Annals Of Vascular Surgery[JOURNAL]
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200 papers
Endovascular Aneurysm Repair in Conical Proximal Aortic Neck Anatomy: Impact of a Conformable Endograft on Proximal Sealing Outcomes.
Bozzani A, Visciglia E, Destefanis Gallo E … +3 more , Salzillo I, Arici V, Stella GM
Ann Vasc Surg · 2026 Jun · PMID 42276371 · Publisher ↗
BACKGROUND: Conical proximal aortic neck anatomy has traditionally been considered a hostile feature for endovascular aneurysm repair (EVAR) due to concerns regarding inadequate proximal sealing and increased rates of ty...
BACKGROUND: Conical proximal aortic neck anatomy has traditionally been considered a hostile feature for endovascular aneurysm repair (EVAR) due to concerns regarding inadequate proximal sealing and increased rates of type Ia endoleak. However, the independent impact of conical morphology and the potential mitigating role of modern conformable endografts remain debated. This study evaluates short- and mid-term outcomes of EVAR in patients with conical neck anatomy, with a specific focus on the effectiveness of the GORE Excluder Conformable endograft. METHODS: We performed a retrospective analysis of prospectively collected data including all consecutive patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm between January 2022 and December 2024. Conical neck anatomy was defined according to Delphi Consensus criteria. Outcomes were compared between patients treated with the GORE Excluder Conformable and those treated with other contemporary devices. Primary endpoints included type Ia endoleak, graft migration, and aneurysm-related mortality. RESULTS: Among 204 EVAR procedures, 60 patients (29.4%) presented conical neck anatomy. Mean follow-up was 20 months (range, 1-34). The overall 30-day type Ia endoleak rate was 5%. Use of the GORE Excluder Conformable was associated with a significantly lower incidence of type Ia endoleak than other devices (0% vs. 9.1%, P < 0.05). No cases of graft migration or aneurysm-related mortality were observed in the Conformable group. Multivariable analysis confirmed device type as an independent protective factor against proximal sealing failure. CONCLUSION: Conical neck anatomy alone should not be considered a contraindication to EVAR. The GORE Excluder Conformable provides a statistically significant reduction in type Ia endoleak in patients with conical proximal necks, supporting its use as a safe and effective strategy in this challenging anatomical setting.
National Trends in Aneurysm Care: Rising Volumes, Greater Efficiency, and Shrinking Surgeon Reimbursement.
Joshi P, Gupta A, Moser GW … +3 more , Kumar S, Sheth SU, Mokashi S
Ann Vasc Surg · 2026 Jun · PMID 42276370 · Publisher ↗
BACKGROUND: Over the past 2 decades, management of aortic, peripheral, and visceral artery aneurysms has been transformed by endovascular techniques, resulting in a growing number of treated patients. Despite this expans...
BACKGROUND: Over the past 2 decades, management of aortic, peripheral, and visceral artery aneurysms has been transformed by endovascular techniques, resulting in a growing number of treated patients. Despite this expansion, vascular surgeon reimbursement has steadily declined. We evaluated national expenditure trends for aneurysm care relative to US gross domestic product and healthcare sector output to contextualize the evolving economic landscape facing vascular surgeons. METHODS: We analyzed nationally representative data from the Medical Expenditure Panel Survey and the National Income and Product Accounts from 2000 to 2021. Outcomes included annual aneurysm-related episodes, total expenditures, per capita spending, and cost per case. Trends were assessed using least squares regression. Expenditures were net of drug rebates and examined using indices of per capita spending and overall medical care expenditures. A derived prevalence index (treated prevalence = per capita index/medical care expenditure index) reflected changes in the proportion of patients treated over time. Medicare reimbursement data (2011-2021) were incorporated to provide surgeon-level payment context. RESULTS: From 2000 to 2021, aneurysm-related episodes increased by approximately 41,000 cases annually (P < 0.0001). Total expenditures rose by $98 million per year (P < 0.0001), while cost per case declined by $11.33 annually (P = 0.011). Per capita spending increased steadily (0.0263/year, P < 0.0001), whereas Medical Care Expenditure Index declined (-0.0039/year, P = 0.011). The prevalence index increased by 0.0335 per year (P < 0.0001). CONCLUSION: Aneurysm care has expanded with increasing efficiency and declining per-case costs. However, Medicare reimbursement has eroded, highlighting a growing disconnect between clinical productivity and Medicare payment.
Progression from Minor to Major Amputation in Patients with Diabetes and Peripheral Arterial Disease: Risk Factors and Clinical Trajectories.
Hinojosa CA, Ricardo AC, Del Valle DD … +8 more , Anaya-Ayala JE, Contreras-Jimenez E, Luna-Vargas L, Torres-Machorro A, Garcia-Alva JR, Olivares-Cruz S, Gilabert-Garcia A, Galaz-Alvarez PE
Ann Vasc Surg · 2026 Jun · PMID 42276369 · Publisher ↗
BACKGROUND: Minor lower extremity (LE) amputation is commonly performed in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) as part of limb preservation strategies; however, progression to major...
BACKGROUND: Minor lower extremity (LE) amputation is commonly performed in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) as part of limb preservation strategies; however, progression to major amputation remains frequent in Mexico. We aim to study and characterize factors associated with progression to major amputations. METHODS: We completed a retrospective multicenter cohort study of adults with DM and PAD who underwent minor LE amputation between 2010 and 2025 at 5 tertiary referral centers in Mexico City. The primary outcome was progression to major amputation, reamputation, and mortality; and multivariable logistic regression was used to identify independent predictors. RESULTS: Among 314 patients undergoing minor amputation, 184 (58.6%) progressed to major amputation, with a median time of 1 month (interquartile range (IQR [1-4]). Chronic limb-threatening ischemia (CLTI) was the strongest predictor of major amputation (adjusted odds ratio [aOR] 9.79, 95% confidence interval [CI], 3.45-27.77, P < 0.001). A proximal level of the index minor amputation was also independently associated with major limb loss (aOR 4.18, 95% CI, 1.56-11.19, P = 0.04). Chronic kidney disease (aOR 3.68, 95% CI, 1.47-9.20, P = 0.005) and smoking history (aOR 2.42, 95% CI, 1.14-5.13, P = 0.021) were additional significant risk factors. Prior revascularization was associated with a nonstatistically significant lower risk of progression (aOR 0.41, 95% CI, 0.16-1.02, P = 0.054). CONCLUSIONS: Progression to major amputation after minor amputation is common and occurs early in patients with DM and PAD. CLTI, proximal minor amputation level, chronic kidney disease, and smoking identify patients at particularly high risk, underscoring the need for improved risk stratification and tailored limb management strategies.
FINANCIAL IMPLICATIONS OF VASCULAR SURGERY CONFERENCE FEES.
Kats A, Martin GM, Patil S … +5 more , Chen J, Dimuzio P, Salvatore D, Nooromid M, Abai B
Ann Vasc Surg · 2026 Jun · PMID 42276368 · Publisher ↗
OBJECTIVE: Conferences are an important venue for trainees and students to engage in scholarly activities and networking. However, cost presents a significant consideration for students looking to attend conferences as i...
OBJECTIVE: Conferences are an important venue for trainees and students to engage in scholarly activities and networking. However, cost presents a significant consideration for students looking to attend conferences as institutional funding varies. In this study, we analyze the attendance costs of vascular conferences. METHODS: Thirty-one vascular surgery conferences were identified with 12 regional and 7 national, and 12 international. Invitation-only conferences were excluded from the analysis. Cost of attendance was stratified by early and regular registration timing and attending, trainee, and student status. Additionally, conference websites were queried individually for scholarship opportunities. Data was presented descriptively and compared using a t-test or chi-squared test where appropriate using R-studio. RESULTS: National and international conferences were associated with significantly higher registration costs compared to regional conferences across nearly all trainee and student fee categories (p<0.05), with national conferences also significantly higher than regional conferences for physician categories (p<0.05). National and international conferences did not significantly differ from one another in any fee category. Registration cost was highest for non-member physicians paying regular rate (regional: $566 ± 323 vs national: $1,182 ± 547, p<0.01) and lowest for member medical students registering early (regional: $65 ± 93 vs national: $362 ± 379, p<0.05; vs international: $244 ± 151, p<0.01). Regional, national, and international conferences had similar scholarship opportunities (25.0% vs 50.0% vs 38.5%, p=0.55). For students, society membership is not associated with meaningful cost savings across any conference category. CONCLUSIONS: Regional meetings are an affordable venue for students to engage in scholarly activities and learn about advancements in vascular surgery. Fees for national and international societies may present a significant barrier to attendance for trainees and medical students. More scholarship opportunities should be provided to aid in conference attendance for students and trainees.
Re: "A Dynamic Machine Learning Approach to Complement Nurse-Led Clinics in Identifying High-Risk Patients with Intermittent Claudication".
Danesino V, Franciscone MM, Bozzani A … +1 more , Bocca Corsico Piccolino A
Ann Vasc Surg · 2026 Jun · PMID 42276367 · Publisher ↗
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Early Multicenter Experience with the Nexus Duo™ Aortic Arch Stent Graft System in the Treatment of Aneurysmatic Aortic Arch Diseases.
Bisdas T, Erb M, Charalambous N … +7 more , Antonello M, Makaloski V, Izquierdo Lamoca LM, Abisi S, Elbasty A, Buz S, Vascular Investigators
Ann Vasc Surg · 2026 Jun · PMID 42276366 · Publisher ↗
BACKGROUND: The Nexus Duo endograft is a novel device designed for endovascular repair of aneurysmal disease of the aortic arch (EAAR). It features a dedicated indwelling branch for the brachiocephalic trunk and a custom...
BACKGROUND: The Nexus Duo endograft is a novel device designed for endovascular repair of aneurysmal disease of the aortic arch (EAAR). It features a dedicated indwelling branch for the brachiocephalic trunk and a customized retrograde branch for either the left common carotid artery (LCCA) or left subclavian artery (LSA). This study evaluates the early clinical outcomes of the Nexus Duo endograft in EAAR. METHODS: This multicenter, observational, physician-sponsored registry retrospectively analyzed prospectively collected data from nine European centers. All consecutive patients who underwent EAAR with the Nexus Duo endograft between January 2023 and April 2025 were included in the study. The primary end point was 30-day mortality. Secondary end points included technical success, overall reinterventions, major adverse events (MAEs), and the incidence of endoleaks at 30 days. RESULTS: Thirty patients (53% female) were treated. Indications for EAAR included nondissecting aneurysm (n = 7, 23.3%), post type-B-dissection aneurysm (n = 7, 23.3%), post type-A-dissection aneurysm (n = 14, 46.7%), false aneurysm (n = 1, 3.3%), and penetrating ulcer (n = 1, 3.3%). The LSA was the target vessel in 17 patients (56.7%). Seventeen patients underwent simultaneous LCCA-LSA bypass (58.6% using polytetrafluoroethylene grafts). Technical success was 100%. At 30 days, the mortality rate was 3.3% (n = 1), the reintervention rate was 16.7%, and the MAE rate was 6.7%. No disabling strokes were observed. One transient ischemic attack occurred and one type Ia endoleak (3.3%) were observed at 30 days. CONCLUSIONS: In this real-world, multicentre study, the Nexus Duo endograft demonstrated a favorable early safety profile, with high technical success, no disabling strokes, and encouraging 30-day outcomes.
Diagnostic imaging modalities for vascular Thoracic Outlet Syndrome (TOS); a topical review and proposed diagnostic pathway.
Hoedemakers T, Mascini LT, de Borst GJ … +4 more , Petri BJ, Smits MLJ, Vonken EPA, van Hattum ES
Ann Vasc Surg · 2026 Jun · PMID 42276365 · Publisher ↗
OBJECTIVE: This topical review aims to provide an overview of current literature on diagnostic modalities for vascular thoracic outlet syndrome (TOS) and evaluates their clinical applicability. Additionally, a structured...
OBJECTIVE: This topical review aims to provide an overview of current literature on diagnostic modalities for vascular thoracic outlet syndrome (TOS) and evaluates their clinical applicability. Additionally, a structured diagnostic pathway is proposed for the assessment of arterial TOS (ATOS) and venous TOS (VTOS). METHODS: Given the absence of standardized guidelines, limited high-quality evidence, and heterogeneous cohorts, this review adopts a topical rather than a systematic approach. A comprehensive literature search of peer-reviewed articles between 2000 and 2006 was conducted in Pubmed. The available literature is summarized to assess the advantages, limitations, and clinical utility of each modality. RESULTS: Imaging plays a vital role in the evaluation of vascular TOS, although protocols vary substantially between centers. For suspected ATOS, computed tomography arteriography (CTA), using a dedicated TOS protocol is proposed as the preferred initial modality, while computed tomography venography (CTV) with TOS protocol is recommended for suspected VTOS. In patients presenting with suspected upper-extremity deep vein thrombosis (UEDVT), duplex ultrasound is recommended for initial assessment. Contrast angiography is reserved for selected cases when non-invasive imaging is inconclusive, or when endovascular intervention is anticipated. Chest radiography (CR) and photoplethysmography (PPG) appear to have limited additional diagnostic value. Intravascular ultrasound (IVUS) may offer complementary information in selected patients with VTOS. CONCLUSION: The diagnostic complexity of vascular TOS underscores the importance of an integrated approach combining clinical evaluation and imaging, preferably within specialized expert centers. The proposed diagnostic pathway provides a practical framework, and may serve as a step toward uniformity in clinical practice across different centers.
Long-Term Durability of TEVAR for Blunt Traumatic Aortic Injury in Young Patients.
Aimanan K, Ahmad A, Arvind M … +3 more , Pian PM, Pillay KV, Hussein H
Ann Vasc Surg · 2026 Jun · PMID 42276364 · Publisher ↗
BACKGROUND: Blunt traumatic aortic injury (BTAI) is the second leading cause of death in blunt trauma. Thoracic endovascular aortic repair (TEVAR) has replaced open repair as standard treatment; however, long-term durabi...
BACKGROUND: Blunt traumatic aortic injury (BTAI) is the second leading cause of death in blunt trauma. Thoracic endovascular aortic repair (TEVAR) has replaced open repair as standard treatment; however, long-term durability in young patients remains insufficiently characterized. METHODS: We conducted a retrospective cohort study of patients aged 16-35 years who underwent TEVAR for computed tomography (CT)-confirmed BTAI at Hospital Kuala Lumpur between 2008 and 2015. Injury severity was graded according to Society for Vascular Surgery criteria. Imaging was analyzed for repair-site remodeling, ascending aortic enlargement, and CT-derived left ventricular mass. Primary outcomes were overall survival and freedom from aortic reintervention. Secondary outcomes included device-related complications, spinal cord ischemia, hypertension, and sequelae following left subclavian artery coverage. RESULTS: Eighteen TEVAR procedures were performed for BTAI during the study period; 12 involved patients aged ≤35 years and formed the study cohort. All injuries were grade III pseudoaneurysms. Mean age was 24 years and mean proximal aortic diameter was 21.8 mm. Stent grafts sized 24-28 mm were deployed with 10-20% oversizing. Left subclavian artery coverage was required in 4 patients, with selective revascularization in 1. Median time to intervention was 3 days. Technical success was 100%. Median follow-up was 9 years (range 7-14), with a maximum of 15 years. All patients survived without reintervention. No endoleak, migration, fracture, or aneurysmal degeneration was detected. Repair-site expansion was modest (5-8%), corresponding to 0.1-0.2 mm per year. Ascending aortic growth remained below clinically significant thresholds. Left ventricular mass remained stable in 11 patients; one demonstrated a 9.2% increase without hypertension or symptoms. CONCLUSION: TEVAR demonstrated excellent long-term durability in young patients with grade III BTAI. Stable aortic remodeling and absence of reintervention over extended follow-up support TEVAR as definitive management in carefully selected trauma survivors.
Hemodynamic Consequences of Renal Artery Ostium Positioning After Inner-Branch Endografting for Juxtarenal Aortic Aneurysms.
Li F, Lu W, Xue W … +6 more , Deng Z, Zhao Y, Chen L, Song H, Zhang H, Tian H
Ann Vasc Surg · 2026 Jun · PMID 42276363 · Publisher ↗
BACKGROUND: To investigate the hemodynamic consequences of renal artery ostium positioning following endovascular repair of juxtarenal abdominal aortic aneurysms (JAAAs) using the novel WeFlow-JAAA inner-branch system. M...
BACKGROUND: To investigate the hemodynamic consequences of renal artery ostium positioning following endovascular repair of juxtarenal abdominal aortic aneurysms (JAAAs) using the novel WeFlow-JAAA inner-branch system. METHODS: Patient-specific computational fluid dynamics analysis was performed on 3 postoperative JAAA cases treated with the WeFlow-JAAA endograft. For each case, 4 models systematically simulated progressive distal migration of the bilateral renal ostia, ranging from a proximal position near the celiac artery to their native anatomical locations. Renal perfusion rates, aortic flow patterns, and established wall shear stress (WSS)-derived metrics (time-averaged wall shear stress [TAWSS], oscillatory shear index [OSI], relative residence time [RRT]) were quantitatively evaluated. RESULTS: Distal renal ostium positioning consistently yielded higher renal perfusion rates compared to proximal placements. However, this improved perfusion was associated with the development of potentially adverse hemodynamic conditions (characterized by low TAWSS and high OSI/RRT) on the perirenal aortic wall adjacent to the ostia. Conversely, proximal placements, while mitigating these adverse perirenal WSS patterns, compromised renal perfusion and generated pronounced flow disturbances in the infrarenal aorta distal to the termination of the inner-branch parallel segments. CONCLUSION: The preliminary findings suggest that renal ostium positioning after WeFlow-JAAA implantation may critically influence postoperative hemodynamics. The simulations indicate maximizing renal perfusion via distal placement may potentially expose the perirenal aortic wall to less favorable long-term WSS conditions. These results underscore the need for careful and potentially patient-specific consideration of device placement to appropriately balance perfusion and aortic wall remodeling risks in juxtarenal endovascular repair.
Procedural and Mid-Term Outcomes of Stented, Unstented Fenestrations and Scallop Configurations for Coeliac Axis Incorporation in Fenestrated Endovascular Abdominal Aortic Aneurysm Repair.
Abdelmalak M, Nadama HH, Rooney K … +4 more , Finch LM, Kyambadde F, Anantha-Krishnan G, Serracino-Inglott F
Ann Vasc Surg · 2026 Jun · PMID 42276362 · Publisher ↗
OBJECTIVE: Incorporation of the coeliac axis (CA) during fenestrated endovascular aneurysm repair (FEVAR) can be achieved using stented fenestrations, unstented fenestrations, or scallop configurations. Comparative evide...
OBJECTIVE: Incorporation of the coeliac axis (CA) during fenestrated endovascular aneurysm repair (FEVAR) can be achieved using stented fenestrations, unstented fenestrations, or scallop configurations. Comparative evidence supporting one strategy over another remains limited. This study aimed to evaluate procedural efficiency, visceral-vessel durability, aneurysm sac behaviour, endoleak incidence, and secondary intervention rates across these three CA management strategies. METHODS: A retrospective single-centre study was conducted of consecutive patients undergoing FEVAR with CA incorporation between 2007 and 2024 using only custom-made Zenith Fenestrated devices. Patients were grouped according to CA configuration: stented fenestration, unstented fenestration, or scallop. Peri-operative metrics, mortality, endoleaks, CA patency, aneurysm sac evolution, and secondary interventions were analysed. Between-group comparisons were performed using appropriate non-parametric or categorical statistical tests. RESULTS: A total of 129 patients were included (58 stented, 26 unstented, 45 scallop), with a median follow-up of 23.4 months [IQR 9.6-59.4]. Baseline demographics and comorbidity profiles were comparable. Operative time, fluoroscopy time, radiation dose, contrast volume, and estimated blood loss did not differ significantly between CA strategies (all p > 0.05). Thirty deaths (23.3%) occurred during follow-up, with no significant survival difference between groups after adjustment for follow-up duration (p = 0.12); 30-day mortality remained below 2%. Endoleak incidence during follow-up was similar across strategies (p = 0.48), predominantly Type II, with no excess of Type I or III endoleaks in any configuration. Aneurysm sac behaviour was comparable, with no significant difference in sac diameter change or rates of ≥5 mm regression. Loss of CA patency and CA-related re-interventions were uncommon and did not differ between groups. Overall secondary intervention rates were similar across CA strategies (p = 0.77). CONCLUSION: In this large single-centre FEVAR cohort, CA incorporation using stented fenestrations, unstented fenestrations, or scallops resulted in comparable procedural efficiency, visceral-vessel durability, aneurysm sac behaviour, and re-intervention rates. These findings support an anatomy-driven, individualised approach to CA management during FEVAR without compromising mid-term outcomes.
Clinical Outcomes of Endovascular and Surgical Treatments for Renal Artery Aneurysm.
Lee SA, Yi B, Gwon JG … +2 more , Cho YP, Han Y
Ann Vasc Surg · 2026 Jun · PMID 42276361 · Publisher ↗
BACKGROUND: A renal artery aneurysm (RAA) is usually asymptomatic and requires no treatment. RAAs larger than 2-3 cm however are at risk of rupture and typically require intervention. This study analyzed the clinical out...
BACKGROUND: A renal artery aneurysm (RAA) is usually asymptomatic and requires no treatment. RAAs larger than 2-3 cm however are at risk of rupture and typically require intervention. This study analyzed the clinical outcomes of endovascular and surgical treatments for RAA. METHODS: This single-center retrospective observational study reviewed 52 RAA procedures performed between January 2011 and December 2024. Baseline patient characteristics, aneurysm anatomy, and clinical outcomes-including technical success, postprocedural renal infarction, perioperative outcomes, and long-term renal outcomes-were compared between endovascular and surgical groups. RESULTS: The mean RAA size was 2.5 cm (range, 0.8-6.5 cm). Endovascular treatment was performed in 28 procedures (17 coil embolizations, 8 stent-assisted coil embolizations, and 3 stent graft insertions), and surgical treatment in 24 procedures (15 in situ repairs, 9 autotransplantations). Technical success was 100% in both groups. Renal infarction occurred more frequently in the endovascular group (67.9% vs. 37.5%; P = 0.03), driven primarily by minimal infarction. The incidence of acute kidney injury (AKI) (10.7% vs. 29.2%; P = 0.16), renal artery occlusion (7.1% vs. 0%; P = 0.49), chronic kidney disease (CKD) stage ≥ 3 (14.3% vs. 4.2%; P = 0.36), and mean glomerular filtration rate (GFR) change (-15.71 vs. -13.92; P = 0.59) did not differ significantly between groups. CONCLUSION: Both endovascular and surgical treatments for RAA demonstrate high technical success and preservation of renal function. Endovascular treatment is associated with a higher incidence of renal infarction and potentially delayed vascular complications; however, long-term renal outcomes were comparable. Treatment selection should be individualized based on aneurysm anatomy and patient-specific considerations.
Integration of Wearable Technology into Vascular Surgery: Insights from an International Online Cross-Sectional Survey.
Raffort J, Lareyre F, Trenner M … +6 more , Teraa M, Nandhra S, Di Lorenzo G, Hinchliffe RJ, D'Oria M, Study Collaborators and European Research Hub
Ann Vasc Surg · 2026 Jun · PMID 42276360 · Publisher ↗
BACKGROUND: Wearable technologies have emerged as powerful tools in digital health and may improve monitoring and personalized care for patients with vascular diseases. However, their integration into routine vascular pr...
BACKGROUND: Wearable technologies have emerged as powerful tools in digital health and may improve monitoring and personalized care for patients with vascular diseases. However, their integration into routine vascular practice remains limited. This study aimed to evaluate the perceptions of vascular specialists regarding the potential clinical and research applications of wearable technologies in vascular surgery. METHODS: An international, cross-sectional web-based survey was conducted among health care professionals involved in vascular care across Europe. The questionnaire assessed participants' demographic characteristics, prior experience with wearable devices, perceived clinical and research applications, and potential barriers to implementation. Descriptive statistics were used to summarize the responses. RESULTS: A total of 133 participants from 33 countries completed the survey. Most respondents were consultant vascular surgeons working in university or teaching hospitals. Overall, 36.1% reported prior experience with wearable technologies, most commonly smartwatches and activity trackers. Respondents identified potential benefits in chronic disease management (80.0%), perioperative monitoring (67.9%), telemedicine (67.2%), and secondary prevention (66.4%). A large majority (90.2%) agreed that wearable devices could support postoperative monitoring after vascular interventions. The most frequently reported barriers to implementation were device cost (71.8%), data security and privacy concerns (42.0% and 40.5%), time constraints (30.5%), and lack of validated devices (26.0%). CONCLUSION: Vascular specialists recognize the potential of wearable technologies to enhance patient monitoring and support vascular research. Nevertheless, economic, technological, and regulatory challenges remain important barriers to their widespread implementation in vascular practice.
Bridging Stent Graft Durability After Branched Endovascular Repair: Geometric Remodeling and Predictors of Target Vessel Instability.
Grosso L, Mezzetto L, Abruzzino G … +4 more , Garcia V, Allegra E, Macrì M, Veraldi GF
Ann Vasc Surg · 2026 Jun · PMID 42269914 · Publisher ↗
INTRODUCTION: Bridging stent graft (BSG) durability is a major determinant of long-term success after branched endovascular aneurysm repair (BEVAR), yet longitudinal data describing time-dependent BSG geometric remodelin...
INTRODUCTION: Bridging stent graft (BSG) durability is a major determinant of long-term success after branched endovascular aneurysm repair (BEVAR), yet longitudinal data describing time-dependent BSG geometric remodeling and its relationship with target vessel instability (TVI) remain limited. METHODS: A single-center retrospective analysis was conducted of consecutive patients undergoing BEVAR for thoracoabdominal aneurysms (January 2018 to December 2024) in whom a self-expanding covered stent (Covera Plus) was used as bridging stent graft. The primary endpoint was freedom from TVI. CTA measurements (branch total length, branch vertical length, tortuosity index, target-vessel sealing, end-stent angle) were analyzed for associations with TVI and for longitudinal trajectories; ROC analyses assessed percent-change thresholds between serial CTAs. RESULTS: The cohort included 52 patients (mean age 74 years) and 208 target vessels; technical success was achieved in 200/208 target vessels (96.1%). Thirty-day mortality was 0%; spinal cord ischemia occurred in 5/52 (9.6%) and acute kidney injury in 6/52 (11.5%) (dialysis 4/52, 7.7%). Median follow-up was 34 months; 9 deaths occurred (17.3%), none aortic-related. 13 target-vessel reinterventions were performed (6.5%), predominantly in renal arteries; no BSG migration was detected. Freedom from TVI at 60 months was 93.5%. Greater BSG total length and higher tortuosity increased TVI risk, whereas longer TVS was protective; remodeling demonstrated progressive reduction in TVS e TI and increasing ESA over time, especially in renal arteries. Percent-change thresholds between CTAs (mean interval 16.5 months) predicted TVI: TVS decrease ≥9.3%, TI increase ≥10.1%, and ESA increase ≥26.7%. CONCLUSIONS: In this single-center BEVAR using a uniform self-expanding bridging platform, mid- to long-term branch durability was favorable, with renal branches remaining the most vulnerable. Both postimplant geometry and its time-dependent evolution were associated with TVI, supporting surveillance strategies that incorporate standardized serial CTA-based geometric assessment and dynamic change thresholds to identify early unfavorable remodeling.
Female Sex is Associated with Adverse Cardiac Remodeling and Increased Antihypertensive Requirements After Thoracic Endovascular Aortic Repair.
Yuan K, Ock C, Helenowski I … +3 more , Schwartz J, Soult MC, Bechara CF
Ann Vasc Surg · 2026 Jun · PMID 42269913 · Publisher ↗
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has largely replaced open surgical repair (OSR) for many thoracic aortic pathologies due to lower perioperative morbidity and mortality. However, the increased aort...
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) has largely replaced open surgical repair (OSR) for many thoracic aortic pathologies due to lower perioperative morbidity and mortality. However, the increased aortic stiffness imparted by stent grafts may have long-term cardiovascular consequences, particularly among women. The purpose of this study is to evaluate sex-specific differences in cardiac remodeling and antihypertensive requirements following TEVAR compared with OSR. METHODS: A retrospective review was conducted of 671 adult patients who underwent TEVAR or OSR for thoracic aortic aneurysm or dissection between January 2015 and January 2022. Of these, 101 patients met inclusion criteria, with complete 3-year antihypertensive medication and ≥1-year echocardiographic follow-up data. Primary outcomes included changes in left ventricular ejection fraction (LVEF), left ventricular hypertrophy (LVH), and antihypertensive medication requirements. Multivariable Poisson generalized estimating equation and logistic regression models were used to identify factors associated with medication escalation and cardiac remodeling. RESULTS: Among female patients, TEVAR was associated with significantly greater antihypertensive medication requirements at 12, 24, and 36 months postoperatively (P < 0.05) compared with OSR. Worsening LVH occurred more frequently after TEVAR (P < 0.05), whereas changes in LVEF, rates of stroke, myocardial infarction, and 1-year mortality were similar between groups. In multivariable analysis, TEVAR independently predicted higher antihypertensive requirements (incidence rate ratio (IRR) 1.48; 95% CI, 1.27-1.73; P < 0.001), while OSR was associated with significantly lower odds of worsening LVH compared with TEVAR (OR 0.11; 95% CI, 0.01-0.63; P = 0.012). No significant differences were observed between TEVAR and OSR among male patients. CONCLUSION: Female patients undergoing TEVAR demonstrated greater adverse cardiac remodeling and higher antihypertensive requirements than those undergoing OSR. These findings suggest that sex-related differences in aortic stiffness and device oversizing may contribute to poorer long-term remodeling outcomes in women, underscoring the need for sex-specific endograft sizing and development of more compliant endografts.
Proximal Seal after Emergency EVAR for Ruptured Abdominal Aortic Aneurysm and its Clinical Implications.
Hijkoop LF, Accarino GA, van Veldhuizen WA … +5 more , Tielliu IFJ, Hendricks CHF, van Lammeren GW, Kropman RHJ, de Vries JPM
Ann Vasc Surg · 2026 Jun · PMID 42269912 · Publisher ↗
OBJECTIVE: Endograft apposition can predict failure after elective endovascular aneurysm repair (EVAR), but its role in ruptured EVAR (rEVAR) has not been investigated separately. This study evaluates early to mid-term o...
OBJECTIVE: Endograft apposition can predict failure after elective endovascular aneurysm repair (EVAR), but its role in ruptured EVAR (rEVAR) has not been investigated separately. This study evaluates early to mid-term outcomes after rEVAR, including proximal apposition and its changes over time. METHODS: In this retrospective, observational, dual-center study of consecutive rEVAR patients, treated between January 2015 and December 2024, aortic morphology and proximal endograft apposition were analyzed. Shortest apposition length (SAL) was measured on early (<3 months) and last postoperative computed tomography angiography (CTA). Records were reviewed for baseline characteristics, complications, and reinterventions. SAL changes were assessed and compared between patients with and without type 1a endoleak (T1aEL). Overall survival was estimated using Kaplan-Meier analysis. Cumulative incidences of T1aEL and reinterventions were assessed using competing risk analysis accounting for mortality. RESULTS: Included were 89 patients. Median follow-up was 47 months (95% confidence interval, 37-71 months). Thirty-four patients (38%) were treated outside of the instructions for use for the proximal neck. Median SAL was 13.7 mm (6.4, 21.8 mm), with 39% (n = 35) having a SAL of <10 mm, as measured on the early CTA. SAL on the early CTA did not differ significantly between patients with and without mid-term T1aEL (10.7 mm [6.5, 19.7 mm] vs. 15.1 mm [8.1, 22.4 mm], P = 0.544). For mid-term T1aEL patients, SAL had diminished and was shorter on the pre-endoleak CTA compared to the SAL on the last CTA of patients without mid-term T1aEL (4.2 mm [0.0, 7.6 mm] vs. 18.5 mm [11.5, 27.0 mm], P = 0.014). CONCLUSION: Short proximal SAL (<10 mm) occurred frequently; however, due to the limited number of mid-term T1aELs, no statistical association could be confirmed between initial short SAL and mid-term T1aELs. A low SAL combined with a decrease during follow-up appeared to be linked to the development of mid-term T1aELs. Serial CTA-applied SAL assessment may help identify patients at risk for T1aEL, guide follow-up, and improve long-term outcomes after rEVAR.
Impact of Parietal Calcification on the Natural History of Visceral Aneurysms.
Batagini NC, Oroski MM, Casella IB … +1 more , Silva ESD
Ann Vasc Surg · 2026 Jun · PMID 42269911 · Publisher ↗
BACKGROUND: Visceral aneurysms (VAs) are rare dilatations of splanchnic arteries that carry a significant risk of rupture. The role of parietal calcification in the natural progression and rupture risk of these aneurysms...
BACKGROUND: Visceral aneurysms (VAs) are rare dilatations of splanchnic arteries that carry a significant risk of rupture. The role of parietal calcification in the natural progression and rupture risk of these aneurysms remains unclear, with most existing literature focusing on abdominal aortic aneurysms. This study aimed to evaluate the relationship between parietal calcification and VA relative growth rates, aneurysm sac thrombosis, and patient survival. METHODS: A retrospective analysis of 138 patients diagnosed with VA was conducted at the Hospital das Clínicas, Faculty of Medicine, University of São Paulo. Calcification was assessed via computed tomography and categorized into four types based on circumferential extent. Patients were grouped into low calcification (types 1 and 2) and high calcification (types 3 and 4) categories. The relative growth rate was calculated as the change in aneurysm diameter over time. Kaplan-Meier curves and Cox regression analyses were used to compare survival rates. RESULTS: Of the 138 patients, 117 had <50% calcification (types 1 and 2) and 21 had >50% calcification (types 3 and 4). Aneurysm growth was higher in the high-calcification group (0.73 mm/year vs. 0.53 mm/year), although not statistically significant (P = 0.42). A higher prevalence of aneurysm thrombosis was noted in the high-calcification group (33.3% vs. 11.1%, P = 0.002). Kaplan-Meier survival analysis revealed a trend toward better 5- and 10-year survival in patients with higher calcification, but this finding was not statistically significant. CONCLUSION: In this cohort of 138 patients, parietal calcification involving more than 50% of the aneurysm circumference was associated with a significantly higher prevalence of intra-aneurysmal thrombosis and a marked female predominance. A nonsignificant trend toward higher annual growth and toward better long-term survival was also observed in heavily calcified aneurysms. These findings suggest that parietal calcification may represent a morphological feature with prognostic relevance in visceral aneurysms and support the need for further studies to determine its role in risk stratification and management.
Toward the Development of an Integrated Anatomic and Hemodynamic Classification for Primary Superficial Venous Insufficiency: Results of a Delphi Consensus.
Sousa J, Mansilha A
Ann Vasc Surg · 2026 Jun · PMID 42269910 · Publisher ↗
BACKGROUND: This study aimed to develop a validated set of expert consensus statements that may serve as the foundation for a new integrated anatomic and hemodynamic classification for primary superficial venous insuffic...
BACKGROUND: This study aimed to develop a validated set of expert consensus statements that may serve as the foundation for a new integrated anatomic and hemodynamic classification for primary superficial venous insufficiency (PSVI). METHODS: A modified Delphi process was conducted among an international panel of 36 high-volume venous specialists. Experts were selected based on procedural experience (≥ 100 procedures per year) and prior participation in a global survey on the conceptual framework of an integrated anatomic-hemodynamic classification for PSVI. Over 2 iterative rounds, 17 initial statements-grouped into anatomic and hemodynamic domains-were evaluated using a 5-point Likert scale. Consensus was defined as ≥ 75% agreement, with interquartile range (IQR) of ≤ 1.0 used to assess consistency. Iterative qualitative feedback informed statement refinement between rounds. RESULTS: Sixteen of 17 initial statements reached consensus in Round 1. Based on expert commentary, 3 statements were removed, 3 substantially revised, and 9 linguistically refined for Round 2. In Round 2, all 16 statements reached consensus (agreement 75.1-100%), with IQR ≤ 1.0 for all but one item (IQR = 1.5). Given the robust agreement and consistent feedback, a third round was deemed unnecessary. CONCLUSIONS: This international Delphi study establishes a foundational set of expert-derived statements on the key anatomic and hemodynamic components to be considered for a new integrated anatomic and hemodynamic classification for PSVI. These findings represent a critical step toward a novel, clinically actionable classification system, with potential to improve disease stratification, therapeutic planning, and outcome evaluation in primary superficial venous disease.
Feasibility of an Intravascular Ultrasound-First Strategy for Below-the-Knee Chronic Total Occlusion Lesions.
Shima Y, Bando G, Irie N … +3 more , Mushiake K, Tanaka H, Abe M
Ann Vasc Surg · 2026 Jun · PMID 42269909 · Publisher ↗
BACKGROUND: Endovascular therapy for below-the-knee chronic total occlusion (BTK CTO) lesions is technically challenging, and retrograde approaches using distal puncture are often required. This study aimed to evaluate t...
BACKGROUND: Endovascular therapy for below-the-knee chronic total occlusion (BTK CTO) lesions is technically challenging, and retrograde approaches using distal puncture are often required. This study aimed to evaluate the feasibility of an intravascular ultrasound (IVUS)-first strategy in BTK CTO lesions. METHODS: In this single-center retrospective study, 263 patients with chronic limb-threatening ischemia undergoing endovascular therapy for BTK CTO lesions between January 2022 and June 2025 were screened. After excluding stenotic lesions and cases treated with angiography-guided antegrade approach alone, 63 lesions were analyzed. Technical success and procedural complications were evaluated. Among lesions treated with an IVUS-first strategy, a subgroup analysis comparing IVUS-only and crossover cases was performed. RESULTS: Among 63 lesions, 34 were treated with an IVUS-first strategy, and 29 underwent primary distal puncture. Technical success showed a trend toward improvement in the IVUS-first group (91.2% vs. 72.4%, p = 0.051), while complication rates were similar (5.9% vs. 13.8%, p = 0.29). In the IVUS-first group, antegrade-only completion was achieved in 70.6% of lesions, whereas 29.4% required crossover to distal puncture. Severe calcification was significantly more frequent in crossover cases (90.0% vs. 29.2%, p = 0.002). CONCLUSION: An IVUS-first strategy enabled antegrade-only completion in approximately 70% of BTK CTO lesions and may help reduce the need for distal puncture in selected cases.
Impact of Probiotics on Coagulation Function in Older Adults Aged ≥60 years Patients Receiving Cefoperazone-Sulbactam: A Retrospective Study.
Li Y, Deng H, Gu Y
Ann Vasc Surg · 2026 Jun · PMID 42269908 · Publisher ↗
BACKGROUND: Coagulation abnormalities are frequently observed in elderly patients, especially in those with antibiotic therapy like cefoperazone-sulbactam. Probiotics are suggested to modify coagulation via their influen...
BACKGROUND: Coagulation abnormalities are frequently observed in elderly patients, especially in those with antibiotic therapy like cefoperazone-sulbactam. Probiotics are suggested to modify coagulation via their influence on gut microbiota and systemic inflammation, however the studies focusing on probiotics in the management of coagulation disturbances in older adults aged ≥60 years patients during antibiotic therapy are limited. Our study aimed to observe the effect of probiotics on coagulation function in older adults aged ≥60 years patients treated with cefoperazone-sulbactam, through comprehensive coagulation parameters including prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), and platelet count (PLT). METHODS: This retrospective study included patients who had received cefoperazone-sulbactam monotherapy or combined with probiotic therapy. Probiotic exposure was defined as oral administration of probiotic preparations prescribed during cefoperazone-sulbactam therapy, initiated concurrently with or during the course of antibiotic treatment according to routine inpatient clinical practice. Baseline characteristics were collected, and coagulation function was assessed before and after treatment. RESULTS: This study included 247 patients aged ≥60 years. Coagulation parameters of the probiotic group were significantly affected by probiotics, TT was decreased while PLT was slightly decreased. Compared with the nonprobiotic group, patients receiving probiotics showed significantly different posttreatment TT and PLT values (both P < 0.01), whereas no significant between-group differences were observed in PT, APTT, or fibrinogen levels (all P > 0.01). The nonprobiotic group showed no significant variations. In subgroup analysis, more profound changes in coagulation parameters were evident in patients with baseline coagulation abnormalities. CONCLUSIONS: Probiotics may play a beneficial role in coagulation function modulation in patients aged ≥60 years treated with cefoperazone-sulbactam. The findings propose probiotics as an adjunctive therapy that should be explored in terms of improving coagulation outcomes and reducing bleeding or thrombosis risk in this population. Intervention studies will be needed to confirm these findings and identify the underlying mechanisms.
Letter to the Editor: Comment on "Stent Diameter, Not Sex, Is Predictive of Reintervention After Common Iliac Artery Stenting".
Manenti A, Coppi G, Coppi F … +1 more , Manco G
Ann Vasc Surg · 2026 May · PMID 42217567 · Publisher ↗
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