Vasc Endovascular Surg [JOURNAL]
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200 papers
Spinal Infarction Following Bilateral Common Iliac Artery Stenting: A Rare Case Report.
Şimşek S, Sağlam T, Karaca MS
Vasc Endovascular Surg · 2026 Aug · PMID 41974095 · Publisher ↗
Spinal cord infarction is an uncommon but devastating complication of vascular and endovascular procedures and is rarely reported after iliac artery interventions. We present a 53-year-old woman with severe bilateral com...
Spinal cord infarction is an uncommon but devastating complication of vascular and endovascular procedures and is rarely reported after iliac artery interventions. We present a 53-year-old woman with severe bilateral common iliac artery stenoses (>90%) who underwent endovascular revascularization via bilateral femoral access with deployment of a terminal aortic covered stent-graft and bilateral "kissing" covered common iliac artery stents. The procedure was angiographically successful with restoration of inline aortoiliac flow. Within the first few postoperative hours, the patient developed acute bilateral lower-extremity weakness progressing rapidly to complete paraplegia. Spinal MRI demonstrated long-segment acute ischemia/infarction at the thoracolumbar level (T11-L2) with diffusion restriction and low ADC values. Despite supportive management, there was no neurological recovery during hospitalization, and the patient remained paraplegic at discharge. This case underscores that spinal cord infarction, although exceedingly rare, can occur after aortoiliac stenting, likely related to procedure-associated microembolization and/or compromise of pelvic-paraspinal collateral pathways, and highlights the need for careful pre-procedural risk assessment and vigilant post-procedural neurological monitoring in high-risk patients.
The Influence of Procedure Setting on Femoral-Popliteal Endovascular Arterial Intervention Practice Patterns in the Medicare Population.
Potluri V, Pinto Rodriguez P, Yuan K … +6 more , Dossani H, Patel S, Patel M, Nguyen K, Silva MB, Blecha M
Vasc Endovascular Surg · 2026 Aug · PMID 41964303 · Publisher ↗
ObjectiveThe purpose of this study is to investigate the influence of practice location on the type of femoral-popliteal endovascular arterial intervention performed in the Medicare population. Additionally, the study in...
ObjectiveThe purpose of this study is to investigate the influence of practice location on the type of femoral-popliteal endovascular arterial intervention performed in the Medicare population. Additionally, the study investigates the distribution of each intervention type among the primary subspecialty stakeholders in endovascular lower extremity care.MethodsA retrospective analysis of claims data from the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary files for each year between 2011 and 2022 was performed. Physicians were divided into four categories: radiologists, cardiologists, vascular surgeons, or others. Claims data were collected for all Current Procedural Terminology (CPT) codes corresponding to endovascular therapy in the femoral-popliteal arterial segment. These CPT codes include interventions such as angioplasty alone, atherectomy with or without angioplasty, stent placement with or without angioplasty, and atherectomy combined with stent placement. Chi-squared testing was used for univariable comparisons.ResultsA total of 292 453 femoral-popliteal segment procedures were included in the study. 16.7% ( = 48 705) of procedures were performed in an Office-based Laboratory or stand-alone outpatient ambulatory surgical centers (OBL) setting, while 83.3% ( = 243 401) took place in a hospital-based setting. Cardiologists performed 31.8% ( = 92 969), interventional radiologists 16.8% ( = 49 200), other specialties 4% ( = 11 730), and vascular surgeons 48.7% ( = 142 480) of all CMS-insured femoral-popliteal segment endovascular interventions during the study period. By 2016, atherectomy-based procedures surpassed angioplasty and stent-alone procedures within the CMS population. Cardiologists performed the highest number of atherectomy procedures, with or without stenting, in the femoral-popliteal segment ( < .001). However, the overall rate of atherectomy performed by cardiology compared to other subdisciplines was within 3 percentage points and not significantly different. Vascular surgeons performed atherectomy at the lowest rate, but within 4% of cardiologists. Atherectomy procedures were performed nearly twice as often in outpatient-based facilities compared to hospital-based facilities (57.3% vs 31.6%, OR 1.81, < .0001). Vascular surgery (44.2%) and cardiology (29.2%) performed the most OBL-based cases, while interventional radiology accounted for 20.0% and other specialties 6.6% ( < .001).ConclusionsThere was a substantial increase in the use of atherectomy in the femoral-popliteal segment in the OBL setting for the CMS population between 2011 and 2022. The rate of atherectomy use is nearly two-fold higher in the OBL setting compared to hospital-based facilities.
Chronic Kidney Disease Is Associated With a Higher Risk of Complications in Type a Aortic Dissection Repair: A Population Study of National Inpatient Sample From 2015-2020.
Li R, Prastein DJ, Huddleston SJ
Vasc Endovascular Surg · 2026 Aug · PMID 41964295 · Publisher ↗
BackgroundWhile chronic kidney disease (CKD) has been identified as a risk factor for mortality in patients with aortic diseases, its impact on the outcomes of type A aortic dissection (TAAD) repair has not yet been thor...
BackgroundWhile chronic kidney disease (CKD) has been identified as a risk factor for mortality in patients with aortic diseases, its impact on the outcomes of type A aortic dissection (TAAD) repair has not yet been thoroughly investigated. This study aimed to conduct a comprehensive, population-based analysis of the association of CKD with in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without CKD while adjusting for demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status. Additional subgroup analyses compared mild, moderate, and severe CKD patients vs non-CKD patients.ResultsThere were 800 (18.68%) CKD patients and 3482 (81.32%) non-CKD patients who underwent TAAD repair. Patients with and without CKD had comparable in-hospital mortality (aOR = 0.883, 95 CI = 0.671-1.163, = .38) and there was no difference in the transfer-in status or indication of delay from admission to operation. Patients with CKD had higher risks of major adverse cardiovascular event (MACE; aOR = 1.519, 95 CI = 1.115-2.069, = .01), myocardial infarction (MI; aOR = 1.693, 95 CI = 1.135-2.524, = .01), cardiogenic shock (aOR = 1.422, 95 CI = 1.136-1.779, < 0.01), mechanical ventilation (aOR = 1.346, 95 CI = 1.109-1.634, < .01), and acute kidney injury (AKI; aOR = 1.933, 95 CI = 1.596-2.343, < .01). However, CKD patients had a lower rate of pacemaker implantation (aOR = 0.384, 95 CI = 0.167-0.882, = .02). Subgroup analyses demonstrated that compared to those without CKD, mild-CKD patients had largely comparable outcomes, moderate-CKD patients had higher AKI, and severe-CKD patients had higher cardiac complications.ConclusionCKD is a significant risk factor for postoperative complications following TAAD repair. It is essential to closely monitor and manage organ system complications, particularly cardiac and renal complications, in patients with severe and moderate CKD undergoing TAAD repair.
Endovascular Fenestration Using a Coaxial Wingman Catheter Through Preshaped Guiding Catheter for Revascularization of Abdominal Visceral Branches Originating From False Lumen in Aortic Dissection.
Nagatomi S, Kanamori D, Yamamoto H
Vasc Endovascular Surg · 2026 Aug · PMID 41964282 · Publisher ↗
IntroductionFollowing thoracic endovascular aortic repair (TEVAR) for aortic dissection, visceral arteries arising from the false lumen may require revascularization when communication between the true and false lumens i...
IntroductionFollowing thoracic endovascular aortic repair (TEVAR) for aortic dissection, visceral arteries arising from the false lumen may require revascularization when communication between the true and false lumens is naturally occluded or iatrogenically sealed. This study describes an endovascular technique using a Wingman catheter for intimal flap fenestration to establish access for revascularization of abdominal visceral arteries originating from the false lumen.Materials and MethodsA coaxial system was developed by inserting an LRK-shaped catheter within a RE-SS-shaped guiding catheter to maintain shape retention. The Wingman 14C catheter was advanced coaxially through this system to penetrate the intimal flap under biplane fluoroscopic guidance. The created fenestration was dilated with an angioplasty balloon, and this communication pathway was utilized for stent-graft placement to revascularize abdominal visceral arteries arising from the false lumen.ResultsIn 1 patient with type B aortic dissection requiring revascularization of the right renal artery, the coaxial insertion of a Wingman 14C catheter through the preshaped guiding catheter successfully achieved obtuse-angle penetration of the intimal flap without complications. Revascularization of the right renal artery was accomplished, with postoperative imaging demonstrating near-complete false lumen thrombosis and favorable aortic remodeling at 6-month follow-up.ConclusionThis approach represents a useful and safe technique for establishing access to the false lumen in aortic dissection patients when communication between lumens has been eliminated, enabling successful revascularization of visceral arteries originating from the false lumen.
Mid-Term Comparison of N-Butyl Cyanoacrylate, Endovenous Laser Ablation, and Radiofrequency Ablation for Chronic Venous Insufficiency.
Dilek I, Kocaoglu AS, Büyükceran EU … +1 more , Nayman A
Vasc Endovascular Surg · 2026 Aug · PMID 41964281 · Publisher ↗
BackgroundChronic venous insufficiency (CVI) is a prevalent vascular disorder with significant morbidity. Minimally invasive endovenous therapies, including N-butyl cyanoacrylate (NBCA), endovenous laser ablation (EVLA),...
BackgroundChronic venous insufficiency (CVI) is a prevalent vascular disorder with significant morbidity. Minimally invasive endovenous therapies, including N-butyl cyanoacrylate (NBCA), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), are widely used, yet comparative mid-term data remain limited. This study aimed to compare these three modalities.MethodsWe retrospectively reviewed 210 patients (70 per group) treated for CVI with NBCA, EVLA, or RFA between January 2018 and June 2022. Inclusion criteria were symptomatic varicose veins classified as CEAP C2-C4b, GSV diameter >5.5 mm, and reflux >0.5 s. The primary endpoint was vein occlusion rate; secondary endpoints included procedure duration, post-procedural pain (VAS) at 6 hours, return to daily activities, complications, and changes in Venous Clinical Severity Score (VCSS). Follow-up was performed at 1 week, 6 months, 12 months, and annually thereafter.ResultsOcclusion rates were high across groups (EVLA 97.1%, RFA 97.1%, NBCA 96.2%; = 0.595). NBCA had the shortest procedure time (11.9 ± 1.3 min), lowest pain scores (VAS 1.2 ± 0.9), and fastest return to activities (1.1 ± 0.3 days), whereas EVLA showed higher pain scores (VAS 3.3 ± 1.7) and longer recovery (1.7 ± 0.8 days). VCSS improved significantly in all groups at 12 months, with no differences at 24-36 months. Complication rates were low (13.3%), with one deep vein thrombosis in the EVLA group.ConclusionsNBCA, EVLA, and RFA provide effective mid-term occlusion and clinical improvement in CVI. NBCA offers shorter procedure time, lower pain, and faster recovery, while RFA ensures durable outcomes with good tolerance. EVLA remains effective with slightly longer recovery. Technique selection may be guided by clinical context and patient preference.
TRIple moDality: Extraction, Aspiration and Thrombolysis in Pulmonary Embolism. Preliminary Results of the TRIDENT-PE Study.
Torres-Herrera C, Gutierrez-Arias R, Lamich R … +10 more , Zamorano A, Dusaillant G, Adasme F, Goset C, Borques E, Potthoff P, Zamorano J, Pedreros F, Ponce Orellana M, Pedreros P
Vasc Endovascular Surg · 2026 Aug · PMID 41964269 · Publisher ↗
ObjectiveTo evaluate the clinical outcomes and safety of a triple percutaneous treatment protocol involving mechanical thrombolysis, direct thromboaspiration, and low-dose tPA thrombolysis in patients with moderate to hi...
ObjectiveTo evaluate the clinical outcomes and safety of a triple percutaneous treatment protocol involving mechanical thrombolysis, direct thromboaspiration, and low-dose tPA thrombolysis in patients with moderate to high or high-risk pulmonary embolism (PE).DesignSingle-center retrospective cohort study.MethodsWe included patients aged 18 years or older with moderate to high or high-risk PE, as determined by a chest vascular scan. The primary outcome was survival. Secondary outcomes included functional capacity (FC), systolic pulmonary artery pressure (sPAP), right ventricle (RV) dilation, and tricuspid annular plane systolic excursion (TAPSE). All outcomes were assessed at 48-h post-procedure and at the 6-month follow-up. Additionally, the incidence of adverse events was evaluated during the 48-h following the procedure.ResultsThirty-five patients were included, comprising 51.43% males, with a mean age of 55 years (SD 18). Survival at 48-h post-procedure was 97%. Of the 19 patients who followed up for 6 months, 95% survived. Eight patients (23%) had FC I-II at admission, which increased to 91% at 48-h post-procedure and 100% at 6 months of follow-up. At admission, 25 patients (71%) had moderate to severe RV dilation. In contrast, 33 patients (94%) had a normal or slightly dilated RV at 48-h post-procedure, and 100% (n/N 19/19) at 6 months of follow-up. In addition, there was a significant reduction in mean baseline sPAP to 36 mmHg (SD 10.3) at 48-h post-procedure and to 29 mmHg (SD 4.9) at 6-month follow-up ( < .001). TAPSE increased significantly to 20.8 mm (SD 4.8) at 48-h post-procedure and to 22.3 mm (SD 2.8) at 6-month follow-up ( < .001). No adverse events occurred.ConclusionIn patients with moderate to high or high-risk PE, the triple percutaneous treatment protocol appears to be an effective and safe intervention. This strategy achieves high survival and adequate FC, normalizing pulmonary vascular pressures and RV function.
Cystic Artery Pseudoaneurysm Bleed With Gallbladder Perforation - A Challenging Clinical Problem.
Rathore KS, Rai A, Selvakumar B … +5 more , Soni SC, Varshney VK, Varshney P, Agarwal L, Ghosh TS
Vasc Endovascular Surg · 2026 Aug · PMID 41964265 · Publisher ↗
Cystic artery pseudoaneurysm bleed is rare which becomes potentially fatal when associated with gallbladder perforation. We report two cases of elderly men who presented with acute onset abdominal pain, shock, metabolic...
Cystic artery pseudoaneurysm bleed is rare which becomes potentially fatal when associated with gallbladder perforation. We report two cases of elderly men who presented with acute onset abdominal pain, shock, metabolic acidosis, low haemoglobin and deranged renal functions. The first patient was resuscitated and with a clinical diagnosis of gallbladder perforation, a percutaneous drain was inserted. However, due to its haemorrhagic output and slow fall in Hb, a computed tomography abdominal angiography was done later which diagnosed cystic artery pseudoaneurysm, which was coil embolized and he underwent elective cholecystectomy. The second patient was hemodynamically unstable and underwent an emergency laparotomy, ligation of the cystic artery pseudoaneurysm and open cholecystectomy. We discuss the diagnostic and management challenges faced in both these cases.
Endovascular Repair of Huge Twin Aneurysms of Renal Artery and Vein Connected by Arteriovenous Fistula.
Toyoda M, Takagi H, Kitamura T
Vasc Endovascular Surg · 2026 Aug · PMID 41964255 · Publisher ↗
Renal arteriovenous fistula (RAVF) is a rare vascular anomaly, and it becomes exceedingly uncommon when accompanied by a renal vein aneurysm (RVA). While several cases of renal artery aneurysm (RAA) accompanied by RAVF h...
Renal arteriovenous fistula (RAVF) is a rare vascular anomaly, and it becomes exceedingly uncommon when accompanied by a renal vein aneurysm (RVA). While several cases of renal artery aneurysm (RAA) accompanied by RAVF have been sporadically reported, progression from RAA to RAVF and then to RVA has not been previously documented. We present a unique case of a 75-year-old man with chronic kidney disease and hypertension who had a huge RAA and RVA connected by a RAVF. Contrast-enhanced computed tomography revealed an aneurysmal dilation of both the renal artery and renal vein, connected by a high-flow fistulous tract. Given the high risk of rupture and the patient's frailty and comorbidities, endovascular treatment was selected as the initial management strategy. Coil embolization of the renal artery aneurysm was successfully performed, and an aortic extender was deployed using a chimney technique to preserve contralateral renal perfusion. Postoperative imaging demonstrated successful occlusion of the RAA and significant reduction in blood flow through the fistula. During the 3-year follow-up, no enhancement was observed in the RAA, and slight reductions in the size of both the RAA and RVA were noted. To our knowledge, this is the first reported case of a huge RAA and RVA connected by a non-aneurysmal RAVF successfully treated with endovascular therapy, with documented long-term outcomes. This case underscores the feasibility and safety of endovascular intervention in select high-risk patients, even in anatomically complex lesions with high-flow dynamics. As device technology continues to evolve, endovascular repair may increasingly become a first-line option for managing such rare and challenging vascular anomalies.
Vascular Injuries Secondary to Penetrating Neck Trauma.
Patel AM, Bui K, Alonso A … +8 more , Smith SM, Nwachuku EC, King E, Farber A, Sanchez SE, Torres C, Saillant NN, Siracuse JJ
Vasc Endovascular Surg · 2026 Aug · PMID 41958061 · Publisher ↗
ObjectivesPenetrating neck trauma with vascular injury can have significant morbidity. Our goal was to examine the management and outcomes of vascular injuries secondary to penetrating neck trauma.MethodsA single-center...
ObjectivesPenetrating neck trauma with vascular injury can have significant morbidity. Our goal was to examine the management and outcomes of vascular injuries secondary to penetrating neck trauma.MethodsA single-center retrospective study identified patients with penetrating neck trauma with vascular injury (2014-2024). Injury characteristics, management, and subsequent morbidity were analyzed.ResultsThere were 47 patients with penetrating neck trauma and associated vascular injury. The average age was 37.5 years, 80.9% were male, and 57% were of Black race. Mechanisms were stabbing (57.4%), firearm (34%), and other causes, including dog bites (8.5%). Vascular injuries were arterial (23.4%), venous (51.1%), and combined arterial/venous. Concurrent aerodigestive injuries occurred in 23.4% of cases. Median time from injury to emergency department (ED) presentation was 20 minutes, with 48.9% intubated enroute or on arrival. There were 72.3% that had an emergency intervention with median time to operating room of 35-minutes. Open arterial repairs included 10% carotid artery bypass, 35% carotid artery repair, and 55% arterial ligation of neck arteries. Open venous repair included 93.1% ligation and 13.8% primary vein repair. Endovascular interventions were vertebral (67%) and inferior thyroid artery (33%) embolizations. There were 12.8% of patients who died soon after presentation (67% trauma bay and 33% in the operating room), and 12.8% suffered a stroke. There were no 30-days or 1-year deaths after discharge, but 25% of patients had at least one 30-days ED visit. Follow-up imaging was received by 66% of discharged patients with an arterial repair.ConclusionsPenetrating neck trauma with vascular injuries require prompt operative repair and are associated with high initial mortality and stroke rate. Combined arterial and venous injuries are common, and aerodigestive injuries should be considered during initial presentation. High rates of ED utilization post-discharge suggest the need for improved follow-up in this patient population.
Perioperative and Long-Term Outcomes of Lower Extremity Revascularization in Patients With Malignancy.
Cormier L, Cherner A, Cox MW
Vasc Endovascular Surg · 2026 Aug · PMID 41949565 · Full text
ObjectiveCancer patients in general are thought to be poor candidates for lower extremity revascularization procedures due to hypercoagulability, potential need for chemotherapy, or multiple other cancer-related co-morbi...
ObjectiveCancer patients in general are thought to be poor candidates for lower extremity revascularization procedures due to hypercoagulability, potential need for chemotherapy, or multiple other cancer-related co-morbidities. While vascular surgeons may shy away from these patients, only one previous study we found has assessed the effect of this relationship on lower extremity bypass patency, and substantially worse outcomes were documented. Our study aims to quantify the risk of poor outcomes for lower extremity revascularization in a large sample of cancer patients, utilizing the TriNetX database.MethodsWithin the US cohort of 55 healthcare organizations in the TriNetX database, we identified 1419 patients diagnosed with either breast, prostate, colon, or non-small cell lung cancer of any stage and 60 609 patients without diagnosis of those cancers who had undergone either an open infra-inguinal bypass of any graft type or endovascular intervention on the infra-inguinal arteries from September 3, 2004 to September 3, 2024. Propensity score matching was conducted, which yielded 1413 patients analyzed in each group, and incidence of arterial thrombectomy, bypass revision, amputation, and arteriogram were recorded for each group at 30-day and 1-year time points. Secondary subgroup analyses were conducted within the cancer cohort to determine whether rates of the same outcomes listed above varied between open versus endovascular interventions.ResultsIn the primary analysis, there was no significant difference in any of the 4 outcomes between cancer patients and non-cancer patients. In the subgroup analysis, open bypass was found to have a significantly lower incidence of repeat arteriogram within 30 days as compared to endovascular intervention (3.62% vs 7.97%; risk ratio [RR], 0.455, = 0.029) and 1 year (18.84% vs 28.62%; risk ratio [RR], 0.658, = 0.007). All other outcomes in both the 30-day and 1-year follow-up periods for the subgroup analysis did not vary significantly between the 2 groups.ConclusionIt is possible that patients with a recent diagnosis of cancer may not have worse outcomes for lower extremity bypass compared to patients without a cancer diagnosis. Cancer patients undergoing endovascular interventions, in contrast, did require more repeat interventions which may suggest that open interventions are preferable in this population. We would, however, caution that overall limb salvage was reasonable in this patient population and results were not markedly worse with any intervention strategy. Cancer diagnosis should not necessarily be seen as a contraindication to a lower extremity revascularization and should be considered on a case-by-case basis.
Large Right True Subclavian Artery Aneurysm Treated With Hybrid Surgery.
Tsouknidas I, Xu MC, Krosser A … +5 more , Joshi G, Abai B, Nooromid M, DiMuzio P, Salvatore DM
Vasc Endovascular Surg · 2026 Aug · PMID 41733498 · Publisher ↗
Subclavian artery (SCA) aneurysms are rare, accounting for less than 1% of peripheral aneurysms. Repair is indicated due to the risk of complications. The electronic medical records in our institution were reviewed and...
Subclavian artery (SCA) aneurysms are rare, accounting for less than 1% of peripheral aneurysms. Repair is indicated due to the risk of complications. The electronic medical records in our institution were reviewed and the case of a patient with large right SCA is presented. An 80 year-old female, with complex medical history, presented with a large right SCA aneurysm. She was deemed high risk for open repair and underwent innominate and common carotid artery stent graft placement, embolization of the sac, and carotid to axillary artery bypass. Her clinical course was complicated by an atheroembolic multiterritorial stroke, and she was found to be clopidogrel resistant. She was discharged to a rehabilitation facility and was recovering well at 3 months after surgery. Detailed and careful pre-operative planning, as well as familiarity with the different surgical approaches is necessary for the best outcomes.
Non-Surgical Pneumoperitoneum After Fenestrated Endovascular Aortic Repair- Case Report.
Apostolidis G, Panuccio G, Nana P … +3 more , Torrealba JI, Al Sarhan DY, Kölbel T
Vasc Endovascular Surg · 2026 Aug · PMID 41733324 · Full text
ObjectivePost-operative pneumoperitoneum is mainly related to gastrointestinal perforation, although non-surgical pneumoperitoneum may also be present, with mechanical ventilation being the leading cause. Herein, we repo...
ObjectivePost-operative pneumoperitoneum is mainly related to gastrointestinal perforation, although non-surgical pneumoperitoneum may also be present, with mechanical ventilation being the leading cause. Herein, we report a case of non-surgical pneumoperitoneum after percutaneous fenestrated endovascular aortic repair (fEVAR).Case reportA 79-year-old female presented with a 58 mm asymptomatic juxtarenal abdominal aortic aneurysm. The preoperative computed tomography angiography (CTA) detected also a diaphragmatic hernia. According to the latest guidelines, an indication for fEVAR was set. The successful implantation of a four-fenestrated custom-made endograft was performed using bilateral percutaneous femoral access. Even though the immediate postoperative period was uneventful, the predischarge CTA revealed a high-volume pneumoperitoneum and pneumomediastinum. The patient developed mild tenderness of the lower abdomen during palpation, and a postoperative elevation of the C-reactive protein (CRP = 205 mg/L) was identified. After general surgery consultation, an exploratory laparoscopy with intraoperative gastro-duodenoscopy were performed, which revealed no evidence of gastrointestinal perforation. The patient was discharged in good general condition on the sixth postoperative day.ConclusionPost-operative pneumoperitoneum may be related to mechanical ventilation due to alveolar injury after fEVAR. Laboratory and imaging findings should be judged in the influence of clinical image. An initial watch and wait approach may be justified.
Median Arcuate Ligament Compressing Multiple Arteries in a Young Man Treated by Surgical Release.
Saikrishana E, Selvakumar B, Yadav T … +5 more , Soni SC, Varshney P, Agarwal L, Birda CL, Rai A
Vasc Endovascular Surg · 2026 Aug · PMID 41718526 · Publisher ↗
Asymptomatic compression of celiac artery (CA) by median arcuate ligament (MAL) is quite common, but simultaneous compression of other arteries by MAL is very rare. A 20-year-old man presented with post-prandial epigast...
Asymptomatic compression of celiac artery (CA) by median arcuate ligament (MAL) is quite common, but simultaneous compression of other arteries by MAL is very rare. A 20-year-old man presented with post-prandial epigastric pain for the past 1 year and a 5 kg weight loss. On examination, he had a body mass index of 17.2 kg/m and was normotensive. Blood tests were unremarkable except for a mildly raised serum creatinine. A CT angiography (CTA) showed MAL-related 60% proximal CA narrowing and 40% proximal right renal artery (RRA) narrowing with a small right kidney. After multi-disciplinary team discussion, surgical MAL release at both sites was planned. The surgery was started laparoscopically to identify CA origin by a 'top to down' approach. The CA origin could not be visualised as it was looping behind the pancreatic neck caudally; hence the procedure was converted to open. CA origin was identified and overlying MAL divided. After kocherisation, RRA origin was found compressed by right limb of MAL and was divided. The operative duration was 200 mins with 50 mL blood loss. The patient had an uneventful recovery. At 12-month, he is asymptomatic with serum creatinine normalised and gained 8 kg weight. A follow-up CTA at 2 months showed a normal CA and RRA. In this report, we discuss briefly about the current presentation, diagnosis and treatment of MAL compression of CA and other upper abdominal arteries. The learning point from this case is that one should carefully inspect all upper abdominal arteries in CTA for MAL-related compression as they may be asymptomatic, and this enables simultaneous treatment at these sites too in a single surgery.
A New Technique Using a Stent and a Plug for the Management of Persistent Type IIIc Endoleak Following Fenestrated Endovascular Aortic Repair (FEVAR).
Alsarayreh M, Farber MA, Parodi FE
Vasc Endovascular Surg · 2026 Jul · PMID 41711099 · Full text
Fenestrated endovascular repair (FEVAR) has become a safe and effective option for the treatment of complex aortic aneurysms (CAA). Complications can occur, including endoleaks like type IIIc endoleak, characterized by f...
Fenestrated endovascular repair (FEVAR) has become a safe and effective option for the treatment of complex aortic aneurysms (CAA). Complications can occur, including endoleaks like type IIIc endoleak, characterized by flow between a fenestration and its bridging stent. Although some endoleaks may resolve spontaneously, most require secondary interventions to prevent further expansion of the aneurysmal sac and other complications. We describe a percutaneous "stent-and-plug" rescue maneuver performed in 5 consecutive patients with refractory type IIIc endoleaks after company-manufactured FEVAR grafts. Under moderate sedation and bilateral femoral access, the target-vessel stent was balloon-protected while the free space of the fenestration causing the endoleak was catheterized contralaterally; a 5 × 16 mm iCast™ stent was deployed within the fenestration, and an Amplatzer vascular plug was positioned inside the new stent. Then, the renal-stent balloon was re-inflated to crush the stent-plug complex and achieve a seal in the fenestration. Endoleaks emerged at a mean of 2.47 months (range 1.10-7.1) after the index repair, persisting despite one (n = 3) or 2 (n = 2) prior angioplasty or re-stenting attempts. The stent-and-plug technique achieved technical success in 4 of the 5 cases; the remaining case required one additional procedure to achieve complete sealing. No renal branch occlusion, dialysis-requiring renal injury, or procedure-related mortality occurred. The mean follow-up after rescue was 8.96 months (range 1.4-15.3), with no sac growth observed. Stenting and plugging the fenestration-free space offers a feasible option for treating persistent type IIIc endoleaks when conventional secondary interventions fail; extended surveillance is necessary to confirm long-term durability.
Outcomes of In-Situ Reconstruction of Secondary Aorto-Enteric Fistulas.
Figl J, Papes D
Vasc Endovascular Surg · 2026 Jul · PMID 41706095 · Publisher ↗
Background and PurposeSecondary aorto-enteric fistulas (SAEF) are the most severe form of aortic graft infection, with a mortality of over 50% during the first year after diagnosis.Materials and MethodsA retrospective re...
Background and PurposeSecondary aorto-enteric fistulas (SAEF) are the most severe form of aortic graft infection, with a mortality of over 50% during the first year after diagnosis.Materials and MethodsA retrospective review of patients treated for SAEF from 2015 to 2021 in University Hospital Centre Zagreb was done to analyze factors that determine the outcome. There were 7 cases of SAEF among 400 cases of open aortic surgery. Mean patient age was 69 years (range 63-88).ResultsFive patients underwent graft removal and in-situ aortic reconstruction using a cryopreserved homograft or a prosthetic Dacron silver graft (Vascutec Gelsoft Plus, Terumo, Tokyo, Japan). In 1 patient direct suture repair of the fistula was done, and the patient underwent recurrent SAEF reconstruction with cryopreserved homograft a year later. There were 3 recurrences of SAEF in 2 patients, 1 case of disruption of the duodenal suture line, and 1 case of cryopreserved graft necrosis and rupture necessitating emergency extra-anatomic bypass. Overall, 1 patient died during surgery (in-hospital mortality 1/7, 15%), and 3 patients are currently alive (follow-up 4-5 years). Overall 1-month survival, 1-year survival and 3-year-survival were 6/7 (85%). All patients received antibiotics for 6 weeks postoperatively.ConclusionThere is no unique, the best, treatment modality proven in the literature for SAEF, so every case should be analyzed for itself. Prolonged antibiotic therapy, complications and re-interventions are common among these patients, so meticulous follow-up is necessary.
Endovascular Management of Tibial Occlusive Disease With Concomitant Metatarsal Pseudoaneurysm and Arteriovenous Fistula in a Diabetic Foot: A Limb Salvage Case.
Jalili J, Akhavi Milani A, Vaseghi S … +3 more , Pourghorban R, Hakimzadeh Z, Malekshoar M
Vasc Endovascular Surg · 2026 Aug · PMID 41706025 · Publisher ↗
BackgroundDiabetic foot ulcers (DFUs) complicated by critical limb ischemia (CLI) present a major therapeutic challenge, especially when associated with chronic total occlusions (CTOs) of below-the-knee (BTK) arteries or...
BackgroundDiabetic foot ulcers (DFUs) complicated by critical limb ischemia (CLI) present a major therapeutic challenge, especially when associated with chronic total occlusions (CTOs) of below-the-knee (BTK) arteries or vascular lesions such as pedal pseudoaneurysms and arteriovenous fistulas (AVFs). While endovascular techniques have expanded the therapeutic landscape, such anatomically complex cases require tailored, multidisciplinary strategies to achieve successful limb salvage.Case PresentationWe report the case of a 52-year-old male with type II diabetes mellitus, end-stage renal disease (ESRD), and a chronic non-healing DFU. Imaging revealed a CTO of the posterior tibial artery (PTA) and pedal-plantar loop, significant stenosis of the dorsalis pedis artery (DPA), and a distal metatarsal artery pseudoaneurysm with an AVF. The patient underwent successful retrograde endovascular recanalization using the pedal-plantar loop technique and flossing-wire method, followed by balloon angioplasty of the DPA and PTA. Coil embolization of the pseudoaneurysm and AVF was performed using a sandwich technique.OutcomeThe patient experienced no peri-procedural complications. Perfusion parameters improved significantly, and complete wound healing was achieved during follow-up. No recurrence, re-intervention, or amputation occurred within 12 months.ConclusionThis case highlights the feasibility and effectiveness of a fully endovascular, hybrid approach for managing complex BTK occlusions combined with distal vascular lesions. The integration of revascularization and targeted embolization in a single session can optimize outcomes in patients with limb-threatening DFUs.
Comparative Outcomes of Carotid Endarterectomy and Carotid Artery Stenting: A Single-Center Experience.
Çelik MC, Çelikten AE, Dolu AK … +8 more , Yiğit G, Türkmen U, Çelik ÖB, Doğru Yılmaz CY, Kalçık M, Yetim M, Bekar L, Karavelioğlu Y
Vasc Endovascular Surg · 2026 Jul · PMID 41642935 · Publisher ↗
BackgroundCarotid endarterectomy (CEA) is recommended as the standard revascularization strategy for patients with carotid stenosis, whereas carotid artery stenting (CAS) is generally reserved for high-risk surgical cand...
BackgroundCarotid endarterectomy (CEA) is recommended as the standard revascularization strategy for patients with carotid stenosis, whereas carotid artery stenting (CAS) is generally reserved for high-risk surgical candidates. However, evidence comparing the safety and efficacy of both approaches in real-world practice remains heterogeneous.MethodsWe retrospectively analyzed 202 patients (mean age: 71.1 ± 8.5 years; 152 males, 75.2%) who underwent carotid revascularization at a single center between October 2016 and April 2025. Patients with symptomatic moderate-to-severe stenosis (50-99%) and asymptomatic severe stenosis (70-99%) were included. Based on the revascularization strategy, patients were divided into CEA (n = 67) and CAS (n = 135) groups. Periprocedural (30-day), 1 and 3-year outcomes including stroke, myocardial infarction (MI), and all-cause mortality were evaluated.ResultsAmong patients, periprocedural stroke occurred in 4.5% of CEA patients and 2.2% of CAS patients ( = 0.653), MI in 1.5% and 0%, ( = 0.720), and all-cause mortality in 4.5% and 0.7% ( = 0.208) respectively. At 1-year follow-up, MI was significantly more frequent after CEA compared with CAS (8.6% vs 1.5%, = 0.029), whereas stroke (8.6% vs 5.3%, = 0.387) and all-cause mortality (10.3% vs 12.9%, = 0.622) did not differ significantly. At 3 years, rates of stroke (12.3% vs 5.3%), MI (10.3% vs 3.8%), and all-cause mortality (22.4% vs 15.9%) were numerically higher in the CEA group, although these differences were not statistically significant. Subgroup analyses according to symptomatic status demonstrated no significant differences in 30-day, 1 or 3-year rates of stroke, MI, or all-cause mortality between the CEA and CAS groups.ConclusionIn this single-center experience, CAS achieved peri-procedural and short-term outcomes comparable to CEA, despite being performed in a more frail and comorbid patient population. These findings suggest that CAS may represent a safe and effective alternative to CEA in high-risk surgical candidates when performed by experienced operators within a multidisciplinary framework.
A Systematic Review of Interventions Designed to Reduce Surgical Site Infection in Patients Who Undergo Transmetatarsal Amputation.
Jess R, Das K, Alawattegama LH … +13 more , Al-Saadi N, Bosanquet D, Chetter I, Fabre I, Garnham A, Gwilym B, Hitchman L, Hughes T, Long J, Magill L, Pinkney T, Popplewell M, Wall M
Vasc Endovascular Surg · 2026 Jul · PMID 41618980 · Publisher ↗
IntroductionSurgical site infection (SSI) following transmetatarsal amputation (TMA) is thought to be common. In patients who have peripheral arterial disease (PAD) or diabetes related foot complications, little is known...
IntroductionSurgical site infection (SSI) following transmetatarsal amputation (TMA) is thought to be common. In patients who have peripheral arterial disease (PAD) or diabetes related foot complications, little is known regarding the effectiveness of interventions designed to reduce SSI following TMA. Our aim was to perform a systematic review of the literature to inform practice and highlight areas that warrant further research to reduce SSI post TMA.MethodsThis review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance and was prospectively registered with the International Prospective Register of Systematic Reviews (CRD4202454958). MEDLINE, EMBASE and Cochrane databases were searched using a predefined search strategy, without date restriction. All randomised controlled trials (RCTs) and observational studies including patients that underwent TMA due to PAD or complications of diabetes related foot disease, with at least 1 intervention designed to promote wound healing or reduce SSI were included. Bias was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.ResultsThe initial search identified 445 papers. Two RCTs and three observational studies, reporting on 378 TMAs and four interventions, were included. The effect of post-operative antibiotic use on the incidence of SSI differed between the studies. The use of antibiotic-impregnated beads embedded within the soft tissues prior to wound closure were associated with a reduction in SSI rate. The use of Negative Pressure Wound Therapy (NPWT) was associated with a reduction in SSI incidence and faster wound healing. No significant difference was identified in the incidence of SSI between different skin preparations.ConclusionData regarding interventions to prevent SSI following TMA are sparse in the current literature. Prolonged post-operative antibiotic use could reduce SSI, while NPWT and antibiotic beads may be beneficial to wound healing. However, larger more robust RCTs are required to confirm these findings.
Claudication and Hypertension From Aortic Occlusion in Takayasu Arteritis: Revascularization With Excimer Laser and Drug-Eluting Stent.
Yao S, Di X, Chen Y
Vasc Endovascular Surg · 2026 Jul · PMID 41556275 · Publisher ↗
ObjectiveTo evaluate the efficacy of a multimodal endovascular approach integrating excimer laser atherectomy (ELA), percutaneous transluminal angioplasty (PTA), and drug-eluting stent (DES) implantation for managing com...
ObjectiveTo evaluate the efficacy of a multimodal endovascular approach integrating excimer laser atherectomy (ELA), percutaneous transluminal angioplasty (PTA), and drug-eluting stent (DES) implantation for managing complex aortic occlusion in Takayasu arteritis (TA).MethodsA 24-year-old female with TA presented with progressively debilitating clinical manifestations, including severe hypertension (217/126 mmHg) and bilateral lower limb claudication that significantly impaired daily function despite medical management. Imaging confirmed a chronic infra-renal aortic occlusion. Given the lesion complexity and the patient's young age, a multidisciplinary team decision prioritized a minimally invasive approach to avoid the higher risks of open surgery. The selected strategy sequentially integrated ELA for controlled debulking of the fibrotic occlusion and DES implantation to mitigate long-term restenosis risk.ResultsAt 6-month follow-up, ankle-brachial indices improved bilaterally, with normalized systolic blood pressure and absence of claudication. Postoperative contrast-enhanced computed tomography angiography (CTA) confirmed sustained aortic artery patency without restenosis or collateral formation.ConclusionThis case demonstrates the feasibility of ELA and DES integration as a minimally invasive strategy for TA-related aortic lesions, achieving durable hemodynamic and clinical outcomes.
Blunt Abdominal Aortic Injury Managed Successfully With Endovascular Stent Graft.
Shah D, Tsouknidas I, Feeney KM … +2 more , Tong RT, Hirsch H
Vasc Endovascular Surg · 2026 Apr · PMID 41507109 · Publisher ↗
Blunt abdominal aortic injury has a low incidence and accounts for only 4-6% of aortic injuries. Both prognosis and management depend on the type and the severity of injury.A 23 year-old female patient presented after a...
Blunt abdominal aortic injury has a low incidence and accounts for only 4-6% of aortic injuries. Both prognosis and management depend on the type and the severity of injury.A 23 year-old female patient presented after a high speed motor vehicle collision, with a focal dissection and a near complete occlusion of the distal aorta leading to acute limb ischemia, an unstable L1-L2 spinal fracture and a grade 3 liver laceration. An endovascular repair with an aortobiiliac stent graft was performed with resolution of her ischemic lower extremity pain. At 18 months follow-up visit, the aortoiliac axis was widely patent and the stent was intact.
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