Vascular And Endovascular Surgery[JOURNAL]
Sun
200 papers
Recurrent Ischaemic Episodes Linked to Carotid Plaque Ulceration: A Multidisciplinary Diagnostic and Management Approach.
Chatterjee K, Sekhar A, Harfoush A … +2 more , Babawale M, Balakrishnan A
Vasc Endovascular Surg · 2026 Feb · PMID 41056126 · Publisher ↗
BackgroundIdentifying the aetiology of ischemic stroke can be challenging, especially when critical findings are overlooked. Stroke assessment often relies on standardised guidelines, primarily focused on carotid stenosi...
BackgroundIdentifying the aetiology of ischemic stroke can be challenging, especially when critical findings are overlooked. Stroke assessment often relies on standardised guidelines, primarily focused on carotid stenosis severity (>50%) as an intervention criterion. However, this approach may neglect high-risk plaque features. This case report highlights the importance of integrating diagnostic findings with clinical presentation to guide management.Case presentationA 68-year-old male presented with sudden-onset transient right arm weakness. Initial imaging, including MRI and CT angiography, revealed a subtle diffusion-weighted imaging (DWI) abnormality in the left hemisphere and moderate carotid atherosclerosis (<50%) that did not meet guideline criteria for endarterectomy. Despite antiplatelet and anticoagulant therapy, the patient experienced multiple recurrent ischemic episodes. Due to the persistence of symptoms, the multidisciplinary team (MDT) recommended advanced vessel wall MRI, which identified intraplaque haemorrhage and plaque ulcerations in the left internal carotid artery-critical findings missed on conventional imaging. This led to a decision to perform carotid endarterectomy. Histology confirmed atheromatous disease with intraplaque haemorrhage. Following surgery, the follow-up scans showed no new infarcts with no clinical recurrence.DiscussionThis case underscores the limitations of relying solely on carotid stenosis degree in stroke management and highlights the importance of identifying high-risk plaque characteristics. Advanced vessel wall imaging proved instrumental in guiding treatment, while MDT collaboration ensured a tailored approach. The findings emphasise the need to prioritise carotid stenosis characteristics over stenosis degree alone when guiding clinical decisions to optimise outcomes in ischemic stroke management.
Technical Success of Stent Placement via Transradial Approach for Aberrant Right Subclavian Artery Stenosis.
Kobayashi Y, Yuzawa C, Hanaoka Y … +5 more , Kobayashi KI, Kurashina M, Shimizu Y, Sato A, Sekijima Y
Vasc Endovascular Surg · 2026 Feb · PMID 41052473 · Publisher ↗
PurposeTo describe a case of recurrent cerebral infarction caused by stenosis at the origin of the aberrant right subclavian artery and to discuss the technical advantages of a radial artery approach for stenting.Methods...
PurposeTo describe a case of recurrent cerebral infarction caused by stenosis at the origin of the aberrant right subclavian artery and to discuss the technical advantages of a radial artery approach for stenting.MethodsA right radial artery approach with a balloon guiding catheter was used to perform stenting, under dual antiplatelet therapy. Distal protection was achieved through proximal balloon occlusion, enabling retrograde contrast visualization of the aortic arch and stenotic segment.ResultsSuccessful stent deployment was achieved with easy access, accurate vessel selection, and full visualization of the landing zone. No perioperative complications occurred, and postoperative CTA follow-up confirmed the absence of in-stent restenosis. The patient was transitioned to single antiplatelet therapy after six months.ConclusionThe radial artery approach with balloon-guided protection appears to be a safe and effective option for treating stenosis at the origin of an aberrant right subclavian artery.
Dual Endovascular Approach for Post-traumatic Rupture of Left Iliac Vein in Emergent Setting.
Baccellieri D, Valente FBA, Guazzarotti G … +3 more , Miglioranza E, Ardita V, De Cobelli F
Vasc Endovascular Surg · 2026 Jan · PMID 40938129 · Publisher ↗
Traumatic venous injuries are associated with high mortality rates. When they involve the inferior vena cava and iliac veins, prompt treatment is necessary in cases of patient instability. Endovascular treatment of a tra...
Traumatic venous injuries are associated with high mortality rates. When they involve the inferior vena cava and iliac veins, prompt treatment is necessary in cases of patient instability. Endovascular treatment of a traumatic injury at the iliac confluence extending to the proximal external iliac vein was performed in a 50-year-old patient following a fall. A GORE Excluder PLC141400 endograft was placed at the bleeding site via percutaneous transfemoral access, combined with simultaneous embolization of the internal iliac vein through right percutaneous jugular access. Effective haemostasis was achieved, along with normalization of blood pressure. Prompt diagnosis and recognition of the condition are vital for achieving blood pressure stabilization and haemostasis in unstable patients.
IntraVascular UltraSound After Below-The-Knee Endovascular Therapy: an Observational Pilot Study.
Wegerif ECJ, Bekken JA, Schreve MA … +3 more , Hogendoorn W, de Borst GJ, Ünlü Ç
Vasc Endovascular Surg · 2026 Jan · PMID 40911391 · Publisher ↗
ObjectiveRestenosis limits the benefit of below-the-knee (BTK) endovascular therapy (EVT). Restenosis may be attributable to limited information from digital subtraction angiography. A promising alternative is intravascu...
ObjectiveRestenosis limits the benefit of below-the-knee (BTK) endovascular therapy (EVT). Restenosis may be attributable to limited information from digital subtraction angiography. A promising alternative is intravascular ultrasound (IVUS). However, data regarding the association between post-EVT IVUS-detected lesions and the risk for future major adverse limb events (MALE) after BTK EVT are scarce.DesignProspective single-arm observational pilot study.MethodsPatients scheduled for BTK EVT were eligible. Altogether, 50 patients were included after informed consent. IVUS was performed in treated BTK vessels to analyze vessel characteristics and, if present, lesions. Lesions were defined as; significant stenoses (≥50%), substantial vessel wall irregularities (highly calcified multisided sharp wall irregularities without significant stenosis and over a longer track post-PTA), any dissections, and incorrect stenting. Follow-up included duplex ultrasound (DUS) after 3, 6 weeks, and 3 and 6 months after EVT by trained independent nurses blinded to IVUS findings. Primary endpoint was MALE, including restenosis/occlusions and major amputation.ResultsIn total, 33/50 (66%) participants had at least one lesion following IVUS. Compared to the group without any lesions, no difference in baseline characteristics was found. Lesions contained mostly significant stenosis (52%) or wall irregularities (20%). Within 6 months, 28 (56%) participants experienced MALE, including 23 restenosis/occlusion. In total, 21/28 (75%) participants with MALE had a lesion on IVUS imaging. Participants with MALE had a higher incidence of any lesions on IVUS compared with the no-lesion group (64% vs 41%), leading to a sensitivity of 0.75 and specificity of 0.45.ConclusionThis study suggests a good sensitivity for IVUS in detecting post-treatment lesions leading to MALE. However, a well-powered study is warranted to confirm these results. Ultimately, a randomized trial should assess the effect of interventions for IVUS-detected lesions post-EVT on reduction of risk of future MALE. However, the first needs are standardized reporting definitions, categorization of IVUS-detected lesions, and standardization of operating procedures.
Novel Use of the RevCore Device in Extensive Subacute Iliocaval Thrombus.
Hahn E, Snyder E, Dorey T … +2 more , Abramowitz S, Jeyabalan G
Vasc Endovascular Surg · 2026 Jan · PMID 40907030 · Publisher ↗
A 49-year-old female presented with subacute onset of severe worsening bilateral lower extremity swelling. Bilateral iliac venous thrombus and extensive thrombus of the inferior vena cava with extension to the right atri...
A 49-year-old female presented with subacute onset of severe worsening bilateral lower extremity swelling. Bilateral iliac venous thrombus and extensive thrombus of the inferior vena cava with extension to the right atrium and bilateral segmental pulmonary emboli was identified on imaging. She was initiated on therapeutic anticoagulation prior to undergoing percutaneous mechanical thrombectomy with the RevCore TM device (Inari Medical, Irvine, CA) with retrieval of white, relatively well-formed organized clot vs mass. Intravascular ultrasound and venography showed significant improvement in the IVC and iliac vein patency, but some narrowing of the vena cava. The patient's course was complicated by hypotension and acidemia requiring extracorporeal membrane oxygenation for seventy-two hours. She was taken back during her hospitalization for additional venogram and intravascular ultrasound with long segment IVC stenting of the IVC stenosis. She was ultimately discharged with significant clinical improvement. While the nitinol coring element on this device is meant for use in venous stent thrombus, this case demonstrates additional uses for the RevCoreTM device in organized thrombus in the native system in selective patients.
Spontaneous Recanalization of a Post-operative Acute Internal Carotid Artery Occlusion.
Cuozzo S, Miceli F, Berard X … +3 more , Ducasse E, Sbarigia E, Brizzi V
Vasc Endovascular Surg · 2026 Jan · PMID 40907003 · Publisher ↗
Spontaneous recanalization (SR) of an internal carotid artery (ICA) is a rare phenomenon. Cases reported in literature described the evolution of dissection or atherothrombotic / cardioembolic acute occlusions. No case o...
Spontaneous recanalization (SR) of an internal carotid artery (ICA) is a rare phenomenon. Cases reported in literature described the evolution of dissection or atherothrombotic / cardioembolic acute occlusions. No case of post-endarterectomy ICA occlusion resolved by SR has never been reported. Herein, we describe the case of a 64-year old male patient who presented an ipsilateral ischemic stroke due to the ICA occlusion in the second post-operative day of a carotid endarterectomy (CEA) and SR 6 months later, without anticoagulant therapy administration. The aim of this report was to increase awareness of this unusual entity and to highlight the usefulness of duplex ultrasound (DUS) surveillance of ICA eventual postoperative occlusions in order to detect accidental recanalization and to propose an adjunctive treatment whenever needed.
Successful Antenatal Embolization of a Complex Pulmonary Arteriovenous Malformation in the Third Trimester of Pregnancy: A Case Report.
Fields S, Pigg T, Navitski A … +3 more , Summers S, Freedman A, Woodham P
Vasc Endovascular Surg · 2026 Jan · PMID 40888574 · Publisher ↗
A pulmonary arteriovenous malformation (PAVM) is an abnormal connection between the pulmonary arterial and venous systems, resulting in a pathologic right-to-left shunt. PAVMs worsen during pregnancy due to physiologic c...
A pulmonary arteriovenous malformation (PAVM) is an abnormal connection between the pulmonary arterial and venous systems, resulting in a pathologic right-to-left shunt. PAVMs worsen during pregnancy due to physiologic changes, yet no treatment guidelines exist for newly diagnosed PAVMs in pregnancy. We report a case of a previously asymptomatic 19-year-old G1 who was incidentally found to have a low oxygen saturation during routine prenatal care at 34 5/7 weeks of gestation. She was diagnosed with a complex, left-sided PAVM. Through the close collaboration of the interventional radiology and high-risk obstetric teams, antenatal embolization was successfully performed, allowing for the prolongation of pregnancy. The patient experienced spontaneous rupture of membranes at 36 1/7 weeks and underwent a successful Cesarean delivery at this time. Embolization of a complex PAVM in the third trimester of pregnancy was successfully and safely achieved by a skilled multidisciplinary team. In comparable clinical scenarios, clinicians should carefully assess maternal and fetal risks-such as neonatal prematurity, radiation exposure, and PAVM-related complications-to guide optimal management.
Safety & Effectiveness of the Obtura 8F Vascular Closure Device in Neuro-Interventional Practice: A Retrospective Analysis.
Padhi R, Sanjay Shethna V, Dhanasekaran J … +1 more , Kumar Shetty K
Vasc Endovascular Surg · 2026 Jan · PMID 40886182 · Publisher ↗
ObjectiveVascular closure devices (VCDs) are essential in modern neuro-interventional procedures, offering advantages over manual compression by accelerating hemostasis, reducing complications, and enabling early ambulat...
ObjectiveVascular closure devices (VCDs) are essential in modern neuro-interventional procedures, offering advantages over manual compression by accelerating hemostasis, reducing complications, and enabling early ambulation. The Obtura 8F VCD is a novel bioabsorbable closure device designed to enhance safety and procedural efficiency. This study evaluates its efficacy and safety in achieving hemostasis and preventing vascular complications following femoral artery access.MethodThis retrospective, single-center study analyzed patients who underwent femoral artery closure with the Obtura 8F VCD. The primary performance endpoint was a successful hemostasis without additional intervention. The primary safety endpoint was the incidence of vascular complications within 30 days and 3 months. Secondary outcomes included time to ambulation and length of hospital stay.ResultsA total of 100 patients (mean age: 59.48 ± 13.03 years, 64% male) were included. Hemostasis was successfully achieved in 96% of cases, and all patients were able to move the limb within 8 hours post-procedure. During hospitalization, hematoma/pseudoaneurysm occurred in 6% of patients, with age ≥65 years, hypertension, and diabetes identified as significant risk factors. No evidence of infection was reported at either 30 days or 3 months. The majority of patients (80%) were discharged within 4-7 days.ConclusionsThe Obtura 8F VCD demonstrated high efficacy in achieving hemostasis with a strong safety profile with no major vascular complications. These findings support its use as a reliable alternative to manual compression, facilitating faster patient recovery and potentially reducing hospital resource utilization.
Effectiveness and Cost-Benefit Evaluation of Closed Incision Negative Pressure Therapy (ciNPT) in Patients After Major Revascularization Procedures.
Bobák R, Ferkodič M, Maduda D … +4 more , Novotný T, Kubíček L, Biroš E, Staffa R
Vasc Endovascular Surg · 2026 Jan · PMID 40882995 · Publisher ↗
IntroductionWound healing complications (WHC) of groin incisions are frequently discussed in vascular surgery. Various preventive measures are often applied to reduce their rates, but not all have the desired effect, and...
IntroductionWound healing complications (WHC) of groin incisions are frequently discussed in vascular surgery. Various preventive measures are often applied to reduce their rates, but not all have the desired effect, and all these measures have their respective costs. The main aim of this study is to determine the effectiveness of closed incision negative pressure therapy (ciNPT) in reducing WHCs in high-risk patients after major revascularization procedures compared to the conventional adhesive dressing and to investigate the cost-benefit of its routine use.Material and methodsFrom April 2023 to October 2024, 30 patients with 60 groin wounds who underwent aortic-bifemoral bypass surgery had their right groin wound treated with ciNPT and left groin wound with a conventional surgical adhesive dressing. The ciNPT system was removed after 7 days postoperatively. Both wounds were examined on the 7 and 30 postoperative day and any WHCs were marked and graded by the Szilagyi classification. Hospitalization costs and hospital stay periods of all patients were also analyzed.ResultsThe ciNPT-treated wound showed a statistically significant reduction in WHCs against the conventionally treated contralateral groin ( = 0.025). None of the ciNPT-treated wounds prolonged hospital stay and a significant increase in hospitalization costs ( < 0.001) has been observed in patients who developed WHCs, prolonging hospital stay ( = 0.007).ConclusionHigh-risk vascular surgery patients are very likely to benefit from ciNPT and the routine use of this method may also be considered economically, however, additional research must be conducted to evaluate indications better.
Etiology is a Factor when Choosing Endovascular or Open Treatment for Acute Mesenteric Ischemia.
Nandurkar TS, Millay OH, Endean ED
Vasc Endovascular Surg · 2026 Jan · PMID 40882991 · Publisher ↗
BackgroundThe role of endovascular therapy for patients presenting with AMI continues to be debated. This study was undertaken to compare open and endovascular treatment of AMI.MethodsAll patients who presented with AMI...
BackgroundThe role of endovascular therapy for patients presenting with AMI continues to be debated. This study was undertaken to compare open and endovascular treatment of AMI.MethodsAll patients who presented with AMI between 2010 and 2022 were identified. Patient demographics, baseline laboratory studies, length of stay (LOS), and outcomes were recorded. Student's t-test was used for quantitative data and Fisher's exact test for qualitative data.ResultsSixty-five patients were treated for AMI: 47 with an open procedure; 18 with endovascular techniques. Of the 18 patients in the endovascular group, 8 (45%) underwent laparotomy/laparoscopy; four (22%) requiring bowel resection. Patients treated with an endovascular approach were more likely to be male (87% vs 45%, = .025), be caused by thrombosis (78% vs 55%, = .005), have lower incidence of other vascular disease (56% vs 87%, = .015) and have a lower initial WBC (11.9 ± 3.9 vs 18.5 ± 8.4, = .0017). There was shorter ICU LOS in the endovascular group (5.5 ± 5.7 vs 13.5 ± 13.8, = .025). A trend for decreased bowel resection was seen in the endovascular group compared the open group [4 (22%) vs 19 (40%), = .25]. A trend for lower mortality was seen in the endovascular group compared to the open group (22% vs 40%, = .25). In the 23 patients that died, the cause of death was directly related to bowel ischemia in 16 (70%), cardiac in 5 (22%) and stroke in 2 (9%).ConclusionEndovascular treatment of AMI has potentially lower mortality and lengths of stay. When choosing endovascular vs open treatment, the status of the bowel should be an important initial determinate. We recommend that the underlying etiology (thrombosis vs embolic) also be a consideration with a low threshold for conversion to an open procedure if endovascular treatment does not rapidly restore mesenteric flow in patients with embolic disease.
The Impact of Introducing a Surgeon-Led Emergency EVAR Service on Outcomes and Cost Efficiency in Ruptured Aortic Aneurysm Management: A UK Single-Center Experience.
Hassan A, Elshiekh A, Matharu N … +3 more , Sergiou A, Elsharkawy A, Mahmood A
Vasc Endovascular Surg · 2026 Jan · PMID 40875662 · Publisher ↗
ObjectiveTo evaluate the impact of introducing a surgeon-led emergency endovascular aneurysm repair (EVAR) service on patient outcomes and cost efficiency in the management of ruptured abdominal aortic aneurysms (rAAA) a...
ObjectiveTo evaluate the impact of introducing a surgeon-led emergency endovascular aneurysm repair (EVAR) service on patient outcomes and cost efficiency in the management of ruptured abdominal aortic aneurysms (rAAA) at a UK tertiary vascular center.MethodsA retrospective cohort study was conducted, including all patients presenting with rAAA between January 2019 and December 2023. Patients were categorized into two time periods: before (: 2019-2020) and after (: 2021-2023) the introduction of the emergency EVAR service. Outcomes assessed included 30-day and one-year mortality, length of hospital stay, complication rates, and return-to-theatre rates. Cost-effectiveness analysis was conducted using incremental cost-effectiveness ratio (ICER) calculations based on Quality-Adjusted Life Years (QALYs).ResultsA total of 71 patients with ruptured abdominal aortic aneurysm were identified, of whom 58 underwent surgical repair (OSR or EVAR). In Period A, all patients (n = 17) underwent open surgical repair. In Period B, 24 received OSR (58.5%) and 17 received EVAR (41.5%). The 30-day mortality rate was significantly lower in the EVAR group (5.9%) compared to OSR in both periods (63.3% and 50%, respectively; = .001). The one-year mortality rate remained unchanged for EVAR but increased for OSR ( = .00075). Return-to-theatre rates were significantly higher in OSR patients ( = .044). ICER calculations showed EVAR to be cost-effective (-£202 526 per QALY within one year).ConclusionThe introduction of a surgeon-led emergency EVAR service significantly improved early survival rates and reduced reintervention rates in rAAA patients while demonstrating cost-effectiveness compared to OSR.
Comparison of Caprini and Worcester Scores for Venous Thromboembolism Risk Stratification in the Setting of Ambulatory Endovenous Surgery.
Power Foley M, Westby D, Brennan O … +2 more , Boyle E, Walsh SR
Vasc Endovascular Surg · 2025 Aug · PMID 40873409 · Publisher ↗
IntroductionPost-operative venous thromboembolism (VTE) remains a significant concern after endovenous ablation (EVA) for varicose veins. Risk stratification tools aid identifying which patients have an increased VTE ris...
IntroductionPost-operative venous thromboembolism (VTE) remains a significant concern after endovenous ablation (EVA) for varicose veins. Risk stratification tools aid identifying which patients have an increased VTE risk. There is no consensus on which currently utilised score is most appropriate for daycase surgery. The aim of this observational study was to compare how 2 institutions utilised the Caprini and Worcester Scores to risk stratify ambulatory EVA patients in real-world practice.MethodsA retrospective review of consecutive patients undergoing truncal ablation under local anaesthetic in 2 separate vascular centres between 2022-23 was performed. Each patient was scored prospectively using either the Caprini and Worcester Score for perioperative VTE risk assessment, and then retrospectively using the alternate tool. Demographics and risk factors were documented and compared between patients categorised as "at risk" by each score. Categorical variables were analysed using Chi-Square and continuous using Mann-Whitney U Tests.ResultsTwo hundred patients undergoing endovenous ablation were included. Over half the cohort were female (n = 122, 61%) and the median age was 53.0 years (range 23-87). Twenty-one percent (n = 42) had a Body Mass Index (BMI) > 30. Overall, 90 patients were flagged as high-risk by either score. Fifty-three patients (26.5%) were flagged by the Worcester Score as either 'moderate' (n = 42, 21%) or 'high risk' (n = 11, 5.5%). Fifty-eight patients (29%) were identified as 'high risk' by the Caprini tool. A significant discrepancy in which patients were categorised as "at risk" by each score was noted, with only 21 patients stratified as "at risk" by both ( = 0.047).ConclusionsA similar proportion of patients were stratified as high risk by each score, however the lack of overlap between the 2 risk assessment tools suggests a discrepancy in what variables are scored for. Further well-powered studies are needed to validate which score is most appropriate for ambulatory EVA.
POSToperative CerebrovascUlar Accident Following Symptomatic Carotid EndarterectoMy (OSTIUM): A Retrospective Case-Control Study.
Chatterjee K, Hood J, Das A … +9 more , R Makar R, Selvarajah B, Irwin Khallaf A, Pulupula K, Karunakarana P, Heyworth J, Farrag G, Harfoush A, Sekhar A
Vasc Endovascular Surg · 2025 Aug · PMID 40751546 · Publisher ↗
BackgroundAlthough carotid endarterectomy (CEA) is effective for moderate to severe symptomatic carotid artery stenosis, it carries a risk of postoperative cerebrovascular accident (POCVA). Currently, there is insufficie...
BackgroundAlthough carotid endarterectomy (CEA) is effective for moderate to severe symptomatic carotid artery stenosis, it carries a risk of postoperative cerebrovascular accident (POCVA). Currently, there is insufficient evidence on the relationship between cranial vascular integrity and intraoperative hemodynamic fluctuations.MethodsIn this retrospective case-control study, we utilised data collected from patients undergoing CEA for symptomatic carotid artery disease between December 2005 and October 2019 in the South Mersey Arterial Centre, UK. Patients with three-dimensional CT angiogram data and evidence of postoperative stroke were considered as cases and matched with those without such evidence considered as controls. 3D-CTA data were analysed following a structured pro-forma and data regarding haemodynamic changes were obtained from operative notes. Variables that showed statistical significance in univariate analysis were included in multivariate logistic regression analysis.ResultsA total of 21 cases and 55 matched controls were identified. Presence of atherosclerotic disease in the vertebral arteries on either side, intracranial atherosclerosis and a drop in the systolic blood pressure were significantly different between cases and controls. Our multivariate logistic regression models indicated that the likelihood of stroke was higher with vertebral artery (V1-V4) stenosis on either side (OR 6.5, 95% CI 1.7-24.6) and an intraoperative systolic blood pressure drop greater than 44 mmHg (OR 6.6, 95% CI 1.6-27.6).ConclusionsThese findings highlight the importance of evaluating posterior circulation abnormalities in POCVA. Moreover, careful intraoperative blood pressure management is crucial in perioperative care. This may aid in developing personalised risk stratification and enhancing intraoperative monitoring during CEA.
Ten-Year Experience With Primary Repair and Selective Patch Angioplasty in Carotid Endarterectomy.
Shehab M, Hornik-Lurie T, Abu Much E … +4 more , Bilman V, Awwad J, Bachar AR, Fajer S
Vasc Endovascular Surg · 2025 Jul · PMID 40678910 · Publisher ↗
IntroductionCarotid endarterectomy (CEA) is a cornerstone in stroke prevention for patients with carotid stenosis, with closure techniques including primary, patch angioplasty, and eversion. The aim of this paper is to p...
IntroductionCarotid endarterectomy (CEA) is a cornerstone in stroke prevention for patients with carotid stenosis, with closure techniques including primary, patch angioplasty, and eversion. The aim of this paper is to present a 10-year analysis of outcomes in patients undergoing primary repair and selective patch angioplasty in CEA.MethodsA retrospective, single-center study including all consecutive patients undergoing elective CEA at our institution between 2014 and 2023. The Primary outcomes were technical success and 30-day overall survival, ipsilateral ischemic stroke, reintervention, and major adverse cardiac events (MACE) rates. The secondary outcomes were >30-day ipsilateral ischemic stroke, reintervention and primary patency. All outcomes were analyzed in relation to the carotid closure technique (primary closure, patch angioplasty, or eversion). A Generalized Linear Mixed Model (GLMM) was used to assess the association between closure technique and both early and late outcomes. Kaplan-Meier estimates were used to analyze follow-up outcomes depending on the closure technique.ResultsA total of 625 CEA procedures were performed on 577 patients [mean age: 71 ± 9 years; 30.7% female], comprising 87.4% primary repairs, 10.4% patch angioplasty, and 2.2% eversion CEA. Technical success was achieved in (n = 615, 98.4%) of the procedures, with no significant difference between repair types ( value .947). The mean follow-up duration was 60 ± 38.45 months. Early (<30-day) ipsilateral stroke and reintervention did not differ significantly across carotid repair groups. GLMM analysis showed that congestive heart failure (CHF) was a significant predictor of increased risk for stroke and MACE (OR: 8.870, CI 95% 2.046-38.451, = .005) (OR: 7.037, CI 95% 1.902-26.038, = .005), respectively. Regional anesthesia significantly lowered the risks of stroke (OR: 0.216, CI 95% .065-.721, = .014) and MACE (OR: 0.380, CI 95% .158-.914, = .032). Long-term (>30-day) ipsilateral stroke and 2-year primary patency were comparable across the groups. GLMM analysis of >30-day stroke revealed no statistically significant differences between patch and primary CEA (OR: 1.947, 95% CI: .321-11.819, = .363). Neither age >80 years ( = 94, 15%) nor female sex ( = 177, 30.7%) were significantly associated with increased stroke risk (age: OR 0.524, 95% CI: 0.021-7.013, = .415; sex: OR 0.524, 95% CI: 0.087-3.152, = .370). The analysis of 2-year patency outcomes revealed no significant associations between patch vs primary CEA, sex, or age greater than 80 years. KM analysis revealed 3-year survival rates of 93% for primary repair, 99% for patch angioplasty, and 90% for eversion ( = .5). Stroke-free survival at 3 years was 95%, 94%, and 100%, respectively ( = .3).ConclusionNo significant differences were observed in early or late stroke, mortality, or 2-year patency on adjusted analysis. KM analysis showed favourable 3-year freedom from ipsilateral stroke in the primary repair group. These results suggest that primary repair is a safe option in anatomically suitable patients and support a selective, patient-tailored approach to carotid artery closure, rather than a uniform strategy for all cases.
Surgical Specialties' Outcomes for Carotid Body Tumor Resection.
Fereydooni S, Kostiuk V, Fereydooni A … +1 more , Judson B
Vasc Endovascular Surg · 2025 Jul · PMID 40650525 · Publisher ↗
ObjectiveThis study aimed to compare 30-day postoperative outcomes of carotid body tumor (CBT) resections performed by vascular surgeons vs otolaryngologists, examining complication rates, operation time, and hospital st...
ObjectiveThis study aimed to compare 30-day postoperative outcomes of carotid body tumor (CBT) resections performed by vascular surgeons vs otolaryngologists, examining complication rates, operation time, and hospital stay duration.MethodsA retrospective cohort analysis was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2020. Patients undergoing CBT resection were identified using CPT code 60605. Only cases performed by vascular surgeons or otolaryngologists were included. The primary outcome was any major postoperative complication, with secondary outcomes including operation time and hospital length of stay. Multivariable logistic and linear regression models adjusted for confounders including age, sex, modified Charlson Comorbidity Index (mCCI), race, surgical setting, and emergency status.ResultsA total of 718 patients (545 vascular surgery, 173 otolaryngology) were included. Patients operated on by vascular surgeons were older (58 vs 51 years, < .001), had a significantly higher incidence of hypertension (51% vs 36%; < .001) and mCCI (1.78 ± 1.47 vs 1.25 ± 1.36; < .001). Otolaryngology surgeries had significantly longer mean operative times (203 vs 145 min, < .001) and a higher, though not statistically significant, rate of major complications (5.3% vs 2.3%, = .07). Adjusted multivariable analysis showed otolaryngology specialty was independently associated with increased odds of severe adverse events (aOR: 2.99; 95% CI: 1.15-7.56; = .021) and longer operation time (aβ: 61; 95% CI: 46-75; < .001), but not with reoperation rates.ConclusionWhile both specialties achieved generally safe outcomes, CBT resections performed by otolaryngologists were associated with longer operative times and higher odds of major complications. These differences may reflect variations in case complexity, patient selection, or surgical expertise, warranting further prospective research into multidisciplinary and specialty-specific outcomes for CBT surgery.
Rare Presentation of Carotid Artery Stent Expulsion via Oropharyngeal Fistula in a Patient With Advanced Head and Neck Cancer-Case Study.
Vansdadia S, Shah R, Herber A … +3 more , Dhupati P, Mehta N, Brink J
Vasc Endovascular Surg · 2025 Jul · PMID 40638081 · Publisher ↗
PurposeThis case report aims to describe the rare and severe complication of carotid artery stent expulsion via an oropharyngeal fistula (OCF) in a 59-year-old male with head and neck cancer. The study emphasizes the uni...
PurposeThis case report aims to describe the rare and severe complication of carotid artery stent expulsion via an oropharyngeal fistula (OCF) in a 59-year-old male with head and neck cancer. The study emphasizes the unique interplay between oropharyngeal cancer and carotid artery blowout and highlights a novel presentation of OCF in a patient with advanced comorbidities.CaseA 59-year-old male with oropharyngeal squamous cell carcinoma, carotid artery stenosis, and multiple comorbidities underwent chemotherapy, pseudoaneurysm embolization, and carotid artery stenting. Four months after carotid artery stent placement, the patient expelled the carotid stent through an oropharyngeal fistula. Imaging confirmed a chronic fistula and occlusion of the right carotid artery. Remarkably, the patient remained hemodynamically stable due to collateral circulation, allowing for safe discharge without further intervention.ConclusionsThis case illustrates an exceedingly rare presentation of carotid artery stent expulsion through an oropharyngeal fistula in a patient with severe carotid stenosis and head and neck cancer. This case underscores the importance of vigilance in patients with high-risk comorbidities undergoing vascular interventions for head and neck cancers. It also adds to the literature by highlighting a potential, albeit rare, complication of carotid stenting in the context of oropharyngeal malignancy.
Endovascular Salvage of a Ruptured Renal Pseudoaneurysm-A Case Report.
Takagi S, Goto Y, Yanagisawa J … +2 more , Ogihara Y, Okawa Y
Vasc Endovascular Surg · 2025 Jul · PMID 40637719 · Publisher ↗
ObjectivesIn recent years, the widespread use of vascular imaging and increased workups for atherosclerotic disease have led to more frequent detection. Although the true incidence remains unclear, the number of renal ar...
ObjectivesIn recent years, the widespread use of vascular imaging and increased workups for atherosclerotic disease have led to more frequent detection. Although the true incidence remains unclear, the number of renal artery aneurysms identified through imaging has increased. Ruptured renal aneurysms are extremely rare and can be life-threatening without emergency treatment. However, only a few studies have focused on its treatment. In this report, we present a case of a ruptured renal pseudoaneurysm treated with endovascular therapy.Case DescriptionA female patient who had previously undergone surgery for a ruptured abdominal aortic aneurysm (rAAA) presented with progressive left-sided lower back pain. Computed tomography revealed a ruptured left renal pseudoaneurysm near the AAA replacement. Chimney endovascular aneurysm repair (Ch-EVAR) was performed immediately. Completion angiography demonstrated no endoleak and preserved flow into the left renal artery. The patient was discharged 4 days post-Ch-EVAR.ConclusionsThis case offers valuable perspectives on managing ruptured renal aneurysms. Ch-EVAR represents a feasible treatment option for such cases. Following treatment for aortic emergencies such as rAAA, careful long-term follow-up is necessary.
Surgical Management of Symptomatic Carotid Artery Webs.
Cao T, Prasad NK, McClellan M … +5 more , Chaparala S, Sarkar R, Nagarsheth K, Kang J, Toursavadkohi S
Vasc Endovascular Surg · 2025 Jul · PMID 40637702 · Publisher ↗
ObjectiveTo demonstrate the demographic profile and postoperative outcomes among a large single-center series of patients undergoing carotid endarterectomy for carotid web.BackgroundCarotid artery web (CaW) is a shelf-li...
ObjectiveTo demonstrate the demographic profile and postoperative outcomes among a large single-center series of patients undergoing carotid endarterectomy for carotid web.BackgroundCarotid artery web (CaW) is a shelf-like intraluminal lesion at the carotid bulb that produces stagnant flow and can result in cerebrovascular ischemia among young and otherwise healthy individuals. While there is no consensus on the ideal management strategy for CaW with ipsilateral stroke, emerging evidence favors open surgical intervention. We present a large single-center experience of carotid endarterectomy for CaW.MethodsSingle-center retrospective review of all patients admitted between January 2016 and September 2023 with acute ischemic stroke, had CT angiography findings consistent with CaW- shelf-like projection at the level of the carotid bulb- and underwent carotid endarterectomy. The main outcome variables were ipsilateral stroke or transient ischemic attack during the follow-up period.ResultsTwenty-three patients who underwent carotid endarterectomy for CaW were identified. The median age was 41 years old [IQR 38 - 47], 19 were female (82%), and 21 were African American (91%). One patient was originally managed with medical therapy alone and presented with recurrent stroke. All patients underwent carotid endarterectomy at a median of 29 days after presentation. Patch angioplasty was used in 16 (70%) patients, 15 with bovine pericardial patch and one with collagen-impregnated polyester patch. The arteriotomy was closed primarily in the other 7 patients. Eleven (48%) patients had mobile thrombus associated with the web present on imaging or surgical exploration. No new cerebrovascular events occurred in the follow-up period, a median of 154 days.ConclusionCarotid endarterectomy is an established procedure that can be applied to the treatment of carotid web in the setting of associated ipsilateral cerebrovascular ischemia. The procedure is associated with minimal complications and demonstrates an absence of recurrent ischemic events at short and medium-term follow-up.
Predicting Major Lower Limb Amputations in Chronic Limb-Threatening Ischemia: The Role of Pedal Medial Arterial Calcification.
Jones HG, Darwish M, Meecham L
Vasc Endovascular Surg · 2025 Jul · PMID 40635586 · Publisher ↗
The Pedal Medial Arterial Calcification (pMAC) score is a radiographic tool that quantifies arterial calcification in the foot, providing a novel approach to predict outcomes in chronic limb-threatening ischemia (CLTI)....
The Pedal Medial Arterial Calcification (pMAC) score is a radiographic tool that quantifies arterial calcification in the foot, providing a novel approach to predict outcomes in chronic limb-threatening ischemia (CLTI). This study investigates the association of pMAC scores with clinical outcomes in patients undergoing major lower limb amputations (MLLA). This retrospective study analyzed data from the National Vascular Registry (NVR) for the Southeast Wales Vascular Network (SEWVN) from July 2022 to June 2024. Patients undergoing MLLA with available preoperative radiographs were included. pMAC scores were categorized into low (0-1), medium (2-3), and high (4-5). Cox proportional hazards regression assessed the impact of pMAC on time to amputation, while additional analyses evaluated its association with revascularization outcomes and systemic comorbidities. A total of 119 patients were included after excluding cases with insufficient imaging. Higher pMAC scores were associated with male gender ( = 0.009) and chronic kidney disease ( = 0.017), though not with preoperative blood test parameters. Each unit increase in pMAC score was associated with a 22% higher risk of amputation over time (HR = 1.22, = 0.049). Medium pMAC scores correlated with shorter time to MLLA ( = 0.0516). Revascularization type did not significantly impact time to amputation ( = 0.66). pMAC predicts amputation risk in CLTI patients, independent of revascularization type. Integrating pMAC into clinical workflows may refine risk stratification and guide postoperative care. Prospective validation is warranted to establish its role in vascular surgery decision-making.
Direct Carotid Puncture Mechanical Thrombectomy in Medium Vessel Occlusion (MEVO) Stroke Using Obtura Closure Device for Hemostasis.
Padhi R, Shethna VS, Dhanasekaran J … +3 more , Kocer N, Rao M, Shetty KK
Vasc Endovascular Surg · 2025 Jul · PMID 40633065 · Publisher ↗
BackgroundMechanical thrombectomy (MT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion. Direct cervical carotid puncture is a recognized approach in unfavorable aortic...
BackgroundMechanical thrombectomy (MT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion. Direct cervical carotid puncture is a recognized approach in unfavorable aortic arch anatomy. However, manual compression/ surgical closure of the access site can be challenging if the International Normalized Ratio (INR) is high and the patient is taking anticoagulation.Case SummaryWe present a case of Stanford type A (STA) aortic dissection (status post Bentall procedure) presenting with acute ischemic stroke (AIS) with left M2-MCA thrombotic occlusion. Conventional transfemoral or transradial approach for MT was deferred due to replaced ascending aorta & arch debranching and a residual thoraco-abdominal aortic dissection flap. Risk of soft tissue blood loss was high with open neck access (surgical cut down) due to high INR of 2.9. So, MT was performed through direct left common carotid artery (CCA) puncture achieving mTICI 3 flow. Due to high INR, manual compression was deferred, puncture site haemostasis was achieved with use of collagen based Obtura vascular closure device (VCD). Patient made substantial neurological recovery with no puncture site complications and MRS-0 at discharge.ConclusionObtura femoral VCD can be an alternative haemostatic device for direct carotid puncture mechanical thrombectomy for AIS.
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