Annals Of Vascular Surgery[JOURNAL]
Sun
200 papers
Predictive Value of 2D Phase Contrast Magnetic Resonance Imaging in Patients with Suspected Chronic Mesenteric Ischemia.
Jones M, Mutwiri G, Obrand J … +2 more , Rommens K, Bandali M
Ann Vasc Surg · 2026 May · PMID 42155626 · Publisher ↗
BACKGROUND: The diagnosis of chronic mesenteric ischemia (CMI) is a clinical diagnosis of symptoms in setting of occlusive arterial disease. The study aimed to determine the predictive value of postprandial superior mese...
BACKGROUND: The diagnosis of chronic mesenteric ischemia (CMI) is a clinical diagnosis of symptoms in setting of occlusive arterial disease. The study aimed to determine the predictive value of postprandial superior mesenteric vein (SMV) flow augmentation on two-dimensional phase contrast magnetic resonance imaging (2D PC-MR) as a measure of impaired perfusion in patients with suspected CMI. METHODS: A retrospective review of all adult patients undergoing evaluation for CMI with 2D PC-MR at a single tertiary university care center between January 1, 2021, and January 1, 2025, was performed. Patients required 1 symptom (postprandial pain, weight loss, food fear) and anatomic disease consistent with CMI (isolated severe SMA stenosis or occlusion, or at least moderate 2 vessel-visceral disease including the SMA). A threshold of postprandial SMV flow augmentation less than 50% was chosen to represent abnormal physiologic response. The diagnosis of CMI was determined by a vascular surgeon. Descriptive statistics and contingency analysis were applied due to the small sample size. RESULTS: Thirty-three patients were included in the study. Two-dimensional (2D) PC-MR demonstrated a sensitivity of 93% and a specificity of 68%. Positive predictive value was 68% and negative predictive value was 93%. Of the 3 patients diagnosed with CMI who underwent intervention and received a postprocedure 2D PC-MR study, all demonstrated symptom resolution and normalization of postprandial SMV flow augmentation. CONCLUSION: A threshold of postprandial SMV flow augmentation less than 50% on 2D PC-MR was sensitive in detecting patients with CMI and demonstrated a good negative predictive value, suggesting it may be used as a screening tool in the future.
Peripheral Revascularization in Diabetic and Nondiabetic Patients: A Single-Center Observational Experience.
Tanaskovic S, Milacic A, Zekic P … +10 more , Nikolic M, Ljatifi E, Vucurevic B, Markovic N, Djurdjevic B, Petrovic J, Babic S, Pesic S, Soldatovic I, Bozic B
Ann Vasc Surg · 2026 May · PMID 42150738 · Publisher ↗
BACKGROUND: Peripheral arterial disease (PAD) is a major cause of morbidity and mortality, particularly among patients with diabetes mellitus (DM). Diabetic arteriopathy primarily affects the below-the-knee (BTK) arterie...
BACKGROUND: Peripheral arterial disease (PAD) is a major cause of morbidity and mortality, particularly among patients with diabetes mellitus (DM). Diabetic arteriopathy primarily affects the below-the-knee (BTK) arteries and is often complicated by ischemic ulcerations and infections. This study describes the clinical characteristics, treatment strategies, and observational outcomes of PAD patients with and without DM undergoing revascularization. METHODS: We retrospectively analyzed 710 patients with PAD treated between 2018 and 2024. Patients were grouped into PAD with DM (PAD/DM; n = 420) and PAD without DM (PAD only; n = 290). Symptomatic PAD was defined as intermittent claudication, rest pain, ulceration, or gangrene requiring revascularization. Follow-up ranged from 1 to 54 months (mean 17.4). RESULTS: PAD/DM patients more often presented with Fontaine III/IV ischemia (P = 0.003), foot infections (37.4% vs. 23.8%; P < 0.001), and gangrene (40.1% vs. 25.9%; P < 0.001). Endovascular treatment was more frequent among PAD/DM patients (71.4% vs. 56.2%; P < 0.001), whereas open surgery (OS) predominated among PAD-only patients (45.0% vs. 26.9%; P < 0.001). Minor amputations and wound revisions were more common in the PAD/DM group (14.0% vs. 2.1%; P < 0.001). No significant differences were observed in intrahospital BTK amputation, above-the-knee (ATK) amputation, surgical site infection, or mortality. During follow-up, ATK amputations were significantly higher in PAD-only patients. When stratifying by disease severity, ATK amputation rates in patients presenting with chronic limb-threatening ischemia (CLTI) were 45.8% in the non-DM group versus 8.7% in the DM group (P < 0.001). Kaplan-Meier analysis demonstrated significantly lower overall survival in the PAD-only group (Log-rank P = 0.011). CONCLUSION: In this single-center experience, PAD patients with diabetes presented with a distinct clinical phenotype characterized by distal disease, foot infections, and a reliance on endovascular interventions. Patients without diabetes presented more frequently with proximal disease requiring OS and, when presenting with CLTI, experienced a substantially higher trajectory of major amputations and long-term mortality.
The Impact of Concomitant Proximal Carotid Interventions on Revascularization and Outcomes.
Lin CF, Thandra S, Hallsten J … +4 more , Ho C, Elsayed N, Zarrintan S, Gaffey AC
Ann Vasc Surg · 2026 May · PMID 42134767 · Publisher ↗
BACKGROUND: Tandem atherosclerotic stenosis involving the carotid bifurcation and ipsilateral proximal common carotid artery is uncommon and optimal management remains unclear. We evaluated perioperative outcomes followi...
BACKGROUND: Tandem atherosclerotic stenosis involving the carotid bifurcation and ipsilateral proximal common carotid artery is uncommon and optimal management remains unclear. We evaluated perioperative outcomes following ipsilateral proximal endovascular intervention (IPE) combined with carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), or transcarotid artery revascularization (TCAR). METHODS: Patients undergoing concomitant proximal carotid intervention in the Vascular Quality Initiative registry between 2016 and 2023 were identified. Patients were stratified by procedure: IPE + CEA, IPE + TFCAS, and IPE + TCAR. The primary outcome was in-hospital stroke. Secondary outcomes included major adverse cardiac events (MACEs) and extended length of stay (LOS >1 day). Multivariable logistic regression was performed. RESULTS: Our study included 843 (61.6%) IPE + CEA, 297 (21.7%) IPE + TFCAS, and 228 (16.7%) IPE + TCAR. TCAR patients were more likely to have history of stroke, greater than 80% ipsilateral carotid stenosis, diabetes, coronary artery disease, and chronic kidney disease compared to IPE + CEA and IPE + TFCAS. When compared to IPE + CEA, both IPE + TCAR and IPE + TFCAS exhibited no difference in stroke (adjusted odds ratio [aOR] = 1.07, P = 0.9), (aOR = 1.36, P = 0.473) and stroke/death/myocardial infarction (aOR = 0.4, P = 0.08), (aOR = 1.08, P = 0.81) but with a significant decrease LOS>1 (aOR = 0.59, P = 0.002), (aOR = 0.42, P < 0.001), respectively. Furthermore, IPE + TCAR and IPE + TFCAS had similar risk of stroke (aOR = 0.85, P = 0.764) and LOS>1 (aOR = 1.4, P = 0.12). CONCLUSION: There is no significant difference observed in the risk of stroke and MACEs in IPE + CEA, IPE + TFCAS, and IPE + TCAR. MACEs occurred less frequently, although not statistically significant, in the IPE + TCAR group and warrants additional investigation. Lastly, endovascular techniques were associated with shorter hospital stay. Further research is needed to establish a standard approach to this multilevel condition.
Real-World Spectrum of Pediatric Referrals to a Tertiary Angiology and Vascular Surgery Center: Classification, Imaging, and Management.
Sousa M, Loureiro L, Machado R
Ann Vasc Surg · 2026 May · PMID 42134766 · Publisher ↗
BACKGROUND: To characterize the real-world spectrum of children referred to a tertiary vascular surgery clinic for suspected vascular disease, including referrals not fully classifiable within International Society for t...
BACKGROUND: To characterize the real-world spectrum of children referred to a tertiary vascular surgery clinic for suspected vascular disease, including referrals not fully classifiable within International Society for the Study of Vascular Anomalies (ISSVA) at first assessment, and to describe imaging use, management, and follow-up. METHODS: We performed a single-center retrospective cohort study at a tertiary hospital in Northern Portugal. Patients aged <18 years referred between January 1, 2014 and November 30, 2024 were identified through vascular surgery outpatient clinic records. Demographics, referral source, presenting features, anatomic distribution, diagnostic grouping, imaging, management, and follow-up were abstracted from clinical records. Analyses were descriptive. RESULTS: Of 184 administratively identified records, 182 children comprised the final cohort. Median age at referral was 6.0 years (interquartile range, 2.0-10.2), and 48.9% were female. Congenital vascular anomaly was the largest high-level diagnostic category (71/182, 39.0%), but acquired vascular disease (43/182, 23.6%), other/not classifiable diagnoses (36/182, 19.8%), and functional vascular disorders (12/182, 6.6%) were also common. ISSVA-aligned classification was possible in 72/182 (39.6%), most often vascular malformation (45/182, 24.7%). Lower-limb involvement predominated (88/182, 48.4%). Duplex ultrasound (95/182, 52.2%) and magnetic resonance imaging (MRI) (61/182, 33.5%) were the main imaging modalities, whereas computed tomography and catheter angiography were uncommon. Observation only was the most frequent management strategy (106/182, 58.2%); any medical therapy and any interventional treatment were recorded in 59/182 (32.4%) and 39/182 (21.4%), respectively. CONCLUSION: Tertiary pediatric vascular surgery practice extends beyond ISSVA-classifiable anomalies. A pragmatic classification strategy, ultrasound- and MRI-centered imaging pathway, and selective intervention within multidisciplinary care reflects contemporary real-world tertiary practice.
The Premature Termination of the Phase III SALAMANDER Trial of REX-001, an Autologous Bone Marrow Cell Therapy, for Chronic Limb Ischemia in Diabetic Patients: Insights and Outcomes.
Peeters JAHM, Hamming JF, Quax PHA … +1 more , Schepers A
Ann Vasc Surg · 2026 May · PMID 42119725 · Publisher ↗
BACKGROUND: To evaluate the efficacy and safety of REX-001, an autologous bone marrow-derived mononuclear cell product, in patients with chronic limb-threatening ischemia (CLTI) who had no options for revascularization....
BACKGROUND: To evaluate the efficacy and safety of REX-001, an autologous bone marrow-derived mononuclear cell product, in patients with chronic limb-threatening ischemia (CLTI) who had no options for revascularization. METHODS: In this multicenter, double-blind, randomized, placebo-controlled phase III clinical trial, diabetic patients with CLTI (Rutherford category 5), no revascularization options, and no urgent need for amputation were enrolled. Bone marrow (250 mL) was processed to create REX-001, and a single intra-arterial injection was administered. Primary endpoints included change in Rutherford classification (to category 4 or lower) or complete ulcer healing within 12 months. Secondary endpoints included limb TcpO2, ulcer size, quality of life, ankle-brachial index, 6-min walking test, and amputation-free survival. RESULTS: The trial was stopped early after an interim analysis of 50% of the patients due to lack of efficacy. Thirty-two patients completed the study (21 REX-001, 11 placebo). Complete ulcer healing or improvement in Rutherford category occurred in 28.6% of REX-001-treated patients and 27.3% of placebo-treated patients. No treatment-related adverse events or safety concerns were identified. Data on secondary endpoints were not available. CONCLUSION: This prematurely ended study failed to confirm REX-001's efficacy for ulcer healing. Nevertheless, the study provides valuable insights into trial design, endpoint selection, and data stewardship, guiding future regenerative therapy research in this challenging patient population.
Complications Post-Endovascular Abdominal Aortic Aneurysm Repair in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis.
Otify EAAA, Sanders I, Borucki J … +2 more , Dhatariya K, Stather P
Ann Vasc Surg · 2026 May · PMID 42119724 · Publisher ↗
BACKGROUND: People with diabetes mellitus (DM) have higher long-term mortality following abdominal aortic aneurysm (AAA) repair than those without DM. However, whether this adverse outcome is directly related to their an...
BACKGROUND: People with diabetes mellitus (DM) have higher long-term mortality following abdominal aortic aneurysm (AAA) repair than those without DM. However, whether this adverse outcome is directly related to their aneurysm is unclear. The aim of the study was to determine the rates of complications in people with and without DM post-endovascular AAA repair. Primary outcome data include AAA sac enlargement, reinterventions, endoleaks, postoperative AAA rupture, and conversion to open surgical repair. METHODS: PubMed, Embase, and Cochrane databases were searched for primary research studies between 2005 and 2025 according to Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. Those undergoing AAA repair via endovascular aneurysm repair were included. RESULTS: Forty-four studies were identified totaling 90,347 people in the control group, and 23,988 in the DM group. Those with DM had a lower rate of reintervention compared to controls (9.51% v 11.92%; odds ratio [OR] 0.82, 95% confidence interval [CI] [0.76-0.88; P < 0.001). However, there was no significant difference in the rate of overall, type I or type II endoleaks (P = 0.22, P = 0.237, P = 0.667, respectively).People with DM were also less likely to have sac enlargement post-AAA repair (9.05% DM v 10.38% controls; OR 0.86 [0.78-0.96]; P = 0.005). Those with DM were more likely to have sac shrinkage (42.89% DM v 41.26% controls; OR 0.92, 95% CI [0.89-0.95]; P < 0.001). In addition, people with DM had a reduced rate of conversion to open surgery (2.11% DM v 3.12% control; OR 0.80, CI [0.66-0.97]; P = 0.023). CONCLUSION: Reinterventions, sac enlargement post-AAA repair, and conversion to open surgical repair were associated with a significant reduction in people with DM; however, the cause for these differences remains unclear.
Benchmarking Surgeon Performance in Lower Extremity Revascularization Using a Composite Outcome Metric.
Bansal R, Cieri IF, Fouzdar S … +7 more , Alvarez AR, Bhatt S, Sheshdeh AB, Lokhande P, Patel S, Teeple W, Dua A
Ann Vasc Surg · 2026 May · PMID 42119723 · Publisher ↗
BACKGROUND: Peripheral artery disease (PAD) programs rely on consistent surgical outcomes for high-level limb-salvage performance. Despite the known influence of procedural volume, reliable surgeon-level benchmarking met...
BACKGROUND: Peripheral artery disease (PAD) programs rely on consistent surgical outcomes for high-level limb-salvage performance. Despite the known influence of procedural volume, reliable surgeon-level benchmarking methods remain limited. The Limb Evaluation and Amputation Prevention Program (LEAPP) is a multidisciplinary limb salvage initiative at a large tertiary center. This study aimed to analyze surgeon performance and volume-outcome patterns using a composite quality assessment framework. METHODS: In this single-center study, 147 PAD patients (Rutherford 0-6) undergoing lower extremity revascularization were followed for 1 year. The primary outcome was adverse event-free survival (freedom from bleeding, thrombotic/stenotic events, or amputation). Surgeon-level performance was assessed using a composite z-score integrating standardized adverse event rates, observed-to-expected ratios, and hazard ratios. RESULTS: Among the cohort, 70.5% had chronic limb-threatening ischemia, the mean age was 70.2 ± 9.7 years and 68.7% were male. A total of 31 patients (21.1%) experienced an adverse event: major bleeding 1.4%, thrombotic/stenotic events 10.2%, and amputation 8.2%. Kaplan-Meier analysis showed no significant differences across surgeons for composite or event-specific outcomes (log-rank P > 0.05 for all). Median intraoperative blood loss varied numerically (range 15-1,500 mL; P = 0.31), with lower values among higher-volume surgeons. Composite z-scores ranged from -1.47 to +1.57; surgeons with positive scores were higher-volume operators. CONCLUSION: Surgeon-level outcomes in our limb-salvage program were consistent, with no significant variation in survival or complication rates across surgeons. Higher-volume surgeons demonstrated numerically lower blood loss and consistently positive composite performance scores, suggesting a directional volume-outcome relationship supporting published literature regarding volume. The composite scoring framework offers a feasible, multidimensional approach for surgeon-level benchmarking and may help maintain consistent outcomes and support quality improvement.
Lower Limb Vein Reflux Patterns and Clinical Correlates in Ghana.
Amoako J, van der Woude F, Mensah S … +7 more , Aryee G, Amankwa-Boahin J, Bruce E, Agyekum RN, Bath MF, Bashford T, Hayfron-Benjamin CF
Ann Vasc Surg · 2026 May · PMID 42119722 · Publisher ↗
BACKGROUND: Peripheral venous disease is a major contributor of morbidity globally; however, limited data exist on its prevalence in sub-Saharan Africa. This study aims to describe the reflux patterns and clinical correl...
BACKGROUND: Peripheral venous disease is a major contributor of morbidity globally; however, limited data exist on its prevalence in sub-Saharan Africa. This study aims to describe the reflux patterns and clinical correlates of chronic venous disease in a Ghanaian population. METHODS: Patients who presented to Korle Bu Teaching Hospital between May 2021 and October 2024 were recruited prospectively into the study. All patients with suspected lower limb venous disease underwent a venous duplex scan by a qualified radiologist, with degree and location of incompetence, and diameter of veins recorded, alongside select patient and clinical factors. RESULTS: A total of 215 limbs from 147 patients were included in the study. The average age was 52.6 years and 72 (49.0%) were male. Venous insufficiency was most common in the great saphenous vein (GSV), occurring in 107 limbs (49.8%), with bilateral disease in 51 patients (34.7%). In addition, 89 limbs (41.4%) manifested clinical C0-C1 disease, 76 limbs (35.3%) had C2 disease, whereas 50 limbs (23.3%) had C3-C6 disease. The mean diameter of GSV was 7.4 mm at the saphenofemoral junction, 5.3 mm at the midthigh level, and 5.3 mm at the knee level. CONCLUSION: Around a quarter of patients in this study manifested late-stage disease, with the most common site of insufficiency being the GSV. There is a significant burden of venous disease in Ghana, and further work is required to develop structured vascular surgery services in the country.
Pelvic Congestion Syndrome: Retrospective Analysis Single-Institution Series Reported in Latin America (2019-2023).
García Valencia LF, Bernal AF, Bautista C … +3 more , García A, Botero IG, Botero JG
Ann Vasc Surg · 2026 May · PMID 42119721 · Publisher ↗
BACKGROUND: Pelvic congestion syndrome (PCS) is a common yet frequently underdiagnosed condition in women with chronic pelvic pain. Endovascular treatment allows both confirmation of the diagnosis and treatment of the ma...
BACKGROUND: Pelvic congestion syndrome (PCS) is a common yet frequently underdiagnosed condition in women with chronic pelvic pain. Endovascular treatment allows both confirmation of the diagnosis and treatment of the main venous abnormalities associated with the syndrome. This study aimed to describe the clinical and radiological characteristics of patients diagnosed with PCS and to evaluate the outcomes of endovascular treatment with gonadal vein coil embolization. METHODS: Retrospective single arm observational study was conducted of patients over 18 years treated for PCS, between 2019 and 2023. Diagnosis was defined by the presence of pelvic symptoms and by imaging findings (evidence of findings suggestive of pelvic congestion syndrome in at least 1 study). All patients underwent phlebography and cavography prior to embolization, and according to the angiographic findings endovascular gonadal vein embolization using coils. Clinical parameters, procedural details, and follow-up were reviewed. Each variable was analyzed independently using the number of patients with available information for that variable as the denominator. RESULTS: A total of 1,417 patients were collected, where 123 patients who were treated exclusively for venous compression syndrome were excluded. Consequently, 1294 patients were included, 77.7% were multiparous, 56% reported dyspareunia (mean Visual Analog Scale (VAS): 6.6), and 50.8% reported dysmenorrhea (mean VAS: 6.9). The average ovarian vein diameter was 6.60 mm ± 1.14 mm. Gonadal embolization was performed in 90.3% of patients. Symptom improvement was reported in 86.8%, among those with complete VAS data, dyspareunia decreased by 70.8% and dysmenorrhea by 72.4%, with statistically significant reductions in both symptoms. The overall complication rate was 1.7%, minor complication rate was 1.11%, and major complication rate was 0.59%. CONCLUSION: PCS is a frequently encountered condition in vascular surgery practice. In our experience, treatment of pelvic congestion syndrome with gonadal embolization leads to symptomatic improvement. Complications, although rare, can occur and must be identified early for treatment.
Re: Sex Differences in the Outcomes After Carotid Revascularization in Real-World Experience.
Keles E, Rahman OF
Ann Vasc Surg · 2026 May · PMID 42114717 · Publisher ↗
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Frailty, Risk Scores, and the Illusion of Prediction in Contemporary Abdominal Aortic Aneurysm Repair.
Destefanis Gallo E, Salzillo I, Bozzani A … +1 more , Arici V
Ann Vasc Surg · 2026 May · PMID 42107699 · Publisher ↗
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Endovenous Microwave Ablation Alone versus High Ligation Combined with Microwave Ablation for Great Saphenous Vein Incompetence: A Propensity Score-Matched Study.
Zhang P, Tang H, Wang X … +6 more , Lu X, Liu Q, Xu H, Zhang X, Wang X, Zhu J
Ann Vasc Surg · 2026 May · PMID 42107698 · Publisher ↗
BACKGROUND: To evaluate the clinical efficacy, perioperative outcomes, and direct healthcare costs of isolated endovenous microwave ablation (EMA) versus high ligation combined with EMA (HL+EMA) for great saphenous vein...
BACKGROUND: To evaluate the clinical efficacy, perioperative outcomes, and direct healthcare costs of isolated endovenous microwave ablation (EMA) versus high ligation combined with EMA (HL+EMA) for great saphenous vein (GSV) incompetence. METHODS: A retrospective cohort study analyzed 205 patients (isolated EMA: n = 104; HL+EMA: n = 101), comprising 86 (42.0%) males and 119 (58.0%) females, treated for primary varicose veins (Clinical-Etiological-Anatomical-Pathophysiological [CEAP] class C3-C4b) between January 2022 and December 2024. To mitigate selection bias, propensity score matching was executed utilizing 8 baseline covariates, including preoperative Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) scores. Nearest-neighbor matching yielded 73 adequately balanced pairs. Primary outcomes were the 12-month VCSS and AVVQ scores. Secondary endpoints included complications, length of stay, early pain scores, and hospitalization costs. RESULTS: At 12 months, both cohorts demonstrated highly significant improvements from baseline; however, no statistically significant between-group differences were detected in VCSS (1.47 ± 0.87 vs. 1.42 ± 1.05, P = 0.805) or AVVQ scores (7.90 ± 3.42 vs. 7.55 ± 2.69, P = 0.460). Overall 30-day complication rates were similar between groups (45.2% vs. 42.5%, P = 0.860). Conversely, the isolated EMA cohort was associated with a significantly abbreviated length of stay (median 2 vs. 6 days, P < 0.001), diminished 12-hr pain scores (median 2 vs. 4, P < 0.001), and a profound reduction in total hospitalization costs (median ¥14,099 vs. ¥17,306, P < 0.001). CONCLUSION: No statistically significant difference in 12-month functional outcomes was detected between isolated EMA and HL+EMA in this propensity score-matched cohort. Isolated EMA was associated with substantially reduced perioperative morbidity and lower direct hospitalization costs. Based on these intermediate-term findings, the routine addition of HL did not confer a detectable clinical advantage for CEAP C3-C4b GSV incompetence; however, longer-term follow-up is warranted.
Machine Learning Models in the Prediction of Adverse Outcomes in Peripheral Arterial Disease: Meta-Analysis.
Ravindhran B, Ubhi L, Nazir S … +7 more , Lathan R, Pymer S, Smith G, Carradice D, Chetter IC, Torgerson D, Mitchell A
Ann Vasc Surg · 2026 May · PMID 42107697 · Publisher ↗
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the performance of machine learning (ML) models compared to traditional statistical approaches in predicting adverse outcomes for patients with perip...
BACKGROUND: This systematic review and meta-analysis aimed to evaluate the performance of machine learning (ML) models compared to traditional statistical approaches in predicting adverse outcomes for patients with peripheral arterial disease (PAD), while also assessing the current limitations and challenges in ML model development and validation. METHODS: A comprehensive search of major databases was conducted for studies published between 2000 and 2025 that applied ML techniques to predict outcomes in PAD patients. Major medical databases (OVID Medline, OVID EMBASE, Cumulated Index in Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials) and clinical trial registers were searched. Two reviewers independently screened studies, extracted data, and assessed quality and risk of bias using the Prediction model Risk Of Bias ASsessment Tool. The methodological quality of the studies included in this review was also assessed using an artificial intelligence/ML-specific quality assessment tool. A modified hierarchical summary receiver operating characteristic analysis was performed and diagnostic odds ratios (DORs) were calculated to compare the predictive performance of various ML models and traditional regression methods in the prediction of major adverse cardiovascular events and major adverse limb events (MALEs). RESULTS: Thirteen studies met the inclusion criteria. Gradient-boosted models demonstrated the highest predictive performance with a DOR of 36.593 (95% confidence interval [CI]: 24.44-54.79), sensitivity of 0.853, and specificity of 0.863 in the prediction of MALE. Even the least performing ML models in each study demonstrate moderate predictive ability with a DOR of 8.616 (95% CI: 5.473-13.564). Traditional regression models consistently underperformed compared to ML approaches, with the lowest DOR of 3.326 (95% CI: 1.814-6.097). The quality assessment revealed a mix of methodological rigor, with 54% of studies rated as low risk of bias and 46% as unclear. CONCLUSION: ML techniques demonstrate superior predictive power for adverse outcomes in PAD patients compared to traditional regression methods.
Rethinking Malperfusion in Acute Type A Aortic Dissection: Anatomy, Timing, and Strategy.
Salzillo I, Destefanis EG, Bozzani A … +1 more , Arici V
Ann Vasc Surg · 2026 May · PMID 42107696 · Publisher ↗
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Clinical Outcomes of Open Repair for Small Popliteal Artery Aneurysms.
Tanaka S, Tanaka K, Ohmine T … +1 more , Okazaki J
Ann Vasc Surg · 2026 May · PMID 42107695 · Publisher ↗
BACKGROUND: Indications for surgical repair of <20 mm popliteal artery aneurysms (PAAs) remain uncertain. Although the SVS recommends intervention for symptomatic small PAAs (sPAAs), clinical outcomes are poorly characte...
BACKGROUND: Indications for surgical repair of <20 mm popliteal artery aneurysms (PAAs) remain uncertain. Although the SVS recommends intervention for symptomatic small PAAs (sPAAs), clinical outcomes are poorly characterized. We evaluated the perioperative and long-term results of open repair for sPAAs. METHODS: This multicenter retrospective cohort study included 34 patients (40 limbs) who underwent open surgery for PAAs between January 2009 and December 2024 at 2 Japanese vascular surgery centers. The sPAA group (maximal diameter <20 mm) was compared with the large PAA group (LPAA; maximal diameter ≥20 mm). Baseline characteristics, operative details, graft patency, limb salvage, and survival were analyzed. Patients requiring primary amputation due to Rutherford III acute ischemia were excluded. RESULTS: Eleven of 40 limbs (27.5%) were classified as sPAA. All limbs in the sPAA group were symptomatic, presenting with acute lower limb ischemia (n = 4), claudication (n = 6), or toe gangrene (n = 1). The median maximal aneurysm diameter was 17.0 mm in the sPAA group and 32.0 mm in the LPAA group. Thrombus occupancy tended to be greater in the sPAA group than in the LPAA group (86.1% vs. 74.9%). Operative approach, graft choice, operative time, blood loss, and length of hospital stay were comparable between the groups. Five-year limb salvage (100% vs. 89.2%; P = 0.264), overall survival (86.1% vs. 84.0%; P = 0.904), primary patency (90.9% vs. 84.6%; P = 0.795), and secondary patency (100% vs. 95.0%; P = 0.480) did not differ significantly between the groups. CONCLUSION: Open repair of symptomatic sPAA group demonstrated favorable outcomes comparable to those of LPAA group. Surgical intervention should be considered for symptomatic sPAA, particularly when thrombus burden is present.
Systematic Review and Reconstructed Individual Patient Data of Atherosclerotic Subclavian Artery Aneurysm in the Endovascular Era.
Frola E, De La Vega Hurtado S, Peluttiero I … +5 more , Mariani E, Scovazzi P, Barili F, Maione M, Mortola L
Ann Vasc Surg · 2026 May · PMID 42105989 · Publisher ↗
BACKGROUND: To summarize incidence, presentation, management, and outcomes of true isolated atherosclerotic subclavian artery aneurysms (SAAs) in the endovascular era using reconstructed individual patient data. METHODS:...
BACKGROUND: To summarize incidence, presentation, management, and outcomes of true isolated atherosclerotic subclavian artery aneurysms (SAAs) in the endovascular era using reconstructed individual patient data. METHODS: Medline and Embase were searched (1993-2025). Primary outcome was 30-day complications; secondary outcomes included follow-up (FU) events and aneurysm characteristics. RESULTS: Sixty-seven SAAs in 66 patients were included. Symptoms occurred in 56%, mainly compression, hemoptysis, or embolization; rupture occurred in 22%. Open, endovascular, and hybrid repair were performed in 34%, 46%, and 20%, respectively. Thirty-day complications occurred in 9%, without differences among strategies. During 12-month median FU, late complications were comparable. Aneurysm diameter, side, and location were not associated with symptoms. CONCLUSION: Atherosclerotic SAAs are rare and frequently symptomatic. Repair should not rely on diameter alone. Open, endovascular, and hybrid approaches are safe.
Incidence, Predictors, and a Bedside Risk Score for Chylous Ascites after Open Abdominal Aortic Surgery: A 20-Year Population-Based Cohort Study.
Nikolić D, Pasternak J, Manojlović V … +3 more , Budinski S, Nikolić MB, Batinić N
Ann Vasc Surg · 2026 May · PMID 42105988 · Publisher ↗
BACKGROUND: Chylous ascites is a rare but morbid complication of retroperitoneal vascular dissection, associated with prolonged hospitalization and reported mortality of 11-18%. No population-based incidence data or risk...
BACKGROUND: Chylous ascites is a rare but morbid complication of retroperitoneal vascular dissection, associated with prolonged hospitalization and reported mortality of 11-18%. No population-based incidence data or risk stratification tool exists. We aimed to estimate procedure-specific incidence, identify independent predictors, and derive an internally validated bedside risk score. METHODS: Retrospective cohort study of 6,382 consecutive open abdominal aortic procedures (2003-2022) across 3 centers in Vojvodina, Serbia. The mean age was 69.1 ± 8.6 years; 79.8% were male. Chylous ascites required milky drainage fluid with triglyceride ≥200 mg/dL. Multivariable logistic regression identified predictors; coefficients informed a points-based score. Internal validation used 1,000 bootstrap resamples (TRIPOD type 1b). RESULTS: Chylous ascites occurred in 47 patients (0.74%; 95% confidence interval [CI]: 0.54-0.98%), five-fold more frequently after ruptured (2.51%) than elective abdominal aortic aneurysm (AAA) repair (0.43%; P < 0.001). Five predictors reached significance: hostile retroperitoneum (aOR 4.21), suprarenal clamping (3.44), redo surgery (3.02), rupture (2.53), and operative time ≥240 min (2.38). Three additional predictors were retained on clinical grounds. The bedside score (0-10 points) stratified observed risk 22-fold (0.26-5.79%). The optimism-corrected area under the ROC curve was 0.79 (95% CI: 0.72-0.86); calibration slope 0.92. CONCLUSION: Chylous ascites is rare but clinically significant, particularly after ruptured AAA repair. A bedside score calculable within 24 hours of surgery identifies patients who may benefit from targeted drain-fluid monitoring and early dietary intervention. The score is most applicable to aneurysm surgery. External validation is required before routine use.
Geometric Reconstruction of the Carotid Bulb: Modified Great Saphenous Vein Interposition for Complex Carotid Artery Disease.
Velioglu Y, Yuksel A, Guven H … +3 more , Kursat Korkmaz UT, Atasoy MS, Kilic AO
Ann Vasc Surg · 2026 May · PMID 42105987 · Publisher ↗
BACKGROUND: Standard carotid endarterectomy techniques may be insufficient for complex carotid artery disease involving high bifurcation, extensive distal plaque, or in-stent restenosis. We describe a modified autologous...
BACKGROUND: Standard carotid endarterectomy techniques may be insufficient for complex carotid artery disease involving high bifurcation, extensive distal plaque, or in-stent restenosis. We describe a modified autologous great saphenous vein (GSV) interposition technique focusing on geometric reconstruction and present its midterm outcomes. METHODS: Between January 2016 and December 2021, 26 patients with complex carotid disease underwent modified GSV interposition grafting. To manage the caliber mismatch between the common and distal internal carotid arteries, a "Hybrid Anastomotic Configuration" was employed, resulting in a "tapered" geometry to optimize flow dynamics. A routine nonshunting strategy under induced hypertension was adopted for all cases. RESULTS: The mean patient age was 66.4 ± 7.9 (range: 47-82) years. Mean clamp and total operative times were 19.0 ± 3.0 (range: 14-25) and 76.1 ± 12.4 (range: 52-100) min, respectively. With respect to early postoperative complications, a transient ischemic attack occurred in one patient (3.8%). No long-term complications were observed. During the follow-up period (mean follow-up: 54 ± 21.6 months, range: 24-90 months), significant internal carotid artery stenosis (> 50%) was detected in only one patient while the remaining 25 patients demonstrated no significant restenosis. Aneurysm formation was not observed in any patient during follow-up. CONCLUSION: The described technique allows for the geometric reconstruction of the carotid bulb, serving as a valuable problem-solving maneuver where standard patching is technically feasible but risky, or contraindicated due to anatomical complexity. It specifically overcomes the challenges of high bifurcation and extensive plaque, ensuring precise distal control and excellent midterm patency without the long-term risks of synthetic materials.
Etiology of Limb Loss after Successful Transmetatarsal Amputation.
Colling M, Stonko DP, Reifsnyder T
Ann Vasc Surg · 2026 May · PMID 42105986 · Publisher ↗
BACKGROUND: Transmetatarsal amputation (TMA) is a functional foot reconstruction for limb salvage following extensive forefoot infection and/or ischemic gangrene. Unfortunately, up to 30% of TMAs progress to major amputa...
BACKGROUND: Transmetatarsal amputation (TMA) is a functional foot reconstruction for limb salvage following extensive forefoot infection and/or ischemic gangrene. Unfortunately, up to 30% of TMAs progress to major amputation. This study evaluates the effects of diabetes and peripheral artery disease (PAD) on long-term TMA outcomes. METHODS: This was a retrospective review of a single-surgeon, single-institution consecutive series of TMAs performed between 2006 and 2024. Patients with PAD and perioperative hemoglobin A1c (HbA1c) ≤ 6.5 (euglycemic PAD), PAD and HbA1c > 6.5 (hyperglycemic PAD), and diabetes without PAD (diabetes [DM] only) were compared for ipsilateral major amputation, primary healing, and all-cause mortality. RESULTS: Among 230 TMAs, 189 healed primarily. Of intact TMAs, 48 were euglycemic PAD, 71 hyperglycemic PAD, and 70 DM only. There were no differences in sex, race, or comorbidities aside from smoking history (P = 0.043) and history of prior revascularization (P < 0.001). Mean HbA1cs were 5.7, 8.3, and 9.1 (P < 0.001). The PAD groups were older (67.1, 66.7, 57.3 years; P < 0.001), had lower toe pressures (34.7, 43.0, 99.0 mm Hg; P < 0.001), and higher WIfI scores (69.1%, 76.0%, 43.6% stage 4; P = 0.009). Primary healing rates were 85.7%, 74.0%, and 89.7% (P = 0.021), with similar 90-day all-cause mortality (P = 0.364). Kaplan-Meier analysis demonstrated superior intact TMA survival in euglycemic PAD (P = 0.049), with 5-year TMA survival rates of 97.8%, 83.6%, and 78.8%. Modeled continuously, each 1% rise in HbA1c increased major amputation odds by 24% (P = 0.005). CONCLUSION: Uncontrolled diabetes is a distinct marker of poor long-term outcomes following TMA for limb salvage.
Impact of Laser Wavelength on Outcomes of Flush Endovenous Laser Ablation: Comparative Evaluation of 1470 nm and 1940 nm Systems and Associated Complications.
Budak AB, Yıldırım A, Gül EB
Ann Vasc Surg · 2026 May · PMID 42105985 · Publisher ↗
BACKGROUND: Flush endovenous laser ablation (fEVLA) has been introduced as a modification of standard EVLA to minimize stump-related recurrence. While both 1,470-nm and 1,940-nm laser systems are widely used, their compa...
BACKGROUND: Flush endovenous laser ablation (fEVLA) has been introduced as a modification of standard EVLA to minimize stump-related recurrence. While both 1,470-nm and 1,940-nm laser systems are widely used, their comparative performance in fEVLA remains insufficiently explored. METHODS: This retrospective study included 277 patients treated with fEVLA for saphenous insufficiency between 2022 and 2025. Patients were categorized by laser wavelength: 1,470 nm (n = 100) and 1,940 nm (n = 177). Procedural parameters, linear endovenous energy density (LEED), complications, duplex-confirmed occlusion, recurrence, and quality-of-life outcomes (Chronic Venous Insufficiency Questionnaire-20 [CIVIQ-20], Venous Clinical Severity score [VCSS]) were evaluated. RESULTS: The 1,940 nm group required significantly lower LEED across all venous segments (e.g., great saphenous vein right: 42 vs. 62 J/cm; P < 0.001). Postoperative complications, including ecchymosis, superficial thrombophlebitis, paresthesia, and hematoma, were more frequent in the 1,470 nm group. Pain scores at 6 hr were significantly lower with the 1,940-nm laser (3.5 ± 1.2 vs. 4.5 ± 1.8; P = 0.05). Early occlusion was 100% in both groups. Three recanalization events occurred during follow-up, with no significant difference between wavelengths. Both groups demonstrated comparable postoperative improvement in CIVIQ-20 and VCSS scores. CONCLUSION: Both wavelengths achieved excellent early occlusion and symptom improvement. However, the 1,940-nm laser enabled effective fEVLA at significantly lower energy levels and was associated with fewer local complications, suggesting a safety advantage in early outcomes.
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