Vascular and endovascular surgery最新文献

{"title":"Transarterial Computed Tomographic Angiography in Patients With Impaired Renal Function Undergoing Endovascular Aortic Repair.","authors":"Efthymios Beropoulis, Apostolos G Pitoulias, Theodosios Bisdas, Giovanni B Torsello, Giovanni Federico Torsello","doi":"10.1177/15385744261501882","DOIUrl":"https://doi.org/10.1177/15385744261501882","url":null,"abstract":"<p><p>PurposeComputed tomography angiography (CTA) is crucial for preoperative planning and postoperative surveillance of endovascular aneurysm repair (EVAR). Renal function impairment however limits pre- and postoperative assessment. The aim of our study was to evaluate the safety and diagnostic value of a novel technique in the setting of patients undergoing EVAR.Methods216 patients with chronic kidney disease undergoing transbrachial placement of an angiography catheter in the aorta for contrast medium administration were analyzed retrospectively. 45 patients with normal kidney function and aortic aneurysms were included as control group. 27 were female, 84 cases were for thoracoabdominal aortic aneurysm, while 106 cases were for abdominal aortic aneurysm. Primary endpoint was the freedom from contrast-induced acute kidney injury. Secondary safety endpoints were freedom from access site complications and cerebrovascular incidents. Imaging quality endpoints were attenuation values and contrast-to-noise-ratios in predefined vessels, validated by intraclass correlation coefficients.ResultsMean creatinine change was -.11 mg/dL, mean GFR change was 2.13% in the intervention group. There were 10 (4.6%) false aneurysms and two access site hematoma (0.93%). Two cerebrovascular incidents (0.9%) were transient. Transarterial CTA attenuation values varied between 210.4 (±89) and 241.4 (±98) Hounsfield units (HU), and 306.35 (±63.27) to 321.39 (±70.12) HU in the control group. The mean amount of contrast medium used in the catheter group was significantly reduced (31.70 ± 5.82 mL) compared to the control group (<i>P</i> = .001). Contrast-to-noise ratios varied between 9.1 (±4.6) and 11.1 (±4.4. Intraclass correlation coefficients between the readings were very good (0.987-0.992).ConclusionCatheter-based transarterial computed tomographic angiography is a safe and efficacious way to evaluate patients with aortic aneurysms, both prior and after EVAR.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261501882"},"PeriodicalIF":0.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229677","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":"Percutaneous and Endovascular Embolization-Based Treatments of Type 1A and Type 1B Endoleaks after Endovascular Aneurysm Repair.","authors":"Mustafa Mehmet Incesu, Mehmet Koray Akkan, Berrak Barutcu Asfuroglu, Umut Asfuroglu, Nesrin Erdogan Kaydu, Abdullah Ozer, Huseyin Demirtas, Gursel Levent Oktar, Erhan Turgut Ilgit","doi":"10.1177/15385744261501888","DOIUrl":"https://doi.org/10.1177/15385744261501888","url":null,"abstract":"<p><p>ObjectiveThis retrospective, observational study was conducted to evaluate the efficacy of embolization-based treatments for Types 1A and 1B endoleaks following endovascular aneurysm repair.DesignA total of 26 patients who underwent endovascular aneurysm repair between January 2005 and September 2023 and subsequently received embolization therapy for Types 1A or 1B endoleak, either at the end of the procedure or during follow-up, were retrospectively reviewed.MethodsEmbolization was performed in 16 patients with Type 1A endoleaks and 10 with Type 1B. Eight of the 16 patients who underwent embolization for Type 1A endoleaks required additional treatments such as aortic cuff placement or a chimney graft. Similarly, six out of the 10 patients treated with embolization for Type 1B endoleaks underwent adjunctive procedures such as iliac stent-graft extension. The primary endpoint was the absence of aneurysm sac enlargement. Secondary endpoints included technical success and the avoidance of endoleak-related reintervention.ResultsAneurysm sac regression or stabilization was observed in 68.7% of Type 1A and 70% of Type 1B endoleak cases over mean follow-up periods of 43.1 and 22.3 months, respectively.ConclusionEmbolization-based endovascular treatment, alone or combined with adjunctive endograft procedures, may achieve aneurysm sac stabilization or regression in a substantial proportion of patients with Types 1A and 1B endoleaks. However, the possibility of recurrence and reintervention, particularly in Type 1A endoleaks, remains an important limitation of this approach and warrants continued imaging surveillance.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261501888"},"PeriodicalIF":0.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229743","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":"Intravascular Lithotripsy of Aortic and Renal Lesions as a Therapeutic Tool for Pickering Syndrome: A Case Report.","authors":"Miguel Martínez-Cachero García, Carlos Ariza Molina, Susana Ana Sanmartino González, Amer Zanabili Al-Sibbai","doi":"10.1177/15385744261501201","DOIUrl":"https://doi.org/10.1177/15385744261501201","url":null,"abstract":"<p><p>We report the case of a 73-year-old woman admitted with Pickering syndrome, a life-threatening condition characterized by recurrent flash pulmonary edema secondary to severe renovascular disease. Computed tomography angiography demonstrated an atrophic left kidney, a heavily calcified visceral aorta with a coral-reef morphology, and a near-occlusive stenosis of the right renal artery. Urgent endovascular treatment was performed with intravascular lithotripsy for plaque modification of the suprarenal aorta and the right renal artery, followed by renal artery stenting. The patient showed prompt clinical recovery, with resolution of pulmonary edema, stabilization of blood pressure, and improvement of renal function. This case illustrates the potential role of intravascular lithotripsy as a minimally invasive adjunct for managing severely calcified aorto-renal disease in high-risk patients, enabling endovascular treatment in otherwise challenging anatomy.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261501201"},"PeriodicalIF":0.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149231333","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":"Collapse and Thrombosis of an Iliac Branch Endovascular Device Following Blunt Force Trauma.","authors":"Autumn Stevens, Peter Henke, Frank Davis, Jeri Stevens, Nicholas Osborne","doi":"10.1177/15385744261501094","DOIUrl":"https://doi.org/10.1177/15385744261501094","url":null,"abstract":"<p><p>Iliac branch endovascular device thrombosis following blunt force trauma has rarely been reported. We describe an 81-year-old man who developed proximal aortobiiliac endograft collapse with subsequent thrombosis after blunt force trauma occurring two months following endovascular aneurysm repair. The patient delayed vascular follow-up for one year and later presented at routine surveillance with progressive bilateral hip and buttock claudication. Despite chronic therapeutic anticoagulation for atrial fibrillation, the patient developed progressive thrombosis with ischemic symptoms. The case highlights a rare mechanical cause of post-EVAR aortoiliac thrombosis and demonstrates the importance of early vascular imaging and consultation following traumatic injury in post-EVAR patients.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261501094"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221271","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":"A Study on Renal Artery Variations by CT Angiography and Their Clinical Importance.","authors":"Jagadeesh Gajendran, Vigneshwaran Ayeegoundenpalayam Baskar, Mahesh Arvinth Rangaiyan, Dillibabu Ethiraj, Niranjan Dhanaji Kanase, Immanuel Judah Pandiaraj, Nihar Gupta, Suresh D Kumar","doi":"10.1177/15385744261500896","DOIUrl":"https://doi.org/10.1177/15385744261500896","url":null,"abstract":"<p><p>AimThis study aimed to evaluate the prevalence, anatomical variations, and branching patterns of the renal arteries using multiphasic computed tomography angiography (CTA), based on the modified classification proposed by Cases et al (2017). Understanding renal artery variations is essential for preoperative planning, renal transplantation, endovascular procedures, and urological interventions.Materials and MethodsA retrospective analysis was conducted on 1220 abdominal CTA studies performed between March 2020 and June 2024. Fourteen cases were excluded according to predetermined exclusion criteria, resulting in 1206 studies being included in the final analysis (700 males, 520 females). All examinations were performed using a 128-slice CT scanner (Siemens SOMATOM; syngo CT VC 40). CTA protocols included 5-mm acquisition and 1-mm reconstruction, with administration of 100-120 mL of iodinated contrast at 5-6 mL/s via an 18G antecubital cannula. Post-processing involved multiplanar reformation, volume rendering, and 3D reconstruction. Two experienced radiologists independently reviewed all studies. Renal arteries were categorized into Types A-E and Patterns I-V. \"Early division\" (Types B and E) and \"polar branches\" (Types C and D) were further grouped for analytical purposes.ResultsAmong 1206 CTA studies, Type A (normal hilar artery) was the most common in both kidneys, with a slightly higher prevalence on the right (74.29%) than on the left (67.99%). Polar branches were more frequent in the left kidney, whereas early divisions were more common in the right kidney. Pattern 1 was predominant bilaterally (RK: 85.73%; LK: 77.61%), followed by Pattern 2. Significant differences were observed between the kidneys in the distribution of Types A, C, D, and Patterns 1 and 2.ConclusionCTA provides excellent visualization of renal artery variations, enabling precise classification and improving surgical, interventional, and transplant planning. Recognition of these anatomical differences is essential for minimizing procedural complications.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261500896"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225727","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":"Volumetric Analysis versus Diameter Measurement for Early Detection of Post-EVAR Sac Progression.","authors":"Sinan Özçelik, Emre Külahcıoğlu, Mehmet Ali Türkcü, Enis Burak Gül, Murat Gevrek, Enes Şenel, Emre Erkal, Hakkı Zafer Işcan","doi":"10.1177/15385744261500865","DOIUrl":"https://doi.org/10.1177/15385744261500865","url":null,"abstract":"<p><p>ObjectiveTo compare diameter- and volume-based surveillance after endovascular aneurysm repair (EVAR) and determine whether volumetric sac assessment identifies postoperative remodeling not captured by conventional maximum diameter measurement.MethodsThis retrospective single-center study included 383 patients who underwent elective EVAR for infrarenal abdominal aortic aneurysm between January 2016 and April 2024. All patients had preoperative and postoperative computed tomography angiography and at least 1 year of follow-up. Maximum sac diameter, total aneurysm sac volume, thrombus volume, thrombus density, neck morphology, and other anatomical variables were assessed using standardized morphometric and three-dimensional morphovolumetric measurements. Sac dynamics were classified by diameter criteria (≥5 mm decrease, stable, or ≥5 mm increase) and volumetric criteria (>10% decrease, stable, or >10% increase).ResultsEndoleaks occurred in 26.1% of patients (n = 100), and secondary interventions were required in 14.1% (n = 54), with a mean time to reintervention of 21.7 ± 10 months. At final follow-up, 74.7% demonstrated sac diameter reduction, 18.5% were stable, and 6.8% had enlargement, whereas volumetric analysis showed shrinkage in 81.7%, stability in 6.0%, and enlargement in 12.3%. At 1, 6, and 12 months, cohort mean diameter changed by -0.6%, -3.1%, and -6.5% from baseline, respectively, while cohort mean volume changed by -0.5%, -5.7%, and -12.5%. Among diameter-stable sacs, 32.4% enlarged volumetrically and 38.0% regressed volumetrically. In enlarging sacs, a 10% volume increase corresponded to an approximately 4 mm diameter increase (R² = 0.72; <i>P</i> < 0.001); this 4 mm value was a regression estimate, not the diameter threshold used for sac classification. Preoperative morphometric and morphovolumetric variables were associated with endoleak and secondary intervention in exploratory analyses.ConclusionVolumetric sac analysis identified additional postoperative remodeling beyond maximum diameter measurement, particularly in apparently stable sacs. A practical surveillance strategy combining rapid diameter-based screening with selective volumetric analysis in stable, borderline, or clinically suspicious cases may improve recognition of adverse sac behavior without requiring routine volumetry in every follow-up study.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261500865"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221296","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":"Snare Assisted Guiding Catheter Stabilization for Left Internal Carotid Artery Access via Right Distal Radial Approach.","authors":"Yuya Kobayashi, Yoshiki Hanaoka, Chinami Yuzawa, Minori Kurashina, Atsushi Sato, Yoshiki Sekijima","doi":"10.1177/15385744261500863","DOIUrl":"https://doi.org/10.1177/15385744261500863","url":null,"abstract":"<p><p>Transradial approach (TRA) is increasingly adopted in neurointervention. However, distal system advancement to the left internal carotid artery (ICA) via a right radial approach can be technically challenging, particularly when a small-caliber system is required. We report a case in which a stable guiding system was established via a right distal radial approach by capturing the guiding catheter with a snare and applying traction. Despite marked ICA tortuosity, distal advancement of the distal access catheter and system push during flow diverter deployment were successfully achieved. This single-case technical experience suggests that snare-assisted guiding catheter stabilization may represent one technical option for addressing support limitations in challenging TRA procedures.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261500863"},"PeriodicalIF":0.7,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217897","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 of Surveillance Imaging Non-compliance Among Patients with TEVAR for Blunt Thoracic Aortic Injury.","authors":"Boris Pekar, Matthew Patrick Anderson, Liza Gadsden, Adam Tanious, Rupak Mukherjee, Jean Marie Ruddy","doi":"10.1177/15385744261501084","DOIUrl":"https://doi.org/10.1177/15385744261501084","url":null,"abstract":"<p><p>ObjectivesBlunt Thoracic Aortic Injury (BTAI) is the second leading cause of death for patients with blunt trauma. Thoracic endovascular aortic repair (TEVAR) has become the standard of care for high-grade BTAI, reducing morbidity and mortality while requiring long-term surveillance imaging to ensure graft integrity and prevent future complications. However, adherence to this protocol is poor. Previous studies evaluating the factors associated with post-operative imaging non-compliance have yielded conflicting results. This study aimed to evaluate predictors of post-TEVAR non-compliance inpatients presenting with BTAI.MethodsA retrospective study on 23 patients was conducted using a single institution Aortic Center Database (2015-2025). Inclusion criteria included patients who were age >18 years and underwent TEVAR for BTAI. Demographic, comorbidity, hospital course, and follow-up data were collected. The Distressed Communities Index (DCI) score was derived from patient's home address ZIP code. Time-to-event analysis defined loss to follow up (LTFU) for vascular imaging as the failure event. Patients were censored at death or if compliant through 1 year following the index TEVAR. Statistical analysis included chi-square, t-tests, and Kaplan-Meier survival.ResultsBased on this single-center review on TEVAR follow-up for BTAI, sex, race, and hospital length of stay did not impact compliance. Medical comorbidities were also non-significant. Patients who presented with a lower injury severity score (<i>P</i> = 0.02) and lived more than 20 miles from their follow-up appointment (<i>P</i> = 0.02) were more likely to be LTFU. While the type of facility was not impactful, all patients who were discharged to a non-home location were LTFU. Interestingly, DCI and insurance status had no impact on follow-up non-compliance.ConclusionsThis study supports the development of targeted, patient-centered surveillance strategies, especially amongst rural populations and those discharged to a non-home location. To fully understand this complex problem, further investigation using a larger database may be indicated.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261501084"},"PeriodicalIF":0.7,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149221284","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":"Outcomes After Major Amputation in Octogenarians.","authors":"Kyle Bui, Anish Patel, Andrea Alonso, Wei Ni Zhou, Jingtong Huang, Elina Farber, Khuaten Maaneb de Macedo, Alik Farber, Jeffrey J Siracuse, Jeffrey Kalish","doi":"10.1177/15385744261500878","DOIUrl":"https://doi.org/10.1177/15385744261500878","url":null,"abstract":"<p><p>BackgroundMajor lower extremity amputations, defined as above-ankle amputations, are morbid and significantly life-changing. Older patients may be more susceptible to poor outcomes. Our goal was to assess the short- and long-term outcomes of major amputations in octogenarians.MethodsA retrospective single-center chart review was performed on all octogenarian patients who underwent a major amputation at a safety-net hospital between 2014-2023. Demographics, operative characteristics, postoperative outcomes, and 30-day and 1-year outcomes were collected and analyzed. Multivariable binary logistic regression evaluated factors associated with 1-year mortality. Fisher's exact test evaluated univariate categorical comparisons because of small cell frequencies.Results56 octogenarian patients underwent a major amputation: 96.4% underwent an amputation for chronic limb-threatening ischemia while 3.6% of patients had acute limb ischemia. Above-knee and below-knee amputations accounted for 73.2 and 26.8% of procedures, respectively; 10.6% were guillotine amputations. Intensive care unit (ICU) admission was required in 26.3% of cases, and total mean hospital length of stay (LOS) was 13.7 days. Postoperatively, 55.4% were discharged to a skilled nursing facility, 17.9% patients to an acute rehab facility, and 12.5% to home with assistance. Thirty-day emergency department use rate was 14.3%, and hospital readmission rate was 12.5%. Most patients (83.9%) were non-ambulatory at 1-year. In-hospital mortality was 8.9%, 30-day mortality was 14.3%, and 1-year mortality was 35.7%. Univariate analyses demonstrated no statistically significant differences among evaluated variables. Multivariable analysis of 1-year mortality was also not statistically significant.ConclusionMajor amputations in octogenarians are highly morbid with high ICU utilization and prolonged LOS with frequent discharge to acute care facilities. About one-third of patients are not alive at 1-year. These findings suggest the need to identify opportunities for improvement in this high-risk patient population undergoing amputations, such as early revascularization, aggressive rehabilitation in concert with geriatrician collaboration, medical optimization, and improved goals-of-care discussions.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261500878"},"PeriodicalIF":0.7,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217862","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":"Association of Referring Specialty With Limb Loss in Chronic Limb-Threatening Ischemia.","authors":"Nabeeha Khan, William Pelit, Brooke Kelly, Matthew Blecha, Michael C Soult","doi":"10.1177/15385744261494483","DOIUrl":"https://doi.org/10.1177/15385744261494483","url":null,"abstract":"<p><p>ObjectiveChronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. While delayed referral is known to worsen outcomes, the impact of referring specialty remains unclear. This study evaluates whether different referral sources to vascular surgery impact mortality and major amputation rates.MethodsA retrospective review was conducted of patients referred to vascular surgery for CLTI at a single institution (2021-2022). The outcomes investigated were mortality, amputation and composite freedom from amputation or mortality (amputation free survival). Univariable analysis was first conducted followed by multivariable Cox regression utilizing variables which had a univariable <i>P</i> value of <0.1 for the outcomes.ResultsAmong 132 patients, 19.7% died and 19.7% underwent major amputation. Mean duration of follow up for included patients was 1471 days (4.03 years). Congestive heart failure (CHF) independently predicted mortality (HR 3.86, <i>P</i> = .0114) on multivariable analysis. Chronic kidney disease (CKD), gangrene, and non-healing wounds were associated with amputation on univariable analysis (<i>P</i> < .05). Referral from emergency medicine had multivariable association with higher amputation rates, while podiatry referral demonstrated a protective effect (HR 0.28, <i>P</i> = .0472). Referral from emergency medicine had multivariable association with reduced amputation free survival relative to all other specialties combined (HR 2.953 (1.66-5.26), <i>P</i> < .001) and relative to other specialties individually (<i>P</i> = .0023).ConclusionsOutcomes in CLTI are associated with variations in both comorbidities and referral patterns. Earlier, multidisciplinary referral pathways may improve limb salvage as patients with CLTI referred from emergency have higher amputation rates and reduced amputation free survival.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261494483"},"PeriodicalIF":0.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198113","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}