Vasc Endovascular Surg [JOURNAL]
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200 papers
Long Term Outcomes of TEVAR for Blunt Thoracic Aortic Injury.
Kumar M, Madison M, Zielke T … +5 more , Brenner R, Aridi H, Corvera J, Fajardo A, Motaganahalli RL
Vasc Endovascular Surg · 2026 Jul · PMID 41467402 · Publisher ↗
ObjectivesThoracic Endovascular Aortic Repair (TEVAR) is now the standard of care for management of aortic injury from trauma. Long term outcomes stratified by the severity of the aortic injury are limited.MethodsThis is...
ObjectivesThoracic Endovascular Aortic Repair (TEVAR) is now the standard of care for management of aortic injury from trauma. Long term outcomes stratified by the severity of the aortic injury are limited.MethodsThis is a single center retrospective analysis of all patients undergoing TEVAR for trauma between January 2008-November 2023. Long term outcomes of mortality and re-intervention were stratified and compared based on the blunt thoracic aortic injury score. Kaplan Meier analysis was used to compute one year and 5-year survival.ResultsA total of 104 patients (age 42 ± 15 years; 72 males; 69%) underwent TEVAR for trauma. Most repairs were for grade 3 (59 patients, 57%) or grade 4 (30 patients, 29%) blunt aortic injuries. The remaining patients included grade 1 (1 patient, 1%), grade 2 (14 patients; 13%). Grade 4 injuries were not associated with higher rate of concomitant neurologic injuries ( = 0.33) or death ( = 0.74). Eighty-seven percent patients had a mean follow up of 4.2 ± 3.3 years. Two patients died due to aortic related causes within 30 days (intra-operative hemorrhage in one patient, graft collapse in one patient who had an unsuccessful exploratory thoracotomy). Overall, one year survival was 92%, and 5-year survival was 88% by Kaplan Meier analysis. Patients with neurologic injury trended toward higher mortality in Kaplan Meier analysis but this was not statistically significant (log rank = 0.22). The grade of injury was not significant for long term survival (log rank = 0.81). Early reintervention was required in 2% patients with none required in long-term. Age>40 ( = 0.17), female sex ( = 0.34) and graft diameter>26 mm ( = 0.41) were not significant for re-intervention. None of the patients experienced endoleaks or spinal cord ischemia.ConclusionsTEVAR is a durable repair for patients with BTAI requiring no re-intervention after one year follow-up. CT surveillance of TEVAR in setting of trauma should be limited to 1 and 5 years after surgery. Long term survival is not related to severity of BTAI.
Comparison of Different Machine Learning Methods in Prediction of Long-Term Survival After Endovascular Aneurysm Repair.
Nishibe T, Iwasa T, Toda N … +6 more , Akiyama S, Kano M, Iwahori A, Fukuda S, Koizumi J, Nishibe M
Vasc Endovascular Surg · 2026 Jul · PMID 41432071 · Publisher ↗
PurposeLong-term survival after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains a clinical concern, particularly in elderly patients with comorbidities. This study aimed to compare different mac...
PurposeLong-term survival after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains a clinical concern, particularly in elderly patients with comorbidities. This study aimed to compare different machine learning (ML) models that capture complex, nonlinear relationships among clinical variables to predict 5-year all-cause mortality following EVAR.MethodsWe retrospectively analyzed 142 patients who underwent elective EVAR between 2013 and 2018. Predictive models for 5-year mortality were developed using 3 supervised ML algorithms: Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Support Vector Classification (SVC). Each model was trained on the entire dataset and internally validated through 5-fold cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, precision, F1 score, and area under the curve (AUC) based on the training set and 5-fold cross-validation. Feature importance was assessed for RF and XGBoost.ResultsThe RF demonstrated the most consistent performance (training AUC 0.80; cross-validation AUC 0.77 ± 0.07). XGBoost achieved the highest training accuracy (0.85) but had lower cross-validation AUC (0.68 ± 0.05). SVC showed stable but modest performance. Key predictors identified by RF and XGBoost included poor nutritional status, octogenarian status, compromised immunity, and active cancer.ConclusionsTree-based ML models, especially RF, may effectively predict long-term survival after EVAR. Incorporating key clinical predictors into preoperative assessment may enhance risk stratification. Future studies should explore external validation and integration with time-to-event models such as Cox proportional hazards, to enhance prognostic accuracy.
From Scores to Scholarship: Evolving Metrics in Vascular Surgery Residency Admissions.
Zazay I, Burmeister JR, Ortiz De Elguea-Lizarraga JI … +3 more , Cormier L, Cherner A, Cox M
Vasc Endovascular Surg · 2026 Jul · PMID 41432051 · Full text
BackgroundIn 2022, the United States Medical Licensing Examination (USMLE) Step 1 transitioned to a pass/fail format, removing a long-standing objective measure from residency applications. This shift led applicants and/...
BackgroundIn 2022, the United States Medical Licensing Examination (USMLE) Step 1 transitioned to a pass/fail format, removing a long-standing objective measure from residency applications. This shift led applicants and/or residency program directors to place increased emphasis on alternative metrics such as research output (RO), though how much programs value this remains unclear. This study explores RO trends among vascular surgery applicants from 2014-2024 and compares them by applicant type and across other competitive surgical specialties.MethodsNRMP Charting Outcomes in the Match reports (2014-2024) were reviewed. The mean number of abstracts, presentations, and peer-reviewed publications (RO) was collected for matched and unmatched U.S. MD seniors applying to vascular surgery. RO data for Doctor of Osteopathic Medicine (DO) and non-U.S. international medical graduate (IMG) applicants were also reviewed for completeness.ResultsRO among matched U.S. MD vascular surgery applicants rose by 54.7%, from 7.0 in 2014 to 12.8 in 2024. The most marked increase occurred between 2018 and 2022 (8.3 to 12.4; +67%), with growth plateauing thereafter after 2022. In contrast, RO among matched DO and IMG applicants declined: DO applicants dropped from 21.3 in 2022 to 9.0 in 2024, and IMG applicants from 60.3 in 2020 to 38.3 in 2024. However, 2024 sample sizes were small, 137 matched U.S. MDs vs only 3 DOs and 6 IMGs, limiting direct comparisons.ConclusionWhile RO among vascular surgery applicants surged after Step 1 became pass/fail, the recent plateau suggests a transient response rather than ongoing growth, differing from trends in other surgical subspecialties. These findings raise concerns about equity and added pressure on underrepresented applicants. Further research is needed to clarify RO's actual role in residency selection and inform fairer evaluation practices.
Novel Use of Lysis-Assisted Covered Endovascular Reconstruction of the Aortic Bifurcation (LA CERAB) in Acute Aortobiiliac Graft Thrombosis: A Case Report.
Anifowose AO, Mann A, Sidhu H … +1 more , Cwinn M
Vasc Endovascular Surg · 2026 Jul · PMID 41432032 · Full text
IntroductionAcute aortic occlusion (AAO) is a rare, life-threatening condition presenting with severe ischemia and requiring urgent intervention. While traditional open surgical approaches, including aortobifemoral and a...
IntroductionAcute aortic occlusion (AAO) is a rare, life-threatening condition presenting with severe ischemia and requiring urgent intervention. While traditional open surgical approaches, including aortobifemoral and axillobifemoral bypasses, are well-established, endovascular techniques such as Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) have emerged as promising alternatives in select cases. This case introduces a novel modification termed Lysis Assisted CERAB (LA CERAB), combining thrombolysis and CERAB to manage acute graft occlusions.MethodsSingle-institution case report highlighting the utility of the LA CERAB technique in select patients.ResultsA 67-year-old male presented two years post-open aortobiiliac aneurysm repair with acute abdominal pain and bilateral limb ischemia without motor impairment. Initial CTA demonstrated complete thrombosis of his graft. He underwent percutaneous bilateral transfemoral catheter-directed thrombolysis. Post-thrombolysis angiography showed graft patency but significant residual thrombus. Subsequent LA CERAB successfully re-lined the graft, secured residual thrombus, and restored perfusion. The patient had an uneventful recovery, discharged home on therapeutic anticoagulation. Follow-up CTA at 2 months demonstrated sustained graft patency. This case highlights its applicability to acute presentations and adds to a growing body of literature on acute aortic graft occlusion interventions.ConclusionThe LA CERAB technique can serve as a novel, minimally invasive approach for select AAO patients presenting with high morbidity risks for transition open surgery. This case underscores patient-specific considerations in treatment strategy selection, illustrating how individualized surgical approaches can achieve favorable immediate and sustained clinical outcomes for future patients.
Staged Fenestrated Endovascular Aneurysm Repair Using Femoral Conduits in a Patient with Aortoiliac Occlusive Disease and Contemporary Literature Review.
Coffman DL, Farres H, Mahajan BM … +4 more , Alsabbagh Y, Jacobs C, Polania-Sandoval C, Erben YM
Vasc Endovascular Surg · 2026 Jul · PMID 41432028 · Publisher ↗
Patients with abdominal aortic aneurysms (AAA) often have comorbidities that make them poor candidates for open surgical repair (OSR). Endovascular aortic aneurysm repair (EVAR) circumvents the morbidity associated with...
Patients with abdominal aortic aneurysms (AAA) often have comorbidities that make them poor candidates for open surgical repair (OSR). Endovascular aortic aneurysm repair (EVAR) circumvents the morbidity associated with OSR of AAA. Candidacy for EVAR is impacted by multiple factors, including the quality and size of vascular access vessels and involvement of visceral arteries, as seen in paravisceral abdominal aortic aneurysms (PVAAA). Additional challenges, such as obesity, can complicate vascular access during EVAR. PVAAA may be better suited for fenestrated EVAR (FEVAR) using a physician-modified endograft (PMEG). In this report, we describe the case of a 64-year-old female patient with a complex PVAAA in the setting of significant aortoiliac occlusive disease (AIOD) with intermittent claudication. We describe a successful staged FEVAR technique in which vascular access challenges were first addressed by recanalization of the iliac system with femoral conduit (FC) creation, followed by successful FEVAR using bilateral FC for deployment of the PMEG. Patients with PAAA have unique and complex pathology that are clinically challenging to address. It is not uncommon that these patients also have co-morbid conditions that make them less-than ideal candidates for open repair. Patients may also have other conditions such as AIOD which make EVAR complex. Staged approach with iliac recanalization and femoral conduit creation followed by FEVAR with PMEG is an effective treatment option for high-risk complex patients and can help avoid common complications such as groin infection and delay in FEVAR which may result in a catastrophic event such as interval AAA rupture.
Primary Retroperitoneal Tumors Presenting as Ruptured Aneurysms.
Kwon YIC, Zhu DT, Farooq SA … +1 more , Larson R
Vasc Endovascular Surg · 2026 May · PMID 41424308 · Publisher ↗
BackgroundRetroperitoneal tumors represent a variety of rare lesions that can arise either from solid organs (kidney, pancreas, adrenals) or less commonly the mesenchymal soft tissue. Depending on histologic subtype, the...
BackgroundRetroperitoneal tumors represent a variety of rare lesions that can arise either from solid organs (kidney, pancreas, adrenals) or less commonly the mesenchymal soft tissue. Depending on histologic subtype, these malignancies often have a variable clinical presentation and prognosis.Case presentationIn the current series, we present 2 cases: first, a patient with Stage 3 retroperitoneal sarcoma eroding the para-visceral aorta causing rupture; second, a kidney transplant recipient with non-Hodgkin's lymphoma presenting as a ruptured right hypogastric arterial aneurysm.ConclusionWe discuss the caveats and pitfalls in diagnosing and treating these complex tumors including clinical and radiographic presentation.
Venous Thrombosis Prophylaxis after Endovenous and Open Surgery for Varicose Veins: A Systematic Review and Network Meta-Analysis.
Ye S, Chen J, Ju J … +1 more , Yang L
Vasc Endovascular Surg · 2026 May · PMID 41424201 · Publisher ↗
BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This stud...
BackgroundVaricose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.MethodsA comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.ResultsA total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.ConclusionsPostoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.
Second-Generation Hydrogel Coils for Transcatheter Arterial Embolization of Acute Arterial Bleeding in the Body Trunk.
Shimohira M, Ikeda S, Ozaki S … +9 more , Saga T, Nakano Y, Takahata K, Maruchi Y, Narita A, Okada H, Yamamoto T, Matsunaga N, Suzuki K
Vasc Endovascular Surg · 2026 May · PMID 41420434 · Publisher ↗
IntroductionFirst-generation hydrogel coils have been shown to reduce the risk of recanalization due to their expansion properties. However, their clinical use has been limited by coil stiffness and time constraints for...
IntroductionFirst-generation hydrogel coils have been shown to reduce the risk of recanalization due to their expansion properties. However, their clinical use has been limited by coil stiffness and time constraints for deployment. Recently developed second-generation hydrogel coils are softer and offer improved deliverability. This study aimed to evaluate their feasibility and effectiveness in transcatheter arterial embolization (TAE) for acute arterial bleeding in the body trunk.MethodsThis retrospective study included 24 TAE procedures performed in 23 patients (15 men, 8 women; median age, 72 years; range, 14-88 years) between March 2019 and November 2024. Indications for TAE included iatrogenic injury (n = 7), gastrointestinal bleeding (n = 5), trauma (n = 3), aneurysm rupture (n = 3), tumor invasion (n = 3), and others (n = 3). Second-generation hydrogel coils were used in all cases, comprising a median of 78% (range, 13-100%) of the total coil length. Technical success was defined as complete occlusion of the target artery on digital subtraction angiography. Clinical success was defined as the absence of rebleeding within 24 h of embolization.ResultsAnemia, hemorrhagic shock, and coagulopathy were present before TAE in 92% (22/24), 21% (5/24), and 25% (6/24) of procedures, respectively. The mean total coil length was 40 cm (range, 4-127 cm), and the mean procedure time was 111 min (range, 58-207 min). Both technical and clinical success rates were 100% (24/24). One complication (4%) occurred: transient liver dysfunction in a patient treated for hepatic artery bleeding.ConclusionsTAE using second-generation hydrogel coils showed high technical and clinical success rates, indicating that these coils may be a feasible and effective option for managing acute arterial hemorrhage in the body trunk.
Propensity Score-Adjusted Comparative Analysis of Modified Eversion Versus Conventional Carotid Endarterectomy: Early Clinical Outcomes and Survival.
Yoon TH, Jeon BH, Lee CH … +2 more , Jang JS, Cho JW
Vasc Endovascular Surg · 2026 May · PMID 41420426 · Publisher ↗
BackgroundCarotid endarterectomy (CEA) remains the standard surgical intervention for carotid stenosis. While the conventional CEA (cCEA) and eversion techniques have been widely investigated, data on the clinical implic...
BackgroundCarotid endarterectomy (CEA) remains the standard surgical intervention for carotid stenosis. While the conventional CEA (cCEA) and eversion techniques have been widely investigated, data on the clinical implications of modified eversion CEA (meCEA), which employs a limited arteriotomy of the carotid bulb, remain scarce. This study aimed to compare the early and mid-term outcomes of meCEA with those of cCEA using adjusted analyses.MethodsIn this retrospective study, 206 patients who underwent CEA between 2015 and 2025 at Daegu Catholic University Hospital were included. Patients were divided into the cCEA (n = 170) and meCEA (n = 36) groups. Baseline characteristics, operative profiles, and postoperative complications were compared using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to adjust for potential confounding. Overall survival (OS) and event-free survival (EFS) were evaluated using IPTW-adjusted Kaplan-Meier and Cox proportional hazards models.ResultsThe meCEA group showed marked intraoperative advantages, including a significantly lower rate of patch angioplasty (25.0% vs 87.1%), shorter operative time (94.3 ± 24.5 vs 139.8 ± 43.7 min), and reduced internal carotid artery clamp time (35.0 ± 12.7 vs 48.5 ± 12.5 min; all < 0.001). No significant differences were observed in postoperative stroke, transient ischemic attack, or in-hospital mortality after PSM adjustment. IPTW-adjusted survival analysis revealed no statistically significant differences in OS (HR: 1.09, 95% CI: 0.38-3.14, = 0.87) or EFS (HR: 1.29, 95% CI: 0.52-3.23, = 0.581) between the groups. However, interpretation of long-term outcomes was limited by a shorter follow-up duration in the meCEA group (22.7 vs 63.9 months).ConclusionsThe meCEA technique offers significant operative benefits while demonstrating comparable early and mid-term safety profiles to conventional CEA. Although no significant survival difference was observed after adjustment, the results suggest that meCEA may serve as an effective alternative to cCEA. Further prospective studies with longer follow-up are needed to validate these findings.
Use of the ExoSeal Vascular Closure Device in Patients With Peripheral Artery Disease: Risk Analysis of Deployment Failure and Prolonged Hemostasis.
Okusako R, Kobayashi T, Okazaki T … +2 more , Hamamoto M, Takahashi S
Vasc Endovascular Surg · 2026 May · PMID 41420402 · Publisher ↗
ObjectivesEndovascular treatment (EVT) of lower extremity artery disease (LEAD) is minimally invasive and has good safety and efficacy. Puncture site complications are common in EVT, but these and the hemostatic time hav...
ObjectivesEndovascular treatment (EVT) of lower extremity artery disease (LEAD) is minimally invasive and has good safety and efficacy. Puncture site complications are common in EVT, but these and the hemostatic time have been reduced by newer hemostatic devices such as ExoSeal. However, factors affecting poor outcomes after use of ExoSeal are unclear. Therefore, the purpose of this study is to identify these factors after ExoSeal deployment in EVT.Material and MethodsA retrospective study was performed for 868 cases in which hemostasis was attempted using ExoSeal between 2019 and 2023. Factors affecting deployment failure and prolonged hemostatic time after ExoSeal were assessed.ResultsThe 868 subjects (569 males, 66%) had a median age of 77 [72-83] years. A femoral antegrade approach was used in 548 cases (63%), with use of a 6Fr sheath in most cases (99%). The lesions were in the femoropopliteal ( = 387, 44%) and infrapopliteal ( = 359, 41%) arteries. The technical success rate of EVT was 97%. ExoSeal was successfully deployed in 812 cases (94%). Cases in which ExoSeal deployment was unsuccessful had significantly more frequent proximal stenting (9% vs 20%, = .01). In the entire cohort, there were 6 (.69%) puncture site complications. Of the 812 cases with successful deployment, the manual compression hemostasis time was prolonged (>10 min) in 51 cases (6%). Hemostatic time was significantly prolonged in cases with proximal stenting or intimal thickening at the puncture site (both, < .001).ConclusionThese results show that ExoSeal is a useful device. However, deployment failure and prolonged hemostatic time were caused by a proximal stent or intimal thickening of the puncture site, and use of hemostatic devices in such cases requires further investigation.
The Relationship Between Neutrophil-to-Lymphocyte Ratio and Restenosis in Patients With Femoropopliteal Chronic Total Occlusion Treated With Drug-Coated Balloon Alone Versus Combined Atherectomy and Drug-Coated Balloon.
Toz H, Kuserli Y, Türkyılmaz G … +3 more , Satılmıs OE, Kavala AA, Türkyılmaz S
Vasc Endovascular Surg · 2026 Feb · PMID 41399992 · Publisher ↗
ObjectivesTo evaluate the clinical, hematological, and anatomical outcomes of rotational atherectomy (RA) combined with drug-coated balloon (DCB) angioplasty compared to DCB alone in patients with femoropopliteal arteria...
ObjectivesTo evaluate the clinical, hematological, and anatomical outcomes of rotational atherectomy (RA) combined with drug-coated balloon (DCB) angioplasty compared to DCB alone in patients with femoropopliteal arterial disease, with particular emphasis on inflammatory markers and mid-term vessel patency.MethodsThis retrospective, single-center study included patients who underwent endovascular treatment for femoropopliteal lesions using either RA combined with DCB (RA + DCB) or DCB alone. Demographic characteristics, lesion morphology, neutrophil-to-lymphocyte ratio (NLR), and Doppler ultrasonography (DUS) findings were compared between the two groups. Primary outcomes were residual stenosis, ankle-brachial index (ABI), and mid-term vessel patency. Secondary outcomes included postprocedural NLR changes and clinical symptom evolution during follow-up.ResultsA total of 150 patients were included, with 75 treated using RA + DCB and 75 with DCB alone. There were no significant differences in baseline demographics or comorbidities between groups. The RA + DCB group demonstrated a higher prevalence of TASC A lesions and left lower extremity involvement. Postprocedural lymphocyte counts were significantly higher, and NLR values were significantly lower in the RA + DCB group. Additionally, this group exhibited lower residual stenosis rates and significantly higher patency rates at 6 and 12 months. Greater clinical improvement and a higher proportion of asymptomatic patients were observed in the RA + DCB group during follow-up.ConclusionsRA combined with DCB offers superior vascular and clinical outcomes vs DCB alone, likely due to improved lesion preparation and reduced inflammation. NLR may serve as both a prognostic biomarker and indicator of treatment efficacy in peripheral arterial interventions.
Shockwave Intravascular Lithotripsy Prior to Stenting for the Treatment of Severe Calcifications of the Superior Mesenteric Artery.
Vo S, Le RT, Lindquester WS … +1 more , Swilley BN
Vasc Endovascular Surg · 2026 Feb · PMID 41399991 · Publisher ↗
BackgroundChronic mesenteric ischemia (CMI) can result from progressive atherosclerotic disease with symptoms arising in severe cases. Endovascular revascularization with a balloon-expandable covered stent is the preferr...
BackgroundChronic mesenteric ischemia (CMI) can result from progressive atherosclerotic disease with symptoms arising in severe cases. Endovascular revascularization with a balloon-expandable covered stent is the preferred first-line treatment for CMI, but balloon deployment may be complicated by severe calcification in the mesenteric arteries. Techniques used to address severe calcification, such as open surgery revascularization and high-pressure, non-compliant balloon dilations, are associated with higher complication rates and calcium fracturing. Intravascular lithotripsy (IVL) is a novel technique to treat arterial calcifications in situ, having previously been used to target atherosclerotic lesions in the coronary and peripheral arterial beds.Case PresentationWe present a 93-year old woman with a one year history of severe postprandial abdominal pain with an acute worsening of her mid-epigastric pain for two days. CTA showed severe calcifications at the origin of the superior mesenteric artery (SMA), which was confirmed and localized by an aortogram. Intravascular lithotripsy (IVL) was used to break down the calcification and prepare the SMA for stenting. Following IVL treatment, two overlapping covered stents were deployed and a final aortogram demonstrated patency of the SMA ostia with distal flow in the ileocecal branch.ConclusionIVL could be considered an adjunct to stenting in the setting of severe atherosclerotic disease in the visceral arteries when endovascular revascularization with stenting or balloon angioplasty is insufficient. Although IVL has been investigated in the treatment of calcifications in the coronary and peripheral arteries, it is necessary to explore IVL as a potential treatment for atherosclerotic lesions in the mesenteric arteries in a larger patient population.
Unique Case of a 6 centimetre Ruptured Popliteal Artery Aneurysm Causing Thigh Compartment Syndrome.
Miladinovic D, Shiraev T
Vasc Endovascular Surg · 2026 May · PMID 41270283 · Publisher ↗
This case highlights a rare and unique sequela following a popliteal artery aneurysm (PAA) rupture. The development of thigh compartment syndrome with haemodynamic instability as a consequence is exceptionally rare, as P...
This case highlights a rare and unique sequela following a popliteal artery aneurysm (PAA) rupture. The development of thigh compartment syndrome with haemodynamic instability as a consequence is exceptionally rare, as PAA rupture typically face resistance to rapid haemodynamic instability due to surrounding musculofascial and bony structures. To date, only 1 other published case report has documented a similar sequence of events. An 81-year-old male with a history of ischaemic heart disease, atrial fibrillation, and type 2 diabetes mellitus, but a lifelong non-smoker, presented in significant hemodynamic compromise due to a ruptured PAA. On examination, the affected extremity was swollen and tense, with sensory deficits distal to the knee, absent power in the hallux and ankle, and a faint dorsalis pedis pulse, but without evidence of acute distal ischemia. Computed tomography angiography (CTA) revealed a peripherally calcified ruptured right PAA, measuring 64 × 44 mm, accompanied by a substantial hematoma surrounding the aneurysm within the posterior thigh compartment. The patient underwent urgent endovascular repair followed by fasciotomies to manage the rupture and prevent further complications. This case demonstrates endovascular repair with a covered stent as a safe and effective alternative to open surgery in high-risk, unstable patients, allowing rapid aneurysm exclusion, limb salvage, and hemodynamic stabilisation. The patient provided informed consent for treatment and for the use of his clinical information in this case report.
The Use of Pressure Indices, Such as Fractional Flow Reserve, in Peripheral Arterial Disease-A Review of Current Literature and Potential Prospects.
Karia K, Al-Rekabi A, Suseeharan M … +2 more , Bahl R, Hamady M
Vasc Endovascular Surg · 2026 Apr · PMID 41259709 · Full text
PurposeTo assess the evidence in the current literature, identify the knowledge gaps and propose future standards for the use of pressure indices in peripheral arterial disease (PAD).MethodsA search of all medical databa...
PurposeTo assess the evidence in the current literature, identify the knowledge gaps and propose future standards for the use of pressure indices in peripheral arterial disease (PAD).MethodsA search of all medical databases was performed to identify studies performed between 01/01/2000 and 31/12/2024, looking at the use of FFR or IFR in the management of PAD. The Newcastle-Ottawa scale was used to assess the quality of the papers. A comparison of the studies was performed using various parameters including; study design, cohort demographics, aim, lesions treated, hyperaemic agent used/pressure indices utilised, FFR endpoint and clinical outcomes.Results136 studies were found in initial search. Only studies investigating FFR were identified, none looked at IFR. Following the application of the exclusion criteria, 8 relevant studies with a total of 247 patients were included in the final analyses. No randomised controlled or prospective trials were found. Significant heterogeneity was observed in the methodology and data collection among the included papers. Despite this, the analysis demonstrated initial evidence showing the potential of pressure measurements to revolutionise diagnostic, intra-procedural and prognostic decisions in PAD, akin to the data that already exists in coronary artery disease.ConclusionsFurther standardised research of FFR is needed in peripheral vascular disease to improve objective understanding of physiological parameters pre and post-treatment. To this end, a standardisation tool has been proposed to homogenise and aid future research in drawing more robust conclusions for the use of pressure indices in PAD.
Catheter Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: Clinical Outcomes From a Single Center Experience.
AbuRahma ZT, Santini A, AbuRahma AF … +6 more , Malnikoff A, Veith C, Umstot E, Laton M, Dean S, Mattox E
Vasc Endovascular Surg · 2026 May · PMID 41217492 · Publisher ↗
BackgroundFew single center studies with small sample size have been published showing clinical benefits of endovascular intervention specifically using mechanical suction thrombectomy for P.E. without systemic/catheter...
BackgroundFew single center studies with small sample size have been published showing clinical benefits of endovascular intervention specifically using mechanical suction thrombectomy for P.E. without systemic/catheter lytic therapy. This study will analyze our initial experience and clinical outcomes in the treatment of P.E. using Inari FlowTriever thrombectomy device.Patient Population/MethodsA single center retrospective study of 50 consecutive patients with acute P.E. were treated with the INARI FlowTriever device between January 2019 to June 2023. All patients were submassive P.E. with right ventricular strain (RV/LV ratio >0.9) and requiring oxygen therapy or having increase in oxygen therapy from baseline. Procedural and clinical success (Improvement in intraoperative pulmonary artery pressures and oxygen therapy) were evaluated along with in hospital procedural related complications with a mean follow up of 8 months (range 1-22.5 months).ResultsAll patients were stratified as intermediate high-risk PE with a mean age of 68 years. Right ventricular dilation was present in 100% of patients with a mean RV/LV ratio of 1.55 (range 0.9-2.7). Mean pre-op Troponin was 434 (median 318, range 6-2332) and mean BNP was 352 (median 154, range 60-1787). Procedural success as defined by SIR guidelines was achieved in 100% of patients. There was 0% hospital mortality, device related mortality, or complications including bleeding, and acute kidney injury (AKI). Significant improvement in FiO2 was noted when comparing the mean pre-procedural FiO2 of 40.6% (range of 21%-100%) to a mean of FiO2 of 28.3% (range of 21%-52%) at 24 h post procedure ( < .0001). Proportion of patients on room air increased from 0% pre procedure to 94% at 48 h. The mean pre-op pulmonary artery pressure improved from 47 mm Hg (range 20-74) to mean post pulmonary artery pressure of 34 mm Hg (range 19-65) < .0001. 97% of patients had a decrease in their pre-op pulmonary pressures intraoperatively.In late follow-up when evaluating pre to post intervention 36/38 (94.4%) of our patients were back to baseline with regards to oxygen requirement. Proportion of patients on room air increased from 0% pre procedure to 94.4% post procedure. 34/38 (89%) of patients reported they were back to baseline in regard to physical activity and 37/38 (97%) of patients reported their breathing status was back to baseline from prior to procedure. Using the modified Medical Research Council Dyspnea Score, 93% of patients reported a pre-op score of four (highest) while 70% reported scores of zero (normal) and or score of one post intervention with 100% showing improvement at 8 month follow up.ConclusionOur study demonstrates both safety and effectiveness in using the INARI FlowTriever for patients with submassive acute pulmonary embolism.
Right Common Carotid Artery Pseudoaneurysm Secondary to Penetrating Trauma by Firearm, Resolved via Open Surgical Repair With Graft Interposition.
Torres Cisneros EN, González Villordo D, Flores Almanza J … +1 more , Barraza Zambada KR
Vasc Endovascular Surg · 2026 May · PMID 41216977 · Publisher ↗
Common carotid artery pseudoaneurysm is the formation of a hematoma outside the vessel wall resulting from a transmural rupture. Its causes include open or blunt trauma, infections, or previous surgical procedures. These...
Common carotid artery pseudoaneurysm is the formation of a hematoma outside the vessel wall resulting from a transmural rupture. Its causes include open or blunt trauma, infections, or previous surgical procedures. These lesions usually present with a wide range of symptoms due to mass effect, and the diagnosis relies on a high index of suspicion and imaging methods. Treatment remains controversial; however, surgical management-either open or endovascular-is generally preferred. This report presents the case of a 19-year-old patient with a history of gunshot wound in neck. Imaging revealed a pseudoaneurysm of the right common carotid artery, which was surgically treated through resection and interposition of an ePTFE graft. This article discusses the etiology, diagnosis, and treatment of post-traumatic carotid artery pseudoaneurysm, with the aim of increasing awareness of this condition and its clinical presentations, thereby promoting timely diagnosis and appropriate therapeutic intervention to prevent fatal outcomes.
Heparin-Induced Thrombocytopenia With a False Negative Anti-PF4 Assay.
Perry TJ, Cass B, Ellis R … +1 more , Khalifeh A
Vasc Endovascular Surg · 2026 May · PMID 41194557 · Publisher ↗
Heparin-induced thrombocytopenia (HIT) is an acquired prothrombotic state from anti-heparin platelet-factor 4 (PF4) mediated activation of platelets. Anti-PF4 assay is used to screen for HIT due to high sensitivity and n...
Heparin-induced thrombocytopenia (HIT) is an acquired prothrombotic state from anti-heparin platelet-factor 4 (PF4) mediated activation of platelets. Anti-PF4 assay is used to screen for HIT due to high sensitivity and negative predictive value. We present a 74-year-old male that had clinical HIT with false negative anti-PF4 and subsequently positive serotonin release assay (SRA). Delay in cessation of heparin led to recurrent limb thrombosis in the setting of multiple revascularization attempts with a poor outcome. We re-emphasize the importance of clinical presentation in management of patients with suspected HIT.
Effectiveness and Safety of Single Antiplatelet Therapy With Prasugrel in Carotid Artery Stenting.
Kinoshita Y, Takahashi S, Hirai S … +8 more , Fujita K, Wakabayashi H, Kim B, Kobayashi Y, Sagawa H, Ishikawa M, Fujii S, Sumita K
Vasc Endovascular Surg · 2026 May · PMID 41183448 · Publisher ↗
BackgroundDual antiplatelet therapy (DAPT) is used peri-operatively as standard care for patients who undergo carotid artery stenting (CAS). Nonetheless, this regimen is associated with several problems, including ischem...
BackgroundDual antiplatelet therapy (DAPT) is used peri-operatively as standard care for patients who undergo carotid artery stenting (CAS). Nonetheless, this regimen is associated with several problems, including ischemic complications due to antiplatelet resistance, as well as hemorrhagic complications. This study investigated the feasibility of single antiplatelet therapy (SAPT) with prasugrel for CAS.MethodsRecords of consecutive patients who underwent elective CAS between January 2015 and December 2024 were reviewed. Patients administered SAPT with prasugrel and those administered DAPT with aspirin and clopidogrel were compared. The P2Y12 reaction unit (PRU) was measured using VerifyNow System. Effectiveness and safety outcomes were defined as ischemic and hemorrhagic complications within 3 months of CAS.ResultsA total of 146 patients were included in this analysis. The absolute PRU value was significantly lower in the SAPT group than in the DAPT group (128.5 vs 163.0, < 0.01). The rate of ischemic events within 3 months did not significantly differ (SAPT vs DAPT, 0.0% vs 3.7%, = 0.53). The rate of hemorrhagic complications also showed no significant difference (SAPT vs DAPT, 5.3% vs 0.9%, = 0.34). Four patients in the SAPT group and twelve patients in the DAPT group regularly took anticoagulants, and the rate of bleeding events did not significantly differ between them.ConclusionsPrasugrel ensured an adequately low PRU value compared with clopidogrel. SAPT with prasugrel may be an alternative to DAPT in patients undergoing CAS without increasing the risk of complications. This regimen may be used safely, even in patients who regularly use anticoagulants.
Quality of Digital Patient Education on Interventional Venous Diseases and Interventions.
Singh SP, Koso M, Ramprasad A … +2 more , Borthwick KG, Makary MS
Vasc Endovascular Surg · 2026 May · PMID 41174935 · Publisher ↗
BackgroundDigital educational resources have transformed patient care as a powerful tool for clinicians to assist patients in their medical decision-making. However, a significant degree of online educational materials i...
BackgroundDigital educational resources have transformed patient care as a powerful tool for clinicians to assist patients in their medical decision-making. However, a significant degree of online educational materials is unstandardized in terms of the quality, readability, and transparency of the information provided to patients. The objective of this study was to evaluate the accuracy, quality, and readability of publicly available digital patient education materials addressing patient questions on venous diseases and image-guided interventions.Materials and MethodsA cross-sectional study addressed the objective of this study by utilizing Rothwell's Classification of Questions, readability scores, and Brief DISCERN.ResultsThe digital educational materials extracted from the methodology of this study were mostly found to be from "Academic Institutions" at 41.3%. (n = 186) and "Medical Practices" at 30.2% (n = 136). Readability scores indicate that most articles on venous diseases or procedures are considered either "fairly difficult" or "difficult" to read. According to the Brief DISCERN assessment, educational materials on venous disease topics generally received higher quality scores compared to those on venous interventions.ConclusionsThe findings revealed a potential discrepancy in the quality of patient education articles between those related to venous diseases and those related to venous interventions. Articles about venous diseases generally scored higher in quality according to the Brief DISCERN assessment. This may suggest that a more substantial amount of high-quality information is available in this area. In terms of readability, these educational articles generally fell short of recommended grade reading levels.
Higher Risk for Morbidity and Non-Aortic Related Mortality in Type 2 Endoleak Patients Treated Outside of Instructions for Use.
Esquetini-Vernon C, Farres H, Polania-Sandoval C … +9 more , Claudio-Medina Y, Morales-Arroyo H, Ritchie C, Jacobs C, Paz-Fumagalli R, Toskich B, Vandenberg J, Mahajan B, Erben Y
Vasc Endovascular Surg · 2026 May · PMID 41172539 · Publisher ↗
ObjectiveTo evaluate outcomes in patients with type 2 endoleak (T2E) and the impact of treatment outside the device instructions for use (IFU).MethodsThis retrospective single-center study included abdominal aortic aneur...
ObjectiveTo evaluate outcomes in patients with type 2 endoleak (T2E) and the impact of treatment outside the device instructions for use (IFU).MethodsThis retrospective single-center study included abdominal aortic aneurysms (AAA) patients who underwent EVAR (2011- 2024). Primary outcomes were 30-day and mid-term complications, reintervention, and mortality by T2E status. Propensity score matching was applied and secondary analysis stratified outcomes by IFU compliance, comparing within (IFU) or outside(IFU) IFU in each T2E group.ResultsAmong 154 EVAR patients (137 men (89.1%) and 17 women (11.0%); mean age 77.5 ± 7.6 years), 77 were T2E(-), and 77 were T2E(+). Baseline characteristics were similar. Thirty-day complications were comparable (T2E(-): 5, 6.4% vs T2E(+): 2, 2.56%, = 0.72). The mean follow-up duration was 2.7 ± 2.4 years. Sac diameter change (Δ) decreased in the T2E(-) (7.7 ± 8.4 mm) and enlarged in the T2E(+) (1.79 ± 12.5 mm; < 0.01). Mid-term graft-related complications (T2E(-): 3, 3.8% vs T2E(+): 49, 62.8%, < 0.01) and reinterventions (T2E(-): 3, 3.8%, vs T2E(+): 20, 25.6% < 0.01) were higher in the T2E(+) with no difference in mortality ( = 1.00). These findings remained after excluding type 1 endoleaks. Among the T2E(+), those treated IFU had longer hospital stays (IFU: 3.0 ± 2.8 days vs IFU: 1.8 ± 2.0 days, = 0.03), higher T1E (IFU: 3, 33.3% vs IFU: 1, 4.34%, < 0.01), higher rates of reintervention (IFU: 9, 100.0% vs IFU:17; 24.6%, < 0.01) and higher all-cause mortality than those within IFU criteria (IFU: 5, 55.0% vs IFU: 13, 18.8%, < 0.01). IFU status did not significantly affect outcomes in T2E(-) patients.ConclusionsT2E is associated with sac growth and increased reinterventions, but not higher mortality. On subgroup analysis, those T2E(+) treated IFU had longer hospitalizations, higher T1E rates, more reinterventions, and higher all-cause; but not aneurysmal-related mortality.
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