovascular treatment (EVT) of lower extremity artery disease (LEAD) is minimally invasive and has good safety and efficacy. Puncture site complications are common in EVT, but these and the hemostatic time have been reduced by newer hemostatic devices such as ExoSeal. However, factors affecting poor outcomes after use of ExoSeal are unclear. Therefore, the purpose of this study is to identify these factors after ExoSeal deployment in EVT.Material and MethodsA retrospective study was performed for 868 cases in which hemostasis was attempted using ExoSeal between 2019 and 2023. Factors affecting deployment failure and prolonged hemostatic time after ExoSeal were assessed.ResultsThe 868 subjects (569 males, 66%) had a median age of 77 [72-83] years. A femoral antegrade approach was used in 548 cases (63%), with use of a 6Fr sheath in most cases (99%). The lesions were in the femoropopliteal (<i>n</i> = 387, 44%) and infrapopliteal (<i>n</i> = 359, 41%) arteries. The technical success rate of EVT was 97%. ExoSeal was successfully deployed in 812 cases (94%). Cases in which ExoSeal deployment was unsuccessful had significantly more frequent proximal stenting (9% vs 20%, <i>P</i> = .01). In the entire cohort, there were 6 (.69%) puncture site complications. Of the 812 cases with successful deployment, the manual compression hemostasis time was prolonged (>10 min) in 51 cases (6%). Hemostatic time was significantly prolonged in cases with proximal stenting or intimal thickening at the puncture site (both, <i>P</i> < .001).ConclusionThese results show that ExoSeal is a useful device. However, deployment failure and prolonged hemostatic time were caused by a proximal stent or intimal thickening of the puncture site, and use of hemostatic devices in such cases requires further investigation.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"331-337"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity Score-Adjusted Comparative Analysis of Modified Eversion Versus Conventional Carotid Endarterectomy: Early Clinical Outcomes and Survival.","authors":"Tae Hong Yoon, Byeng Hun Jeon, Chul Ho Lee, Jae Seok Jang, Jun Woo Cho","doi":"10.1177/15385744251410019","DOIUrl":"10.1177/15385744251410019","url":null,"abstract":"<p><p>BackgroundCarotid endarterectomy (CEA) remains the standard surgical intervention for carotid stenosis. While the conventional CEA (cCEA) and eversion techniques have been widely investigated, data on the clinical implications of modified eversion CEA (meCEA), which employs a limited arteriotomy of the carotid bulb, remain scarce. This study aimed to compare the early and mid-term outcomes of meCEA with those of cCEA using adjusted analyses.MethodsIn this retrospective study, 206 patients who underwent CEA between 2015 and 2025 at Daegu Catholic University Hospital were included. Patients were divided into the cCEA (n = 170) and meCEA (n = 36) groups. Baseline characteristics, operative profiles, and postoperative complications were compared using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to adjust for potential confounding. Overall survival (OS) and event-free survival (EFS) were evaluated using IPTW-adjusted Kaplan-Meier and Cox proportional hazards models.ResultsThe meCEA group showed marked intraoperative advantages, including a significantly lower rate of patch angioplasty (25.0% vs 87.1%), shorter operative time (94.3 ± 24.5 vs 139.8 ± 43.7 min), and reduced internal carotid artery clamp time (35.0 ± 12.7 vs 48.5 ± 12.5 min; all <i>P</i> < 0.001). No significant differences were observed in postoperative stroke, transient ischemic attack, or in-hospital mortality after PSM adjustment. IPTW-adjusted survival analysis revealed no statistically significant differences in OS (HR: 1.09, 95% CI: 0.38-3.14, <i>P</i> = 0.87) or EFS (HR: 1.29, 95% CI: 0.52-3.23, <i>P</i> = 0.581) between the groups. However, interpretation of long-term outcomes was limited by a shorter follow-up duration in the meCEA group (22.7 vs 63.9 months).ConclusionsThe meCEA technique offers significant operative benefits while demonstrating comparable early and mid-term safety profiles to conventional CEA. Although no significant survival difference was observed after adjustment, the results suggest that meCEA may serve as an effective alternative to cCEA. Further prospective studies with longer follow-up are needed to validate these findings.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"338-347"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}