Vascular and endovascular surgery最新文献

{"title":"Retrograde Tibialis Anterior Artery Access as an Alternative Route for Stent-Based Endovascular Repair of Femoral Access-Site Complications.","authors":"Israel Cohen, Daniel Raskin, Amit Talmon, Ariel Rauchwerger, Efrat K Gilat, Yiftach Barash, Boris Khaitovitch","doi":"10.1177/15385744261496707","DOIUrl":"https://doi.org/10.1177/15385744261496707","url":null,"abstract":"<p><p>BackgroundFemoral arterial access can lead to complications, including bleeding, pseudoaneurysms, arteriovenous fistulas (AVFs), and dissections. When utilizing endovascular methods, the treatment of these complications is typically performed via contralateral femoral access. For appropriate patients, the tibialis anterior (TA) approach offers a promising alternative, providing distal access with minimal risk of complications. This study evaluates the single retrograde TA approach for managing femoral artery access complications.Patients and MethodsA single-center retrospective analysis was conducted, including 11 patients who underwent endovascular treatment for femoral access complications via a single ipsilateral TA approach. Baseline demographics, procedural characteristics, and outcomes were collected from hospital records. Technical success was defined as the ability to obtain retrograde tibialis anterior access, advance a catheter to the target site, and deliver the intended therapy. Procedural success was defined as effective treatment of the vascular injury with preservation of patency in both the treated vessel and the tibialis anterior artery used for access.ResultsEleven patients (median age, 73 years; 55% male) underwent stent-based endovascular treatment. The most common vascular injuries were pseudoaneurysms (45%) and arteriovenous fistulas (45%), most often involving the superficial femoral artery (82%). All procedures achieved 100% technical and procedural success. The median procedure time was 50 minutes (IQR: 37-73), and the median fluoroscopy time was 4.4 min (IQR: 2.4-7.3). During 30-day follow-up, one Class B adverse event (vasovagal reaction) and one Class D adverse event (intracranial hemorrhage, unrelated) were observed. No reinterventions, permanent sequelae, or deaths occurred.ConclusionThe single retrograde TA artery approach demonstrates high technical and procedural success, providing an effective alternative for managing femoral access complications. Further multicenter studies are needed to validate these findings and explore long-term outcomes.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261496707"},"PeriodicalIF":0.7,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168556","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":"Assessing Patient Preferences for Management of Mixed Arterial and Venous Leg Ulcers.","authors":"Mohammed Alagha, Abdallah Alagha, Stewart R Walsh","doi":"10.1177/15385744261494635","DOIUrl":"https://doi.org/10.1177/15385744261494635","url":null,"abstract":"<p><p>IntroductionManagement of Mixed Arterial Venous Leg Ulcers (MAVLU) represents a clinical dilemma. The ideal sequencing of intervention 'veins-first' vs 'artery-first' remains uncertain. With the paucity of current MAVLU guidelines, we evaluated our patients' preferences to help establish momentum in developing clinical evidence.MethodsThis is a prospective, cross-sectional study to elicit patient preferences using the Discrete Choice Experiment (DCE). The DCE task contained the two options veins-first vs artery-first intervention. The block randomisation method was utilised to provide alternating order of the choice set. Through in-person structured interviews, five main aspects (attributes) of each intervention were discussed to allow comparison (type of anaesthesia, duration and complexity of intervention, associated risks, and post-operative stay). Once the preference has been expressed, patients were asked to rank these attributes in order of importance to indicate their influence on decision-making.ResultsOf 30 patients of MAVLU reviewed over a 12-month period, 26 were suitable for inclusion. 77% of patients (20/26) opted for a veins-first approach. The lower procedural risk associated with venous intervention was the most important attribute in the veins-first group. Similarly, most of those who chose the artery-first approach (6/20) believed that the higher risk profile and complexity or arterial interventions are an unavoidable necessity to achieve ulcer healing.Conclusion'veins-first' approach in treating MAVLU was the predominant choice in our case series. Holistic risk-benefit assessment is essential in joint decision making.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744261494635"},"PeriodicalIF":0.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149140053","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":"Part II: Acute Lower Limb Ischemia-Reperfusion Injury: Contemporary Clinical Management and Review of Randomized Controlled Trials.","authors":"Ashley A Peters, Chanpreet Kaur, Lauren Carmon, Gloria Grace Poland, Vivian Gahtan","doi":"10.1177/15385744261442204","DOIUrl":"10.1177/15385744261442204","url":null,"abstract":"<p><p>Acute limb ischemia (ALI) is a medical emergency that can be due to prolonged tourniquet application, peripheral arterial disease, arterial embolization, and/or arterial thrombosis. To prevent associated morbidity and mortality, ischemia time should be minimized by urgent or emergent revascularization. However, revascularization can lead to ischemia-reperfusion injury (IRI), a devastating complication that can cause limb loss, multi-organ failure, and/or death. Currently, management of IRI largely relies on preventative measures and supportive care. In Part 2 of this two-part review article, we will briefly review the pathophysiology of IRI discussed in Part 1, and then discuss contemporary interventions to perfuse an acutely ischemic limb, clinical strategies that have been used to reduce and/or prevent IRI, and lastly, randomized controlled trials that have investigated pharmacological interventions to neutralize or mitigate IRI toxicity.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"623-637"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793678","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 Matching Analysis of the Impact of Retrograde Access During Endovascular Revascularization.","authors":"Andrew Min, Laurel Wong, Shruti Mavuri, Shiven Sharma, Michael Daidone, Darya Dehkan, Ageliki Vouyouka, Windsor Ting, Michael Marin, Peter Faries, William Beckerman, Ajit Rao","doi":"10.1177/15385744261443883","DOIUrl":"10.1177/15385744261443883","url":null,"abstract":"<p><p>Background/ObjectivesIn treating Peripheral Artery Disease (PAD), the contralateral femoral artery is commonly used for endovascular access. When antegrade access is not feasible, retrograde access via tibial or pedal vessels may be used. This study evaluates the impact of retrograde access on longitudinal outcomes using propensity score matching to emulate a randomized trial.MethodsThis retrospective analysis included patients who underwent endovascular revascularization at two institutions between 2014 and 2022. Retrograde access was defined as access via the anterior tibial, posterior tibial, peroneal, or dorsalis pedis artery. Major Adverse Limb Events (MALE) included arterial bypass, minor amputation, or major amputation. Propensity score matching was performed using known predictors of retrograde access: chronic kidney disease, gangrene, prior PAD surgery, chronic total occlusion, number of patent tibial vessels, age, and gender. Full matching minimized data loss. Univariate logistic regression estimated the effect size of retrograde access on MALE, reintervention, and death.ResultsAfter matching, 57 retrograde and 276 antegrade access patients were included. Covariate balance was achieved, with all absolute mean differences <0.1. Retrograde access was not significantly associated with reintervention (OR = 1.88, CI: 0.97-3.73, <i>P</i> = .065), death (OR = 1.74, CI: 0.84-3.46, <i>P</i> = .12), or MALE (OR = 1.32, CI: 0.67-2.51, <i>P</i> = .4).ConclusionRetrograde access does not significantly impact the odds of adverse outcomes and is a viable option when antegrade access is not feasible. However, elevated odds ratios and limited sample size suggest further study is warranted.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"595-602"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701273","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":"External Iliac Vein Injury During Acetabular ORIF: Endovascular Rescue in Orthopaedic Trauma and Review of Surgical Considerations.","authors":"Bibhas Amatya, Michael A Holzman, Dipankar Mukherjee","doi":"10.1177/15385744261447453","DOIUrl":"10.1177/15385744261447453","url":null,"abstract":"<p><p>BackgroundMajor vascular injuries during orthopedic procedures such as open reduction and internal fixation (ORIF) of acetabular fractures are rare but potentially fatal. The iliac veins are particularly vulnerable during anterior approaches due to their close proximity to the pelvic brim.PurposeTo describe the management of an iatrogenic external iliac vein injury sustained during acetabular ORIF via a modified Stoppa approach and to highlight the role of endovascular techniques as a rescue strategy.Research DesignDescriptive case study and literature review.Study SampleSingle patient undergoing acetabular ORIF complicated by intraoperative external iliac vein injury.Data Collection and/or AnalysisIntraoperative findings, management strategy, and postoperative outcomes were systematically documented. A narrative review of the contemporary literature on endovascular management of iliac and inferior vena cava injuries was performed.ResultsThe injury resulted in sudden, massive hemorrhage that could not be controlled through open exposure due to limited visualization and significant bleeding risk. An intraoperative endovascular approach was therefore adopted. Sequential deployment of aortic cuff stent-grafts via femoral access achieved rapid hemostasis while preserving venous patency. Postoperative imaging confirmed patent stents without evidence of extravasation.ConclusionsEndovascular stent grafting represents a viable and potentially life-saving alternative to open repair for major iliac venous injuries, particularly in anatomically challenging settings. This paper demonstrates the importance of preoperative vascular preparedness and the integration of endovascular rescue strategies into orthopedic trauma surgery.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"638-643"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793750","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":"Development and Validation of a Web Calculator for Predicting the Risk of Lower Limb Varicose Veins.","authors":"Siqi Wang, Yuqin Wang, Xinxin Feng, Zhonghao Sun, Wenjing Yang, Yue Zhao, Xia Wang","doi":"10.1177/15385744261442205","DOIUrl":"10.1177/15385744261442205","url":null,"abstract":"<p><p>The aims of the present study were to develop and validate a predictive model for lower limb Varicose Veins, and to visualize the results using a web calculator for assessing the probability of patients developing Lower Limb Varicose Veins. A convenience sampling method was employed to select 421 patients from December 2023 to April 2024 at the health check-up center and vascular surgery outpatient clinic of a tertiary hospital in Xuzhou City. Based on the results of univariate and logistic regression analysis, a prediction model was constructed using logistic regression in machine learning and internally validated. The results were visually presented through a web calculator. This prediction model was developed based on variables such as gender, age, body mass index, standing time, exercise, education level, smoking, and family history. All tested indicators showed that the model has reliable discrimination and calibration. For clinical medical personnel, the web calculator prediction model can quickly and accurately identify patients with lower limb varicose veins, providing reference for developing personalized intervention measures. Furthermore, the web calculator provides a convenient and practical screening tool for primary healthcare providers and the public.Reporting MethodThis study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"577-588"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679766","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":"Optimizing Contrast Agent Usage and Evaluating Clinical Safety via Dilution Technique in Endovascular Abdominal Aortic Aneurysm Repair.","authors":"Yusuke Ki, Toru Kuratani, Yuki Oga, Tomoaki Kudo","doi":"10.1177/15385744261447457","DOIUrl":"10.1177/15385744261447457","url":null,"abstract":"<p><p>ObjectiveContrast-induced nephropathy remains a significant concern in patients undergoing endovascular aneurysm repair (EVAR), particularly those with pre-existing renal impairment. This study aimed to evaluate the feasibility and safety of using a one-quarter diluted contrast agent during EVAR to reduce contrast volume without compromising imaging quality or clinical outcomes.MethodsWe retrospectively reviewed EVAR procedures performed between July 2022 and September 2024. A total of 96 patients were included, with 50 receiving undiluted contrast and 46 receiving a one-quarter diluted solution. All procedures were conducted using the same angiographic system and protocol. Pixel values and signal-to-noise ratios (SNRs) were measured from digital subtraction angiography (DSA) images. Subjective image quality was independently evaluated by three vascular surgeons using a standardized 5-point scale. Postoperative type I/III endoleaks were identified on contrast-enhanced CT or ultrasound within 30 days. Statistical comparisons were performed using Welch's <i>t</i>-test, Mann-Whitney U test, chi-square test, or Fisher's exact test, as appropriate.ResultsProcedural success was achieved in all cases. The diluted group achieved a 70% reduction in contrast volume (19.8 ± 11.5 mL vs 67.7 ± 30.5 mL; <i>P</i> < .001). Pixel values (2.87 ± 8.75 vs 2.99 ± 5.59; <i>P</i> = .936), SNRs, and surgeon-rated image quality were comparable between groups. The incidence of type I/III endoleaks (2.0% vs 4.3%; <i>P</i> = .606) and radiation parameters did not differ significantly.ConclusionsUse of a one-quarter diluted contrast agent during EVAR provided image quality and safety comparable to undiluted contrast while significantly reducing contrast volume. This technique may represent a practical strategy to mitigate renal risk in patients with impaired kidney function.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"614-622"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793726","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":"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":"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":"644-647"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","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":"Popliteal Artery Entrapment Syndrome: Surgical Management and Long-Term Outcomes.","authors":"Tomas Quezada Alvarez, Mauricio Gonzalez-Urquijo, Jose Francisco Vargas, Francisco Valdes, Michel Bergoeing, Leopoldo Marine","doi":"10.1177/15385744261442206","DOIUrl":"10.1177/15385744261442206","url":null,"abstract":"<p><p>BackgroundPopliteal artery entrapment syndrome (PAES) is a rare vascular condition resulting from abnormal anatomical relationships between the popliteal artery and surrounding musculoskeletal structures, often causing limb ischemia. This study presents a case series of PAES patients treated surgically at a single academic center in Chile.MethodsA retrospective review was performed on patients diagnosed with PAES from January 2012 to December 2023. Data included demographics, symptoms, diagnostic modalities, PAES type, limb involvement, surgical approach, and outcomes. All patients underwent pulse volume recordings with dynamic maneuvers and confirmatory imaging. Follow-up was conducted regularly, and data were analyzed using SPSS v25.ResultsTwelve patients (83.3% male) with a median age of 40 years (range: 22-63) and 13 affected limbs were treated. Intermittent claudication was the most common symptom (58.3%), followed by critical (25.0%) and acute limb ischemia (16.4%). Imaging confirmed PAES in all cases, predominantly type I (46.1%) and type III (38.4%). All patients underwent surgical decompression, and 46.1% required arterial revascularization. Postoperative complications occurred in 16.6%, and median hospital stay was 2.5 days (range: 1-7). Median follow-up of was 70.5 months (range: 12-105), primary patency rate was 92.3%, and 83.3% of patients remained asymptomatic during follow-up.ConclusionSurgical treatment of PAES is safe and effective, offering favorable mid-term outcomes with low morbidity. Early diagnosis and a multidisciplinary approach are essential to prevent irreversible arterial injury and optimize long-term results.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"589-594"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679789","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":"Contemporary Outcomes of Short Medial Bypass for the Treatment of Popliteal Artery Aneurysms.","authors":"Thomas Lyons, Sui Wu Tee, Pushpa Veeralakshmanan, Ross Melvin, Abdelrahman Farrag, Maciej Juszczak, Gary Lambert, Alok Tiwari","doi":"10.1177/15385744261447454","DOIUrl":"10.1177/15385744261447454","url":null,"abstract":"<p><p>BackgroundPopliteal artery aneurysms are the most common peripheral artery aneurysms, treated by endovascular stenting or open surgical repair by bypass. Short medial bypass is the predominant open surgical repair; however published outcomes frequently combine all techniques (medial and posterior, short and long, vein and prosthetic), preventing accurate interpretation of technique-specific results.MethodsWe present a retrospective cohort study of across 2 UK tertiary centres between January 2014 and December 2019. All patients underwent short exclusion bypass with autologous saphenous vein only. Short bypass was defined as inflow from mid-distal superficial femoral artery or above-knee popliteal artery to outflow at below-knee popliteal artery, tibioperoneal trunk, or crural vessel.Results69 limbs in 59 patients underwent short bypass over this period. Median age was 71 years, 96% were male and a PAA median size of 35 mm. Five-year outcomes demonstrated overall survival of 83.1% (95% CI: 74.0 - 93.2%), amputation-free survival of 76.3% (95% CI: 66.2 - 87.9%), and secondary patency of 90.1% (95% CI: 82.9 - 98.0%). Thirty percent required reintervention, predominantly for graft stenosis or ongoing sac perfusion. There was no evidence of proximal inflow disease progression that required intervention.ConclusionsShort medial bypass requires reintervention in 1 in 3 patients within 5 years for sac perfusion or graft stenosis but achieves excellent secondary patency.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"603-613"},"PeriodicalIF":0.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793680","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}