Vascular And Endovascular Surgery[JOURNAL]
Sun
200 papers
Part I: Acute Lower Limb Ischemia-Reperfusion Injury: Pathophysiology and Experimental Interventions.
Carmon L, Peters AA, Laban N … +3 more , Langert K, Maier KG, Gahtan V
Vasc Endovascular Surg · 2026 Apr · PMID 41138233 · Publisher ↗
Ischemia-reperfusion injury (IRI) secondary to acute limb ischemia is a complex clinical phenomenon induced by a variety of pathologies, including arterial embolization, arterial thrombosis, vascular trauma, advanced per...
Ischemia-reperfusion injury (IRI) secondary to acute limb ischemia is a complex clinical phenomenon induced by a variety of pathologies, including arterial embolization, arterial thrombosis, vascular trauma, advanced peripheral vascular disease, traumatic crush injuries, and/or prolonged tourniquet application. The restoration of blood flow and oxygen to the limb after an ischemic period, while necessary, is ultimately the driving force of IRI. The exaggerated inflammation, oxidative stress, and tissue damage caused by IRI often lead to limb dysfunction, limb loss, multi-organ failure, and/or death. While no gold-standard therapy currently exists, various in vitro and in vivo models have been developed to explore potential therapeutic strategies. Currently, pharmacological agents with anti-inflammatory and/or antioxidant properties, as well as non-pharmacological strategies, have been investigated, and some agents show promise in mitigating the effects of lower extremity ischemia-reperfusion injury (IRI). In this review article, we provide a comprehensive overview of the pathophysiology of IRI, discuss the local and systemic effects of IRI, and examine the experimental models used to investigate IRI. We also outline the current in vitro and in vivo pharmacological and non-pharmacological interventions studied to reduce IRI.
Cerament® Bone Void Filler in Vascular Patients With Calcaneal Osteomyelitis: Outcomes From a Prospective Case Series.
Nagineti P, Walmsley J, Mohideen T … +3 more , Allen M, Manners D, Mittapalli D
Vasc Endovascular Surg · 2026 Apr · PMID 41135183 · Publisher ↗
ObjectiveCerament® bone void filler combined with an antimicrobial agent has been shown to be effective in both reducing post operative infections and the treatment of osteomyelitis in orthopaedic surgery. Patients under...
ObjectiveCerament® bone void filler combined with an antimicrobial agent has been shown to be effective in both reducing post operative infections and the treatment of osteomyelitis in orthopaedic surgery. Patients under the care of vascular surgery have significant co-morbidities with a mixture of lower limb arterial insufficiency and poor wound healing secondary to diabetes. Conventional management for heel ulcers relies on the improvement of distal blood flow, debridement of infected tissue and antibiotic therapy, though many patients fail to improve with these measures. The purpose of this case series was to report the outcomes of Cerament® G and V in vascular patients who have not responded to conventional treatments.MethodsConsecutive patients with heel ulceration and osteomyelitis secondary to peripheral vascular disease and/or diabetic complications were included and followed up for a median duration of 8 months. Patients underwent a single application of Cerament® G or V to the calcaneal body and debridement. Outcomes included improvement in ulceration, repeat surgical intervention, amputation rate, further anti-microbial therapy, and impact on mobility.ResultsAfter exclusion of two patients due to death and major limb amputation during index admission, 20 patients were included in the study with a median age of 76 years (range 49-87), of which 70% were males. 14 patients (70%) had improvement in their ulcer appearance at follow up. 4 patients (20%) required repeat Cerament® and 4 patients (20%) required lower limb amputation. 3 (15.0%) patients required further course of anti-microbial treatment. Mobility was improved in 5 patients (25%, < 0.01).ConclusionIn this case series of high-risk vascular patients, single-stage application of Cerament® for heel ulcers with calcaneal osteomyelitis was associated with improvement of ulcer healing, limb preservation, and improved mobility. Further randomized, controlled studies are needed to confirm efficacy in comparison to standard therapy.
Carotid Body Tumors: From Basic to Clinical Practice.
Yu J, Yuan W, Cao K … +4 more , Hou C, Wang Z, Han Y, Wang T
Vasc Endovascular Surg · 2026 Apr · PMID 41127900 · Publisher ↗
Carotid body tumors (CBTs) are rare neoplasms originating from the carotid body. A comprehensive synthesis of the available evidence is essential to enhance the understanding of this condition among clinicians and resear...
Carotid body tumors (CBTs) are rare neoplasms originating from the carotid body. A comprehensive synthesis of the available evidence is essential to enhance the understanding of this condition among clinicians and researchers. This review aims to provide a comprehensive overview of CBTs, encompassing their epidemiology, pathophysiology, clinical manifestations, current treatment modalities, and associated complications. A narrative literature review was conducted, synthesizing information from relevant studies identified through a systematic search of electronic databases. The review included studies focusing on human subjects with carotid body tumors, encompassing case reports, case series, cohort studies, and relevant review articles. The literature search was primarily conducted in the PubMed database. The search strategy utilized a combination of keywords and Medical Subject Headings (MeSH) terms related to "carotid body tumors," "chemodectoma," and "paraganglioma." Retrieved articles were screened based on titles and abstracts, and full texts of relevant studies were reviewed for data extraction. Data on epidemiology, pathogenesis, clinical features, treatments, and complications were then thematically analyzed. Epidemiological data indicate a slight increase in the global incidence of CBTs, although they remain relatively uncommon. The pathogenesis involves factors such as genetic predisposition, chronic hypoxia, and geographical influences. Clinical presentation is variable, commonly featuring neck masses, carotid sinus syndrome, and voice changes, depending on tumor size and location. Primary treatment options include surgical excision, radiotherapy, and embolization, with the choice of modality influenced by patient age, tumor size, and location. While surgery is often the preferred approach, it carries risks of complications such as cranial nerve injury, stroke, and hemorrhage. The review also identifies and discusses rare complications, including baroreceptor reflex failure. A thorough understanding of the multifaceted aspects of CBTs is crucial for refining diagnostic and therapeutic strategies. This integrated knowledge is expected to contribute to improved patient survival and quality of life.
Comparison of the Safety and Efficacy of Three Techniques for Coil Embolization of Splenic Artery Aneurysms: A Retrospective Single-Center Study.
Weng Y, Lang D
Vasc Endovascular Surg · 2026 Apr · PMID 41124099 · Publisher ↗
ObjectiveThe coil embolization is the most common endovascular intervention used to treat splenic artery aneurysms (SAAs) and this study aimed to analyze the safety and efficacy of 3 different coil embolization technique...
ObjectiveThe coil embolization is the most common endovascular intervention used to treat splenic artery aneurysms (SAAs) and this study aimed to analyze the safety and efficacy of 3 different coil embolization techniques.MethodsA retrospective study was conducted on 60 patients with SAAs who underwent endovascular intervention at Ningbo NO. 2 Hospital from November 2020 to November 2023. The coil embolization technique included Sac embolization (SE, = 25), the isolation technique (IT, = 23) and Stent-assisted coil embolization (SACE, = 12). Perioperative and follow-up data were collected. The primary outcomes assessed were technical success and 30 day, 12 months, and 24 months survival rates. Secondary outcomes included major complications, early or later re-intervention, Post-embolization syndrome (PES) and freedom from end-organ ischemia.ResultsThe SAAs diameter in the SE group, the IT group and the SACE group were 21 mm (16-35), 21 mm (15-70) and 22.4 ± 2.4 mm, respectively. The technical success rate in the SE and SACE groups was 100%, while in the IT group was 95.7% (22/23). There were no significant differences between the 3 groups in terms of major complication (2/25 SE group, 2/23 IT group, 2/12 SACE group, = 0.733), PES (4/25 SE group, 8/23 IT group, 1/12 SACE group, = 0.178), or early re-intervention rates (1/25 SE group, 0/23 IT group, 1/12 SACE group, = 0.675). The mean follow-up times for the 3 groups were 27.7 ± 10.5 months (SE group), 29.7 ± 9.1 months (IT group) and 22.8 ± 6.4 months (SACE group), respectively. Compared to the SE group, the risk of splenic infarction was higher in the IT group (0% vs 17.4%, = 0.046). No splenic abscesses, Splenectomy, and late re-intervention occured in the cohort. The 30-day, 12-month, and 24-month mortality rates were 0. During the follow-up, 1 non-aneurysm-related death occured in the IT group (4.3%, 1/23) at 37 months postoperatively.ConclusionAll 3 coil embolization techniques, including the SE, the IT and the SACE, have a favorable safety and efficacy. The IT may have a higher risk of splenic infarction. For SAAs with different anatomical features, the preferred coil embolization technique may be different.
Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation.
Hanson AD, Ojeda DJ, Saleem A … +4 more , Sagues E, Gudino A, Krug R, Samaniego EA
Vasc Endovascular Surg · 2026 Apr · PMID 41100890 · Publisher ↗
IntroductionThere is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and...
IntroductionThere is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and safety of different medical regimens after CAS.MethodsThis retrospective observational study included patients with pre-existing atrial fibrillation who underwent CAS from 2011 to 2024. Patients were divided into three treatment groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT). The primary outcome was the incidence of major bleeding. Secondary outcomes included the incidence of clinically relevant minor bleeding, recurrent stroke, and stent thrombosis.ResultsOf the 1047 patients who underwent CAS, 129 met the inclusion criteria: 31 in the DAPT group, 46 in the AA group, and 52 in the TT group. At 3 months, major bleeding events occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 7.7% (4/52) in the TT group ( = 0.71). Ischemic stroke after stent placement occurred in 6.4% (2/31) of cases in the DAPT group, compared to 4.3% (2/46) in the AA group and 1.9% (1/52) in the TT group ( = 0.57). Stent thrombosis occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 1.9% (1/52) in the TT group ( = 0.32).ConclusionOur findings suggest no significant differences in bleeding events or ischemic outcomes among the different antiplatelet and anticoagulation regimens in patients with atrial fibrillation who underwent CAS.
The Predictive Role of BUN/Creatinine Ratio and Inflammatory Markers in Determining Amputation Risk in Acute Limb Ischemia Patients.
Yasar A, Ayar MS, Caliskan F … +1 more , Yucel SM
Vasc Endovascular Surg · 2026 Apr · PMID 41091951 · Publisher ↗
ObjectiveAcute limb ischemia (ALI) is a time-sensitive vascular emergency that often presents to the emergency department and can result in limb loss or mortality if not managed promptly. Identifying simple, cost-effecti...
ObjectiveAcute limb ischemia (ALI) is a time-sensitive vascular emergency that often presents to the emergency department and can result in limb loss or mortality if not managed promptly. Identifying simple, cost-effective biomarkers at the time of initial emergency department evaluation could facilitate early risk stratification and guide timely intervention, particularly in resource-limited settings. This study aimed to evaluate the predictive value of three readily available laboratory markers-neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and blood urea nitrogen (BUN)/creatinine ratio-for assessing amputation risk in patients with ALI.MethodsWe conducted a single-center, retrospective cross-sectional study of 138 patients diagnosed with ALI who presented to the emergency department between January 2020 and January 2023. Demographic and laboratory data were collected. ROC analysis was performed to evaluate the predictive performance of NLR, PLR, and BUN/creatinine ratio for amputation risk, and multivariate logistic regression identified independent predictors.ResultsAmong the biomarkers analyzed, the BUN/creatinine ratio demonstrated the highest predictive performance for amputation risk (AUC: 0.727, sensitivity: 69.0%, specificity: 68.8%), although the discriminative ability was only moderate. NLR (AUC: 0.666) and PLR (AUC: 0.647) also showed associations with amputation risk, though with lower predictive values. Female gender emerged as an additional independent predictor of amputation risk (OR: 4.16, 95% CI: 1.47-11.81, = .007).ConclusionsOur findings suggest that the BUN/creatinine ratio may serve as an accessible biomarker with moderate predictive performance, whose main utility may lie in helping to exclude patients at low risk of amputation. While NLR and PLR also showed potential value, further prospective multicenter studies are required to validate their clinical applicability.
Early and Mid-term Results From a Tertiary Care Center for Total Aortic Arch Replacement Using the Thoraflex Hybrid Graft.
Koskas L, Doizi S, Zagzoog M … +2 more , Davaine JM, Koskas F
Vasc Endovascular Surg · 2026 Apr · PMID 41091130 · Publisher ↗
ObjectiveTo report the outcomes of the frozen elephant trunk (FET) technique for patients with chronic aortic dissection and thoracic aortic aneurysm.MethodsPatients undergoing the FET technique using the Vascutek Thoraf...
ObjectiveTo report the outcomes of the frozen elephant trunk (FET) technique for patients with chronic aortic dissection and thoracic aortic aneurysm.MethodsPatients undergoing the FET technique using the Vascutek Thoraflex hybrid graft for chronic aortic dissection and thoracic aortic aneurysm from 2013 to 2021 were included. Outcomes included mortality rates, peri-operative complications and aortic related re-interventions. Patients were categorised into aortic dissection and thoracic aortic aneurysm groups.Results39 patients were identified, of whom 56% (n = 22) had a thoracic aortic aneurysm and 44% (n = 17) chronic aortic dissection. Patients with aneurysm had a significantly higher rate of peripheral artery disease at baseline. A significant difference was found in in-hospital mortality rate (27% in patients presenting with aneurysm (n = 6) vs 0% (n = 0) in patients with dissection). Peri-operative complications were 2 (5%) post-operative strokes, 1 (3%) symptomatic spinal cord ischemia, 2 (5%) lower limb ischemia and 4 (10%) ischemic colitis. The median follow-up was 14.8 (2.9-46.5) months. During follow up, mortality from all cause was 18% (n = 7), and aortic re-intervention rate 18% (n = 7) after 39.4 (19.8-45.5) months.ConclusionsThe FET technique is a good therapeutic option for aortic disease of the aortic arch and proximal descending aorta. While the postoperative outcome was acceptable given the high mortality rates of such disease and their treatment, outcomes were better among patients presenting with aortic dissection, particularly in terms of peri-operative mortality.
Educational Attainment and Outcomes of Hemodialysis Access Creation.
Patel N, Schneider A, Cheng TW … +6 more , Alonso A, McNamara T, Maaneb De Macedo K, King E, Farber A, Siracuse JJ
Vasc Endovascular Surg · 2026 Apr · PMID 41091004 · Publisher ↗
ObjectiveHigher education has historically correlated with improved health outcomes, yet its impacts on end-stage renal disease (ESRD) patients undergoing hemodialysis are not well understood. The goal of this study was...
ObjectiveHigher education has historically correlated with improved health outcomes, yet its impacts on end-stage renal disease (ESRD) patients undergoing hemodialysis are not well understood. The goal of this study was to characterize patient factors and outcomes associated with initial arteriovenous (AV) access creation by patient education level.MethodsWe performed a single-center retrospective review of patients who underwent initial AV access creation from 2014-2021. Education groups were defined as primary (elementary school), secondary (middle/high school equivalent), and tertiary (college or higher). Univariable, multivariable, and Kaplan-Meier analyses were performed.ResultsWe identified 480 patients with primary (20.2%), secondary (54.6%), or tertiary education levels (25.2%). Patients with primary education were more likely to be of Hispanic ethnicity (58.8% primary vs 17.9% secondary vs 9.9% tertiary; < 0.0001) or underinsured (Medicaid/uninsured) (62.9% vs 46.2% vs 39.7%; < .001), but less likely to have English proficiency (27.1% vs 79.4% vs 77.5% tertiary; < .001).Univariable analysis showed no significant differences in access-related steal or 30-day readmission. On Kaplan-Meier analysis, 2-year survival was 89.5% (primary education), 89.1% (secondary education), and 89.7% (tertiary education) ( = .99). Maturation at 180 days was 80.8%, 75.4%, and 75.3%, respectively ( = .4). On multivariable analysis, neither 30-day index readmission nor loss of primary patency were significantly associated with education level.ConclusionsAlthough education level was not associated with adverse outcomes once patients were undergoing hemodialysis, many of our patients only have primary school education. Earlier attempts at improving healthcare literacy and preventative care should be examined before the deterioration of kidney function.
Assessing Vascular Surgery Readmission Data in Commonly Used Quality Metric Programs.
Aljobeh A, Khomutova A, Winkeler I … +4 more , Pak S, Murphy J, Giannopoulos S, Tassiopoulos A
Vasc Endovascular Surg · 2026 Feb · PMID 41067226 · Publisher ↗
BackgroundThirty-day hospital readmissions are a critical healthcare quality metric used to evaluate hospital performance and patient outcomes. Vascular surgery readmission rates are among the highest and most costly. Ac...
BackgroundThirty-day hospital readmissions are a critical healthcare quality metric used to evaluate hospital performance and patient outcomes. Vascular surgery readmission rates are among the highest and most costly. Accurate data on patient readmissions is essential for improving care quality and reimbursement processes. The accuracy of readmission data, often derived from quality metric programs like NSQIP and Vizient, is challenged by misclassification or improper capture of readmissions.MethodsWe conducted a single-institution retrospective analysis using the NSQIP and Vizient registries to identify patients who underwent vascular surgery between 2018 and 2023 and were subsequently readmitted to our institution within 30 days. Demographic, procedural, and readmission data were reviewed to identify factors associated with procedure-related vs non-procedure related readmissions. Logistic regression was employed to determine variables that significantly predicted procedure-related readmissions.ResultsAmong 2375 vascular surgery operations captured by NSQIP and Vizient during the study period, 219 patients (9.2%) were readmitted within 30 days. Of these, 89 (40.6%) were procedure-related and 130 (59.4%) were non-procedure-related. Baseline demographics, comorbidities, and perioperative characteristics were largely similar between groups, although patients with non-procedure-related readmissions were more likely to be functionally dependent (39.2% vs 22.5%, = 0.009) and current smokers (30.8% vs 20.2%, = 0.08). In multivariable logistic regression, functional dependence (OR 0.41, 95% CI 0.19-0.88, = 0.022) and current smoking within 1 year (OR 0.48, 95% CI 0.23-0.99, = 0.047) were independently associated with lower odds of procedure-related readmission, suggesting that these patients are more likely to return for medical decompensation rather than surgical complications.ConclusionsVascular surgery readmissions are frequent and costly, and factors such as functional health status and pre-existing complications should be considered in prevention strategies. Accurate documentation and coding, combined with targeted transitional care interventions, will be essential to reduce unnecessary readmissions and to ensure fair institutional benchmarking under current quality metric programs.
Medium Term Outcomes of Bypass Surgery for Recurrent Superficial Femoral Artery Lesions After Endovascular Treatment.
Tachibana H, Kobayashi T, Okazaki T … +7 more , Mochizuki S, Maeda K, Kodama H, Oshita M, Arakawa M, Katayama A, Takahashi S
Vasc Endovascular Surg · 2026 Feb · PMID 41066775 · Publisher ↗
ObjectiveThe study was performed to examine clinical outcomes of bypass surgery for recurrent superficial femoral artery (SFA) occlusive lesions after endovascular treatment (EVT).MethodPatients who underwent bypass surg...
ObjectiveThe study was performed to examine clinical outcomes of bypass surgery for recurrent superficial femoral artery (SFA) occlusive lesions after endovascular treatment (EVT).MethodPatients who underwent bypass surgery for a recurrent SFA lesion after EVT at 4 Japanese vascular centers from 2015 to 2020 were analyzed retrospectively. The primary endpoint was graft patency (primary, assisted primary, and secondary).ResultsA total of 46 patients were included in the study. The patients had high rates of hypertension (85%), diabetes (70%), and chronic kidney disease (63%). Clinical presentation before EVT was intermittent claudication in 16 cases (35%) and chronic limb-threatening ischemia in 30 cases (65%). Initial EVT was performed for complex SFA lesions (lesion length, 200 [125-260] mm; reference vessel diameter, 5.3 [4.7-6.0] mm; chronic total occlusion, 50%; poor below-the-knee runoff vessel, 60%). The final device was a bare-nitinol stent in 26 cases (56%), stent graft in 9 (20%), and drug-eluting stent in 7 (15%). A total of 46 surgical reconstructions (above-the-knee femoropopliteal bypass, 15 (33%); below-the-knee femoropopliteal bypass, 7 (15%); tibial bypass, 24 (52%)) were performed using autologous vein grafts (72%) and prosthesis grafts (28%) in a median period of 300 [145-556] days from initial EVT. The median procedure time was 201 [159-299] min. No case had early graft occlusion or hospital death within 30 days. The median follow-up period was 27 (12.7-49.2) months. The 3-year primary, assisted primary, and secondary graft patencies were 57%, 70%, and 77%, respectively; the 3-year limb salvage was 84%; and the 3-year survival was 66%.ConclusionMedium term outcomes were acceptable in patients with bypass surgery for a recurrent SFA lesion after EVT.
Endovascular Management of Aortic Injuries Caused by Pedicle Screws: A Two-Case Series With a Proposed Decision-Making Framework.
Rosales S, Rodriguez-Buitrago A, Tarazona M … +4 more , Araque-Puello Y, Alarcon-Palomino J, Ramon JF, Alvarado-Gomez F
Vasc Endovascular Surg · 2026 Feb · PMID 41066704 · Publisher ↗
IntroductionPedicle screw-related aortic injuries are rare but potentially life-threatening complications of spinal instrumentation. While some cases remain asymptomatic for extended periods, delayed recognition increase...
IntroductionPedicle screw-related aortic injuries are rare but potentially life-threatening complications of spinal instrumentation. While some cases remain asymptomatic for extended periods, delayed recognition increases the risk of catastrophic vascular events. Early diagnosis and appropriate management are critical to prevent severe morbidity and mortality. Traditional open vascular repair carries significant risks, whereas thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive alternative. However, clear guidelines for diagnosis and treatment in spine surgery remain lacking.MethodsWe present 2 cases of aortic injury caused by pedicle screws following spinal instrumentation. Both patients underwent multidisciplinary management, including intravascular ultrasound (IVUS) for vascular assessment, TEVAR for aortic repair, and pedicle screw removal/repositioning. A review of the literature was conducted to contextualize these cases within existing management strategies.ResultsBoth patients were successfully treated with TEVAR and pedicle screw revision, without perioperative complications. IVUS played a crucial role in confirming the extent of vascular involvement and guiding intervention. At 18-month and 24-month follow-up, both patients remained asymptomatic, with no evidence of graft migration, endoleak, or spinal instability.ConclusionsPedicle screw-related aortic injuries, though uncommon, pose a serious risk in spine surgery. Multidisciplinary management involving spine and vascular surgery is essential for optimal outcomes. IVUS enhances diagnostic accuracy, allowing for precise treatment planning. Endovascular stent placement, combined with appropriate pedicle screw revision, is an effective and safe management strategy. Given the lack of standardized guidelines, we propose a structured decision-making approach for spine surgeons encountering vascular complications. Future research should focus on risk stratification, screening protocols, and long-term outcomes of endovascular management in spinal instrumentation.
Aortic Pleomorphic Sarcoma Presenting With Claudication: A Rare Diagnostic Challenge.
Ünlü Z, Karaca S, Kapkin AY … +1 more , Islamoglu F
Vasc Endovascular Surg · 2026 Jan · PMID 41066667 · Full text
Aortic pleomorphic sarcomas are rare, aggressive vascular tumors often presenting with nonspecific symptoms that delay diagnosis. We describe a 53-year-old male who presented with isolated lower extremity claudication. E...
Aortic pleomorphic sarcomas are rare, aggressive vascular tumors often presenting with nonspecific symptoms that delay diagnosis. We describe a 53-year-old male who presented with isolated lower extremity claudication. Examination revealed absent pulses in the left leg, and duplex vascular ultrasound showed monophasic flow. CT angiography demonstrated a 48 mm infrarenal abdominal aortic aneurysm extending to the iliac bifurcation, a bulge in the left common iliac artery, and high-grade stenosis in a short segment. The patient underwent surgical repair with a Y-graft. Histopathological analysis confirmed undifferentiated pleomorphic sarcoma with a high Ki67 index (65%) and absence of specific immunohistochemical markers. Postoperative PET-CT revealed metastatic disease involving lungs, liver, and bones. The patient subsequently received systemic chemotherapy. This case highlights the diagnostic challenges of undifferentiated pleomorphic sarcoma when they present with isolated ischemic symptoms rather than signs of malignancy Early recognition through imaging and histopathology is essential, as surgical resection remains the cornerstone of treatment despite poor prognosis.
Patch Angioplasty for the Treatment of Hemodialysis Access Dysfunction.
Li X, Ye Q, Zhang L … +7 more , Guan W, Song H, Zeng C, Li C, Xie M, Zhao B, Wu H
Vasc Endovascular Surg · 2026 Feb · PMID 41065071 · Publisher ↗
BackgroundThe treatment of hemodialysis access dysfunction include creating a new fistula, balloon dilation, or stent implantation. However, these options are not suitable for all patients. We adopted patch angioplasty t...
BackgroundThe treatment of hemodialysis access dysfunction include creating a new fistula, balloon dilation, or stent implantation. However, these options are not suitable for all patients. We adopted patch angioplasty to reconstruct the hemodialysis access and observed this group of cases to evaluate the feasibility, effectiveness, and safety of this surgical method.MethodsBetween 2021 and 2024, we performed 14 cases of patch angioplasty using PTFE patch material. We recorded the time of fistula establishment, time of patch angioplasty, surgical site, transitional dialysis status using central venous catheter, complications, and patency of the fistula in this group of cases.ResultsAll 14 patients successfully underwent patch angioplasty, with a technical success rate of 100%. During follow-up, 3 patients died respectively 2, 8, 9 months post-operation. The longest follow-up time was 38 months. The primary patency rates for target lesions were as follows: 92.3% at 3 months (12/13), 81.8% at 6 months (9/11), 77.8% at 12 months (7/9), and 57.1% at 24 months (4/7). The cumulative patency rates were: 3 months 100% (13/13), 6 months 90.9% (10/11), 12 months 88.9% (8/9), and 24 months 71.4% (5/7). No cases experienced infection, bleeding, pseudoaneurysm, or steal syndrome.ConclusionsPTFE patch angioplasty for hemodialysis access reconstruction yields a high technical success rate and serves as an effective solution after hemodialysis access dysfunction. It has high safety and good patency rates, making it a recommended method for access reconstruction.
Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic Review and Management Algorithm.
Pegler A, Sivakumaran Y
Vasc Endovascular Surg · 2026 Feb · PMID 41062077 · Publisher ↗
BackgroundAortic dissection following endovascular aneurysm repair (EVAR) may be iatrogenic or a de-novo event. This study aims to systematically review all cases of dissection following EVAR to identify complications sp...
BackgroundAortic dissection following endovascular aneurysm repair (EVAR) may be iatrogenic or a de-novo event. This study aims to systematically review all cases of dissection following EVAR to identify complications specific to each scenario and develop a management algorithm depending on the clinical presentation.MethodsA comprehensive literature search of MEDLINE, Embase, and CENTRAL databases was performed for all studies relating to dissection following EVAR or fenestrated/branched EVAR (F/BrEVAR). Data collected included timing (differentiating iatrogenic and de-novo events), entry tear location, endograft involved, complications, management, and subsequent outcomes. Due to limited data availability, descriptive data was collected and outcomes compared depending on dissection type and timing. Risk of bias was assessed using a standardised tool for case reports.Results46 patients in 37 studies were included. Complications included endograft compression (52.2%), endoleak (15.2%), and rupture (13.0%). Compression was less likely in endografts with proximal fixation (41.9%), compared to those without (69.2%). Type A dissection after EVAR required cardiac surgery with a high mortality (20.0%). In Type B dissection, 2 cases were diagnosed intra-operatively during F/BrEVAR, 1 died. 8 were diagnosed <4 weeks post-operatively, all managed medically with no complications or mortality. 31 were diagnosed >4 weeks, with mortality of 25.8% and high rates of endograft compression (58.1%), endoleak (16.1%), and rupture (19.4%).ConclusionAortic dissection following EVAR may cause endograft compression, endoleak, or rupture, with significant mortality. Complications are more frequent following Type A dissection and late Type B dissection. Early Type B dissection may be amenable to medical management.
Optimizing Endovascular Aortic Repair With Carbon Dioxide: A Systematic Review Toward Zero Contrast Use.
Felici L, Vento V, Davì A … +7 more , Montecchiani L, Xodo A, Cacioppa LM, Floridi C, Magnus L, Gatta E, Chisci E
Vasc Endovascular Surg · 2026 Feb · PMID 41061752 · Publisher ↗
Endovascular Aneurysm Repair (EVAR) is a proven, safe, and effective treatment; however, its application may be limited by the potential adverse effects of iodinated contrast medium (ICM), which can exacerbate renal func...
Endovascular Aneurysm Repair (EVAR) is a proven, safe, and effective treatment; however, its application may be limited by the potential adverse effects of iodinated contrast medium (ICM), which can exacerbate renal function and may be contraindicated in patients with renal insufficiency. This review aims to provide an overview of "zero-iodine contrast EVAR," which uses CO exclusively, as a strategy to mitigate the risk of acute kidney injury (AKI) associated with ICM. A systematic literature review was conducted in PubMed, Embase, and Cochrane databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify EVAR cases performed using carbon dioxide. The Medical Subject Headings (MeSH) terms used were "endovascular repair AND abdominal aortic aneurysm AND contrast medium" and "endovascular repair AND abdominal aortic aneurysm AND carbon dioxide," with inclusion criteria limited to articles in English published until December 2024. The literature search yielded 1167 papers. After removing duplicates, titles and abstracts were screened, and 68 papers underwent full-text review. A total of 16 studies were included in the analysis, encompassing 1625 patients. Of these, 837 patients underwent EVAR with ICM, and 788 patients underwent EVAR with CO. Of these, 510 patients were treated with EVAR using CO exclusively. Although this method still faces inherent limitations due to the physicochemical characteristics of CO, its use, when combined with additional technical precautions, enables the achievement of zero-contrast results in standard EVAR procedures.
Endovascular Management of Common Femoral Artery Occlusion Caused by Suture-mediated Vascular Closure Devices: A Single-Center Experience.
Kim YH, Hwangbo L, Ko JK
Vasc Endovascular Surg · 2026 Feb · PMID 41061705 · Publisher ↗
ObjectiveVascular closure devices (VCDs) are frequently employed to achieve hemostasis at the femoral puncture site, offering an alternative to traditional manual compression. However, a rare yet significant complication...
ObjectiveVascular closure devices (VCDs) are frequently employed to achieve hemostasis at the femoral puncture site, offering an alternative to traditional manual compression. However, a rare yet significant complication is common femoral artery (CFA) occlusion caused by suture-mediated VCDs. The optimal management of this complication remains unclear, with open surgical repair traditionally regarded as the standard of care. This paper aims to share our clinical experience in managing CFA occlusions caused by suture-mediated VCDs and to introduce our preferred endovascular treatment strategy.MethodsAt our institution, approximately 250 femoral artery hemostasis procedures using suture-mediated VCDs are performed annually. Over the past 10 years, we encountered 6 cases of CFA occlusion following the use of such devices. This corresponds to an incidence rate of approximately 0.24%. In all cases, endovascular management was selected as the primary treatment modality over open surgical intervention. Our endovascular approach consisted of initial balloon angioplasty, with adjunctive stenting performed when residual stenosis exceeded 50%.ResultsEndovascular treatment was technically successful in all 6 cases, with no major procedural complications. The mean degree of stenosis prior to balloon angioplasty was 91.9%, including 3 cases of long segmental occlusion. Balloon angioplasty alone was sufficient in 4 cases, while the remaining 2 required additional stenting to address significant residual stenosis. Final angiography demonstrated an average residual stenosis of 25.1%. During the follow-up period (mean duration: 37.8 months), no patients reported symptoms of lower extremity ischemia.ConclusionThis case series highlights the feasibility and efficacy of endovascular management as a first-line approach for CFA occlusion caused by suture-mediated VCDs. When diagnosis is delayed, long segmental occlusion with considerable thrombus burden may limit the effectiveness of balloon angioplasty alone, necessitating adjunctive stenting. Therefore, timely diagnosis and intervention are essential to optimize outcomes in these cases.
In-Hospital Outcomes of Type A Aortic Dissection Repair in Patients With Obstructive Sleep Apnea: A Population Study of National Inpatient Sample From 2015 to 2020.
Li R, Prastein DJ, Huddleston SJ
Vasc Endovascular Surg · 2026 Feb · PMID 41058559 · Publisher ↗
BackgroundObstructive sleep apnea (OSA) is a recognized risk factor for aortic dissection development due to its association with arterial hypertension, negative intrathoracic pressures during respiratory efforts, and fu...
BackgroundObstructive sleep apnea (OSA) is a recognized risk factor for aortic dissection development due to its association with arterial hypertension, negative intrathoracic pressures during respiratory efforts, and further development of aortic false lumen. However, the impact of OSA on the outcomes of type A aortic dissection (TAAD) repair has not been extensively investigated. Therefore, this study aimed to perform a population-based analysis of the impact of OSA on in-hospital outcomes following TAAD repair.MethodsPatients who underwent TAAD repair were identified in National Inpatient Sample from the last quarter of 2015-2020. Multivariable logistic regressions were employed to compare the in-hospital outcomes between patients with and without OSA, where demographics, comorbidities, hospital characteristics, primary payer status, and transfer-in status were adjusted for.ResultsThere were 465 (10.86%) and 3817 (89.14%) patients with and without OSA who underwent TAAD repair. Patients with and without OSA had comparable in-hospital mortality (9.89% vs 15.75%, aOR = 0.744, 95 CI = 0.535-1.035, = .08). Patients with OSA had a higher risk of diaphragmatic paralysis (0.86% vs 0.21%, aOR = 4.821, 95 CI = 1.405-16.539, = .01) but lower risks of pericardial complications (12.04% vs 19.02%, aOR = 0.675, 95 CI = 0.501-0.909, = .01) and cardiogenic shock (11.40% vs 18.21%, aOR = 0.643, 95 CI = 0.472-0.875, = .01). All other in-hospital outcomes were comparable.ConclusionWhile OSA is a known risk factor for the development of TAAD, it does not appear to significantly affect short-term surgical outcomes. Future research should focus on stratifying OSA by duration and severity and examining the long-term prognosis of these patients.
Long-Segment Adventitial Cystic Disease of the Popliteal Artery Requiring Adductor Hiatus Division: A Case Report.
Kim H, Kim HK
Vasc Endovascular Surg · 2026 Feb · PMID 41057019 · Publisher ↗
BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case Summary...
BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case SummaryA 53-year-old man presented with progressive left calf claudication for one year, worsening over the last 6 months. Imaging studies, including computed tomography and magnetic resonance imaging, identified a cystic lesion compressing the popliteal artery, with duplex ultrasound estimating its length at 6 cm. However, intraoperative findings revealed the lesion extended over 10 cm into the adductor hiatus. To achieve proximal control, adductor hiatus division was required. The cystic segment was resected, and a great saphenous vein interposition graft was placed. The patient recovered uneventfully with complete symptom resolution.ConclusionThis case highlights the feasibility of a posterior approach with adductor hiatus division for long-segment ACD, emphasizing the importance of thorough preoperative assessment and tailored surgical planning.
Stent-Graft Malposition Into a False Lumen Causing Occlusion Following Blunt External Iliac Artery Injury: Case Report of a Novel Technique of Endovascular Therapy for Recanalization.
Aoki R, Inoue A, Hasegawa A … +3 more , Kambe M, Utsunomiya D, Sekikawa Z
Vasc Endovascular Surg · 2026 Feb · PMID 41056538 · Publisher ↗
IntroductionBlunt trauma to the external iliac artery (EIA) is rare but potentially fatal. Endovascular stent-graft placement is used to control hemorrhage and restore limb perfusion. However, the safety profile and pote...
IntroductionBlunt trauma to the external iliac artery (EIA) is rare but potentially fatal. Endovascular stent-graft placement is used to control hemorrhage and restore limb perfusion. However, the safety profile and potential complications associated with stent-graft treatment are not well documented. We report a case of EIA injury following blunt trauma complicated by stent-graft deployment into a false lumen, successfully managed with an endovascular rescue technique.Case ReportAn 88-year-old man sustained blunt pelvic trauma with active extravasation from the left EIA. Initially, a covered stent-graft was deployed, which inadvertently caused arterial occlusion due to placement within a false lumen. A rescue procedure was performed using an endovascular approach, where a guidewire was advanced through the perigraft space and snared to establish a pull-through technique. Over this, a second stent-graft was deployed within the perigraft space, restoring flow through the true lumen. Follow-up computed tomography images confirmed successful recanalization and persistent exclusion of the false lumen.ConclusionThis case highlights the potential for stent-graft misplacement in EIA trauma and the importance of ensuring access to the true lumen. Accessing the perigraft space and placing an additional stent-graft represents a new therapeutic approach to achieve recanalization in similar complex vascular injuries.
Association Between Life's Essential 8 Score and Stroke Risk in American Adults.
Tan J, Zhu H, Zeng Y … +1 more , Li M
Vasc Endovascular Surg · 2026 Feb · PMID 41056326 · Publisher ↗
ObjectiveThe purpose of this study was designed to assess the correlation between Life's Essential 8 (LE8) score and the risk of stroke in American adults using data from subjects of the NHANES.MethodsSubjects' data were...
ObjectiveThe purpose of this study was designed to assess the correlation between Life's Essential 8 (LE8) score and the risk of stroke in American adults using data from subjects of the NHANES.MethodsSubjects' data were obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2020.The ..LE8 score integrates health behaviors as well as health factors. We employed weighted multivariate logistic regression models as well as propensity score matching methods to explore the relationship between these health behaviors, health factors, and LE8 scores and stroke risk. In addition, the restricted cubic spline (RCS) technique was used to examine possible nonlinear associations between these variables and stroke risk.ResultsA total of 31,653 subjects were included in this study, of whom 1187 (3.8%) had stroke. After considering all covariates, the results of weighted logistic regression modeling showed that subjects with intermediate cardiovascular health (CVH) levels had a significantly lower risk of stroke compared to subjects with low CVH levels(OR = 0.5,95%CI:0.41-0.61), while subjects with high CVH levels had a further reduced risk of stroke (OR = 0.29,95%CI:0.16-0.51). After propensity score matching, the results remain consistent with the above.RCS analysis showed a significant nonlinear correlation between LE8 score and stroke risk( for nonlinear< 0.001). The results of the subgroup analyses were consistent across categories, indicating a significant negative association between LE8 and stroke.ConclusionAmong American adults, LE8 scores are negatively associated with stroke risk, which can be reduced through early screening and customized interventions for those with low CVH.
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