Annals Of Vascular Surgery[JOURNAL]
Sun
200 papers
Exclusion of Healthy Aorta in Complex Aneurysmatic Aortic Pathologies in Endovascular Repair.
Díaz de Lope-Díaz RG, Hernández Mateo MM, Hernando Rydings M … +2 more , Cantalejo Ferrer MS, Martínez López I
Ann Vasc Surg · 2026 May · PMID 42103136 · Publisher ↗
BACKGROUND: Endovascular repair (ER) requires to seal within a healthy aorta, resulting in longer exclusion in comparison to open repair. This study aimed to quantify the length and the number of occluded segmental arter...
BACKGROUND: Endovascular repair (ER) requires to seal within a healthy aorta, resulting in longer exclusion in comparison to open repair. This study aimed to quantify the length and the number of occluded segmental arteries after every ER compared to a hypothetical open repair (HOR) and, secondary, to assess the anatomical factors related to spinal cord ischemia (SCI) in juxtarenal (JAAAs) and pararenal aneurysms (PAAAs). METHODS: Patients treated by ER between 2014 and 2023 in our center were included. Using OsiriX®, we reviewed every preoperative and postoperative CTA scans, generating center lumen lines for measurements. RESULTS: Seventy-seven patients were included (37 JAAA, 6 PAAA and 34 TAA) undergoing 39 fenestrated endovascular aortic repair (FEVAR), 31 branched endovascular aortic repair, and 7 branched/FEVAR. Median length of aortic exclusion in ER is 276.41 ± 112.31 mm compared to HOR 182.07 ± 87.18 mm (P < 0.001, with significance maintained in JAAA, PAAA, and type III TAAA. The number of occluded segmental arteries after ER was significant in the juxtarenal (P < 0.001) and type III TAA compared to HOR. Four cases of transient SCI in the JAAA and PAAA, with significant association identified for aortic exclusion >250 mm and with the chronic or intended internal iliac arteries occlusion. CONCLUSION: ER results in significantly longer aortic exclusion and more occluded segmental arteries than HOR, particularly in JAAA and PAAA. It is necessary to perform a comparative study with open repair to better evaluate the potential increased risk of SCI in these subgroups.
Letter to the Editor Regarding: "Alterations in Arterial Stiffness and Cardiac Function Following Complex Endovascular Repair of Pararenal and Thoracoabdominal Aortic Aneurysms".
Manenti A, Pagnoni G, Coppi G … +2 more , Coppi F, Manco G
Ann Vasc Surg · 2026 May · PMID 42082099 · Publisher ↗
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Arterial and Venous Thrombotic Complications Following Recreational Nitrous Oxide Misuse: A Comprehensive Review.
Stephan D, Zamperini C, Cordeanu EM
Ann Vasc Surg · 2026 Apr · PMID 42067022 · Publisher ↗
Recreational nitrous oxide (NO) misuse has increased markedly over the past decade, particularly among adolescents and young adults. Although neurological toxicity is well established, venous and arterial thrombotic even...
Recreational nitrous oxide (NO) misuse has increased markedly over the past decade, particularly among adolescents and young adults. Although neurological toxicity is well established, venous and arterial thrombotic events remain underrecognized in cardiovascular practice. A comprehensive review of the literature was performed by searching PubMed/MEDLINE, Embase, and Google Scholar from inception to January 2026, using combinations of "nitrous oxide," "thrombosis," "pulmonary embolism," "deep vein thrombosis," "stroke," "myocardial infarction," "aortic thrombus," and "homocysteine." All case reports, case series, observational studies, and systematic reviews published in English or French reporting thrombotic events temporally associated with recreational NO use were included. Eighteen studies comprising over 40 individual thrombotic events were identified. Manifestations include deep vein thrombosis, pulmonary embolism, cerebral venous sinus thrombosis, ischemic stroke, acute limb ischemia, myocardial infarction, and aortic thrombi. Patients were predominantly young (median age 24-26 years), predominantly male (approximately 70%), and lacked conventional cardiovascular risk factors. Hyperhomocysteinemia was nearly universal, often despite normal serum vitamin B12 levels. NO irreversibly inactivates vitamin B12-dependent methionine synthase, resulting in functional cobalamin deficiency and a prothrombotic state through endothelial dysfunction, platelet activation, and impaired fibrinolysis. Failure to identify NO exposure may lead to diagnostic delay and recurrent events. Management requires site-specific anticoagulation or antiplatelet therapy, prompt parenteral vitamin B12 replacement, and cessation of NO use supported by addiction care. Increased awareness among vascular specialists is essential for timely diagnosis and prevention of recurrence.
Outcomes of Carotid Endarterectomy versus Transcarotid Artery Revascularization in Patients with Significant Cardiac Comorbidities.
Baghbani A, Sandhu HK, Tanaka A … +5 more , Keyhani A, Keyhani K, Saqib NU, Miller CC, Wang SK
Ann Vasc Surg · 2026 Aug · PMID 42067021 · Publisher ↗
BACKGROUND: Patients with left ventricular ejection fraction (LVEF) <30% or persistent arrhythmia are often considered at elevated risk for carotid revascularization. While carotid endarterectomy (CEA) remains standard,...
BACKGROUND: Patients with left ventricular ejection fraction (LVEF) <30% or persistent arrhythmia are often considered at elevated risk for carotid revascularization. While carotid endarterectomy (CEA) remains standard, transcarotid artery revascularization (TCAR) has emerged as a less invasive alternative. Comparative outcomes of these procedures in high-risk cardiac patients remain poorly defined. METHODS: A retrospective review of a prospectively maintained database identified all CEA and TCAR procedures performed between December 2015 and August 2025. High cardiac risk was defined as LVEF <30% and/or persistent arrhythmia. Baseline demographics, perioperative variables, and outcomes were compared using stratified and survival analyses. RESULTS: Among 2,466 patients, 405 (16.4%) met high-risk criteria (CEA: n = 200; TCAR: n = 205). Compared with low-risk patients, the high-risk cohort was older (75.4 vs. 71.7 years, P < 0.01) and had higher rates of coronary artery disease (64.4% vs. 42.0%, P < 0.01) and anticoagulant use (39.4% vs. 5.6%, P < 0.01). Blood loss was greater with CEA than TCAR (50 vs. 25 mL, P < 0.01) but similar across risk groups. Among high-risk patients, perioperative ipsilateral stroke (1.0% vs. 2.4%), myocardial infarction (1.0% vs. 0.5%), and 30-day mortality (1.5% vs. 2.4%) did not differ between CEA and TCAR. The median follow-up was 20 months after CEA and 11 months after TCAR, with no difference in long-term survival or stroke-free outcomes (Gray's test P = 0.35). CONCLUSION: In patients with severe cardiac comorbidities, CEA and TCAR offer comparable perioperative and long-term results. Both represent safe and durable options for carotid revascularization in this high-risk population.
Thirty Years of the CELA Society: Advancing Endovascular Surgery in Latin America.
Galvagni P, Criado F, Cerezo M … +9 more , Carbonell JP, Ferreira M, Morera DC, Espíndola M, Rubio V, Esperón A, Timaran CH, Porras-Colón J, Sociedad de Cirujanos Endovasculares de Latinoamérica (CELA)
Ann Vasc Surg · 2026 Jul · PMID 42055838 · Publisher ↗
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Assessing Nationwide Lower Limb Revascularization Practice Through the National Consultant Information Program.
Singh AA, Adeosun J, Booth M … +3 more , Williams N, Pherwani AD, Boyle JR
Ann Vasc Surg · 2026 Aug · PMID 42025792 · Publisher ↗
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Abandoning Routine Drainage in Common Femoral Artery Exposure: A Prospective Study of Wound Outcomes and the Impact ofObesity.
Desbois E, Zagzoog M, Cameliere L … +2 more , Berger L, Vautier H
Ann Vasc Surg · 2026 Aug · PMID 42019721 · Publisher ↗
BACKGROUND: To prospectively evaluate the safety and clinical outcomes of a no-drain approach for common femoral artery (CFA) exposure, challenging the routine use of closed suction drainage. METHODS: This single-center,...
BACKGROUND: To prospectively evaluate the safety and clinical outcomes of a no-drain approach for common femoral artery (CFA) exposure, challenging the routine use of closed suction drainage. METHODS: This single-center, prospective, observational study (December 2023-June 2025) enrolled consecutive patients undergoing CFA exposure using a strict no-drain protocol. The primary end point was 30-day major adverse events (mortality, rehospitalization, or surgical reintervention). Secondary end points included primary patency, graded wound complications at 14 and 30 days, and multivariate predictors of wound morbidity. RESULTS: We analyzed 151 patients (median age 67; 78.1% male; 21.2% obese), with 67.5% undergoing hybrid procedures. The 30-day major adverse event rate was 8% (n = 12), and 3-month primary patency was 97.4%. Early wound morbidity at 14 days included major dehiscence (16.5%) and superficial infection (10.6%), managed conservatively or with vacuum-assisted closure. Despite this early morbidity, major surgical reoperation for wound complications remained low at 2.6%. Multivariate analysis identified body mass index as the sole independent predictor of wound complications (adjusted odds ratio 1.14; 95% confidence interval 1.06-1.23; P < 0.001). Complication rates were similar between isolated CFA endarterectomy and hybrid procedures (21.4% vs 24.5%; P = 0.32). CONCLUSION: A no-drain approach for CFA exposure is feasible and yields a low rate of surgical reoperation, a profile that extends even to complex hybrid procedures. Although early local wound morbidity is notable and requires proactive management, it is primarily driven by patient phenotype, specifically obesity.
The (In)Visible Chairs: Highlighting the Gender Gap in European and Italian Vascular Meetings.
Giacomelli E, Campolmi M, Peruffo M … +2 more , Dorigo W, D'Oria M
Ann Vasc Surg · 2026 Aug · PMID 42009278 · Publisher ↗
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Single-Center Multidisciplinary Experience with Type A Dissections with Malperfusion.
Brennan L, Wahidi R, Liu T … +8 more , Seyoum N, Wanken ZJ, Brescia A, Kachroo P, Sanchez L, Zayed MA, Ohman JW, Washington University Collaborative for Aortic Research (WashU-CAR)
Ann Vasc Surg · 2026 Aug · PMID 41967671 · Publisher ↗
BACKGROUND: Malperfusion of the viscera and/or lower extremities in type A aortic dissection carries high morbidity and mortality. However, risk factors associated with organ or limb malperfusion are not well understood....
BACKGROUND: Malperfusion of the viscera and/or lower extremities in type A aortic dissection carries high morbidity and mortality. However, risk factors associated with organ or limb malperfusion are not well understood. We evaluated these risk factors in a population of patients who developed malperfusion in the setting of an acute type A dissection and reviewed the surgical interventions performed. METHODS: A retrospective analysis was conducted on 178 patients with acute type A aortic dissection at a single quaternary care center from 2017 to 2023. Data collection included demographics, aortic dissection anatomy, peripheral neurovascular exam, surgical repair, and postoperative survival and limb outcomes. Limb malperfusion was defined as pulse deficit, sensory loss/pain, or motor loss in one or both limbs. Visceral malperfusion was defined as any ischemia of the intraabdominal viscera informed by radiographic evidence. RESULTS: Patients in our cohorts were predominantly male (n = 118; 66%) with comorbidities of a typical cardiovascular cohort. Malperfusion of any type occurred in n = 36 (20%) patients; n = 16 (9.0%) underwent fasciotomies, n = 8 underwent extra-anatomic bypasses, and 1 underwent major amputation. Twenty-two (64.7%) cases of malperfusion were alleviated with type A repair alone. Malperfusion was associated with distal dissection zone (P < 0.001) and higher lactate at presentation (P = 0.02). CONCLUSION: We present a large single-center retrospective analysis of type A aortic dissection and vascular interventions for malperfusion. Distal dissection zone and lactate were associated with malperfusion. Early mortality was similar between patients with malperfusion who did or did not receive additional vascular surgery intervention.
Polymer Ring Sealing Stents for Abdominal Aortic Aneurysms with "Hostile Neck" Feature: A Safe Alternative for Patients "Less Fit" for Open Repair.
Elsayed Y, Bakheet M, Ahmed N … +3 more , Babiker T, Rawshdeh B, Banihani M
Ann Vasc Surg · 2026 Aug · PMID 41967670 · Publisher ↗
BACKGROUND: Standard endovascular aneurysm repair (EVAR) is recommended for patients "less fit" for open surgical approach but still have a reasonable life expectancy. The use of polymer ring sealing stents (ovation and...
BACKGROUND: Standard endovascular aneurysm repair (EVAR) is recommended for patients "less fit" for open surgical approach but still have a reasonable life expectancy. The use of polymer ring sealing stents (ovation and ALTO) has increased since 2015 to cater for short and conical abdominal aortic aneurysm (AAA) necks with small access vessels. We reviewed the performance of those stents in the "less fit" group. METHODS: All patients with multidisciplinary team outcome (not fit for open repair) who underwent EVAR using polymer ring sealing stents since 2015 were included with completed 5 years follow-up. Clinical and radiological data were collected for patient demographics, AAA characteristics, aneurysm sac stability and/or regression, AAA rupture, surgical conversion, stent-graft complications, secondary intervention and overall survival. RESULTS: Sixty-three patients who were not fit for open repair were offered polymer sealing stents. Thirty-day mortality was (1.6%). The overall annual mortality rate for year 1, 2, 3, 4 and 5 was 5.4%, 9%, 5.3%, 0%, and 24%, respectively. Satisfactory seal was achieved in 89% of the patients at 4 years with sac regression in 62% of the patients. The average reintervention rate was 2.5%. There were 2 cases of type 1 endoleak treated with limb extension and/or embolization. One patient required explantation due to infection. Only 1 patient died from AAA rupture 5 years postrepair. CONCLUSION: Polymer ring sealing stents offer a reasonable option for patients deemed not fit for open repair with "hostile neck." Unsurprisingly, the 5-year survival in this cohort is less than standard EVAR but aneurysm-related mortality seems comparable.
Endovascular Intervention Reduces Thrombosis Risk in Retrievable Inferior Vena Cava Filters: A Multicenter Propensity-Matched Analysis.
Wang XN, Zhang H, Li XY … +6 more , Xia SB, Guo MJ, Chang WK, Ding MC, Lu Q, Zhang L
Ann Vasc Surg · 2026 Apr · PMID 41967669 · Publisher ↗
BACKGROUND: Current guidelines recommend retrievable inferior vena cava filters (RIVCFs) placement prior to endovascular intervention (EI) for deep vein thrombosis (DVT), yet the impact of EI on RIVCF-related thrombosis/...
BACKGROUND: Current guidelines recommend retrievable inferior vena cava filters (RIVCFs) placement prior to endovascular intervention (EI) for deep vein thrombosis (DVT), yet the impact of EI on RIVCF-related thrombosis/trapped embolus (T/TE) remains controversial. METHODS: In this prospective registry-based study (ChiCTR1800014252), 2,773 patients undergoing RIVCF placement across 103 Chinese centers (2018-2019) were stratified into EI (n= 1,472) and no-EI (n= 1,301) groups. Propensity score matching (1:1) balanced 23 baseline variables (e.g., DVT acuity and anticoagulation). The primary end point was RIVCF T/TE (defined as inferior vena cava obstruction or thrombus >5 cm above the filter), validated by core-lab adjudicated imaging (computed tomography/angiography). All treating physicians from the 103 participating centers received unified standardized training on the clinical selection criteria for EI and non-EI therapy prior to the study initiation, ensuring consistent intercenter decision-making. The selection of therapeutic modalities was further based on individualized clinical characteristics, including the anatomical location of DVT, thrombus burden, presence of procedural contraindications, and patient's informed consent after full risk-benefit explanation. RESULTS: After matching (n= 1,007 per group), EI was associated with a 46% lower risk of RIVCF T/TE (8.9% vs. 14.0%, P< 0.001; odds ratio = 0.54, 95% confidence interval: 0.41-0.71). Symptomatic pulmonary embolism rates were comparable (1.2% vs. 2.8%, P= 0.07). No brand-specific differences in T/TE incidence were observed (P= 0.32). CONCLUSION: This study challenges the necessity of routine RIVCF placement before EI, demonstrating that EI itself reduces thrombosis risk. These findings advocate for selective filter use, potentially sparing patients from device-related complications.
Comprehensive Evaluation and Management Strategies for Asymptomatic Carotid Artery Stenosis: A Critical Review and Network Meta-Analysis.
Lübke T, Lisii C, Heckenkamp J
Ann Vasc Surg · 2026 Aug · PMID 41967668 · Publisher ↗
BACKGROUND: Management of asymptomatic carotid artery stenosis (ACAS) is variable, including carotid endarterectomy (CEA), carotid artery stenting (CAS), and best medical treatment (BMT). The contemporary risk-benefit pr...
BACKGROUND: Management of asymptomatic carotid artery stenosis (ACAS) is variable, including carotid endarterectomy (CEA), carotid artery stenting (CAS), and best medical treatment (BMT). The contemporary risk-benefit profiles of invasive versus medical therapies remain unclear. METHODS: A systematic review and network meta-analyses were conducted using data from randomized controlled trials (RCTs) including patients with ≥50% ACAS. Outcomes assessed were 30-day stroke and mortality, long-term stroke (30 days-10 years), and stroke subtypes (major, minor, ipsilateral, contralateral). Traditional (pre-2000) and modern (post-2000) BMT were compared to assess temporal improvements in medical therapy. RESULTS: Eleven RCTs (14,295 randomized participants) were identified; 9 trials contributed extractable asymptomatic data (12,320 participants) to at least one endpoint-specific network meta-analysis. Compared with CEA, BMT was associated with lower odds of 30-day stroke (odds ratio [OR]: 0.29, 95% confidence interval [CI]: 0.16-0.55) and 30-day stroke/death (OR: 0.26, 95% CI: 0.15-0.44). CAS showed higher point estimates for early neurologic events versus CEA, but precision was limited for composites (e.g., 30-day stroke/death OR: 1.71, 95% CI: 0.97-2.99). For nonprocedural long-term stroke, CEA was associated with lower odds than BMT (BMT versus CEA OR: 2.22, 95% CI: 1.70-2.90), whereas CAS and CEA were similar (CAS versus CEA OR: 1.09, 95% CI: 0.85-1.41). In the post-2000 subset, ipsilateral stroke after 30 days numerically favored CAS versus CEA (OR: 0.84, 95% CI: 0.32-2.19) but remained imprecise. Surface Under the Cumulative Ranking were used as supportive summaries and interpreted in the context of effect sizes and uncertainty. CONCLUSION: In RCT evidence for ACAS, BMT was associated with the most favorable 30-day profile, while CEA reduced nonprocedural long-term stroke versus BMT. CAS may carry higher early neurologic risk, with long-term outcomes largely comparable to CEA; a possible modern-era advantage for ipsilateral stroke is hypothesis-generating given wide CIs and potential misclassification of "modern" therapy around the year-2000 cut point. Contemporary decision-making should prioritize absolute risks, patient-specific procedural risk, and sustained adherence to intensive medical therapy.
Atherectomy for Tibial Revascularization in CLTI: Signal or Noise?
Hicks CW
Ann Vasc Surg · 2026 Aug · PMID 41966324 · Publisher ↗
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Comparison of Complication Rates of Midline Catheter versus Peripherally Inserted Central Catheter: An Update Systematic Review and Meta-Analysis.
Tian Y, Wang R, Yao X … +1 more , Song P
Ann Vasc Surg · 2026 Aug · PMID 41956153 · Publisher ↗
BACKGROUND: In this meta-analysis, we compared the clinical outcomes and complications of using midline catheters (MCs) versus peripherally inserted central catheters (PICCs) among patients undergoing intravenous therapy...
BACKGROUND: In this meta-analysis, we compared the clinical outcomes and complications of using midline catheters (MCs) versus peripherally inserted central catheters (PICCs) among patients undergoing intravenous therapy (IVT). Our goal was to evaluate the relative risk of complications from MCs and PICCs. METHODS: We performed an extensive review and meta-analysis of randomized controlled trials (RCTs) and observational investigations. Literature screening was carried out using the electronic databases Embase, Ovid, Cochrane Library, PubMed, and Google Scholar from the day of database establishment till February 26, 2025. Eligible studies included those that compared complication rates among patients using either PICCs or MCs for IVT. Our primary end point was major complications, including catheter-related vein thrombosis (CRVT) and catheter-related bloodstream infection (CRBSI). Among the secondary end points were phlebitis, pain, catheter dislodgement, catheter infiltration, and total complications. All data analyses were conducted using Stata (version 14). RESULTS: The initial screening produced 8,410 articles. Among them, only 11 studies, including 3 RCTs and 8 observational investigations, met our strict inclusion criteria. Based on our meta-analysis, MCs were associated with a significantly higher incidence of CRVT compared to PICCs (incidence rate ratio [IRR], 1.91; 95% confidence interval [CI], 1.13-3.23; P = 0.016; I= 13.5%), but with a significantly lower incidence of CRBSI (IRR, 0.58; 95% CI, 0.37-0.91; P = 0.018; I= 0%). Among secondary outcomes, MCs showed a markedly increased risk of infiltration (IRR, 8.41; 95% CI, 2.53-27.93; P = 0.001; I= 0%) and total complications (IRR, 2.54; 95% CI, 1.29-5.02; P = 0.007; I= 78.8%). No statistically significant differences were observed between MCs and PICCs in terms of phlebitis (IRR, 2.11; 95% CI, 0.78-5.68; P = 0.14; I= 0%), dislodgement (IRR, 2.33; 95% CI, 0.58-9.33; P = 0.23; I= 63.5%), or pain (IRR, 1.76; 95% CI, 0.49-6.38; P = 0.39; I= 32.7%) CONCLUSION: Our findings suggest that MCs increased the risk of CRVT and reduced the risk of CRBSI relative to PICCs. These findings can help guide future analyses and direct comparative RCTs to further characterize the efficacy and risks of PICCs versus MCs.
Clinical Outcomes of Iliac Vein Stenting: A Single-Center Retrospective Study with Extended Follow-up.
Cui HJ, Li ML, Zhao L … +1 more , Wu YF
Ann Vasc Surg · 2026 Aug · PMID 41956152 · Publisher ↗
BACKGROUND: Iliac vein stenting is used for the treatment of symptomatic iliofemoral venous obstruction caused by nonthrombotic iliac vein lesions, postthrombotic syndrome, and acute deep vein thrombosis. However, eviden...
BACKGROUND: Iliac vein stenting is used for the treatment of symptomatic iliofemoral venous obstruction caused by nonthrombotic iliac vein lesions, postthrombotic syndrome, and acute deep vein thrombosis. However, evidence regarding mid- to long-term clinical outcomes remains sparse. METHODS: This retrospective single-center study included consecutive patients who underwent iliac vein stenting between April 2016 and June 2023. Patients were categorized into nonthrombotic iliac vein lesion, postthrombotic syndrome, and acute deep vein thrombosis groups. Primary, assisted primary, and secondary patency were evaluated using Kaplan-Meier analysis. Clinical outcomes were assessed using the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) clinical class, Venous Clinical Severity Score, and Villalta score. Adverse events, reinterventions, and device-related outcomes were recorded during follow-up. RESULTS: A total of 105 patients were included, with a mean follow-up of 54 months. The cohort consisted of 44 patients with nonthrombotic iliac vein lesions, 31 with postthrombotic syndrome, and 30 with acute deep vein thrombosis. Technical success was achieved in all procedures. At 5 years, primary patency was 97.4% in the nonthrombotic iliac vein lesion group, 87.0% in the postthrombotic syndrome group, and 100% in the acute deep vein thrombosis group. Assisted primary and secondary patency rates exceeded primary patency across all groups. Clinical severity scores and CEAP classes significantly improved by the final follow-up. Reintervention was required in 4 patients. No stent fracture or migration was observed. CONCLUSION: Iliac vein stenting was associated with sustained patency and clinical score reduction during extended follow-up in patients with different etiologies of iliofemoral venous obstruction.
Restoring Access to Kidney Transplantation: Midterm Outcomes of Pre-Emptive Aortobifemoral Bypass in Candidates with Severe Aortoiliac Disease.
Chavent B, Caradu C, Palmier M … +4 more , Millon A, Arsicot M, Favre JP, AURC Collaborators
Ann Vasc Surg · 2026 Aug · PMID 41956151 · Publisher ↗
BACKGROUND: Severe aortoiliac calcification and occlusive disease may preclude safe arterial clamping and anastomosis during kidney transplantation (KT), particularly as KT candidates age and accumulate comorbidities suc...
BACKGROUND: Severe aortoiliac calcification and occlusive disease may preclude safe arterial clamping and anastomosis during kidney transplantation (KT), particularly as KT candidates age and accumulate comorbidities such as diabetes and peripheral arterial disease (PAD). Pre-emptive aortobifemoral bypass (ABFB) can restore durable inflow; however, multicenter data describing subsequent transplant access and outcomes stratified by symptom status remain limited. METHODS: This retrospective multicenter cohort study was conducted across 12 French and 1 Belgian center between 1984 and 2017. Patients undergoing elective ABFB as part of pretransplant vascular assessment prior to (re)listing or waiting-list reactivation were included and stratified as asymptomatic (Rutherford 0-1) or symptomatic (Rutherford 2-5). The primary endpoint was access to KT (proportion transplanted and time from waiting-list reactivation to KT). Secondary endpoints included primary and secondary bypass patency, freedom from reintervention, perioperative major complications, survival, and pre-KT mortality. RESULTS: A total of 129 patients were included (mean age 57 years; 85% male; 88% on dialysis). Thirty-day and in-hospital mortality was 1.6% (n = 2), and major 30-day complications occurred in 17.8% (n = 23). Median follow-up was 5.4 years. Preoperative imaging demonstrated severe external iliac calcifications in 77.5% of patients (n = 100); 9.3% (n = 12) had complete iliac occlusions. Overall, 55% underwent KT (n = 71). Median time from waiting-list reactivation to KT was 13 months (interquartile range [IQR]: 6-31) and was significantly shorter in asymptomatic PAD (11 months (IQR: 3-22) versus 21 months (IQR: 9-47); P = 0.006). Pre-KT mortality occurred in 9% (n = 11). Primary/secondary bypass patency was 95.8%/100% at 1 year and 90.8%/98.7% at 5 years, without significant differences by symptom status. Overall survival was 94.8% at 1 year and 79.5% at 5 years, favoring asymptomatic patients (1-/5-year 94.4%/92.1% vs. 95.2%/69.1%; log-rank P = 0.04). Secondary vascular procedures were required in 40% of patients. CONCLUSION: Pre-emptive ABFB enabled KT in over half of high-risk candidates with acceptable early risk and midterm patency. Symptomatic PAD identifies a higher-risk subgroup, supporting early vascular assessment and careful multidisciplinary selection.
Degenerative Thoracic Aortic Aneurysm is Associated With Higher Modified Frailty Index and Mortality Compared to Patients With Dissecting Thoracic Aortic Aneurysm, With or Without Thoracic Endovascular Aortic Repair.
Chan BYL, Chan YC, Groenewald C … +2 more , Cheung GC, Cheng SW
Ann Vasc Surg · 2026 Aug · PMID 41951205 · Publisher ↗
BACKGROUND: The prevalence of thoracic aortic aneurysm (TAA) is increasing with aging population and prevalence of imaging as incidental discovery. More patients require operation for TAA and frailty predicts negative su...
BACKGROUND: The prevalence of thoracic aortic aneurysm (TAA) is increasing with aging population and prevalence of imaging as incidental discovery. More patients require operation for TAA and frailty predicts negative surgical outcomes better than chronological age alone in vascular patients. The aim of this study was to compare patients with degenerative and chronic dissecting aneurysm, with respect of their association with modified frailty index (mFI) and mortality with or without thoracic endovascular aortic repair (TEVAR). METHODS: Patients diagnosed with degenerative or dissecting TAA in a tertiary referral vascular center from January 2015 to December 2024 were included. Frailty was measured with 5-factor (mFI-5) and 11-factor (mFI-11). Demographics and characteristics of TAA were analyzed by chi-squared test and univariate analysis. Mortality was analyzed with Kaplan-Meier curve, while association were examined by multivariate Cox regression. RESULTS: Degenerative TAA constituted 124/287 (43.2%) patients and dissection accounted for 163/287 (56.8%) patients. For patients with degenerative aneurysms, 1-year mortality, 5-year mortality, and aortic-related mortality (ARM) were 18.0%, 55.6%, and 10.5%, respectively. For dissecting aneurysms, 1-year, 5-year, and ARM were 5.6% (P < 0.001), 16.0% (P < 0.001), and 1.8% (P = 0.002), respectively. For patients who underwent TEVAR, the 30-day, 1-year and 5-year postoperative mortality for patients with degenerative TAA were 4.8%, 30.0%, and 50.0%. The respective postoperative mortality for dissecting TAA were 2.1% (P = 0.492), 4.8% (P < 0.001), and 10.0% (P = 0.009). mFI-5 (mean 1.61 vs. 1.22, P < 0.001) and mFI-11 (mean 2.12 vs. 1.36, P < 0.001) were significantly higher in degenerative TAA patients. mFI also were the most significant factor to predict postoperative mortality of the entire cohort (hazard ratio [HR]: 2.71, P < 0.001 for mFI-5; HR: 2.27, P < 0.001 for mFI-11). CONCLUSION: Patients with degenerative TAA had higher mFI-5 and mFI-11 when compared to patients with dissecting TAA. Degenerative TAA is also associated with higher 1-year mortality, 5-year mortality, ARM, and postoperative mortality in patients who underwent TEVAR.
Frailty, Glasgow Aneurysm Score, and Intraoperative Factors in Predicting Early Outcomes after Elective Abdominal Aortic Aneurysm Repair.
Stehno O, Miskeje O, Sedivy P … +1 more , Neuberg M
Ann Vasc Surg · 2026 Aug · PMID 41951204 · Publisher ↗
BACKGROUND: Accurate preoperative risk stratification in patients undergoing elective abdominal aortic aneurysm (AAA) repair remains challenging. Traditional risk scores such as the Glasgow aneurysm score (GAS) rely prim...
BACKGROUND: Accurate preoperative risk stratification in patients undergoing elective abdominal aortic aneurysm (AAA) repair remains challenging. Traditional risk scores such as the Glasgow aneurysm score (GAS) rely primarily on static clinical variables and may inadequately reflect physiological reserve. Frailty indices and pulmonary function measures have emerged as potential adjuncts, but their predictive value in contemporary AAA populations is unclear. METHODS: We conducted a single-center cohort study including 504 patients undergoing elective AAA repair between November 2019 and December 2024. Patients were treated with open repair (OR; n = 331) or endovascular aneurysm repair (EVAR; n = 173). The five-factor modified frailty index (mFI-5), GAS, and preoperative pulmonary function (FEV/FVC ratio) were assessed. Primary outcomes were 30-day mortality and postoperative morbidity; secondary outcomes included delayed extubation. Multivariable logistic regression and receiver operating characteristic analyses were performed; however, mortality analyses were primarily descriptive due to the low number of events. RESULTS: Overall, 30-day mortality was low (1.4%; EVAR 1.2%, OR 1.5%), precluding meaningful multivariable analysis and identification of reliable predictors of death. Neither GAS nor mFI-5 was associated with mortality. Higher mFI-5 was associated with increased postoperative morbidity despite identical median values between groups (median = 2; P = 0.036), with each one-point increase in mFI-5 associated with a higher risk of complications (OR ≈ 1.34; P = 0.023). GAS was not associated with postoperative complications. In contrast, suprarenal clamping or short neck anatomy and increased intraoperative blood loss were the strongest independent predictors of morbidity and prolonged ventilation. Preoperative FEV/FVC ratio was not independently associated with postoperative complications or ventilation duration. CONCLUSION: In this contemporary cohort with low perioperative mortality, GAS demonstrated limited predictive value for early outcomes after elective AAA repair. The mFI-5 was associated with postoperative morbidity but not with prolonged ventilation and should be used only as an adjunctive risk assessment tool. Anatomical and intraoperative factors-particularly neck anatomy and blood loss-remain the principal determinants of early postoperative outcomes.
Atherectomy with Angioplasty versus Angioplasty Alone for Critical Limb-Threatening Ischemia with Isolated Tibial Disease.
Ebirim EC, Ramachandran S, Tsukagoshi J … +3 more , Ortiz de ElgueaLizarraga JI, Cherner A, Cox M
Ann Vasc Surg · 2026 Aug · PMID 41941893 · Publisher ↗
BACKGROUND: Critical limb-threatening ischemia (CLTI) causes significant morbidity and mortality worldwide. Although simple balloon angioplasty has been around for decades, the use of atherectomy devices for CLTI treatme...
BACKGROUND: Critical limb-threatening ischemia (CLTI) causes significant morbidity and mortality worldwide. Although simple balloon angioplasty has been around for decades, the use of atherectomy devices for CLTI treatment has expanded exponentially in recent years. There remains a gap in research on the comparative outcomes of adjunct atherectomy versus stand-alone angioplasty in patients with critical limb ischemia, particularly for patients with isolated tibial disease. METHODS: Using TriNetX Data Network, a global federated database of over 250 million patients, we conducted a retrospective cohort study of CLTI patients who underwent tibial atherectomy versus balloon angioplasty alone, up to July 2024. Patients younger than 18 years or with a history of prior or concomitant vascular intervention, including open and endovascular procedures, were excluded. Eligible patients were 1:1 propensity score-matched for preoperative covariates, including demographics and comorbidities. Three-month, 12-month, and 5-year outcomes of mortality, major and minor amputations, and reintervention were calculated and compared between the 2 cohorts using odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: This study identified 752 patients who underwent atherectomy-assisted angioplasty and 3,195 who underwent angioplasty alone. A total of 749 patients in each cohort were matched to compare outcomes spanning 5 years. In total, 72.1% were male, 63.7% White, and the mean age was 66.5 ± 12.3 (Table 1). The mean follow-up period was 687 days for the atherectomy group and 744 days for the angioplasty group. Three-month outcomes resulted in comparable OR for mortality (OR [95% CI] = 1.13 [0.73-1.74]), major amputation (OR [95% CI] = 1.08 [0.77-1.51]), and reintervention (OR [95% CI] = 1.06 [0.81-1.40]). However, atherectomy was associated with significantly fewer minor amputations (OR [95% CI] = 0.74 [0.57-0.96]). The same trend continued out to 5 years, with comparable mortality and reintervention rates and significantly fewer minor amputations (23.4% vs. 30.0%, OR [95% CI] = 0.71 [0.56-0.89]) in the atherectomy group. Notably, major amputation was also significantly lower in the atherectomy group at 5 years compared to the balloon angioplasty group (14.6% vs. 18.4%, OR [95% CI] = 0.75 [0.57-0.99]). HRs for major amputation at 3 months, 12 months, and 5 years were close to 1, with the 5-year HR at 0.816. CONCLUSION: This study suggests a potential clinical advantage of atherectomy for first-time revascularization in patients with critical limb ischemia and isolated tibial disease. The reductions in adverse outcomes suggest atherectomy offers long-term clinical benefits over angioplasty alone, warranting further investigation.
Comparing Venous Reflux in Reverse Trendelenburg Position to Standing Position Using Duplex Ultrasound.
Abbareddy L, Iqbal A, Kinstlinger N … +7 more , Le L, Rodriguez GB, Gawronski M, Mateo RB, Babu SC, Laskowski I, Goyal A
Ann Vasc Surg · 2026 Aug · PMID 41937041 · Publisher ↗
BACKGROUND: Chronic venous insufficiency (CVI) is a common vascular disorder ranging from asymptomatic varicose veins to venous ulceration. Venous reflux, the primary pathophysiologic mechanism, is typically evaluated us...
BACKGROUND: Chronic venous insufficiency (CVI) is a common vascular disorder ranging from asymptomatic varicose veins to venous ulceration. Venous reflux, the primary pathophysiologic mechanism, is typically evaluated using duplex ultrasound (DUS) in the standing position (SP). However, some patients cannot tolerate SP and require assessment in the reverse Trendelenburg (RT) position. METHODS: We conducted a cross-sectional study to compare venous reflux detection using DUS in the SP versus RT. A total of 105 patients with CVI were evaluated, with disease severity classified using the revised Clinical-Etiological-Anatomical-Pathophysiological system. Vein diameter and reflux duration were measured at the saphenofemoral junction (SFJ), great saphenous vein (GSV), saphenopopliteal junction (SPJ), and small saphenous vein (SSV). Agreement between positions was assessed using Cohen kappa, and paired differences in reflux detection were evaluated using McNemar test. RESULTS: Overall agreement between positions was high across venous segments, with concordance of 83% at the SFJ, 78% in the GSV, 95% in the SSV, and 81% at the SPJ. Reflux was detected more frequently in RT than in SP at the SFJ (174 vs. 149 limbs; P < 0.001), and a similar trend observed at the GSV (159 vs. 146 limbs; P = 0.061). Reflux detection at the SSV was similar between positions. Mean vein diameters at the SFJ and GSV were significantly smaller in RT (both P ≤ 0.01). CONCLUSION: RT DUS demonstrates good agreement with SP and detects reflux more frequently at the SFJ. RT positioning may represent a reliable initial diagnostic approach, and combining RT and SP may further improve diagnostic yield in CVI assessment.
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