Vascular and endovascular surgery最新文献

{"title":"Primary Aortic Malignant Peripheral Nerve Sheath Tumor.","authors":"Hisaya Mori, Hisato Takagi","doi":"10.1177/15385744241290014","DOIUrl":"10.1177/15385744241290014","url":null,"abstract":"<p><p>A 74 year-old woman suffering 1 month persisting lumbago was referred with diagnosis of thoracic aortic aneurysm. Blood examinations indicated slightly or moderately elevated noradrenaline, dopamine, and homovanillic acid with normal-range vanillylmandelic acid. Contrast-enhanced CT scans revealed a tumor, protruding both intra- and extra-luminally, in the wall of the distal descending thoracic aorta without any primary focuses in the whole body. Primary aortic sarcoma or periaortic catecholamine-producing paraganglioma infiltrating the aorta was suspected. The tumor with the normal proximal and distal aorta 2-3 cm apart from it was completely resected under femoro-femoral partial cardiopulmonary bypass. Macroscopically, the tumor was originated from the aortic wall and protruded both intra- and extra-luminally. Immunohistochemically, positive S-100 and vimentin; Ki67 levels of 40%; and negative CD34, CK AE1/AE3, and SMA were identified. The aforementioned findings definitively diagnosed primary aortic malignant peripheral nerve sheath tumor, which has been never reported in the literature.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"309-314"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335648","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 Branched EVAR in Treatment of Juxtarenal Aortic Aneurysm and Essential Accessory Renal Artery: Another Tool on the Shelf? A Case Report.","authors":"Donatas Opulskis, Imam T P Ritonga, Philipp Franke, Martin J Austermann, Marco Virgilio Usai","doi":"10.1177/15385744241290011","DOIUrl":"10.1177/15385744241290011","url":null,"abstract":"<p><strong>Objective: </strong>We present the case of a 58-year-old male patient referred to our department from a smaller facility for further evaluation and treatment strategy regarding the choice between open or endovascular surgery. The patient was diagnosed with a 6 cm asymptomatic juxtarenal aortic aneurysm and a 5 mm diameter accessory renal artery (ARA) supplying the lower half of left kidney. Further diagnostic assessments indicated that the left ARA was perfusing over 40% of the left kidney.</p><p><strong>Methods: </strong>Given the patient's significant pre-existing medical conditions and elevated perioperative risk, the decision was made to proceed with minimally invasive endovascular surgery using a custom-made 5-branches stent graft (BEVAR).</p><p><strong>Results: </strong>In the early postoperative period, the patient reported left flank pain. A subsequent CT scan identified a partial infarction in the left kidney due to the occlusion of an early small branch from the upper left renal artery. However, laboratory results showed no significant change in renal function compared to preoperative values. The patient was discharged 6 days post-surgery, with no additional complications observed during the early postoperative period.</p><p><strong>Conclusion: </strong>This case report demonstrates that BEVAR is acceptable technique with satisfactory early postoperative outcomes for treating juxtarenal aortic aneurysms with an accessory renal artery in patients who are high-risk candidates for open repair and anatomically unsuitable for FEVAR or Ch-EVAR procedures.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"303-308"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Pedal Bypass in a Patient With Pseudoxanthoma Elasticum.","authors":"Suvi Väärämäki, Olli Hautero, Vesa Rajala, Pasi Nevalainen","doi":"10.1177/15385744241290007","DOIUrl":"10.1177/15385744241290007","url":null,"abstract":"<p><strong>Objectives: </strong>Pseudoxanthoma elasticum (PXE) is a rare metabolic disease, causing calcification in the arterial media layer and further peripheral artery disease (PAD). A high rate of failure has been reported after endovascular and open surgical management of PAD among patients with PXE. Critical limb ischemia (CLI) rarely develops in PXE, and there are only few reports of its treatment.</p><p><strong>Methods: </strong>We present a case report of a 57 year-old female diagnosed with pseudoxanthoma elasticum (PXE). She presented with critical limb ischemia (CLI) and was successfully treated with pedal bypass using the great saphenous vein.</p><p><strong>Results: </strong>Despite obtaining suboptimal outcomes through the initial approach of percutaneous transluminal angioplasty to treat critical limb ischemia, the subsequent bypass operation proved to be a success. At the first follow-up appointment at 1 month, the patient was asymptomatic and the ulceration had almost healed. The patient underwent an ultrasound examination at 3, 6, 12, and 24 months after discharge, and the surveillance was uncomplicated.</p><p><strong>Conclusions: </strong>With a clear indication for surgery, limb-threatening ischemia can be successfully treated with distal bypass, if necessary, in patients with PXE similarly to atherosclerotic PADs. Appropriate diagnostic and surveillance imaging and the utilization of a multidisciplinary team are key components for effective management of PAD in patients with PXE.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"315-319"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Perioperative Outcomes After Carotid Revascularization With Special Emphasis on Myocardial Infarction - A Systematic Review With Meta-Analysis of Randomized Control Trials.","authors":"Panagiota Valaki, Konstantinos G Moulakakis, Spyridon Mylonas, Christos Karathanos, Konstantinos Batzalexis, Athanasios Giannoukas","doi":"10.1177/15385744251330930","DOIUrl":"https://doi.org/10.1177/15385744251330930","url":null,"abstract":"<p><p>Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) through systematic review and meta-analysis.MethodsA multiple electronic search was performed in Medline (database provider PubMed), Web of Science Core Collection, EMBASE (database provider Ovid) and Cochrane Central Register of Controlled Trials databases for articles from 2000 up to 2023 reporting outcomes after carotid revascularization. Randomized control trials comparing the perioperative events (30-day results) after CAS and CEA stating the perioperative risk of myocardial infarction were included in the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of twelve randomized control trials (RCTs) with 11 153 patients were identified and considered eligible. The pooled risk of periprocedural stroke was found to be reduced after CEA compared to CAS [OR: 1.6, CI 95%:1.3-2.1, <i>P</i> < 0.05], while PMI was found to be more frequent after CEA, favoring CAS [OR: 0.4, CI 95%: 0.2-0.7, <i>P</i> < 0.05]. Periprocedural mortality was lower but not reaching statistical significance in the CEA compared to CAS [OR: 1.1, CI 95%: 0.6-2.1, <i>P</i> = 0.68]. The pooled OR for composite endpoint of stroke, MI or death was in favor of CEA as safer treatment [OR: 1.3, CI 95%: 1-1.5, <i>P</i> < 0.05].ConclusionsPMI risk was lower after CAS, although the currently available data do not demonstrate any increase in mortality rates.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330930"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744610","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":"The Impact of Intra-abdominal Cancer Stage on Outcomes after Abdominal Aortic Aneurysm Repair.","authors":"Andrea L Lubitz, Lynde K Lutzow, Jessica Beard, Frank Schmieder, Xiaoning Lu, Huaqing Zhao, Lawrence Oresanya","doi":"10.1177/15385744251330679","DOIUrl":"https://doi.org/10.1177/15385744251330679","url":null,"abstract":"<p><p>ObjectiveA significant number of patients undergoing abdominal aortic aneurysm (AAA) repair have a prior diagnosis of cancer. Further information on outcomes following AAA repair in patients with recent intra-abdominal malignancy diagnosis could help guide decision making.MethodsWe used the 2005-2016 Surveillance, Epidemiology and End Results (SEER)-Medicare database to examine outcomes of AAA repair in patients with a recent intra-abdominal malignancy diagnosis. Patients who had undergone AAA repair within 2 years following a cancer diagnosis were included in the study and stratified by cancer stage. We used Kaplan-Meir curves and survival models to compare outcomes of AAA repair in patients with cancer to a cohort without cancer.ResultsWe identified 2614 patients with intra-abdominal malignancy and 2680 patients without cancer who had AAA repairs. Cancer stages were: 53% stage I, 31% stage II, 11% stage III and 5% stage IV. Cancer patients were less likely to undergo open repair (20% vs 28% <i>P</i> < 0.001) or emergent repairs (15% vs 24% <i>P</i> < 0.001). Survival 2 years after AAA repair was 81% for patients without cancer and 78% for the cancer cohort. 2-year mortality by cancer stage was 20% for stage I, 20% for stage II, 33% for stage III and 69% for stage IV cancer patients (AHR for 2-year mortality, Stage I 1.10 (95% CI 0.94-1.27), Stage II 1.25 (95% CI 1.05-1.50), Stage III 2.01 (95% CI 1.62-2.50), Stage IV 5.23 (95% CI 4.17-6.56)).ConclusionPatients with late-stage intra-abdominal malignancies had significantly poorer prognosis following repair of a synchronous AAA as compared to patients without cancer. This data could help inform decision making around the role of AAA repair in the setting of concomitant intra-abdominal malignancy.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330679"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744612","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":"Single Versus Double Antiplatelet Therapy in Patients Undergoing Endovascular Treatment With a Stent for an Iliac Occlusive Lesion.","authors":"Taira Kobayashi, Takanobu Okazaki, Ryo Okusako, Masaki Hamamoto, Shinya Takahashi","doi":"10.1177/15385744251330934","DOIUrl":"https://doi.org/10.1177/15385744251330934","url":null,"abstract":"<p><p>ObjectiveEndovascular treatment (EVT) for an aorto-iliac occlusive lesion is performed worldwide as first-line treatment. However, the choice of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT) after aorto-iliac revascularization is controversial. The purpose of the study was to assess clinical outcomes in patients with SAPT or DAPT after iliac EVT, using propensity score matching.MethodPatients who underwent EVT for a de-novo iliac occlusive lesion at a single center from 2017 to 2023 were analyzed retrospectively. Comparisons were made between SAPT and DAPT cases after propensity score matching. The primary endpoints of the study were freedom from restenosis and freedom from target lesion revascularization (TLR).ResultsA total of 150 patients underwent iliac EVT and received SAPT (n = 93) or DAPT (n = 57). The DAPT group had a significantly higher rate of coronary artery disease (<i>P</i> = .010). After matching, the differences in baseline and procedural details were diminished. The technical success rate of EVT, access site complications, and manual compression time did not differ between the groups. The median follow-up period was 33 (20-47) months. During follow-up, restenosis occurred in 11 cases (7%) and 10 cases (7%) underwent TLR. After matching, the 5-year freedom from restenosis did not differ significantly in the SAPT and DAPT groups (92% vs 90%, <i>P</i> = .80). Freedom from TLR also did not differ between the groups (<i>P</i> = .80). There was a tendency for a lower incident rate of major bleeding in the SAPT group (7% vs 18% at 5 years, <i>P</i> = .10).ConclusionsRetrospective analysis using propensity score matching showed that SAPT after iliac EVT resulted in similar freedom from restenosis and TLR compared with DAPT.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330934"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702209","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":"Enhancing Routine Reporting of IVC Filters: An Interventionalist's Approach to Improving Patient Safety in an Underserved Urban Area.","authors":"Muhammad U Shahid, Vishaal Kondoor, Neel Nirgudkar, Owen Gantz, Paul Ippolito, Pratik Shukla, Abhishek Kumar","doi":"10.1177/15385744251330080","DOIUrl":"https://doi.org/10.1177/15385744251330080","url":null,"abstract":"<p><p>PurposeTo determine whether concurrent reporting and follow-up on diagnostic imaging could be used as an effective tool to raise IVC filter (IVCF) awareness in an underserved urban community. <b>Methods:</b> For this prospective study, radiologists at our institution flagged plain-film and cross-sectional imaging in which an IVCF was identified from October 2018 to October 2019. For consent, a phone survey was conducted to assess the patient's knowledge and understanding related to IVC filter placement. Key data points on the survey included patients' awareness of filter presence, placement date, location, difference between filters, satisfaction regarding peri-procedural education, and plan for filter removal. Patients desiring further information were scheduled for follow-up in the Vascular Interventional Radiology clinic. <b>Results:</b> 77 patients were identified with an IVC filter. 34 patients (15 males, 19 females; mean age 56y +/- 13.6 years) consented. 23.5% were unaware of their IVC filter. Of those aware, 61.5% were dissatisfied with their consultation/education during placement and 88% pursued further IR consultation indicating a desire to consult a clinician regarding their filter. During the study, 8 patients with IVCF (23.5%) were deemed no longer medically necessary; 6 underwent retrieval and 2 were pending at study conclusion. <b>Conclusion:</b> In underserved urban communities, patients with indwelling IVC filters may not have received appropriate follow-up instructions regarding filter retrieval or may be unaware they have one altogether. Diagnostic imaging is an effective tool to identify these patients, raise awareness, and improve retrieval of filters that are no longer indicated.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330080"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712423","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":"The Alpha to Omega of Dialysis Access: Arteriovenous Fistula and Graft (Part 1).","authors":"Mohammad Ghasemi-Rad, Kelly Trinh, Mohadese Ahmadzade, Kevin Agahi, Xavier Jefferson, Carleigh Klusman, David Leon, David Wynne, Jie Cui","doi":"10.1177/15385744251328396","DOIUrl":"https://doi.org/10.1177/15385744251328396","url":null,"abstract":"<p><p><b>Background:</b> Vascular access is a critical determinant of hemodialysis efficacy in patients with end-stage kidney disease (ESKD). The choice between arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) influences long-term dialysis outcomes, with AVFs offering superior patency but higher maturation failure rates and AVGs providing immediate usability at the expense of increased complications. Recent advancements in endovascular techniques and biomaterials have introduced novel approaches to optimizing vascular access. <b>Purpose:</b> This review examines the latest evidence on AVF and AVG creation, focusing on factors affecting maturation, long-term patency, and emerging minimally invasive techniques, such as percutaneous AVF creation, to enhance hemodialysis access outcomes. <b>Research Design:</b> A systematic review of current literature, clinical guidelines, and innovations in vascular access for dialysis patients was conducted. Emphasis was placed on comparative effectiveness studies, patency and complication rates, and new endovascular approaches. <b>Study Sample:</b> Data were sourced from clinical trials, registry reports, and systematic reviews evaluating AVF and AVG outcomes, as well as emerging endovascular fistula technologies. <b>Data Collection and/or Analysis:</b> Key parameters such as patency rates, infection rates, thrombosis incidence, and maturation success were analyzed. Particular attention was given to procedural innovations, including bioengineered grafts and percutaneous fistula creation, assessing their impact on long-term dialysis access viability. <b>Results:</b> AVFs maintain superior long-term patency but are hindered by primary failure rates, necessitating interventions for maturation. AVGs, while more prone to infection and thrombosis, offer a viable alternative when native vessels are unsuitable. Endovascular AVF creation has demonstrated high technical success and promising long-term outcomes, reducing the need for traditional surgical approaches. Advances in biomaterials and adjunctive pharmacologic therapies may further improve vascular access durability. <b>Conclusions:</b> Individualized vascular access planning remains essential to optimizing hemodialysis outcomes. The evolution of minimally invasive techniques, coupled with improved patient selection criteria and emerging biomaterials, offers new opportunities for enhancing dialysis access longevity. Future research should focus on refining endovascular approaches and integrating novel technologies to minimize complications and improve access patency.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251328396"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694979","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":"Predicting Long-Term Survival after Endovascular Aneurysm Repair Using Machine Learning-Based Decision Tree Analysis.","authors":"Toshiya Nishibe, Tsuyoshi Iwasa, Masaki Kano, Shinobu Akiyama, Shoji Fukuda, Jun Koizumi, Masayasu Nishibe","doi":"10.1177/15385744251329673","DOIUrl":"https://doi.org/10.1177/15385744251329673","url":null,"abstract":"<p><p>ObjectiveEndovascular aneurysm repair (EVAR) has become a preferred method for treating abdominal aortic aneurysms (AAA) due to its minimally invasive approach. However, identifying factors that influence long-term patient outcomes is crucial for improving prognosis. This study investigates whether machine learning (ML)-based decision tree analysis (DTA) can predict long-term survival (over 5 years postoperatively) by uncovering complex patterns in patient data.MethodsWe retrospectively analyzed data from 142 patients who underwent elective EVAR for AAA at Tokyo Medical University Hospital between October 2013 and July 2018. The dataset comprised 24 variables, including age, gender, nutritional status, comorbidities, and surgical details. The decision tree classifier was developed and validated using Python 3.7 and the scikit-learn toolkit.ResultsDTA identified poor nutritional status as the most significant predictor, followed by compromised immunity, active cancer, octogenarians, chronic kidney disease, and chronic obstructive pulmonary disease. The decision tree identified 9 terminal nodes with probabilities of long-term survival. Four of these terminal nodes represented groups of patients with a high probability of long-term survival: 100%, 84%, 77%, and 60%, whereas the other 5 terminal nodes represented groups of patients with a low probability of long-term survival: 17%, 25%, 30%, 45%, and 47%. The model achieved a moderately high accuracy of 76.1%, specificity of 72.4%, sensitivity of 81.8%, precision of 65.2%, and area under the receiver operating characteristic curve of 0.84.ConclusionML-based DTA effectively predicts long-term survival after EVAR, highlighting the importance of comprehensive preoperative assessments and personalized management strategies to improve patient outcomes.</p>","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251329673"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694978","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":"Hospital Volume and Social Determinants of Health Do Not Impact Outcomes in Fenestrated Visceral Segment Endovascular Aortic Repair for Patients Treated at VQI Centers.","authors":"Ruojia Debbie Li, Rylie O'Meara, Priya Rao, Ian Kang, Michael C Soult, Carlos F Bechara, Matthew Blecha","doi":"10.1177/15385744251330017","DOIUrl":"https://doi.org/10.1177/15385744251330017","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectiveThe purpose of this study is to investigate the impact of social determinants of health on access to high volume centers and clinical outcomes in fenestrated abdominal aortic endografting. Further, the effect of center volume in fenestrated endografting on outcomes will be sought as this is ill defined. The data herein have the potential to affect referral patterns and locations of complex fenestrated aortic aneurysm care. If lower volume centers achieve equivalent outcomes to higher volume centers, then limiting access to a small number of centers may not be justified.MethodsVascular Quality Initiative (VQI) was utilized as the data source. Four adverse outcomes categories were investigated : (1) Lack of follow up data in the VQI database at 1 year postoperatively; (2) Thirty day operative mortality; (3) Composite perioperative adverse event outcome; and (4) Twelve month mortality. Social determinants of health exposure variables included rural status, non-metropolitan living area, highest and lowest decile and quintile area deprivation index, insurance status, and non-home living status. Designated categories were created for patients operated on in centers within the top 25% of case volume, centers in the bottom 25% of case volume, and in centers with less than 10 total fenestrated endograft cases. Univariable analyses were performed with Chi-squared testing for categorical variables and &lt;i&gt;t&lt;/i&gt; test for comparison of means. Multivariable binary logistic regression was performed to identify risks for the composite adverse perioperative event.ResultsThere was no statistically significant association with the composite adverse perioperative event category, 30-day mortality or 12-month mortality for any of the social determinants of health or center volume categories. Patients who live in rural areas (&lt;i&gt;P&lt;/i&gt; = .029) and patients with Military/VA insurance (&lt;i&gt;P&lt;/i&gt; &lt; .001) were significantly more likely to be lost to follow up at their index VQI center at 1 year. When accounting for all standard co-morbidities, none of the following variables had any significant association with the composite adverse perioperative event on multivariable analysis: absolute center volume as an ordinal variable (&lt;i&gt;P&lt;/i&gt; = .985); procedure at a bottom 25&lt;sup&gt;th&lt;/sup&gt; percentile volume center (&lt;i&gt;P&lt;/i&gt; = .214); procedure at a center with less than 10 total fenestrated cases in the database (&lt;i&gt;P&lt;/i&gt; = .521); rural home status (&lt;i&gt;P&lt;/i&gt; = .622); remote from metropolitan home status (&lt;i&gt;P&lt;/i&gt; = .619); highest 10% ADI (&lt;i&gt;P&lt;/i&gt; = .903); highest 20% ADI (&lt;i&gt;P&lt;/i&gt; = .219); Lowest 10% of ADI (&lt;i&gt;P&lt;/i&gt; = .397). The variables that had a statistically significant multivariable association with the composite adverse event were 3 or 4 visceral vessels stented vs 2 vessels (&lt;i&gt;P&lt;/i&gt; &lt; .001), baseline renal insufficiency (&lt;i&gt;P&lt;/i&gt; &lt; .001), female sex (&lt;i&gt;P&lt;/i&gt; &lt; .001), ESRD on dialysis (&lt;i&gt;P&lt;/i&gt; = .002), and history of coronary revasculizaiton (&lt;i&gt;P&lt;/i&gt; = .047).","PeriodicalId":94265,"journal":{"name":"Vascular and endovascular surgery","volume":" ","pages":"15385744251330017"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701530","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}