Annals Of Vascular Surgery[JOURNAL]
Sun
200 papers
What Every Vascular Surgeon Should Know About External Iliac Artery Endofibrosis.
Leon LR
Ann Vasc Surg · 2026 Aug · PMID 41935827 · Publisher ↗
About 40 years ago, reports of a rare vascular disease affecting young and otherwise healthy endurance athletes began to emerge, an entity coined external iliac artery endofibrosis (EIAE). We herein summarize the current...
About 40 years ago, reports of a rare vascular disease affecting young and otherwise healthy endurance athletes began to emerge, an entity coined external iliac artery endofibrosis (EIAE). We herein summarize the current knowledge pertaining to this disease, focusing on the important key facts that the vascular practitioners must be aware when dealing with these patients.
Do Collaterals Matter? Comparing the Clinical Outcomes of Direct Revascularization (DR), Indirect Revascularization-With-collateral (IR-tc), and Indirect-without-collateral (IR-wc) in Endovascular Revascularization of Chronic Limb-Threatening Ischemia Patients.
Shahat M, Mohamed NA, Reyad A … +3 more , Abdalmoneim M, Hagag M, Abdelmonem M
Ann Vasc Surg · 2026 Aug · PMID 41935826 · Publisher ↗
BACKGROUND: Revascularization plays a critical role in chronic limb-threatening ischemia (CLTI) care, aiming to prevent limb loss and improve survival. Revascularization, whether via surgical bypasses or endovascular the...
BACKGROUND: Revascularization plays a critical role in chronic limb-threatening ischemia (CLTI) care, aiming to prevent limb loss and improve survival. Revascularization, whether via surgical bypasses or endovascular therapies, plays a major role in saving the limb, prolonging overall patient survival, and improving their quality of life. Our study aims to compare the clinical outcomes of direct revascularization versus indirect revascularization (with or without collaterals) in isolated infrapopliteal percutaneous transluminal angioplasty for the management of CLTI patients with tissue loss. PATIENTS AND METHODS: This is a prospective, nonrandomized, comparative clinical study conducted at 2 tertiary centers. The study included all consecutive patients presenting between March 2022 and March 2023 with CLTI due to isolated infrapopliteal arterial occlusive disease or successfully treated proximal femoral lesions with Rutherford stage 5 and 6, and had either critical ischemia/vascularity ankle-brachial index less than 0.4. RESULTS: One hundred and seventeen patients were assessed for eligibility; 17 patients were excluded from the analysis due to failed revascularization to the ankle (n = 17). The remaining 100 patients with technically successful infrapopliteal endovascular treatment with inline flow to the ankle were included (50 in the DR group and 50 in the IR group) and included in the analysis. Limb salvage, however, was significantly higher in the direct group (98%) than in the indirect group without collaterals (74.1%, P = 0.004). Within the indirect group, patients with collateral supply (IR-tc) had higher limb salvage rates (91.3%) than those without collaterals (IR-wc, 74.1%). DISCUSSION: The optimal strategy for wound revascularization remains controversial. The angiosome model emphasizes restoring blood flow directly to the tibial artery, which supplies the ulcerated foot region, and several studies have demonstrated improved healing and limb salvage with this approach. Conversely, other reports suggest that wound healing is more strongly influenced by factors such as pedal arch integrity, ulcer location and extent, and patient comorbidities. Recently, increasing focus has been placed on the contribution of collateral circulation to revascularization outcomes. Some studies indicate that indirect revascularization (IR), particularly when supported by collateral vessels (IR-tc), may yield results comparable to direct revascularization (DR). CONCLUSION: Direct revascularization provides highly effective treatment outcomes in CLTI. In the indirect revascularization group, patients without collateral supply to the ischemic area were associated with the poorest outcomes and a higher risk of limb loss.
Trends and Disparities in Aortic Stenosis and Coronary Artery Disease-Related Mortality Among U.S. Adults Aged ≥65 Years, 1999-2024.
Daniyal SM, Sarwar M, Fahim SL … +9 more , Khatoon NM, Noor A, Batool F, Riaz M, Ajaz H, Gondal HT, Aftab Z, Gul I, Fonarow GC
Ann Vasc Surg · 2026 Aug · PMID 41935825 · Publisher ↗
BACKGROUND: Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist in older adults due to shared risk factors and overlapping pathophysiologic mechanisms. Despite substantial advances in surgical and t...
BACKGROUND: Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist in older adults due to shared risk factors and overlapping pathophysiologic mechanisms. Despite substantial advances in surgical and transcatheter therapies, national mortality trends in patients with concurrent AS and CAD remain incompletely defined. METHODS: Using the CDC WONDER database, we analyzed U.S. mortality records from 1999 to 2024 for adults aged ≥65 years in whom AS (I35.0) and CAD (I20-I25) were listed as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and temporal trends were assessed with Joinpoint regression to estimate Annual Percentage Changes (APCs) and Average Annual Percent Changes (AAPCs) across demographic and geographic subgroups. RESULTS: From 1999 to 2024, 215,647 deaths were recorded, with overall AAMR changing from 21.48 to 17.90. Males had higher AAMRs than females (26.32 vs. 12.15 in 2024). By race and ethnicity, the highest rates in 2024 occurred among non-Hispanic (NH) White populations (20.84), followed by Hispanic or Latino (9.67), NH Black or African American (8.54), and NH Asian or Pacific Islander populations (6). Regionally, the highest mortality in 2024 was observed in the Midwest (20.40), followed by the West (19.14), Northeast (18.08), and South (15.68). CONCLUSION: Despite an overall decline, AS- and CAD-related mortality remains substantial, with persistent sex, racial, and geographic disparities. These findings highlight an urgent need for improved early detection, optimized management of concomitant AS and CAD, and expanded access to specialized cardiac care in underserved regions.
Beyond Anatomy: Integrating Host Reserve Biomarkers with Society for Vascular Surgery Wound, Ischemia, and Foot Infection to Predict Major Amputation in Chronic Limb-Threatening Ischemia - A Retrospective Study From a Tertiary Center in South India.
Paul A, Subhalal A, J B S … +1 more , O S S
Ann Vasc Surg · 2026 Aug · PMID 41935824 · Publisher ↗
BACKGROUND: Chronic limb-threatening ischemia (CLTI) carries a high risk of major amputation. Although the Society for Vascular Surgery (SVS) Wound, Ischemia, and Foot Infection (WIfI) classification provides validated a...
BACKGROUND: Chronic limb-threatening ischemia (CLTI) carries a high risk of major amputation. Although the Society for Vascular Surgery (SVS) Wound, Ischemia, and Foot Infection (WIfI) classification provides validated anatomical risk stratification, substantial heterogeneity persists within advanced stages. We evaluated whether integrating systemic physiological biomarkers and Doppler-based ischemia grading appears to improve prediction of major amputation. METHODS: In this retrospective cohort study, 66 diabetic patients with CLTI (January 2024-January 2026) were analyzed. Baseline SVS WIfI stage, arterial Doppler waveform-based ischemia grade, and admission biomarkers (serum albumin, hemoglobin (Hb), and neutrophil-lymphocyte ratio [NLR]) were recorded. The primary endpoint was major amputation or in-hospital mortality. Predictive performance of an anatomical-only model was compared with a composite model incorporating host reserve biomarkers using multivariable logistic regression and receiver operating characteristic (ROC) analysis. RESULTS: Major amputation occurred in 31 patients (47.0%). WIfI stage strongly predicted outcome (P < 0.001), with 76.3% of stage 4 patients requiring amputation. Doppler-based ischemia grade showed a significant graded association with limb loss (P < 0.001). Patients undergoing major amputation had lower serum albumin (1.94 vs. 2.45 g/dL; P < 0.001), lower Hb (9.15 vs. 10.48 g/dL; P = 0.005), and higher NLR (9.12 vs. 5.46; P = 0.003). Model discrimination improved from area under the ROC curve 0.846 to 0.907 (DeLong test, P = 0.015) with biomarker integration. CONCLUSION: While SVS WIfI staging remains an important anatomical predictor, the addition of Doppler waveform morphology and systemic physiological markers appears to improve risk stratification, supporting a dual-axis framework integrating anatomical severity and host resilience in CLTI; however, these findings should be considered exploratory and require validation in larger prospective cohorts.
Risk Factors for Delirium after Abdominal Aortic Aneurysm Repair.
Li J, Slade MD, Ferrante LE … +4 more , Tonnessen BH, Dardik A, Cardella JA, Ochoa Chaar CI
Ann Vasc Surg · 2026 Aug · PMID 41935823 · Publisher ↗
BACKGROUND: Delirium after abdominal aortic aneurysm (AAA) repair is an underreported complication that adversely impacts postoperative recovery. This study aims to characterize risk factors for delirium after AAA repair...
BACKGROUND: Delirium after abdominal aortic aneurysm (AAA) repair is an underreported complication that adversely impacts postoperative recovery. This study aims to characterize risk factors for delirium after AAA repair in older adults using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: The ACS-NSQIP database was queried for intact AAA repairs and linked to the Geriatric Surgery and AAA repair modules. The primary outcome was postoperative delirium, determined by a standardized chart-based assessment. Demographics, clinical characteristics, and postoperative outcomes were compared between patients with and without delirium. Backward stepwise logistic regression identified factors independently associated with delirium. RESULTS: There were 529 repairs (75% endovascular), and 9.5% of patients developed delirium postoperatively. Delirium was more common following open repair compared to endovascular repair (23.8% vs. 4.8%) and with older age (77.4 ± 5.6 vs. 75.6 ± 6.5 years), lower body mass index (26.7 vs. 28.5 kg/m), and increased bleeding risk (24% vs. 12%) (P < 0.05). Patients with delirium were more likely to have been living alone preoperatively (33% vs. 17%; P = 0.024), but otherwise did not vary in baseline comorbidities including cognitive and functional impairment (P > 0.05). On multivariable analysis, older age, increased bleeding risk, open repair, and paravisceral aneurysm proximal extent were independently associated with delirium. CONCLUSION: Among older adults undergoing AAA repair, operative factors were more strongly associated with delirium than patient characteristics. Delirium prevention bundles and monitoring protocols should be prioritized in the perioperative care of older adults at high risk, such as those undergoing open AAA repair.
Comparative Outcomes of Carotid Endarterectomy, Transfemoral Carotid Artery Stenting, and Transcarotid Artery Revascularization in Community Hospital Settings: A Multicenter Retrospective Study.
Hanandeh A, Zia Z, Cabrera V … +6 more , Calderin J, Meadows R, Chen M, Vulpe D, Cires G, Fisher F
Ann Vasc Surg · 2026 Aug · PMID 41933576 · Publisher ↗
BACKGROUND: To compare perioperative and 1-year outcomes of carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), and transfemoral carotid artery stenting (TF-CAS) using data from a large multicente...
BACKGROUND: To compare perioperative and 1-year outcomes of carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), and transfemoral carotid artery stenting (TF-CAS) using data from a large multicenter real-world cohort of symptomatic patients treated across community hospital settings. METHODS: A retrospective analysis was performed on 37,482 symptomatic patients who underwent CEA, TCAR, or TF-CAS within the HCA Healthcare system from 2016 to 2023. Symptomatic status was defined by documented ipsilateral stroke, transient ischemic attack (TIA), or amaurosis fugax. Primary outcomes included 90-day stroke, 30-day all-cause mortality, 30-day myocardial infarction (MI), 30-day wound infection, and 1-year restenosis. Multivariable logistic regression with firth correction was used to assess associations between procedure type and outcomes, adjusting for age, Elixhauser comorbidity index, and antiplatelet therapy. RESULTS: Of the 37,482 patients included in the analysis, 28,021 (74.76%) underwent CEA, 8,603 (22.95%) underwent TF-CAS, and 858 (2.29%) underwent TCAR. The 90-day stroke rates were 2.80% after TCAR, 3.31% after CEA, and 5.96% following TF-CAS (P < 0.0001). Thirty-day mortality was 1.05% after TCAR, 1.07% after CEA, and 3.16% after TF-CAS (P < 0.0001). Rates of MI did not significantly differ across procedure types. No 30-day wound infections occurred in the TCAR group (0/858), compared with 129/28,021 (0.46%) after CEA and 10/8,603 (0.12%) after TF-CAS (P < 0.0001). One-year restenosis rates were low across all modalities; 1.28% after TCAR, 0.85% after CEA, and 0.94% after TF-CAS with no significant adjusted differences between groups (P = 0.35). CONCLUSION: In this large symptomatic cohort, CEA and TCAR demonstrated similar perioperative safety, while TF-CAS was associated with higher 90-day stroke and 30-day mortality. One-year restenosis rates were low and comparable across all 3 approaches. These findings demonstrate that CEA and TCAR achieve comparably favorable outcomes with low rates of stroke, mortality, and perioperative complications, supporting both as safe and effective options for symptomatic patients. Conversely, TF-CAS was linked to significantly higher stroke risk, underscoring the need for selective use based on anatomy and patient-specific factors. Overall, the results reinforce a personalized, risk-adjusted approach to carotid revascularization.
Impact of Hemodialysis on the Natural Course of Patients with Peripheral Arterial Occlusive Disease: A Propensity Score-matched Analysis.
Kwon H, Shin I, Baek CH … +5 more , Yoo J, Han Y, Gwon JG, Lee SA, Cho YP
Ann Vasc Surg · 2026 Aug · PMID 41932604 · Publisher ↗
BACKGROUND: We aimed to compare long-term outcomes of patients with peripheral arterial occlusive disease (PAOD), stratified by hemodialysis (HD) status, who had not undergone any vascular interventions, and to clarify t...
BACKGROUND: We aimed to compare long-term outcomes of patients with peripheral arterial occlusive disease (PAOD), stratified by hemodialysis (HD) status, who had not undergone any vascular interventions, and to clarify the long-term impact of HD on the natural course of PAOD among these patients. METHODS: Between January 1995 and August 2020, 2,733 adult patients with PAOD who had not received any vascular interventions were included in this study and divided into 2 groups based on their HD status: non-HD (n = 2,516, 92.1%) and HD (n = 217, 7.9%) groups. The outcomes were lower limb amputations and all-cause mortality. RESULTS: Patients in the HD group were younger and more likely to experience atherosclerosis than those in the non-HD group. A significantly higher risk of lower limb amputation (3.5% vs. 22.6%, P < 0.001) and all-cause mortality (7.1% vs. 28.6%, P < 0.001) were observed in the HD group compared to the non-HD group. During the propensity score (PS)-matched analysis, all amputation and all-cause mortality rates were significantly higher in the HD PS-matched group than in the non-HD PS-matched group (both P < 0.001). However, no significant difference was observed in the rate of major amputation between the 2 PS-matched groups (P = 0.63). HD was significantly associated with an increased risk of lower limb amputation and all-cause mortality (both P < 0.001). CONCLUSION: Patients with PAOD undergoing HD who did not receive any vascular interventions were at greater risk of long-term lower limb amputation and death. HD was a significant risk factor associated with increased lower limb amputation and mortality rates among these patients.
Re: "Arterial and Venous Thromboembolism in Critically Ill, COVID-19 Positive Patients Admitted to Intensive Care Unit.
Gallo ED, Salzillo I, Bozzani A … +1 more , Arici V
Ann Vasc Surg · 2026 Aug · PMID 41932603 · Publisher ↗
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Effects of Remote Ischemic Preconditioning in Patients with Acute Lower Extremity Ischemia.
Apichartpiyakul P, Apaijai N, Chansakaow C … +2 more , Chattipakorn SC, Chattipakorn N
Ann Vasc Surg · 2026 Aug · PMID 41932602 · Publisher ↗
BACKGROUND: Acute limb ischemia (ALI) requires urgent revascularization but this can cause ischemia/reperfusion injury. Remote ischemic preconditioning (RIPC) has shown benefit in reducing infarct size and improving endo...
BACKGROUND: Acute limb ischemia (ALI) requires urgent revascularization but this can cause ischemia/reperfusion injury. Remote ischemic preconditioning (RIPC) has shown benefit in reducing infarct size and improving endothelial function in acute myocardial ischemia. We hypothesized that RIPC may mitigate adverse outcomes in ALI following revascularization. METHODS: In a triple-blinded, randomized controlled trial, 28 ALI patients (Rutherford Classes 1-2b) scheduled for surgical revascularization were assigned to RIPC or control groups. The primary outcome was changes in kidney function; secondary outcomes included oxidative stress, mitochondrial function in peripheral blood mononuclear cells (PBMCs), and clinical outcomes. RESULTS: Fourteen patients were in each group, and baseline characteristics were similar. Changes in kidney function (creatinine clearance, neutrophil gelatinase-associated lipocalin) did not differ between groups. No significant differences were found in hospital stay, local complications (compartment syndrome, muscle necrosis), or systemic complications (heart failure, pulmonary edema, 30-day amputation/mortality). At the cellular level, RIPC reduced mitochondrial oxidative stress in PBMCs at 24 hours postrevascularization (P < 0.05) but had no effect on overall cellular oxidative stress. Mitochondrial function was decreased 24 hours postoperation in both groups; RIPC did not modify this effect. CONCLUSION: RIPC did not significantly affect renal function, clinical outcomes, or cellular changes in ALI patients, though it transiently reduced mitochondrial oxidative stress. These results suggest limited clinical benefit of RIPC in this setting. Larger studies are needed to further explore the protective mechanisms of RIPC in ALI.
Did the era of Drug-Coated Balloons Begin in Below-The-Knee Interventions.
Yildirim A, Dogan S, Besli F
Ann Vasc Surg · 2026 Aug · PMID 41932601 · Publisher ↗
Abstract loading — click title to view on PubMed.
Femoral-Axis Oncovascular Reconstruction in Thigh Sarcomas: A Structured Narrative Review of Decision-Making, Techniques, and Outcomes.
Marzano A, Bittoni C, Miceli F … +5 more , Ascione M, Gagliardo di Carpinello G, Di Girolamo A, di Marzo L, Mansour W
Ann Vasc Surg · 2026 Aug · PMID 41932600 · Publisher ↗
Thigh sarcomas (soft-tissue and bone) may encase or invade the femoral vascular axis, historically prompting primary amputation. Contemporary limb-sparing surgery increasingly incorporates planned en bloc vascular resect...
Thigh sarcomas (soft-tissue and bone) may encase or invade the femoral vascular axis, historically prompting primary amputation. Contemporary limb-sparing surgery increasingly incorporates planned en bloc vascular resection and reconstruction to secure oncologic margins while preserving limb function. This structured narrative review addresses 3 femoral-axis-specific decision domains in thigh and groin sarcoma surgery: (1) arterial planning, with particular attention to the common femoral bifurcation and profunda femoris artery; (2) selective venous reconstruction versus ligation; and (3) adjunctive factors influencing graft durability, including conduit choice, soft-tissue/lymphatic management, and surveillance. Across contemporary cohorts and meta-analyses, limb salvage is achievable in most patients, but perioperative morbidity remains substantial and is driven primarily by wound/lymphatic complications and graft thrombosis. Current evidence supports mandatory arterial reconstruction after circumferential resection of the femoral axis, while the need for venous reconstruction remains unresolved and should be individualized according to deep venous trunk loss, preoperative patency/collateralization, field hostility, and anticoagulation feasibility. We propose a pragmatic femoral-axis decision framework emphasizing profunda preservation, selective venous reconstruction, proactive wound/coverage planning, and standardized reporting to improve reproducibility and future comparative inference.
What Every Vascular Surgeon Should Know About the Thromboelastography.
Rodriguez A, Cieri IF, Sheshdeh AB … +4 more , Patel S, Bansal R, Fouzdar SS, Dua A
Ann Vasc Surg · 2026 Aug · PMID 41932599 · Publisher ↗
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Determinants of Survival, Reamputation, and Prosthetic Use after Major Lower-Limb Amputation for Peripheral Artery Disease: A Retrospective Cohort Study.
Marcelo Cabral J, Mendes D, Bandeira M … +5 more , Cardoso S, Queirós M, Almeida H, Pinelo A, Silva I
Ann Vasc Surg · 2026 Aug · PMID 41932598 · Publisher ↗
BACKGROUND: Major lower limb amputation remains a necessary treatment for advanced peripheral artery disease and is associated with substantial mortality and functional limitation. This study aimed to identify clinical f...
BACKGROUND: Major lower limb amputation remains a necessary treatment for advanced peripheral artery disease and is associated with substantial mortality and functional limitation. This study aimed to identify clinical factors associated with mortality and rehabilitation outcomes following major lower limb amputation. METHODS: A retrospective review was performed of all patients undergoing major lower limb amputation, above-the-knee (AK) or below-the-knee (BK), between June 2017 and December 2023. Demographic characteristics, comorbidities, amputation level, reamputation, prosthesis use, and mortality were analyzed. Cox regression models were used to identify predictors of mortality and amputation level. Associations were assessed using chi-squared and nonparametric tests where appropriate. Statistical significance was defined as P < 0.05. RESULTS: A total of 585 patients were included (mean age, 72 years), with AK amputations accounting for 61%. Overall mortality was 45%, with a mean time to death of 325 days. At 5 years after major amputation, cerebrovascular disease, cardiac insufficiency, atrial fibrillation, active malignancy, and dialysis dependence were independently associated with increased mortality, while anticoagulant therapy was protective. Regarding amputation level, cerebrovascular disease, cardiac insufficiency, atrial fibrillation, and dementia were independently associated with a higher likelihood of undergoing AK rather than BK amputation. BK amputations were associated with higher reamputation rates (P < 0.001), but greater prosthesis use compared with AK amputations (38% vs. 14%). Five-year survival was higher after BK than AK amputation (63% vs. 51%). CONCLUSION: BK amputation is associated with improved long-term survival and functional outcomes despite higher reamputation rates. Optimization of cardiovascular and renal comorbidities may improve survival following major lower limb amputation.
Underuse of Preoperative Testing Before Index Peripheral Vascular Interventions for Claudication in the Outpatient Setting.
Tsou TC, Dun C, White M … +8 more , McDermott KM, Wu YHA, Weaver ML, Kalbaugh C, Siracuse JJ, Salameh M, Black JH, Hicks CW
Ann Vasc Surg · 2026 Aug · PMID 41921912 · Full text
BACKGROUND: Guidelines across vascular surgery, cardiology, and radiology specialties recommend appropriate preoperative testing prior to revascularization for claudication. We aimed to identify patient and physician cha...
BACKGROUND: Guidelines across vascular surgery, cardiology, and radiology specialties recommend appropriate preoperative testing prior to revascularization for claudication. We aimed to identify patient and physician characteristics associated with the absence of preoperative testing before peripheral vascular interventions (PVIs) performed for claudication. METHODS: Using 100% Medicare fee-for-service claims data, we identified all patients undergoing an index PVI for claudication between 01/2017 and 12/2024. We used CPT codes to identify preoperative testing, which included noninvasive physiologic studies (ABI, pulse volume recordings [PVRs]), near infrared thermography, duplex ultrasound, MRA of the abdomen and pelvis with runoff, CTA of the abdomen and pelvis with runoff, MRA of the lower extremity, or CTA of the lower extremity. Lack of preoperative testing was defined as no preoperative test within 3 months prior to index PVI. We evaluated the associations of patient and physician characteristics with the lack of preoperative testing using multivariable hierarchical logistic regression. We performed sensitivity analyses defining lack of preoperative testing as no testing within 6 and 12 months prior to index PVI. RESULTS: Of 167,406 patients undergoing index PVI for claudication by 3,771 physicians, 27.4% received no preoperative testing. The odds of receiving no preoperative testing significantly increased over time (adjusted odds ratio [aOR] 1.02 per year, 95% confidence interval [95% CI] 1.02-1.03). Patients without preoperative testing were more likely to be age ≤ 64 years (versus age 65-74, aOR 1.06, 95% CI 1.01-1.11), Black (versus White, aOR 1.10, 95% CI 1.05-1.15), or Hispanic (versus White, aOR 1.20, 95% CI 1.11-1.31), and to receive an iliac intervention (aOR 1.29, 95% CI 1.22-1.36). Patients treated by physicians of cardiology (aOR, 1.98; 95% CI, 1.87-2.10), radiology (aOR, 1.20; 95% CI, 1.09-1.33), and other nonvascular surgery specialties (aOR, 1.27; 95% CI, 1.13-1.42) had higher odds of not receiving preoperative testing compared to patients treated by vascular surgeons. Sensitivity analyses using 6 and 12 months as the time cutoff for testing prior to PVI did not substantially change the results. CONCLUSION: Compliance with society guidelines for preoperative testing prior to outpatient PVI for claudication varies substantially by patient and physician characteristics. Cross-specialty adherence will help ensure patients with claudication receive consistent, evidence-based, high-value care.
Socioeconomic Disadvantage Is Associated with Health Care Disparities in Mortality, Readmission and Long-Term Anticoagulation in Young Patients Following Submassive (Intermediate-Risk) Pulmonary Embolism.
Hafeez MS, Phillips A, Reitz K … +5 more , Mulukutla S, Johnson A, Sridharan N, Avgerinos E, Chaer RA
Ann Vasc Surg · 2026 Aug · PMID 41921911 · Publisher ↗
BACKGROUND: Submassive pulmonary embolism (sPE) can result in increased morbidity and mortality but the impact of social determinants of health using the Area Deprivation Index (ADI) on outcomes has not been explored. ME...
BACKGROUND: Submassive pulmonary embolism (sPE) can result in increased morbidity and mortality but the impact of social determinants of health using the Area Deprivation Index (ADI) on outcomes has not been explored. METHODS: Patients admitted with sPE (2013-2019) at one health care network were divided into terciles by ADI. To capture a workforce cohort, patients older than 60 or with a diagnosis of cancer were excluded. Outcomes included overall and cardiovascular and pulmonary embolism (PE) specific mortality. Groups were compared using Kaplan-Meier curves, and multivariable Cox-proportional models. Time-to-readmission was also compared. RESULTS: A total of 2,013 patients met selection criteria. More deprived patients were more likely to be younger, female, of Black race, and smokers (P < 0.001) with a greater incidence of comorbidities (P < 0.05). Compared with residence in less deprived areas, residence in more deprived neighborhoods was associated with worse survival at 1 year (98.8% vs. 96.1%, adjusted hazard ratio [aHR] = 3.23, [1.69-6.20], P < 0.001) and at 5 years (95.8% vs. 90.9%, aHR = 2.46, [1.49-4.06], P < 0.001). Residence in the most deprived neighborhoods was associated with higher cardiovascular and PE specific mortality in the first (0.4% vs. 2.0% mortality, aHR = 4.87, [1.28-18.55], P = 0.02). Residence in the most deprived neighborhoods was associated with more readmissions as well (6.4% vs. 11.1%, P = 0.005, aHR = 1.39 95% confidence interval [CI] = 1.12-1.71, P = 0.002). CONCLUSION: Among patients with sPE, residence in deprived neighborhoods was associated with increased overall, cardiovascular and PE specific mortality as well as long-term hospital readmissions. Socioeconomic deprivation was also associated with lower anticoagulation use and compliance after discharge. Focused follow-up may help mitigate these disparities.
A Core Outcome Set for Intact Abdominal Aortic Aneurysms Under Surveillance.
Zwetsloot SLM, Rijken L, Koncar I … +11 more , Dias-Neto M, Lee R, Tulamo R, Behrendt CA, Lareyre F, Smit NN, Smorenburg SPM, Ayyalasomayajula V, Jongkind V, Yeung KK, VASCUL-AID Collaborators & Expert Consensus Meeting Collaborators
Ann Vasc Surg · 2026 Aug · PMID 41921910 · Publisher ↗
BACKGROUND: Current literature on AAA is characterized by selective outcome reporting, while guideline recommendations are frequently based on studies of poor methodological quality. To improve evidence synthesis, standa...
BACKGROUND: Current literature on AAA is characterized by selective outcome reporting, while guideline recommendations are frequently based on studies of poor methodological quality. To improve evidence synthesis, standardization of outcome measures through a core outcome set (COS) is advocated, particularly in artificial intelligence (AI) research. A COS consists of essential outcomes for reporting in clinical research based on patient and expert consensus. This study aimed to create a COS for research on patients with AAA under surveillance. This COS will be innovatively applied in AI research focused on cardiovascular disease progression. METHODS: First, a longlist of AAA outcomes was identified through a systematic literature search and focus groups with patients, caregivers, and healthcare professionals. A three-round European Delphi survey was subsequently conducted with patients and healthcare professionals. In an expert consensus meeting with key opinion leaders and patients, the COS was finalized. RESULTS: The 91-outcome AAA longlist was used in the Delphi study, in which 104 patients and 153 healthcare professionals participated. The highest-rated outcomes from the third Delphi round were discussed in the expert consensus meeting, attended by 23 key opinion leaders, 2 patients, and 1 patient representative from a patient society. Ten core preoperative and postoperative outcomes were chosen across 6 health domains, with AAA rupture, survival, health-related quality of life, clinical success, and graft infection attaining 100% consensus for inclusion in the COS. CONCLUSION: This COS consists of 10 outcomes and should be implemented in clinical and AI research on AAA under surveillance.
A ruptured giant femoral artery aneurysm presents as DVT.
Iyer S, Oh E, Pandya Y … +1 more , Sachdev U
Ann Vasc Surg Brief Rep Innov · 2026 Mar · PMID 41918803 · Full text
Femoral artery aneurysm and rupture are rare. Deep vein thrombosis (DVT) from compression typically aids in detection, yet this aneurysm evaded ultrasound. A 74-year-old male with right thigh pain and swelling was diagno...
Femoral artery aneurysm and rupture are rare. Deep vein thrombosis (DVT) from compression typically aids in detection, yet this aneurysm evaded ultrasound. A 74-year-old male with right thigh pain and swelling was diagnosed with right popliteal and femoral vein DVT. He presented to the emergency department with worsening pain and swelling in the medial thigh despite anticoagulation. Imaging revealed a 12-cm ruptured superficial femoral artery (SFA) aneurysm. A SFA to below-knee popliteal artery bypass was performed without postoperative complications. Vascular labs and practitioners should consider peripheral aneurysm as a rare but important cause for DVT that is unresponsive to anticoagulation.
Stent Diameter, Not Sex, Is Predictive of Reintervention after Common Iliac Artery Stenting.
Lowenkamp MN, Reitz KM, Sridharan N … +2 more , Eslami MH, Madigan MC
Ann Vasc Surg · 2026 Aug · PMID 41912028 · Full text
BACKGROUND: Female sex is associated with adverse limb events following revascularization for peripheral artery disease (PAD). Specifically, poorer patency, with more reinterventions following iliac artery stenting. We h...
BACKGROUND: Female sex is associated with adverse limb events following revascularization for peripheral artery disease (PAD). Specifically, poorer patency, with more reinterventions following iliac artery stenting. We hypothesize stent diameter will be associated with an increased risk of reintervention among all patients regardless of sex group. METHODS: We included adults undergoing unilateral, elective, index, common iliac stenting only for PAD (Vascular Quality Initiative peripheral vascular interventions database; 2015-2022) excluding those with aneurysms and lacking follow-up. Stents <8 mm were defined as small. Kaplan-Meier and multivariable Cox regression compared 1-year reintervention. Interaction terms evaluated subgroups. RESULTS: We identified 4,844 patients including 1,935 (40.0%) females. Females were older (67.8 ± 10.7 vs. 67.1 ± 9.7) with fewer comorbidities and were less frequently prescribed perioperative aspirin (72.9% vs. 76.2%) or statins (75.8% vs. 79.6%, all P < 0.05). Most stents were for claudication (64.4%), yet females had more critical limb threatening ischemia (39.5% vs. 32.7%; P < 0.001). Although females received smaller stents (38.0% vs. 17.8%, P < 0.001), sex was not associated with reintervention. Smaller stents were associated with increased reintervention (P < 0.001). The association between small stents and increased reinterventions did not differ between sexes (p-interaction>0.05). CONCLUSION: Small stent diameter, not female sex, was associated with an increased risk of reintervention following iliac stents for PAD. However, females were less frequently medically optimized and received smaller stents, possibly contributing to long-term stent failure described previously.
The Combined Effect of Renin Angiotensin System Blockade and Metformin on Abdominal Aortic Aneurysm Growth Rate in People with Diabetes Mellitus-A Propensity-Matched Retrospective Cohort Study.
Otify EAAA, Nunney I, Dhatariya K … +1 more , Stather PW
Ann Vasc Surg · 2026 Aug · PMID 41905460 · Publisher ↗
BACKGROUND: Identification of a safe and effective medical therapy for abdominal aortic aneurysm (AAA) remains a significant unmet clinical need. This study evaluated the associations between commonly prescribed medicati...
BACKGROUND: Identification of a safe and effective medical therapy for abdominal aortic aneurysm (AAA) remains a significant unmet clinical need. This study evaluated the associations between commonly prescribed medications in type 2 diabetes mellitus (T2DM), HbA measurements, and AAA growth over a 14-year surveillance period. METHODS: A retrospective cohort study including all patients enrolled in the AAA screening and surveillance program at Norfolk and Norwich University Hospital NHS Foundation Trust. Records of AAA size, risk factors, medications, outcomes, complications, and mortality were analyzed. A 1:1 propensity matching was undertaken to validate results. RESULTS: The study comprised 986 patients (84.7% male), of whom 199 had T2DM. The mean initial AAA diameter did not differ significantly between groups (39.3 mm [standard deviation (SD) 7.2] in T2DM versus 39.4 mm [SD 6.9] in non-T2DM; P = 0.68). Patients with T2DM had a significantly lower mean AAA growth rate (2.2 mm/year [SD 3.1] vs. 2.7 mm/year [SD 2.9]; P = 0.042). The mean follow-up duration was longer in the T2DM group (5.2 years [SD 3.6] vs. 4.6 years [SD 3.3]; P = 0.03). Use of metformin and angiotensin-converting enzyme inhibitor/angiotensin II receptor type I blocker therapy was independently associated with reduced AAA growth rates (1.40 mm/year, 95% confidence interval [CI] 1.05-1.88; and 1.67 mm/year, 95% CI 1.52-1.83, respectively). Combined therapy was associated with the greatest reduction (1.19 mm/year, 95% CI 0.97-1.47) compared with neither medication (1.94 mm/year, 95% CI 1.78-2.12). These findings remained significant after 1:1 propensity score matching. CONCLUSION: Metformin and ACEi/angiotensin II receptor type I blocker therapy are associated with reduced AAA growth rates, with the greatest protective effect observed in patients receiving combined therapy.
What Every Vascular Surgeon Should Know About Vascular Ehlers-Danlos Syndrome.
Lian T, Bhandari A, Shalhub S
Ann Vasc Surg · 2026 Aug · PMID 41905459 · Publisher ↗
Vascular Ehlers-Danlos syndrome (VEDS) vascular type is a rare autosomal dominant disorder caused by pathogenic variants in the COL3A1, resulting in abnormal type III collagen and a high risk of arterial dissection, rupt...
Vascular Ehlers-Danlos syndrome (VEDS) vascular type is a rare autosomal dominant disorder caused by pathogenic variants in the COL3A1, resulting in abnormal type III collagen and a high risk of arterial dissection, rupture, and other life-threatening complications at a young age. Diagnosis requires a high index of clinical suspicion and confirmatory genetic testing, which also enables cascade screening and informs prognosis through genotype-phenotype correlations. Management is centered on multidisciplinary care, including vascular surgery, cardiology, and genetics, with baseline head-to-pelvis vascular imaging followed by annual to biannual surveillance. Medical therapy emphasizes strict blood pressure control, typically with beta-blockers and angiotensin receptor blockers, alongside lifestyle modification and avoidance of high-risk medications. Although historically associated with high morbidity, both open and endovascular interventions are increasingly feasible with careful patient selection and meticulous technique, though risks of iatrogenic injury and device-related complications remain substantial. Longitudinal care requires ongoing surveillance and psychosocial support, and pregnancy carries significant maternal risk necessitating specialized management. Advances in genetic characterization and operative strategies have improved outcomes; however, substantial morbidity persists, and future efforts are focused on integrating biologic and ultrastructural markers of tissue integrity to refine risk stratification and enable personalized decision making.
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