Annals Of Vascular Surgery[JOURNAL]
Sun
200 papers
Glucagon-like Peptide-1 as a Promising Marker of Postoperative Intestinal Ischemia After Abdominal Aortic Surgery.
Tomandlova M, Novotny T, Staffa R … +3 more , Krivka T, Radova L, Tomandl J
Ann Vasc Surg · 2026 May · PMID 42105984 · Publisher ↗
BACKGROUND: Acute intestinal ischemia is a severe postoperative complication of abdominal aortic surgery, and delayed diagnosis markedly limits therapeutic options. At present, no reliable biochemical marker for early de...
BACKGROUND: Acute intestinal ischemia is a severe postoperative complication of abdominal aortic surgery, and delayed diagnosis markedly limits therapeutic options. At present, no reliable biochemical marker for early detection is available. This study assesses whether perioperative changes in glucagon-like peptide-1 (GLP-1) may serve as an early biomarker of postoperative intestinal ischemia. METHODS: This prospective single-center cohort study enrolled 80 patients undergoing elective abdominal aortic surgery. Total serum GLP-1 concentrations were measured at 8 perioperative time points spanning the preoperative, intraoperative, and postoperative periods. Intestinal ischemia was diagnosed using contrast-enhanced magnetic resonance imaging or surgical confirmation. RESULTS: The perioperative time course of GLP-1 was similar across all patients, with peak concentrations consistently observed 24 hr after complete declamping during vascular reconstruction. Six patients developed intestinal ischemia; these individuals exhibited significantly higher GLP-1 levels at all postoperative time points than patients without ischemia (P < 0.02). GLP-1 demonstrated the highest predictive ability at 24 hr after complete declamping (area under the receiver operating characteristic curve [AUC] 0.993); similarly, measurements obtained at 6 hr after complete declamping exhibited excellent predictive performance (AUC 0.919). CONCLUSION: Perioperative elevation of GLP-1 demonstrates high specificity for intestinal ischemia, independent of diabetes mellitus or age. Serum GLP-1 concentrations show promise as reliable predictive biomarkers for postoperative intestinal ischemia, with the best diagnostic accuracy observed at 6 and 24 hr after complete declamping during vascular reconstruction.
Reduced Iliac TAWSS as a Hemodynamic Correlate of Aortic Stent-Graft Partial Thrombus Formation.
Ngo DHA, Lee KH, Lee JI … +3 more , Hwang HP, Han YM, Kwak HS
Ann Vasc Surg · 2026 May · PMID 42105983 · Publisher ↗
BACKGROUND: It was hypothesized that post-endovascular aneurysm repair (EVAR) iliac flow disturbances and geometry variation may predispose to thrombus formation within the aortic stent component. METHODS: A retrospectiv...
BACKGROUND: It was hypothesized that post-endovascular aneurysm repair (EVAR) iliac flow disturbances and geometry variation may predispose to thrombus formation within the aortic stent component. METHODS: A retrospective cohort of 52 patients (average age of 72 ± 5.2 years; 88.8% male) treated with infrarenal bifurcated stent graft was analyzed using patient-specific iliac geometry measurement and computational fluid dynamics (CFDs) analysis. Digital computed tomography angiography (CTA) datasets were reconstructed to obtain aortoiliac lumen geometry, and pulsatile flow simulations were performed to compute time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and WSS extremes. Iliac geometric parameters (tortuosity, bifurcation angle) were also quantified. Patients were stratified by presence or absence of aortic in-stent thrombus detected during surveillance CTA. RESULTS: Iliac WSS metrics differed between groups, with the thrombus cohort demonstrating lower mean TAWSS (0.3 Pa vs. 0.77 Pa, P = 0.006). Conversely, OSI and geometric parameters showed no significant intergroup differences. Spearman analysis revealed strong inverse correlations between TAWSS and OSI (ρ = -0.60 to -0.64, P < 0.001), while tortuosity did not correlate with either WSS metrics. Multivariate analysis adjusting for age and mean hemodynamic parameters did not demonstrate statistically significant associations with aortic thrombus. CONCLUSION: Reduced iliac TAWSS magnitude, rather than OSI or iliac tortuosity, appears to characterize post-EVAR hemodynamics in patients who develop aortic in-stent thrombus. These data support a mechanistic role for low-shear outflow conditions in promoting thrombotic complications after EVAR and highlights the potential value of shear-based CFD profiling for risk stratification.
Clinical Value of 2D Perfusion Angiography for Chronic Limb-Threatening Ischemia Revascularization.
Herrera Mingorance JD, Avila Cabreja JA, Gutiérrez Velez AJ … +1 more , Salmeron Febres LM
Ann Vasc Surg · 2026 May · PMID 42105982 · Publisher ↗
BACKGROUND: To evaluate the clinical utility of intraoperative 2D perfusion angiography (2DPA) in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization. METHODS: This single-center prospecti...
BACKGROUND: To evaluate the clinical utility of intraoperative 2D perfusion angiography (2DPA) in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization. METHODS: This single-center prospective observational cohort study included consecutive patients with CLTI who underwent endovascular or hybrid revascularization with intraoperative 2DPA. Perfusion angiography was performed before and after revascularization using a standardized contrast injection protocol. Quantitative perfusion parameters included arrival time (AT), time to peak (TTP), wash-in rate (WIR), mean transit time, width and area under the curve. Pre-post changes (Δ) in perfusion metrics were analyzed in relation to technical success and 12-month outcomes, including major adverse limb events (MALE) and major adverse cardiovascular events. RESULTS: Seventy-four patients (mean age, 71.9 ± 11.5 years; 71.6% male) were included with technical success in 93.2% of procedures. After multivariable adjustment, revascularization was associated with significant improvements in AT (-1.44 seconds; P < 0.001), TTP (-3.6 seconds; P < 0.001), WIR (2.19 units; P = 0.022), and width (-2.8 seconds; P = 0.035). Greater postprocedural increases in TTP were independently associated with higher MALE risk (adjusted hazard ratio, 2.16; 95% confidence interval 1.19-3.90; P = 0.011). Increases in AT and WIR were associated with shorter and longer MALE-free survival, respectively, in univariable analyses, but lost significance after adjustment. No perfusion parameter was associated with major adverse cardiovascular events. CONCLUSION: Intraoperative 2DPA quantitatively characterizes tissue perfusion changes after revascularization in CLTI. A limited reduction in TTP after the procedure is independently associated with subsequent MALE, suggesting that TTP may indicate residual ischemia and support postoperative risk stratification.
Real-World Outcomes of Open Aortic Repair Versus Endovascular Aortic Repair in Ruptured Abdominal Aortic Aneurysms: Does Neck Anatomy Make a Difference?
Rahgozar S, Zarrintan S, Fallentine J … +3 more , Hamouda M, Lee JT, Malas M
Ann Vasc Surg · 2026 May · PMID 42105981 · Publisher ↗
BACKGROUND: Several studies have demonstrated superior outcomes with endovascular aortic repair (EVAR) compared to open aortic repair (OAR) in patients with infrarenal ruptured abdominal aortic aneurysms (rAAAs). However...
BACKGROUND: Several studies have demonstrated superior outcomes with endovascular aortic repair (EVAR) compared to open aortic repair (OAR) in patients with infrarenal ruptured abdominal aortic aneurysms (rAAAs). However, in emergent settings, aortic neck suitability for EVAR and adherence to instructions for use criteria are often not met in a significant proportion of patients. We aimed to compare EVAR and OAR in patients with rAAA using a recent national database, incorporating favorable neck (FN) versus hostile neck (HN) anatomy. METHODS: We analyzed Vascular Quality Initiative data for rAAA from 2018 to 2024. Two analyses were performed: first, a comparison between OAR and EVAR; second, a comparison among 3 cohorts: OAR, EVAR with FN (EVAR-FN), and EVAR with HN (EVAR-HN). HN anatomy was defined as neck length <15 mm, neck diameter >30 mm, or infrarenal angle >60°. The primary outcomes were 30-day and 1-year mortality. Secondary outcomes included postoperative complications, intensive care unit stay >3 days, red blood cell transfusion >4 units, and postoperative reintervention. Logistic and Cox regressions were used for the analyses. RESULTS: A total of 4,578 rAAA repairs were performed, of which 3,275 (71.5%) were EVAR. Among EVAR cases, 2,452 (74.9%) had HN anatomy. Thirty-day mortality was 35.5% for OAR and 21.5% for EVAR (P < 0.001). One-year mortality was 43.1% for OAR, 31.5% for all EVARs, 26.4% for EVAR-FN, and 33.2% for EVAR-HN. After adjusting for confounders, EVAR was associated with reduced 30-day and 1-year mortality (adjusted odds ratio [aOR] = 0.66, 95% confidence interval [CI] = 0.52-0.84, P = 0.001; and adjusted hazard ratio [aHR] = 0.79, 95% CI = 0.67-0.93, P = 0.005). EVAR was also associated with reduced risk of postoperative complications. When stratified by neck anatomy, EVAR-FN was associated with more pronounced reduced 30-day (aOR = 0.46, 95% CI = 0.33-0.65; P < 0.001) and 1-year mortality (aHR = 0.66, 95% CI = 0.53-0.82; P < 0.001) compared with OAR. EVAR-HN was associated with reduced 30-day mortality (aOR = 0.74, 95% CI = 0.58-0.94; P = 0.013) but not 1-year mortality (aHR = 0.84, 95% CI = 0.71-1.00; P = 0.052) compared with OAR. EVAR-HN was also associated with increased 30-day and 1-year mortality compared with EVAR-FN. CONCLUSION: The majority of rAAAs are treated today with EVAR, and 75% of these patients present with HN anatomy. EVAR was associated with reduced postoperative mortality and complications compared with OAR, regardless of neck anatomy. However, EVAR maintained a 1-year survival advantage over OAR only in patients with FN anatomy. While EVAR-HN demonstrated similar 1-year mortality to OAR, it remains the preferred option due to better perioperative outcomes and lower 30-day mortality. Longer-term follow-up is needed to evaluate reintervention, rupture, and aneurysm-related mortality, particularly in patients with HN anatomy.
Impact of Intravascular Ultrasound Guidance on Strategy and Patency in Endovascular Treatment of Peripheral Arterial Disease: A Prospective Randomized Study.
Goran RE, Zaragozá García JM, González Rodríguez P … +7 more , Morales Gisbert SM, Crespo Moreno I, Martínez Perelló I, Yoldi Martin-Calpena RP, Echaide Artieda A, Ramírez González PS, Gómez Palonés F
Ann Vasc Surg · 2026 May · PMID 42105980 · Publisher ↗
BACKGROUND: To evaluate whether intravascular ultrasound (IVUS) guidance influences procedural strategy and improves patency compared with angiography-guided endovascular treatment. METHODS: In this randomized clinical t...
BACKGROUND: To evaluate whether intravascular ultrasound (IVUS) guidance influences procedural strategy and improves patency compared with angiography-guided endovascular treatment. METHODS: In this randomized clinical trial, patients with lower limb peripheral arterial disease were assigned 1:1 to IVUS-guided or angiography-only procedures. Primary outcomes included primary patency, assisted primary patency, and secondary patency. Secondary outcomes included target vessel revascularization, target lesion revascularization, target limb revascularization, and major amputation. In the IVUS group, changes in procedural strategy and detection of residual lesions were also analyzed. RESULTS: A total of 59 patients (65 procedures) were included. The IVUS group included 27 patients (33 procedures; mean age 71.3 years; 55.5% men). Occlusions comprised 43.8% of lesions, with 53.1% Trans-Atlantic Inter-Society Consensus classification D and 56.3% Global Limb Anatomic Staging System classification 3. The control group included 32 patients (32 procedures; mean age 70.3 years; 81.8% men) with comparable lesion profiles (P > 0.05). IVUS prompted changes in therapeutic strategy in 72% of procedures (22% device type, 78% sizing) and identified 28.1% significant residual lesions versus 6.2% with angiography, with 100% technical success. At a median follow-up of 7 months, primary, assisted primary, and secondary patency were higher in the IVUS group (95%, 95%, and 100%) compared with the control group (80%, 80%, and 90%) (P < 0.05). Reintervention rates were significantly lower in the IVUS group (target vessel revascularization 0% vs. 18.2%, target lesion revascularization 3.1% vs. 21.2%; P < 0.05), whereas no significant differences were observed in limb revascularization (target limb revascularization 0% vs. 6.1%; P > 0.05) or major amputation (0% vs. 6.1%; P > 0.05). CONCLUSION: IVUS guidance significantly influences procedural decision-making and improves short-term to midterm patency outcomes. Its use appears particularly beneficial in complex lesions, where enhanced lesion characterization and optimization of device selection may reduce residual disease and reintervention rates.
Closing the Gap: Mechanical Thrombectomy for Acute Pulmonary Embolism in Regional and Rural North Queensland, Australia.
Choy OS, Sun D, Khattak Y … +6 more , Brown D, Dwivedee A, Junise M, Vedanayagam V, Velu R, Manzoor MU
Ann Vasc Surg · 2026 May · PMID 42105979 · Publisher ↗
BACKGROUND: To evaluate the feasibility and early outcomes of large-bore mechanical thrombectomy for intermediate-high- and high-risk pulmonary embolism (PE) in a regional Australian tertiary referral center. METHODS: A...
BACKGROUND: To evaluate the feasibility and early outcomes of large-bore mechanical thrombectomy for intermediate-high- and high-risk pulmonary embolism (PE) in a regional Australian tertiary referral center. METHODS: A retrospective cohort study was conducted at a regional tertiary hospital in North Queensland between January 2022 and June 2025. Consecutive patients undergoing mechanical thrombectomy following multidisciplinary Pulmonary Embolism Response Team evaluation were included. Demographic, procedural, and short-term clinical outcomes were analyzed descriptively. RESULTS: Twenty-three patients underwent mechanical thrombectomy. Technical success was achieved in all cases (100%), with no immediate procedural complications. Eleven patients (47.8%) required postprocedural intensive care unit admission. Mean oxygenation saturation increased modestly following intervention (94.7% to 96.4%), although interpretation is limited by heterogeneity in oxygen support. Among 17 patients with follow-up imaging within 48 hours, 6 (35.3%) demonstrated reduction in right ventricular to left ventricular ratio to < 0.9. The mean hospital length of stay was 17.9 ± 21.6 days (median 9 days). Thirty-day mortality was 8.7%. CONCLUSION: Large-bore mechanical thrombectomy for acute PE was feasible and safely delivered in a regional Australian center, with acceptable short-term outcomes in a high-risk cohort. These findings support the potential for appropriately resourced regional centers to provide advanced interventional PE care.
Interfacility Transfer is Associated with Higher Postoperative Amputation in Patients Undergoing Lower Extremity Bypass for Acute Limb Ischemia: A Multi-institutional Study from Vascular Quality Initiative.
Zarrintan S, Rahgozar S, Vootukuru NR … +2 more , Moacdieh MP, Malas MB
Ann Vasc Surg · 2026 May · PMID 42105978 · Publisher ↗
BACKGROUND: Patients with acute limb ischemia (ALI) should undergo an urgent/emergent revascularization procedure without delay to prevent limb loss. However, interfacility transfer (IFT) is inevitable in certain circums...
BACKGROUND: Patients with acute limb ischemia (ALI) should undergo an urgent/emergent revascularization procedure without delay to prevent limb loss. However, interfacility transfer (IFT) is inevitable in certain circumstances, particularly when optimal surgical service is unavailable. IFT can delay surgical care and compromise outcomes. We aimed to investigate the impact of IFT on postoperative outcomes and 1-year mortality of lower extremity bypass (LEB) in patients presenting with ALI. METHODS: The Vascular Quality Initiative database was queried for patients presenting with ALI and undergoing LEB between 2003 and 2023. The patients were stratified by IFT status. The primary outcome was postoperative major amputation. The secondary outcomes were postoperative complications, 30-day mortality, prolonged length of stay (PLOS, ≥7 days), return to the operating room for thrombosis or revision, major adverse cardiovascular events, major adverse limb events (MALE), and 1-year mortality. Logistic and Cox regressions were used for multivariate analyses. RESULTS: There were 9,302 bypasses performed for ALI during the study period, of which 1,952 (21.0%) were performed after transfer from an index hospital. These bypasses were performed on 9,302 limbs from 8,493 patients. After adjusting for potential confounders, IFT was associated with increased risks of major amputation (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.14-1.84; P = 0.002), PLOS (aOR = 1.36, 95% CI: 1.18-1.56; P < 0.001), and MALE (aOR = 1.28, 95% CI: 1.07-1.53; P = 0.008). However, IFT was not associated with the risk of death at 1 year (adjusted hazards ratio = 1.03, 95% CI: 0.84-1.25; P = 0.772). The logistic regression model for IFT revealed that being a current smoker, obesity, moderate-to-severe anemia, having aneurysmal disease, undergoing urgent and emergent bypasses, and having the bypass performed over the weekend were associated with being transferred. CONCLUSION: Patients presenting with ALI requiring transfer for LEB are more likely to experience limb loss, PLOS, and MALE. Although transfer of patients with ALI is inevitable in certain situations, every effort should be made to manage these patients at the initial institution and transfer should be limited to conditions where an appropriate team to manage ALI is not available.
Thoracic Branch Endoprosthesis as Safe Alternative Therapy for Blunt Traumatic Aortic Injury Requiring Zone 2 Coverage.
Meltzer RS, Keskey RC, Hamzat I … +3 more , Abou Ali AN, Hampton DA, Eslami MH
Ann Vasc Surg · 2026 May · PMID 42105977 · Publisher ↗
BACKGROUND: Blunt traumatic aortic injury (BTAI) involving the left subclavian artery (zone 2) poses a challenging problem. Thoracic branch endoprosthesis (TBE) with a left subclavian artery side branch has emerged as a...
BACKGROUND: Blunt traumatic aortic injury (BTAI) involving the left subclavian artery (zone 2) poses a challenging problem. Thoracic branch endoprosthesis (TBE) with a left subclavian artery side branch has emerged as a novel tool for thoracic endovascular aortic repair (TEVAR) for injuries requiring a zone 2 seal. We hypothesized that TBE is a noninferior method for zone 2 BTAI repair. DESIGN: Retrospective analysis of a prospectively collected data from National Trauma Data Bank. METHODS: The 2017-2022 American College of Surgeons Trauma Quality Programs Participant Use File data were abstracted. Inclusion criteria were adult patients (>16 years old) who had undergone a TBE or TEVAR with an open aortic arch debranching procedure (TEVAR-DB). Patient demographics, complications (stroke, deep venous thrombosis, ventilator associated pneumonia, acute respiratory distress syndrome, Surgical Site Infection, and unplanned return to operating room), intensive care unit length of stay (ICU-LOS), and mortality were compared. Wilcoxon signed-rank tests and linear regressions were performed. Significance was P < 0.05. RESULTS: There were 3,538 patients who sustained a traumatic aortic injury and underwent endovascular repair. Ninety-four patients met inclusion criteria (TBE (n = 61) and TEVAR-DB (n = 33)). There was no difference in gender, age, abbreviated injury scale, or Injury Severity Score between the groups. The TBE group had a significantly lower Glasgow Coma Score on presentation (TBE: 10.8 ± 5.2 vs. TEVAR-DB: 13.0 ± 4.1, P = 0.04). In addition, there was no difference in complications between the groups. On multivariate analysis, a significant association was not present between procedure type and stroke rate, ICU-LOS, or mortality. CONCLUSION: TBE is noninferior to TEVAR-DB for the treatment of BTAI requiring a zone 2 seal. In the appropriate patient population, it may demonstrate a less invasive treatment alternative.
Abdominal Aortic Aneurysm Repair in the Brazilian Public Healthcare System: A 10-Year Analysis of Outcomes.
Lellis Navarro Minchillo Lopes L, Rao SA, Feinglass JM … +5 more , Ho KJ, Reilly MA, Chao CL, El-Gabri D, Pinho Navarro T
Ann Vasc Surg · 2026 May · PMID 42103148 · Publisher ↗
BACKGROUND: The majority of studies evaluating outcomes after abdominal aortic aneurysm (AAA) repair originate from high-income countries. In Brazil, a middle-income country, the public health-care system (Sistema Único...
BACKGROUND: The majority of studies evaluating outcomes after abdominal aortic aneurysm (AAA) repair originate from high-income countries. In Brazil, a middle-income country, the public health-care system (Sistema Único de Saúde; SUS) is the primary provider of high-complexity inpatient care. This study examines 10-year trends in AAA repair within SUS. METHODS: DATASUS, the information technology department of SUS, was queried using procedure-specific codes for open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) performed between 2014 and 2023. Procedures were stratified by timing of intervention (elective versus nonelective), sex, and ethnicity. We calculated the annual and 10-year means for procedure volume, length of stay (LOS), in-hospital mortality, inflation-adjusted expenditure, and reimbursement for each procedure type. Trends over the decade were analyzed using chi-squared and t-tests. RESULTS: Of 11,140 AAA repairs performed from 2014-2023, 69.6% were EVAR and 59.2% were nonelective. Overall annual number of AAA repairs declined by 28.6% from 1,430 in 2014-1,021 in 2023. Concurrently, the proportion of elective AAA repairs decreased from 46.6%-41.6%, and the proportion of OAR increased from 26.8%-34.7%. Most patients were male (75.9%) and White (56.9%). Mean in-hospital mortality was higher after OAR than EVAR (40.3% nonelective OAR vs. 7.3% nonelective EVAR; and 16.0% elective OAR vs. 2.6% elective EVAR). Mean LOS declined by 29.3% for elective procedures. The annual expenditure on AAA repair decreased by 80.3%, with 92.0% spent on EVAR. Hospital reimbursement per EVAR procedure decreased by 81.3%, while OAR decreased by 66.8%. CONCLUSION: There was a 28.6% decrease in number of AAA repairs performed in the Brazilian public health-care system over the past decade. This was associated with an increase in in-hospital mortality and decrease in LOS and reimbursement. Our results suggest a gap in AAA care in Brazil and raise concerns for an increasing number of untreated patients.
Multicenter Registry Validation of the Modified Harborview Risk Score for Risk Stratification in Ruptured Abdominal Aortic Aneurysm.
Chaturvedi A, Balian J, Kwon OJ … +5 more , Tabibian K, Sanaiha Y, Benharash P, de Virgilio C, Bowens N
Ann Vasc Surg · 2026 May · PMID 42103147 · Publisher ↗
BACKGROUND: The modified Harborview Risk Score (mHRS) has been proposed as a bedside tool to stratify operative risk in patients with ruptured abdominal aortic aneurysms (rAAA), but its performance across operative strat...
BACKGROUND: The modified Harborview Risk Score (mHRS) has been proposed as a bedside tool to stratify operative risk in patients with ruptured abdominal aortic aneurysms (rAAA), but its performance across operative strategies in contemporary multicenter settings remains incompletely characterized. METHODS: A retrospective cohort analysis was performed using the 2012-2022 American College of Surgeons National Surgical Quality Improvement Program Targeted endovascular aneurysm repair (EVAR) dataset. Adult patients undergoing open surgical repair (OSR) and EVAR of rAAA were included. The mHRS was calculated by assigning 1 point for age >76 years, creatinine >2 mg/dL, international normalized ratio >1.8, and systolic blood pressure <70 mm Hg. Multivariable regression and Royston-Parmar flexible parametric models were constructed to assess risk-adjusted outcomes stratified by mHRS. RESULTS: Among 2,291 patients, 55.8% underwent EVAR, and 44.2% underwent OSR. The distribution of the mHRS was similar between groups, with median of 1 (1-2) in both cohorts (P = 0.007). After multivariable adjustment, each point increase in the mHRS with OSR (reference: EVAR) yielded higher odds of mortality and complications, including aneurysm hemorrhage (all P < 0.001). When assessed across the mHRS stratum, the risk-adjusted mortality progressively increased for both modalities, with EVAR demonstrating improved outcome at each mHRS level compared to OSR. Time-to-event analysis demonstrated that the decline in freedom from mortality at 30 days was more pronounced following OSR compared to EVAR, particularly at higher mHRS (≥3). CONCLUSION: Our findings using the mHRS suggest that higher scores are associated with increased morbidity and mortality following OSR and EVAR for rAAA, with EVAR demonstrating more favorable outcomes across risk strata.
Neurologic Outcome of Patients with Blunt Traumatic Aortic Injury: An Observational Single-Center Cohort Study.
Mayer-Suess L, Lutz M, Wippel D … +10 more , Moelgg K, Frank F, Kiechl S, Kluckner M, Wipper S, Gizewski ER, Knoflach M, Freund M, Loizides A, Enzmann FK
Ann Vasc Surg · 2026 May · PMID 42103146 · Publisher ↗
BACKGROUND: Evidence on blunt traumatic aortic injury (BTAI)-associated neurological complications is limited. We aimed to assess their prevalence and long-term impact. METHODS: This single-center retrospective cohort st...
BACKGROUND: Evidence on blunt traumatic aortic injury (BTAI)-associated neurological complications is limited. We aimed to assess their prevalence and long-term impact. METHODS: This single-center retrospective cohort study included consecutive BTAI patients treated at the University Hospital of Innsbruck (2005-2023). This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Patients were identified by keyword search and confirmed by 2 independent raters; clinical records and imaging were reviewed, and neurologic diagnoses adjudicated by 2 independent neurologists. RESULTS: Eighty-six BTAI patients were included. Concomitant neurologic pathologies were present in 51 of 86 (59.3%) cases, including traumatic brain injury (TBI) diagnoses (intracranial bleeding 30.2%, diffuse axonal injury 15.1%, and skull fractures 10.5%), potentially vascular- or treatment-related cerebral ischemia (11.6%), trauma-related cervical artery dissections (8.1%), peripheral nerve injuries (10.5%), and spinal cord injuries (7.0%). In-hospital complications included 10 cases (11.6%) of neurologic worsening (National Institute of Health Stroke Scale or modified Rankin Scale [mRS] increase ≥1), with 1 of the seven intrahospital deaths being due to a neurologic cause. Of 86 BTAI patients, 51 (59.3%) had neurologic pathologies-TBI (55.8%), cerebral ischemia (11.6%), peripheral nerve (10.5%), cervical artery dissection (8.1%), and spinal cord injuries (7.0%). 10 (11.6%) had in-hospital neurologic worsening; one of seven deaths was neurologic. Upon follow-up (median 6.8 years), 40.5% remained functionally dependent (mRS >1). Higher Glasgow Coma Scale was associated with lower in-hospital mortality (OR: 0.833; 95% confidence interval [CI]: 0.717, 0.969), concomitant neurologic injuries (OR: 0.692; 95% CI: 0.536, 0.893), and functional dependence (OR: 0.782; 95% CI: 0.651, 0.940; P = 0.009). Higher Injury Severity Score showed the reverse for mortality (OR: 1.063 [1.022, 1.106]; P = 0.002), neurologic injuries (OR: 1.077 [1.025, 1.131]; P = 0.003), and dependency (OR: 1.191 [1.061, 1.336]; P = 0.003). Only three of 33 (9.1%) thoracic endovascular aortic repair (TEVAR)-related °III-subclavian steal cases were symptomatic, all with upper extremity ischemia. CONCLUSION: Concomitant neurologic pathologies in BTAI are frequent and have long-term impact, underscoring the need for multidisciplinary care with neurologic screening and early neurorehabilitation; TEVAR-associated subclavian steal had minimal clinical impact.
Impact of Early Sac Regression on Postendovascular Aneurysm Repair Midterm Outcomes.
Yıldırım A, İşcan HZ, Akkaya BB … +5 more , Özçelik S, Sevim AE, Selvitopi Z, Kasımzade F, Aytekin B
Ann Vasc Surg · 2026 May · PMID 42103145 · Publisher ↗
BACKGROUND: This study aims to identify predictors of aortic sac regression after endovascular aneursym repair (EVAR) and to evaluate the impact of early sac regression and these factors on adverse events such as endolea...
BACKGROUND: This study aims to identify predictors of aortic sac regression after endovascular aneursym repair (EVAR) and to evaluate the impact of early sac regression and these factors on adverse events such as endoleak, reintervention, and late mortality. METHOD: Retrospective analysis of 383 consecutive patients undergoing EVAR (2019-2025) at a single centre. Sac regression was defined as ≥5 mm decrease in maximum diameter or ≥10% volume reduction. Follow-up included computed tomography angiography to 3 years (or Doppler ultrasound/noncontrast CTA in renal impairment). Binary logistic regression identified predictors; Cox regression and Kaplan-Meier assessed late mortality, endoleak, and reintervention. RESULTS: Median follow-up was 25 months (max 99). Sac regression occurred in 293 patients (76.5%). Nonregression was associated with older age (P = 0.04), dual antiplatelet therapy (P < 0.001), larger inferior mesenteric artery diameter (>3 mm; P = 0.04), and more patent lumbar arteries (P = 0.06). Nonregressors had significantly higher rates of all endoleak types, reinterventions, and longer hospital stays (P < 0.05). No aneurysm-related mortality occurred in the regression group (versus 1 case). Volume change showed superior area under the curve for predicting endoleak (0.927 vs. 0.852) and reintervention compared with diameter change. Multivariable predictors of nonregression included age, dual antiplatelet use, neck length, and inferior mesenteric artery diameter. CONCLUSION: Sac regression was strongly associated with markedly improved midterm outcomes, including significantly lower rates of all endoleak types, reinterventions. Advanced age, dual antiplatelet therapy use, shorter neck length, and larger inferior mesenteric artery diameter emerged as independent predictors of failure to regress. Volume-based assessment outperformed diameter-based measurement in predicting sac changes more sensitively. These findings support the integration of volumetric monitoring into risk-stratified surveillance protocols, particularly for stabilized sacs and emphasize the value of individualized follow-up strategies guided by both sac regression status and volumetric changes, to further improve long-term outcomes following EVAR.
Cryopreserved Superficial Femoral Artery Allografts for Redo Infrainguinal Bypasses: A Single-Center Experience.
DeHaven C, Soucy JW, Zil-E-Ali A … +3 more , Lavanga E, Dogbe L, Aziz F
Ann Vasc Surg · 2026 May · PMID 42103144 · Publisher ↗
BACKGROUND: Great saphenous vein (GSV) is the ideal conduit for peripheral bypasses. Cryopreserved superficial femoral artery (Cryo-SFA) is an alternative conduit in patients with chronic limb-threatening ischemia (CLTI)...
BACKGROUND: Great saphenous vein (GSV) is the ideal conduit for peripheral bypasses. Cryopreserved superficial femoral artery (Cryo-SFA) is an alternative conduit in patients with chronic limb-threatening ischemia (CLTI) who lack suitable autogenous vein. Data on outcomes with Cryo-SFA remain limited. This study aimed to assess the postoperative outcomes and patency of Cryo-SFA for infrainguinal revascularization. METHODS: A retrospective review of patients undergoing redo infrainguinal bypass with Cryo-SFA between January 2015 and May 2025 was performed at a single institution. All patients had at least one prior failed ipsilateral bypass and no suitable autogenous conduit. Demographics, operative details, and postoperative outcomes were collected. Primary patency was assessed using Kaplan-Meier estimates within 1 year. RESULTS: A total of 33 patients undergoing infrainguinal bypass using Cryo-SFA were studied. The mean age was 66.7 ± 10 years, and 60.61% (n = 20) were men. Indications included tissue loss (n = 13, 39.4%), ischemic rest pain (n = 10, 30.3%), infection (n = 6, 18.2%), and prior bypass complications (n = 4, 12.1%). Tibial arteries were the most common distal target (n = 20, 60.6%). At 30 days, primary patency was 93.9% (n = 31), with no mortality or major amputations. At the 1-year time end point, 3% mortality was observed. Among surviving patients, 1-year primary patency was 50% (n = 16), primary-assisted patency was 59.4% (n = 19), and secondary patency was 81.3% (n = 26). All patients who lost graft patency ultimately underwent major amputation (n = 6, 18.8%). CONCLUSION: In this high-risk cohort of patients with CLTI, failed prior revascularization, and limited conduit options, Cryo-SFA demonstrated favorable early outcomes with modest 1-year patency in a high-risk cohort despite frequent tibial targets. Cryo-SFA may serve as a viable salvage conduit for complex infrainguinal revascularization in carefully selected patients.
Quantitative Assessment of the Readability of Patient Education Material by the Society of Vascular Surgery.
Hakimi A, Othman L, Soucy JW … +4 more , Chatzis KD, Zil-E-Ali A, Ali T, Aziz F
Ann Vasc Surg · 2026 May · PMID 42103143 · Publisher ↗
BACKGROUND: Health literacy is a key determinant of patient outcomes. Patient education materials (PEMs) are intended to improve health literacy. The National Institute of Health (NIH) and American Medical Association (A...
BACKGROUND: Health literacy is a key determinant of patient outcomes. Patient education materials (PEMs) are intended to improve health literacy. The National Institute of Health (NIH) and American Medical Association (AMA) recommend that PEMs should be written at or below an eighth-grade and sixth-grade reading level, respectively. Despite these recommendations, repeated studies demonstrate that most PEMs are written at significantly higher reading levels, limiting their effectiveness for most patients. The purpose of this study was to evaluate the readability of publicly available PEMs from the Society for Vascular Surgery (SVS). METHODS: Fifteen SVS PEMs were identified and downloaded from the SVS website. They were then converted to plain text. Their readability was assessed using the following 6 validated indices: Flesch-Kincaid Grade Level, Flesch Reading Ease (FRE), Gunning-Fog Index, Coleman-Liau Index, Automated Readability Index, and Simple Measure of Gobbledygook (SMOG). Descriptive statistics, analysis of variance (ANOVA), Kruskal-Wallis, and Cohen's d were used to compare results against NIH/AMA benchmarks and assess differences across indices. RESULTS: All 15 SVS PEMs analyzed were written above the recommended sixth-grade reading level (P < 0.01), and 12 exceeded the eighth-grade reading level (P < 0.05). Despite significant variations between readability metrics, all indices produced consistent grade level estimates for all PEMs and showed that the average readability scores using each metric were above sixth grade level. The mean readability grade levels across the 6 validated indices ranged from 8.63 to 14.56, with cerebrovascular disease, arterial dissection, and deep venous thrombosis being the most difficult to understand. There were statistically significant variations observed between the readability metrics used (ANOVA P < 0.0001; Kruskal-Wallis P < 0.0001) with an Eta-squared analysis suggestive that 30.6% of the variance in readability scores was attributable to the choice of readability calculator used. FRE scores categorized 73% of PEMs as "fairly difficult" or "very difficult." Of note, the SMOG index produced the lowest grade levels, while the Coleman-Liau index produced the highest (difference = 3.33 grade level). CONCLUSION: PEMs from the SVS consistently exceed the readability thresholds recommended by the NIH and AMA, mirroring trends observed in other medical specialties. Poorly designed PEMs can exacerbate existing disparities in health literacy and further worsen poor outcomes in an already sick patient population. These results underscore the need for the SVS to improve patient handouts to better align with national readability standards.
Comparing BEST-CLI Participants with Patients Treated at a Tertiary Center Serving a Regional-Remote Population.
Thanigaimani S, Sun D, Choy OS … +2 more , Tian K, Golledge J
Ann Vasc Surg · 2026 May · PMID 42103142 · Publisher ↗
BACKGROUND: The BEST-CLI trial established the first large-scale evidence for revascularization of chronic limb-threatening ischemia (CLTI), but its restrictive eligibility criteria may limit applicability to regional-re...
BACKGROUND: The BEST-CLI trial established the first large-scale evidence for revascularization of chronic limb-threatening ischemia (CLTI), but its restrictive eligibility criteria may limit applicability to regional-remote populations. METHODS: We retrospectively evaluated BEST-CLI eligibility in a consecutive cohort of patients treated for CLTI at a tertiary vascular center serving the North Queensland regional and remote Australian population. Trial criteria were applied independently by 2 vascular surgeons. The primary outcome was the composite of all-cause mortality and major adverse limb events and was compared by eligibility and procedure type using risk-factor adjusted Cox proportional models. RESULTS: Patients (n = 388) were followed for a median of 2.4 (interquartile range 1.3, 3.9) years, and 277 (71.4%) of them were deemed ineligible for BEST-CLI. Ineligible patients lived significantly further from the tertiary center than eligible patients (median 225.6 vs 73.1 km, P = 0.038), with rurality significantly associated with ineligibility (P = 0.011). BEST-CLI eligible patients had a significantly lower risk of primary outcome events than ineligible patients (adjusted hazard ratio: 0.53, 95% confidence intervals: 0.39, 0.71, P < 0.001). CONCLUSION: The strict eligibility criteria in the BEST-CLI trial would have excluded many rural and remote patients with CLTI who have worse outcomes then eligible patients. Trial findings may not be generalizable to regional populations, underscoring the need for relevant benchmarks and strategies to address inequities to clinical trial access.
Baseline Descending Aortic Diameter Drives Long-Term Failure of Conservative Management in Uncomplicated Type B Aortic Dissection.
Becker D, Frenzer C, Messerli M … +5 more , Khanicheh E, von Tengg-Kobligk H, Makaloski V, Kotelis D, Jungi S
Ann Vasc Surg · 2026 May · PMID 42103141 · Publisher ↗
BACKGROUND: Failure of conservative management in patients with initially uncomplicated type B acute aortic dissection (TBAAD) remains clinically relevant. This study evaluated whether commonly cited imaging-based morpho...
BACKGROUND: Failure of conservative management in patients with initially uncomplicated type B acute aortic dissection (TBAAD) remains clinically relevant. This study evaluated whether commonly cited imaging-based morphologic features are associated with long-term failure of conservative management. METHODS: This retrospective single-center cohort study included consecutive patients treated for uncomplicated TBAAD between 2000 and 2018 with high-quality baseline computed tomography angiography and ≥1 year of imaging follow-up. Baseline morphologic parameters were assessed with centerline-based analysis and included descending thoracic aortic diameter (DTAD), ascending aortic diameter, true and false lumen dimensions, and primary entry tear characteristics. Failure of conservative management was defined as the need for surgical or endovascular intervention >3 months after initial presentation. Cox proportional hazards models evaluated associations between morphologic parameters and subsequent intervention. RESULTS: Eighty-nine patients (median age 65 years; 65.2% male) were included with a median follow-up of 7.6 years. During follow-up, 33 patients (37.1%) required aortic intervention, mainly due to aneurysmal degeneration or rapid growth. Baseline DTAD was significantly larger in patients requiring intervention (median 41 mm vs. 37 mm; P = 0.026). DTAD ≥40 mm was independently associated with intervention (adjusted hazard ratio [HR] 2.15; 95% confidence interval [CI] 1.05-4.42; P = 0.037). DTAD analyzed as a continuous variable remained associated with intervention risk (HR: 1.09 per mm; 95% CI: 1.02-1.16; P = 0.011). Other morphologic features were not associated with aortic growth or need for intervention. CONCLUSION: Baseline descending thoracic aortic diameter was the only morphologic imaging feature consistently associated with long-term failure of conservative management in uncomplicated TBAAD.
The Rising Procedural Burden in Vascular Surgery: An 8-Year Nationwide Population-Based Analysis with Projections to 2035.
Vicente-Jiménez S, Perez-Fernández E, Maria Elvira-Martinez C … +4 more , Barber-Pérez PL, Maynar M, de Benito L, Lopez-Valcarcel BG
Ann Vasc Surg · 2026 May · PMID 42103140 · Publisher ↗
BACKGROUND: This study aimed to quantify the evolving procedural burden in vascular surgery within a nationwide health system and to estimate future workload projections through 2035. METHODS: A retrospective, population...
BACKGROUND: This study aimed to quantify the evolving procedural burden in vascular surgery within a nationwide health system and to estimate future workload projections through 2035. METHODS: A retrospective, population-based study was conducted using the Spanish National Hospital Discharge Registry (RAE-CMBD) from 2016 to 2023. All surgical and endovascular procedures performed in vascular surgery departments were identified and classified by type. Age- and sex-adjusted incidence rates per 100,000 inhabitants were calculated using direct standardization. Temporal trends were assessed using multivariable Poisson regression models with population size as an offset. Linear projections of procedural volume were estimated through 2035 based on observed annual trends. RESULTS: Between 2016 and 2023, the adjusted incidence of vascular procedures increased from 266.8 to 380.4 per 100,000 population, representing a 43% relative increase. Growth was consistent across age and sex groups (incidence rate ratio 1.04; 95% confidence interval 1.00-1.08; P = 0.049). The largest annual increases were observed in thoracic endoprosthesis implantation (+13%), venous stenting (+10%), endovascular lower limb revascularization (+9%), varicose vein interventions (+8%), and endovascular aortoiliac revascularization (+7%; all P < 0.01). Projections indicate a further 59% increase in overall procedural volume by 2035 compared with 2023. CONCLUSION: Vascular surgery is experiencing a sustained and clinically significant increase in procedural demand, driven largely by expanding endovascular activity. If current trends continue, workload will rise substantially over the next decade. These findings highlight the need for anticipatory workforce planning, training adaptation, and resource allocation to ensure the sustainable delivery of vascular surgical care.
Male Sex and Distal Aortic Expansion after TEVAR: A Single-Center Analysis with Bayesian Evidence Synthesis.
Cui D, Li X, Xu C … +4 more , Pan H, Fang L, Bi J, Dai X
Ann Vasc Surg · 2026 May · PMID 42103139 · Publisher ↗
BACKGROUND: A prior meta-analysis identified male sex as a predictor of distal aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (pooled risk ratio [RR] 3.00; 95% confidence...
BACKGROUND: A prior meta-analysis identified male sex as a predictor of distal aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (pooled risk ratio [RR] 3.00; 95% confidence interval [CI] 1.22-7.35). This study aimed to evaluate the association between sex and distal aortic expansion in a single-center patient-level cohort and to explore the integration of prior evidence using Bayesian methods. METHODS: We retrospectively analyzed 145 consecutive patients who underwent TEVAR for type B aortic dissection or intramural hematoma between 2014 and 2023. Distal aortic expansion was defined as an increase ≥5 mm in maximal thoracic aortic diameter during follow-up. Firth logistic regression assessed the association between male sex and expansion, adjusting for preoperative aortic diameter and hypertension. Bayesian logistic regression was performed using weakly informative priors and a secondary exploratory informative prior derived from the published meta-analysis, with consideration of differences between RR and odds ratio (OR), to obtain posterior probabilities of clinically relevant effect thresholds. RESULTS: Twenty-six patients (17.9%) developed expansion. Firth regression yielded an adjusted OR of 3.92 (95% CI 0.94-36.29; P = 0.064). Under a weakly informative prior, the posterior distribution remained centered near the maximum likelihood estimate with wide credible intervals, reflecting substantial uncertainty. Bayesian analysis (informative prior: log OR ∼ no+rmal [1.10, 0.46]) produced a posterior median OR of 3.43 (95% credible interval 1.58-7.85). The posterior probability that the true OR exceeds 1 was 99.8%, and that it exceeds 2 was 90.4%. Results were similar under weakly informative priors; the posterior distribution remained centered near the maximum likelihood estimate, indicating consistency with the observed data while reducing imprecision. CONCLUSION: In this single-center cohort, male sex showed a directionally consistent association with distal aortic expansion compared with prior meta-analytic findings, although the precision of the estimate was limited by sample composition. Despite limited frequentist precision, Bayesian analysis provides a probabilistic interpretation of the effect size and demonstrates how incorporation of prior evidence may influence inference in small-sample settings. These findings should be interpreted with caution and warrant confirmation in larger, independent cohorts.
Management of Secondary Aortoduodenal Fistula: The Role of Emergency Endovascular Repair and Timing of Definitive Open Surgery in a Single-Center Case Series.
Akabane K, Nakamura K, Kuroda Y … +7 more , Mizumoto M, Hayashi J, Hirooka S, Kobayashi K, Ochiai T, Arai S, Uchida T
Ann Vasc Surg · 2026 May · PMID 42103138 · Publisher ↗
BACKGROUND: Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after abdominal aortic surgery, characterized by catastrophic hemorrhage and persistent infection. Emergency endovascular aor...
BACKGROUND: Secondary aortoduodenal fistula (SADF) is a rare but life-threatening complication after abdominal aortic surgery, characterized by catastrophic hemorrhage and persistent infection. Emergency endovascular aortic repair (EVAR) is increasingly performed initially as a less invasive approach for rapid hemostasis in patients presenting with hemorrhagic shock; however, it does not eliminate the underlying source of infection. Although definitive open surgery to remove the infectious source remains essential, the optimal timing has not been established due to the rarity of this condition. Therefore, we evaluated emergency EVAR as an initial hemostatic strategy and the association between timing of definitive surgery and clinical outcomes. METHODS: We retrospectively reviewed six consecutive patients with SADF treated at our institution from 2016 to 2025. Emergency EVAR was performed in patients presenting with hemorrhagic shock, followed by definitive surgery. Until 2021, definitive surgery was performed electively after stabilization of the patient's general condition, whereas since 2022, it has been performed as early as clinically feasible. RESULTS: Emergency EVAR was performed in five patients to achieve hemostasis, and none of the patients died before definitive surgery. During follow-up, four patients died of sepsis due to recurrent infection within 2 years after surgery. Longer intervals from diagnosis to definitive surgery were observed in these patients. CONCLUSION: Emergency EVAR was an effective life-saving strategy for initial hemostasis. However, unfavorable outcomes were associated with prolonged delays before definitive surgery, suggesting that earlier transition to definitive surgery for infection control may be related to overall outcomes.
A Systematic Review and Study-Level Meta-Analysis Investigating the Association Between Pre-endovascular Intervention C-Reactive Protein Levels and Femoropopliteal Artery Restenosis.
Pasha H, Jain K, O'Callaghan D … +4 more , Coughlan JJ, Colleran R, Byrne RA, Rai H
Ann Vasc Surg · 2026 May · PMID 42103137 · Publisher ↗
BACKGROUND: Restenosis in previously treated femoral or popliteal arteries remains a clinical issue, leading to repeat procedures, and major adverse limb events. Elevated pre-endovascular intervention levels of C-reactiv...
BACKGROUND: Restenosis in previously treated femoral or popliteal arteries remains a clinical issue, leading to repeat procedures, and major adverse limb events. Elevated pre-endovascular intervention levels of C-reactive protein (CRP), a marker of systemic inflammation, have previously been associated with coronary restenosis; however, its association with femoropopliteal artery restenosis is unclear. We conducted a systematic review and study-level meta-analysis to assess the association between pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. METHODS: Online databases of PubMed, EMBASE, MEDLINE (OVID), Scopus, and Web of Science were searched for relevant articles published until September 30, 2025. A Z-test using a random effects model was used to pool study-level results to obtain pooled standardized mean difference- and its 95% confidence intervals. A P value of <0.05 indicated statistical significance. RESULTS: After screening a total of 331 unique articles, 14 studies, including 2,097 patients (562 restenosis cases/1,535 no-restenosis controls), were available for quantitative synthesis. Pooled results suggested a significant association between higher pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. (standardized mean difference = 0.44, 95% confidence interval, 0.09-0.78, P = 0.01). There was no evidence of publication bias, both visually via Begg's funnel plot and statistically via Egger's test results (P = 0.52). Leave-one-out sensitivity analysis supported the robustness of the pooled results. CONCLUSION: This systematic review and study-level meta-analysis suggests a significant association between higher pre-endovascular intervention CRP levels and the subsequent development of femoropopliteal artery restenosis. Our findings should be interpreted with caution and further large-scale prospective investigations are warranted to substantiate our results.
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