Orimoto Y, Ishibashi H, Arima T
… +3 more, Mitsuoka H, Kawai Y, Kodama A
Ann Vasc Surg
· 2026 May · PMID 42203031
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BACKGROUND: To prevent distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for double-barrel Stanford type B aortic dissection (TBAD), we adopted the PETTICOAT-Snowshoe technique...BACKGROUND: To prevent distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for double-barrel Stanford type B aortic dissection (TBAD), we adopted the PETTICOAT-Snowshoe technique. In this technique, a proximal stent graft is deployed, followed by the extension of a bare stent above the celiac artery and deployment of a second stent graft within the bare stent. This study aimed to evaluate its mid-term outcomes and feasibility in preventing distal SINE. METHODS: This single-center retrospective study included patients who underwent the PETTICOAT-Snowshoe technique for double-barrel TBAD between October 2017 and July 2025. The primary endpoint was distal SINE. Secondary endpoints included aortic-related reintervention and mortality. Overall survival and freedom from aortic-related reintervention were estimated using the Kaplan-Meier method. RESULTS: Sixty-three patients (median age, 61 years; 78% male) were analyzed, including acute (14%), subacute (30%), and chronic (56%) dissections. The median total length of covered stent grafts was 225 mm, and the median distal oversizing ratio was 30%. The median follow-up duration was 53 months. No distal SINE occurred during the follow-up. One patient (2%) died within 30 days due to retrograde type A dissection. Aortic-related reintervention was required in 11 patients (17%), and 8 patients (13%) died. The 5-year overall survival rate was 82.0 ± 5.9% (95% CI, 70.4-93.6%), while the freedom from aortic-related reintervention rate was 79.1 ± 6.0% (95% CI, 67.3-90.9%). The true lumen ratio improved from 26.0% preoperatively to 58.2% at 1 year and remained stable at 5 years. CONCLUSION: The PETTICOAT-Snowshoe technique was associated with no distal SINE during the mid-term follow-up and may be a promising strategy for preventing distal SINE after TEVAR.
Mabrouk M, Fouda A, Habiba A
… +2 more, Elkassaby M, Kassem A
Ann Vasc Surg
· 2026 May · PMID 42176977
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BACKGROUND: Deeply located arteriovenous fistulas (AVFs) pose a major challenge in hemodialysis access, especially in obese patients, where the cephalic vein lies beyond the optimal cannulation depth. Second-stage superf...BACKGROUND: Deeply located arteriovenous fistulas (AVFs) pose a major challenge in hemodialysis access, especially in obese patients, where the cephalic vein lies beyond the optimal cannulation depth. Second-stage superficialization techniques such as tunnel transposition and lipectomy are often required, yet comparative data on their effectiveness remain limited. To compare the clinical outcomes of tunnel transposition versus lipectomy for second-stage superficialization of deep brachiocephalic AVFs. METHODS: This multicenter retrospective study included 127 patients with mature brachiocephalic AVFs and cephalic veins located >6 mm from the skin surface, who underwent superficialization between January 2020 and May 2024. Patients were assigned to tunnel transposition (n = 69) or lipectomy (n = 58) groups. Outcomes included technical success, time to cannulation, complication rates, and long-term patency. Data were analyzed using t-tests, chi-squared tests, and Kaplan-Meier survival analysis. RESULTS: Demographics and comorbidities were comparable between groups. The mean post superficialization vein depth was lower in the tunnel group (2.48 ± 0.34 mm) compared to the lipectomy group (2.71 ± 0.92 mm), though not statistically significant (P = 0.057). Difficult cannulation occurred significantly more often in the lipectomy group (10.34% vs. 1.45%; P = 0.047). Other complications, including hematoma, infection, thrombosis, and postoperative steal syndrome, were similar. Primary and secondary patency rates up to 24 months showed no significant difference between groups. CONCLUSION: Tunnel transposition and lipectomy are both effective for superficializing deep brachiocephalic AVFs. However, tunnel transposition may reduce the rate of difficult cannulation and may be preferred in patients with severe vein depth or scarring.
Keten MF, Yilmaz C, Biyikli K
… +7 more, Tanyeri Uzel S, Balaban I, Ceneli D, Karaduman A, Guvendi Sengor B, Eminoglu H, Zehir R
Ann Vasc Surg
· 2026 May · PMID 42176976
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BACKGROUND: Acute limb ischemia (ALI) is associated with high risks of mortality and major amputation despite advances in endovascular therapy. In patients treated with catheter-directed thrombolysis (CDT), early risk st...BACKGROUND: Acute limb ischemia (ALI) is associated with high risks of mortality and major amputation despite advances in endovascular therapy. In patients treated with catheter-directed thrombolysis (CDT), early risk stratification is clinically important. The Aggregate Index of Systemic Inflammation (AISI) reflects systemic inflammatory burden, but its prognostic role in this setting remains unclear. METHODS: We retrospectively analyzed consecutive patients with Rutherford class IIa ALI treated with CDT between January 2016 and December 2024. Admission AISI was calculated from routine complete blood count parameters. The primary outcome was a composite of in-hospital mortality and/or major amputation. Multivariable logistic regression analyses using log-transformed AISI were adjusted for relevant clinical covariates. Discrimination was assessed using receiver operating characteristic analysis. RESULTS: A total of 219 patients were included, and the composite outcome occurred in 24.7%. Higher AISI was associated with a significantly increased rate of adverse outcomes (40.5% vs. 8.3%, P < 0.001). AISI demonstrated moderate discriminatory ability (area under the curve = 0.74). In multivariable analysis, log-transformed AISI independently predicted the composite outcome (odds ratio 2.49, 95% confidence interval 1.52-4.10; P < 0.001). CONCLUSION: Elevated admission AISI is independently associated with early adverse outcomes in ALI patients undergoing CDT and may support early risk stratification.
Ann Vasc Surg
· 2026 May · PMID 42176975
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BACKGROUND: Infrapopliteal atherosclerosis and calcification are major causes of chronic limb ischemia. This study aimed to identify causative genes and immune cell phenotypes driving this pathology to develop targeted t...BACKGROUND: Infrapopliteal atherosclerosis and calcification are major causes of chronic limb ischemia. This study aimed to identify causative genes and immune cell phenotypes driving this pathology to develop targeted therapeutic strategies. METHODS: Bulk RNA transcriptomics (bulk RNA-seq) and summary data-based Mendelian randomization (SMR) were integrated to identify key genes associated with infrapopliteal atherosclerosis. Subsequently, single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) were employed to characterize the target gene's specific expression and spatial distribution in calcified vessels. Mendelian randomization (MR) combined with scRNA-seq was utilized to identify immune cell phenotypes causally associated with the disease. Molecular mechanisms were investigated via in silico knockout and protein-protein interaction analyses, followed by therapeutic drug prediction via enrichment analysis. RESULTS: Integrated analysis identified HLA-B as the robust causative gene for infrapopliteal atherosclerosis (P = 0.002, β = 0.274). scRNA-seq analysis showed that HLA-B was significantly upregulated in B cells in calcified vascular tissue. Additionally, MR analysis combined with scRNA-seq identified IgD- CD27- B cell %B cell and IgD+ CD24- B cell %lymphocyte as immune cell phenotypes causally associated with the disease. In silico knockout combined with protein docking revealed a strong interaction between HLA-B and MRPL18, and ST analysis demonstrated higher overall expression of HLA-B in calcified vessels, particularly in plaques and calcified regions. Drug enrichment analysis suggested that allopurinol, abacavir, and lamotrigine could be potential therapeutics targeting HLA-B. CONCLUSION: Integrated multiomics revealed HLA-B upregulation drives infrapopliteal atherosclerosis and calcification, identifying IgD- CD27- B cell %B cell and IgD+ CD24- B cell %lymphocyte as causal immune phenotypes.
Goyal KA, Chick JFB, Shin DS
… +3 more, Haurani M, Viggiano BT, Makary MS
Ann Vasc Surg
· 2026 May · PMID 42176974
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BACKGROUND: To assess trends in resident diversity within vascular surgery as compared to other specialties over the past decade. METHODS: The American Association of Medical Colleges Graduate Medical Education Database...BACKGROUND: To assess trends in resident diversity within vascular surgery as compared to other specialties over the past decade. METHODS: The American Association of Medical Colleges Graduate Medical Education Database was accessed for the academic years 2012-2013 and 2022-2023, and demographic information regarding racial and ethnic makeup of medical specialty training programs was collected, categorized as White/Caucasian, Asian/Pacific Islander, Hispanic/Latino, Black, and Native American. Changes in resident diversity in vascular surgery over the past decade were compared to other residencies using Chi-squared analysis (P < 0.05). RESULTS: In the 2022-2023 academic year, vascular surgery residency programs ranked 14th of the 25 examined specialties in percent enrollment of White residents (51%), ninth in Asian/Pacific Islanders (27%), 10th in Hispanic/Latino residents (9.4%), eighth in Black residents (6.3%), and third in Native American residents (0.26%). Between 2012-2013 and 2022-2023, vascular surgery residencies demonstrated the largest increase in percent enrollment of Black residents (4.8%). Upon Chi-squared analysis, vascular surgery residencies experienced significantly higher increases of Asian/Pacific Islander (P = 0.0008 and 0.0015, respectively) and Black (P = 0.0016 and P = 0.008, respectively) resident enrollment than both the surgical and nonsurgical specialties. Vascular surgery residencies did not differ in regard to changes in White, Hispanic/Latino, and Native American enrollment as compared to surgical and nonsurgical specialties. CONCLUSION: Vascular surgery residencies ranked ninth, 10th, eighth, and third in proportional enrollment of Asian/Pacific Islander, Hispanic/Latino, Black, and Native American residents, respectively, and were among the top specialties demonstrating increases in representation of both Black and Asian residents.
Shah P, Ginsberg E, Chauhan S
… +2 more, Guida N, Shah T
Ann Vasc Surg
· 2026 May · PMID 42176973
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BACKGROUND: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to lower complication rates and superior long-term patency. Historically, time to first cannulation has been pro...BACKGROUND: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to lower complication rates and superior long-term patency. Historically, time to first cannulation has been prolonged, leading to prolonged catheter dependence. This study evaluates whether an early access protocol can safely reduce time to AVF cannulation and therefore permacath removal. METHODS: A retrospective review was conducted on all patients who underwent autogenous AVF creation with preexisting dialysis catheters at our institutions between July 2018 and October 2024. Patients were grouped by protocol: those from 2018 to 2021 (Standard Protocol) and those from 2021 to 2024 (early access protocol). Time to first cannulation and time to dialysis catheter removal were compared between groups. Statistical analysis was performed utilizing the Shapiro-Wilk test, 2 tailed t-test, Wilcoxon signed-rank tests, and chi-squared tests with significance set at P < 0.05. RESULTS: Of the 286 AVFs that were created during the study period, 128 met inclusion criteria with 77 patients in the early access protocol group and 51 in the standard protocol group. As shown in Table 1, patients in the early access protocol had significantly shorter times to cannulation (41.6 ± 23.8 days vs. 57.9 ± 41.2 days, P = 0.01) and permacath removal (98.3 ± 55.4 days vs. 133.6 ± 71.1 days, P < 0.01) than those in the standard protocol. There were no significant differences in sex, American Society of Anesthesiologists class, tobacco use, laterality of fistula, or complication rates. Although not statistically significant, there was a trend in the early access protocol cohort for increased adjunctive procedures. CONCLUSION: Our early access protocol significantly reduced the time to AVF cannulation and catheter removal without increasing complication rates. These findings support the implementation of early access strategies to improve time to AVF cannulation rates, reduce catheter-related risks, and enhance overall vascular access outcomes.
Del Río-Solá ML, Jimenez-Caja M, de la Torre-Casaseca C
… +2 more, Asensio Rodriguez S, Perez Fernández S
Ann Vasc Surg
· 2026 May · PMID 42167723
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BACKGROUND: Fenestrated and branched endovascular aneurysm repair (F/BEVAR) has emerged as an advanced technique for the treatment of complex aortic aneurysms involving visceral and renal branches. Despite its increasing...BACKGROUND: Fenestrated and branched endovascular aneurysm repair (F/BEVAR) has emerged as an advanced technique for the treatment of complex aortic aneurysms involving visceral and renal branches. Despite its increasing adoption, procedure-related complications remain a major concern, while the scientific landscape continues to evolve. OBJECTIVE: To analyze the distribution of complications associated with F/BEVAR and evaluate global research trends through a combined clinical and bibliometric approaches. METHODS: A retrospective clinical analysis of complications was performed using R (R Foundation for Statistical Computing, Vienna, Austria). A bibliometric analysis was conducted using VOSviewer to assess co-authorship, keyword co-occurrence, citation patterns, and journal distribution. Data were retrieved from the Scopus database using a predefined search strategy. A total of 646 records were identified, of which 529 publications were included after applying predefined selection criteria. RESULTS: A total of 529 publications were analyzed. Scientific output demonstrated a sustained increase over time, with a marked acceleration after 2015 and a progressive rise in citation impact. Keyword co-occurrence analysis revealed a highly interconnected structure centered on procedural techniques, aneurysm characteristics, and clinical outcomes. Bibliographic coupling highlighted a partially fragmented citation network, particularly among recent publications, suggesting an evolving and rapidly expanding field. The United States was the leading contributor, followed by major European countries. From a reporting perspective, endoleak (36.3%) and occlusion (34.0%) were the most frequent complications, predominantly affecting renal branches (72.0%). CONCLUSION: F/BEVAR research has experienced substantial growth over the past two decades, accompanied by a transition in research emphasis from technical feasibility toward outcome-driven and data-oriented investigation. This evolution reflects the maturation of the field but does not, in itself, imply improvement in clinical outcomes, which cannot be inferred from the bibliometric or text-mining data presented here. Endoleak and branch occlusion remain the most persistently and frequently reported complications, with a predominant involvement of renal branches, underscoring persistent technical challenges in target vessel preservation.
Hamid K, Dhahri AA, Rao A
… +5 more, Farrag A, Ahmed A, Fairhead J, Pherwani AD, Jaipersad AS
Ann Vasc Surg
· 2026 May · PMID 42162862
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BACKGROUND: National registries report on procedures and outcomes for patients with abdominal aortic aneurysms (AAAs) leaving the outcomes of patients who do not undergo surgery undefined. This study aimed to determine s...BACKGROUND: National registries report on procedures and outcomes for patients with abdominal aortic aneurysms (AAAs) leaving the outcomes of patients who do not undergo surgery undefined. This study aimed to determine survival of patients who do not undergo or decline intervention, termed 'turned down' for AAA repair, and evaluate the CHADS-VASc score as a predictor of mortality. METHODS: Prospectively collected data were analyzed on all patients turned down for elective AAA repair within a large tertiary vascular network in England between 2016 and 2024. Demographic, clinical, and aneurysm characteristics were recorded, and CHADS-VASc score was calculated for each patient. Kaplan-Meier survival analysis and Cox regression were used to assess long-term survival and identify predictors of mortality. RESULTS: Of 1,181 patients with infrarenal AAA referred for repair, 286 (24.2%) were declined intervention. The mean age at turndown was 83 years, and 69% were male. Mean AAA diameter at turndown was 6.0 cm. One-, 3-, and 5-year survival rates were 74%, 19%, and 5%, respectively. Increasing aneurysm size was significantly associated with AAA-related mortality. Age and higher CHADS-VASc scores were independently associated with reduced survival at 3 years (P = 0.001 and P = 0.05, respectively) CONCLUSION: Patients with AAA who are turned down for repair exhibit high early mortality, a reflection of advanced age, frailty, and comorbidity. The CHADS-VASc score serves as a simple and practical tool to predict survival. These findings highlight the need for follow-up and ideally registry inclusion of nonoperated patients to help predict outcomes and enable shared decision-making with patients.
Hargiss JB, Farres H, Falen JS
… +5 more, Alsabbagh Y, Esquetini-Vernon C, Sandoval CP, Jacobs C, Erben Y
Ann Vasc Surg
· 2026 May · PMID 42162861
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BACKGROUND: Thoracic outlet syndrome (TOS) arises from compression of neurovascular structures as they traverse the thoracic outlet at the base of the neck, with 3 main types: neurogenic, venous, and arterial. Establishe...BACKGROUND: Thoracic outlet syndrome (TOS) arises from compression of neurovascular structures as they traverse the thoracic outlet at the base of the neck, with 3 main types: neurogenic, venous, and arterial. Established risk factors include acute trauma, repetitive upper extremity use, or congenital anatomical variations. Birth trauma, although relatively rare, remains a recognized cause of injury to the brachial plexus, yet its role in TOS development has not been investigated. This study aims to explore the prevalence of reported birth trauma among patients with clinically diagnosed and surgically treated TOS at our institution. METHODS: We conducted a retrospective cross-sectional study using a survey-based methodology among patients diagnosed with TOS, who underwent first-rib resection at our institution between 2001 and 2024. Eligible patients were contacted by telephone or electronic communication and invited to participate in a brief standardized survey that was developed in conjunction with professionals in Obstetrics and Gynecology, screening for instances of birth trauma. RESULTS: A total of 41 responses were collected. Mean age was 40.1 years, with 29 females (71%) and 12 males (29%). Mean body mass index was 27.1. Most reported Caucasian race (90%). Six of the 41 patients reported shoulder dystocia (SD) (15%). Five patients reported the occurrence of forceps assisted vaginal delivery (AVD) during their birth (12% of the entire cohort, 15% of those born vaginally). CONCLUSION: SD and AVD are relatively rare observations in the general population, with rates consistently falling between 1 and 3% per year for multiple decades. Our cohort reported a 4- to 10-fold increase in birth trauma, higher than expected. Almost one-quarter (24%) of patients surveyed with established neurogenic thoracic outlet syndrome reported SD or forceps AVD. This finding could have profound clinical implications. If SD or AVD are found to be factors that influence the development of TOS later in life, clinicians can expect an increased incidence of TOS in the coming years, they can screen for symptoms earlier in the disease course, and earlier intervention may lead to decreased morbidity in the patients we serve. We believe our pilot study findings warrant further investigation with a larger sample size.
Seike Y, Yoshida K, Koda Y
… +5 more, Shijo T, Inoue Y, Horinouchi H, Fukuda T, Matsuda H
Ann Vasc Surg
· 2026 May · PMID 42162860
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BACKGROUND: This study assessed whether preemptive side branch embolization improves early to mid-term outcomes after endovascular aneurysm repair (EVAR), focusing on sac enlargement and reintervention for persistent typ...BACKGROUND: This study assessed whether preemptive side branch embolization improves early to mid-term outcomes after endovascular aneurysm repair (EVAR), focusing on sac enlargement and reintervention for persistent type II endoleak. METHODS: A total of 536 patients were included and categorized into three periods based on embolization strategy. In period 1 (n = 142), no preemptive embolization was performed. In period 2 (n = 111), inferior mesenteric artery (IMA) embolization was conducted when indicated. In period 3 (n = 283), embolization of the IMA and/or lumbar arteries (LAs) was performed according to anatomical findings. Early and mid-term outcomes were evaluated across all three periods, with additional analysis performed using propensity score matching (PSM). RESULTS: Freedom from sac enlargement (≥5 mm) was comparable between period 1 and period 2 groups (log-rank, P = 0.45) but was significantly higher in period 3 than in period 2 (log-rank, P < 0.01) and was significantly higher in period 3 compared to period 1 (log-rank, P < 0.01). Freedom from reintervention, including aneurysm rupture prior to reintervention, did not differ significantly among the three groups. After PSM, the period 3 group demonstrated significantly greater freedom from sac enlargement (log-rank, P < 0.01), whereas the rates of reintervention or rupture remained statistically similar across the groups. CONCLUSION: An aggressive embolization strategy targeting both the IMA and LA was safe and associated with favorable early outcomes. Mid-term results suggested effective suppression of sac enlargement after EVAR. However, longer-term follow-up is required to confirm sustained benefits in reducing reintervention and rupture.
Ponte BJ, Saback Fonseca JR, Fioranelli A
… +5 more, Alexandrino da Silva MF, Teivelis MP, Milanez de Campos JR, Amaro E, Wolosker N
Ann Vasc Surg
· 2026 May · PMID 42162859
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BACKGROUND: Primary hyperhidrosis (HH) causes substantial functional and psychosocial impairment. While anticholinergic therapy has become first-line treatment, video-assisted thoracic sympathectomy (VATS) remains the on...BACKGROUND: Primary hyperhidrosis (HH) causes substantial functional and psychosocial impairment. While anticholinergic therapy has become first-line treatment, video-assisted thoracic sympathectomy (VATS) remains the only definitive option for patients with refractory disease. Large-scale, real-world data on the safety and utilization of VATS for HH at a national level remain limited. METHODS: We conducted a nationwide retrospective analysis including all patients who underwent VATS for HH in Brazil between 2015 and 2023. Data were obtained from publicly available governmental databases encompassing both public and private health-care systems. Procedure volumes, demographic characteristics, regional distribution, reimbursement, in-hospital mortality, and health-care sector differences were analyzed. RESULTS: A total of 26,980 VATS procedures for HH were performed during the study period. Most patients were female (64.5%) and aged 15-39 years (82.7%). Procedures were predominantly performed in the private health-care system (75.3%), with marked regional concentration in the Southeast (48.3%) and South (29.5%) regions. Overall in-hospital mortality was extremely low (0.048%) and did not differ significantly between public and private sectors. Despite similar safety profiles, the mean cost per procedure in the private system was substantially higher, resulting in more than 90% of total national expenditures. CONCLUSION: In this nationwide cohort of nearly 27,000 procedures, VATS sympathectomy for primary HH demonstrated a low mortality rate across both public and private health-care systems, supporting its role as a safe definitive surgical therapy when appropriately indicated. The marked disparities in access and cost highlight important system-level differences but do not appear to compromise procedural safety.
Ravindhran B, Hatfield-Chetter G, Morris-Jarvis J
… +7 more, Stedman N, Carradice D, Smith G, Thakker D, Bicknell C, Chetter I, Pymer S
Ann Vasc Surg
· 2026 May · PMID 42162858
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BACKGROUND: To develop and validate dynamic machine learning (ML) models to predict 6-month adverse outcomes in intermittent claudication (IC), enabling risk-ranked prioritization for surveillance and timely revasculariz...BACKGROUND: To develop and validate dynamic machine learning (ML) models to predict 6-month adverse outcomes in intermittent claudication (IC), enabling risk-ranked prioritization for surveillance and timely revascularization. METHODS: This study included patients from a prospectively maintained nurse-led IC clinic registry (2020-2024). Predictors included demographics, comorbidities, medications, smoking exposure, frailty, ankle-brachial pressure index [ABPI], and treadmill performance. We first trained feedforward neural networks (multilayer perceptron and radial basis function) and then developed ensemble models (Least Absolute Shrinkage and Selection Operator logistic regression, gradient boosting, random forest, and XGBoost; stacking meta-learner logistic regression with 3-fold cross-validation). Data were split 70/30 with stratification. Model performance was assessed using discrimination (area under the receiver operator characteristic curve) and F1 score, and calibration (Brier score). RESULTS: In the cohort (n = 629), IC deterioration requiring revascularization occurred in 132 patients (21.0%), chronic limb-threatening ischemia (CLTI) progression in 27 (4.3%), and mortality in 34 (5.4%) at 6 months. Ensemble models achieved area under the curve values of 0.712 (IC revascularization), 0.754 (CLTI), and 0.828 (mortality), and Brier scores of 0.154, 0.039, and 0.047, respectively. F1 scores were >0.70 for all model iterations. Earlier neural network models demonstrated low cross-entropy but less favorable probability accuracy (Brier ∼0.22) and F1 performance, motivating transition to ensemble approaches. Key predictors included ABPI, maximum walking distance and initial claudication distance, age, renal disease, chronic obstructive pulmonary disease, smoking exposure, and frailty. CONCLUSION: Ensemble ML models provide calibrated 6-month risk estimates for revascularization, CLTI, and mortality after nurse-led IC clinic assessment, which may support patient prioritization for surveillance and early escalation of care. External validation and prospective impact evaluation are warranted and represent our next steps.
Inal E, Farres H, Polania-Sandoval C
… +2 more, Brigham TJ, Erben Y
Ann Vasc Surg
· 2026 May · PMID 42162857
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BACKGROUND: This study aimed to evaluate the current state of shared decision-making (SDM) in vascular surgery with a focus on abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and carotid disease by sy...BACKGROUND: This study aimed to evaluate the current state of shared decision-making (SDM) in vascular surgery with a focus on abdominal aortic aneurysm (AAA), peripheral arterial disease (PAD), and carotid disease by synthesizing both qualitative and quantitative evidences. METHODS: We conducted a mixed-methods systematic review following PRISMA guidelines. MEDLINE, Embase, CENTRAL, Web of Science, and Epistemonikos were searched through October 2025. Primary quantitative, qualitative, and mixed-methods studies involving adult patients with AAA, PAD, or carotid artery disease were included. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Due to heterogeneity, results were synthesized narratively without meta-analysis. RESULTS: Fifty-two studies were included, comprising 26 quantitative, 19 qualitative, and 7 mixed-methods studies. Twenty-four studies evaluated SDM in AAA, 14 in PAD, 5 in carotid artery disease, and 9 included mixed vascular cohorts. In AAA, observer-rated SDM improved after SDM interventions, with OPTION-5 scores increasing from 28.7% to 37.8% (P-value <0.001). Patient knowledge improved; however, patient-reported SDM, decisional conflict, satisfaction, and quality of life measures showed no significant change. In PAD, observer-rated SDM remained low (mean OPTION-5 score of 31.0%), despite high patient-reported SDM (SDM-Q-9 score of 93.0%). SDM interventions improved patient knowledge, particularly in intermittent claudication, while decisional outcomes remained unchanged. In carotid artery disease, although 93.0% of patients preferred SDM, only 54.0% reported being offered treatment choices. CONCLUSION: In vascular surgery, despite a strong preference among patients to be actively involved in decisions regarding their care, SDM remains inconsistently implemented in clinical practice. Further SDM interventions should be implemented to address this discrepancy and to improve patient care.
Alappan UD, Chetty AK, Carter W
… +5 more, Wells N, Alameddine D, Inzucchi SE, Guzman R, Ochoa Chaar CI
Ann Vasc Surg
· 2026 May · PMID 42162856
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BACKGROUND: Diabetes mellitus (DM) is a significant risk factor for peripheral arterial disease (PAD) and can lead to chronic limb-threatening ischemia requiring revascularization. Though Sodium Glucose Cotransporter-2 i...BACKGROUND: Diabetes mellitus (DM) is a significant risk factor for peripheral arterial disease (PAD) and can lead to chronic limb-threatening ischemia requiring revascularization. Though Sodium Glucose Cotransporter-2 inhibitors (SGLT2i) have cardiorenal benefits, there is concern for increased amputation-risk in patients with PAD. This study assesses SGLT2i use in patients with DM undergoing lower extremity revascularization (LER) for PAD and associated outcomes. METHODS: A retrospective cohort review of patients undergoing LER for PAD (2013-2020) in a tertiary care center was performed. Open and endovascular LERs were included. Patients undergoing initial revascularization for acute limb ischemia or with SGLT2i contraindication were excluded (chronic kidney disease stage 4/5/dialysis). Characteristics/outcomes of patients on versus not on SGLT2i at index revascularization were compared using propensity 3:1-matching and Kaplan-Meier (KM) curves for long-term outcomes. R software was used for analysis. RESULTS: Two thousand thirty-nine patients underwent LER for PAD and 1147 (56.3%) had DM. SGLT2i use increased from 0% to 10.3% (2013-2020; P < 0.001). Differences in demographics, comorbidities, and procedural type (endovascular/open/hybrid) were significant prior to matching but not after. Fifty-six point four percent of patients used insulin preoperatively with no difference in preoperative and postoperative hemoglobin A1C between the groups. Patients on SGLT2i had higher perioperative return to operating room (24.6% v 10.8%; P = 0.006) but shorter length of hospital stay (4.5 vs. 7.0; P = 0.046) compared to patients not on SGLT2i. There was no difference in perioperative major or minor amputation or KM analysis of major amputation, all-cause-mortality, or MALE-free-survival between the groups. CONCLUSION: SGTL2i use has increased in patients with DM undergoing LER and was not associated with increased amputation after LER.
Slim H, Gouda Y, Li Y
… +4 more, Manu C, Valenti D, Campbell B, Edmonds M
Ann Vasc Surg
· 2026 May · PMID 42155627
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BACKGROUND: Traditional open limb bypass surgery has risks of perioperative complications and prolonged recovery due to large wounds and extensive dissections. We describe a new concept in bypass revascularization, the m...BACKGROUND: Traditional open limb bypass surgery has risks of perioperative complications and prolonged recovery due to large wounds and extensive dissections. We describe a new concept in bypass revascularization, the minimally invasive novel open revascularization (MINOR) approach - which has 3 elements: shortest possible length of vein bypass, endoscopic vein harvesting (EVH), limited incisions to minimise tissue damage. METHODS: Analysis of prospectively collected data over 18 months on sequential, unselected patients treated by the MINOR approach. Primary outcomes were technical success, wound complications, and major adverse limb event (MALE) or death at 1 year. Secondary outcomes were graft patency at 1 year and limb salvage and amputation-free survival at 18 months. RESULTS: A total of 73 patients (63% with diabetes) underwent 81 infra-brachial and infra-inguinal MINOR bypasses: 91% for chronic limb threatening ischemia (CLTI) and 9% for popliteal aneurysm. Bypasses were to popliteal artery in 19(23%), tibial arteries (distal) in 32(40%), and pedal or palmar arches (ultra-distal) in 30(37%). Bypass conduits included autologous great saphenous, small saphenous, cephalic, and basilic veins. Technical success was 100% with no significant wound complications, and a MALE or death at 1 year was 17.3%. The primary, assisted primary and secondary patency rates at 1 year were 60.5%, 76.5%, and 85.2%, respectively. 1-year mortality rate was 4%. Limb salvage and amputation-free survival rates at 18 months were 94% and 86.4%, respectively. CONCLUSION: The MINOR approach is an efficient and safe bypass procedure, suitable for complex distal and ultra-distal bypasses, with low complication rates and favourable graft patency, limb salvage, and mortality rates. It offers improved outcomes for patients at risk of amputation from limb ischemia.