Annals Of Vascular Surgery[JOURNAL]
Sun
200 papers
Re: "Contemporary Outcomes of Staged versus Primary Major Amputation for Severe Foot Infection".
Gallo ED, Visciglia E, Sutton M … +1 more , Salzillo I
Ann Vasc Surg · 2026 Jul · PMID 42401234 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Role of Large Bore Mechanical Thrombectomy Devices in Tumour Thrombus.
Austin C, Barklimore J, Villalba L
Ann Vasc Surg · 2026 Jul · PMID 42398810 · Publisher ↗
BACKGROUND: Tumour thrombus presents specific challenges, with patients requiring thrombus removal for diagnosis, staging, symptom relief or curative treatment however, many patients are not offered intervention due to r...
BACKGROUND: Tumour thrombus presents specific challenges, with patients requiring thrombus removal for diagnosis, staging, symptom relief or curative treatment however, many patients are not offered intervention due to risks and low success rate of traditional options. In select patients open surgical thrombectomy remains the standard curative approach but carries significant morbidity. Large-bore mechanical thrombectomy devices may provide a minimally invasive alternative with potential diagnostic and therapeutic capabilities. METHODS: A retrospective, single-centre study (January 2022 - June 2025) included seven consecutive oncological patients undergoing endovascular mechanical thrombectomy for venous or pulmonary tumour thrombus. Primary outcomes were diagnostic yield and procedural safety; secondary outcomes included restoration of vessel patency, symptom improvement, and impact on oncological management. RESULTS: Seven patients, four male, median age 73 years old (range 55-80) underwent thrombectomy across renal, caval, iliac, and pulmonary vascular beds. There were no procedural complications. Mean estimated blood loss was 40ml (0-240mL). Diagnostic tissue was obtained in all patients . Technical success with restoration of patency and symptomatic improvement occurred in six patients (86%), with one failure due to tumour wall invasion. Oncologic management was influenced in all cases, including two renal cell carcinoma patients who proceeded to curative nephrectomy following thrombectomy. CONCLUSIONS: This observational study demonstrates the feasibility of large bore mechanical thrombectomy devices for oncological patients with tumour thrombus in a small case series and may be an option in select cases at the discretion of the operator and multi-disciplinary team.
Utility of Hand Grip Strength in Predicting Mortality Risk in Chronic Limb-Threatening Ischaemia.
Goves KG, Essop-Adam A, Black I … +5 more , Payne TJ, Rayt HS, Sayers RD, Haunton VJ, Houghton JSM
Ann Vasc Surg · 2026 Jul · PMID 42398809 · Publisher ↗
BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is associated with increased mortality, reported as high as 50% at five years. Sarcopenia, defined as low skeletal muscle strength, quantity and quality, is associate...
BACKGROUND: Chronic limb-threatening ischaemia (CLTI) is associated with increased mortality, reported as high as 50% at five years. Sarcopenia, defined as low skeletal muscle strength, quantity and quality, is associated with adverse outcomes. This study investigated the association of sarcopenia using hand grip strength with two-year mortality in people with CLTI. METHODS: This single-centre prospective cohort study (NCT04027244) included patients undergoing procedures for CLTI between May 2019 and May 2021 (minimum age: ≥65 initially; ≥50 from November 2019). Hand grip strength was measured using the Jamar+ digital hand dynamometer with five seated repetitions bilaterally. Sarcopenia was defined as maximum grip strength of <16kg in women and <27kg in men. The association of sarcopenia with two-year mortality was analysed using Cox regression and reported as hazard ratios (HR) with 95% confidence intervals (CI). The multivariable model adjusted for age, sex, frailty and Charlson comorbidity index (CCI). RESULTS: 97 participants were included. 25 (26%) had sarcopenia on hand grip strength. Those with sarcopenia were a mean 11.5 years older (p<.001). Sarcopenia was also associated with worse Wound, Ischaemia, foot Infection clinical stage (p=.011), frailty (p=.001), and greater CCI score (p=.012). At two-years, 25 people (26%) had died: 17 of whom had sarcopenia (68%) compared to eight without (32%). Sarcopenia was independently associated with worse two-year mortality (HR 6.4; 95% CI 2.4, 17.2; p<.001). CONCLUSIONS: Hand grip strength was strongly associated with worse two-year survival in people with CLTI. Grip strength may be a useful adjunct to risk stratification and aid shared decision making in CLTI.
Precision Imaging Evaluation and Clinical Application Progress of Vascular Calcification in Lower Extremity Peripheral Artery Disease.
Ding S, Wang X, Pan X
Ann Vasc Surg · 2026 Jul · PMID 42392505 · Publisher ↗
Lower extremity peripheral artery disease (PAD) affects a large and growing population worldwide and imposes a substantial clinical burden, particularly among older adults and patients with diabetes, chronic kidney disea...
Lower extremity peripheral artery disease (PAD) affects a large and growing population worldwide and imposes a substantial clinical burden, particularly among older adults and patients with diabetes, chronic kidney disease, and other cardiovascular risk factors.Vascular calcification is a common and clinically important feature of PAD. It can impair diagnostic accuracy, reduce vascular compliance, increase procedural difficulty during endovascular therapy, and adversely affect long-term outcomes, including restenosis, limb loss, and mortality. Therefore, accurate assessment of calcification is essential for risk stratification, treatment planning, and prognostic evaluation.Although advances in imaging have improved the detection and characterization of lower extremity arterial calcification, several challenges remain. Current imaging approaches are limited by inconsistent scoring standards, heterogeneous CT thresholds, incomplete differentiation between intimal and medial calcification, insufficient detection of active microcalcification, and limited evidence linking imaging findings to treatment selection and post-intervention outcomes. This review summarizes the pathophysiological basis of lower extremity arterial calcification in PAD, recent progress in multimodal imaging evaluation, and the clinical application of imaging findings in endovascular treatment planning. We further discuss imaging-guided vessel preparation strategies, current translational limitations, and future directions, including standardized scoring systems, prospective outcome-based validation, artificial intelligence-assisted quantification, and molecular imaging of active calcification.
Efficacy and Safety of Autologous Versus Prosthetic Grafts in the Repair of Popliteal Artery Aneurysms: A Systematic Review and Meta-Analysis.
Costa MM, Mulatti GC, Godoi A … +6 more , Furtado CL, Cardoso Massoni M, Felippe VA, Mansuri Z, Nora F, Brandão ML
Ann Vasc Surg · 2026 Jun · PMID 42379512 · Publisher ↗
BACKGROUND: Popliteal artery aneurysms (PAA) present a severe risk of progression to acute limb ischemia. Open surgery (OS) is the gold standard treatment; however, prosthetic grafts are acceptable in highly selected cas...
BACKGROUND: Popliteal artery aneurysms (PAA) present a severe risk of progression to acute limb ischemia. Open surgery (OS) is the gold standard treatment; however, prosthetic grafts are acceptable in highly selected cases, especially when the great saphenous vein (GSV) is not available. METHODS: We performed a systematic review and meta-analysis of studies comparing autologous versus prosthetic grafts for patency and limb preservation outcomes in patients with PAAs. MEDLINE, Embase, and Cochrane Central were systematically searched from inception through October 2024. Outcomes were pooled using a frequentist random-effects model as odds ratios (OR), mean differences (MD), and hazard ratios (HR) with 95% confidence intervals (CI) on RStudio (Version 4.5.0). Risk-of-bias assessments were performed using ROBINS-I and MINORS. RESULTS: Twenty-two observational studies were pooled comprising 9,145 PAAs in 8,370 patients, of whom 6,434 (74.51%) were treated with autologous grafts and 2,200 (25.49%) with prosthetic grafts. Follow-up ranged from 12 to 86 months. Repair with autologous conduits significantly improved long-term primary patency (HR 3.93; p < 0.001), secondary patency (HR 6.02; p < 0.001), and long-term limb salvage (HR 2.69; p = 0.044) compared with prosthetic conduits. There were no significant differences in in-hospital amputation (p = 0.36), myocardial infarction (MI; p = 0.61), mortality (p = 0.50), 2-year primary patency (p = 0.25), 5-year secondary patency (p = 0.06), or length of hospital stay (LOS; p = 0.95). Risk of bias was classified as moderate-to-high, reflecting confounding factors inherent to observational studies and moderate methodological quality by MINORS. Despite these limitations, treatment effects consistently favored autologous grafts in both short- and long-term analyses; however, caution is warranted given the limited number of available studies. CONCLUSION: The use of autologous conduits significantly favors both short-term and long-term efficacy and safety in the OS repair of PAAs. Given the limitations of the existing evidence, further comparative studies are needed.
Prognostic Value of Frailty in Aortic Surgery: A Systematic Review and Meta-Analysis Comparing Frailty Assessment Tools.
Coutinho ML, Delgado LM, Torres IO … +4 more , Rocha-Neves J, Zerati AE, D'Oria M, Leão PP
Ann Vasc Surg · 2026 Jun · PMID 42372863 · Publisher ↗
INTRODUCTION: Frailty is increasingly recognized as an important determinant of outcomes after aortic vascular surgery, but assessment methods vary substantially and the optimal tool for risk stratification remains uncer...
INTRODUCTION: Frailty is increasingly recognized as an important determinant of outcomes after aortic vascular surgery, but assessment methods vary substantially and the optimal tool for risk stratification remains uncertain. This systematic review and meta-analysis evaluated the prognostic value of preoperative frailty and compared the predictive performance of different frailty instruments in aortic surgery. METHODS: PubMed, Embase, and Cochrane Library were searched from inception to April 27, 2026. Eligible studies included patients undergoing open, endovascular, or hybrid aortic procedures involving abdominal, thoracic, thoracoabdominal, arch, and proximal aortic diseases, including aneurysms and dissections, assessed frailty preoperatively, and reported postoperative outcomes. RESULTS: Thirty studies comprising 419,459 patients were included. Frailty was associated with higher early mortality (OR 2.20; 95% CI 1.54-3.14) and late mortality (HR 2.18; 95% CI 1.64-2.90). Frail patients also had increased risks of major complications (OR 2.52; 95% CI 1.22-5.19), acute kidney injury (OR 1.64; 95% CI 1.34-2.02), and non-home discharge (OR 5.50; 95% CI 3.05-9.92). Associations were consistent across surgical approaches and aortic segments. Judgment-based or phenotype-like tools yielded higher effect estimates than deficit-accumulation indices, although differences were not statistically significant; among index-based tools, mFI-11 outperformed mFI-5. CONCLUSION: Preoperative frailty strongly predicts mortality, morbidity, and loss of functional independence after open, endovascular, and hybrid aortic surgery across different aortic segments and pathologies, including aneurysmal and dissecting aortic disease. Routine frailty assessment may improve risk stratification and perioperative decision-making.
A Single-Center Experience with Paravisceral Transaortic Endarterectomy: Establishing Evidence for Efficacy and Safety in Complex Aortic Occlusive Disease.
Pairawan S, Lee M, Shepard A … +5 more , Halabi M, Sullivan B, Kabbani L, Nypaver T, Weaver M
Ann Vasc Surg · 2026 Jun · PMID 42372862 · Publisher ↗
BACKGROUND: The outcomes of paravisceral transaortic endarterectomy (TAE) performed at our tertiary care center were reviewed. METHODS: A retrospective analysis was performed of patients with paravisceral atherosclerotic...
BACKGROUND: The outcomes of paravisceral transaortic endarterectomy (TAE) performed at our tertiary care center were reviewed. METHODS: A retrospective analysis was performed of patients with paravisceral atherosclerotic occlusive disease who underwent TAE 01/2006-04/2026. Patient demographics, operative details, and postoperative outcomes were assessed. RESULTS: Nineteen paravisceral TAE patients were majority White (80%) and female (68%) with mean age of 66 years. Major risk factors included active tobacco use (42%), hypertension (79%) and hyperlipidemia (79%). Supraceliac clamping was performed in 18 (95%) with mean clamp time of 33 minutes. Mean operating room time was 490 minutes (± 116 minutes) and estimated blood loss was 1167 mL (± 934 mL). Intraoperative duplex was performed in 10 patients with reintervention in 3 patients for retained distal plaque and 1 patient for dissection. Postoperative complications included pneumonia (21%), acute kidney injury (25%), and gastrointestinal bleeding (5%). Median hospital length of stay was 15 days. There were no 30-day mortalities. Two patients required readmission within 30 days: for disposition planning and chest wall hematoma. Two patients required 1-year reinterventions for superior mesenteric artery stenosis, superior mesenteric artery thrombosis. Mean follow-up was 30 months with 17 of 19 (89%) alive without recurrent symptoms. CONCLUSION: Paravisceral TAE is feasible and effective for complex paravisceral aortic occlusive disease, when unsuitable for endovascular methods. TAE demonstrated favorable outcomes, with no 30-day mortality, low reintervention rates, and durable symptom relief in most patients. These findings support the continued role of TAE in appropriately selected patients at specialized centers.
Predictive Model for Thrombosis in Mature Autologous Arteriovenous Fistula.
Zhang Y, Liu F, Li X … +2 more , Xu Y, Jiang H
Ann Vasc Surg · 2026 Jun · PMID 42365896 · Publisher ↗
OBJECTIVE: Based on the "high-risk stenosis-thrombosis" theory, this study developed a risk prediction model for thrombosis in mature autogenous arteriovenous fistulas (AVF). METHODS: Clinical data from 521 maintenance h...
OBJECTIVE: Based on the "high-risk stenosis-thrombosis" theory, this study developed a risk prediction model for thrombosis in mature autogenous arteriovenous fistulas (AVF). METHODS: Clinical data from 521 maintenance hemodialysis (MHD) patients treated at the vascular access clinic of Central Hospital Affiliated to Shandong First Medical University between January 2023 and December 2023 were retrospectively analyzed. The dataset was randomly divided into a training set and a validation set at a ratio of 7:3. Logistic regression (LR) and extreme gradient boosting (XGBoost) prediction models were constructed using the training cohort, and their predictive performance was subsequently compared in the validation set. RESULTS: The results indicated that recent fistula dysfunction within the past month, large short-term fluctuations in diastolic blood pressure during dialysis, low hemoglobin levels, a history of two or more prior AVF failures, and regional or buttonhole cannulation were identified as risk factors for AVF thrombosis. The XGBoost model outperformed the LR model across all performance metrics in the training set. However, in the validation set, the LR model achieved a slightly higher AUC of 0.955 (95% CI: 0.924-0.985) compared with the XGBoost model's AUC of 0.954 (95% CI: 0.921-0.988). CONCLUSIONS: Although both the LR and XGBoost models showed favorable predictive performance, the LR model is recommended as a baseline screening tool for identifying patients at high risk of arteriovenous fistula thrombosis, given the clinical principle of favoring an appropriate over a more complex model.
Renal Artery Involvement Predicts Renal Atrophy Without Affecting AKI Incidence After TEVAR in Debakey IIIb Aortic Dissection: A Single-Center Retrospective Analysis.
Zhou B, Ge Y, Rong D … +3 more , Liu F, Lu W, Guo W
Ann Vasc Surg · 2026 Jun · PMID 42364766 · Publisher ↗
OBJECTIVE: To investigate whether preoperative renal artery involvement independently predicts postoperative acute kidney injury (AKI) and renal atrophy in patients with Debakey IIIb aortic dissection who underwent thora...
OBJECTIVE: To investigate whether preoperative renal artery involvement independently predicts postoperative acute kidney injury (AKI) and renal atrophy in patients with Debakey IIIb aortic dissection who underwent thoracic endovascular aortic repair (TEVAR), and to explore the association between AKI and renal atrophy. METHOD: Retrospective analysis of 82 patients. AKI was defined per KDIGO criteria. Renal atrophy was defined as a renal length reduction >1.00 cm. Univariate analysis compared clinical variables between groups, while binary logistic regression analyzed AKI risk factors and generalized estimating equations (GEE) identified independent predictors of renal atrophy. RESULT: Patients with renal artery involvement had higher postoperative serum creatinine and lower pre-/postoperative estimated glomerular filtration rate (p<0.05). AKI incidence was identical between groups (9.76% each, p=1.00). GEE analysis showed renal artery involvement was an independent predictor of renal atrophy [OR (95%CI): 4.71 (1.94-11.44), p=0.001]. No factors were significantly associated with AKI in logistic regression. CONCLUSION: Preoperative renal artery involvement does not correlate with postoperative AKI but independently predicts long-term renal atrophy after TEVAR in Debakey IIIb dissection.
Duplex Ultrasound Surveillance After Endovascular Therapy for Peripheral Arterial Disease: A Retrospective Cohort Study.
Warburton TM, Thomas SD, Lennox AF … +2 more , Katib N, Varcoe RL
Ann Vasc Surg · 2026 Jun · PMID 42364765 · Publisher ↗
BACKGROUND: Post-operative duplex ultrasound (DUS) surveillance is common practice globally, yet there is limited evidence to demonstrate its efficacy. This study aimed to determine the incidence of adverse events in a c...
BACKGROUND: Post-operative duplex ultrasound (DUS) surveillance is common practice globally, yet there is limited evidence to demonstrate its efficacy. This study aimed to determine the incidence of adverse events in a contemporary cohort of patients undergoing post-endovascular-therapy DUS surveillance and to inform the design of a planned randomized controlled trial. METHODS: A retrospective cohort study was conducted at Prince of Wales Hospital, Sydney, Australia. We reviewed consecutive patients who underwent endovascular intervention of the femoropopliteal arterial segment for symptomatic peripheral arterial disease between 2016-2017, with 24-month follow-up completed prior to COVID-19. The primary endpoint was a composite of target vessel occlusion, major adverse limb event (MALE), and/or death. RESULTS: Forty-eight patients met inclusion criteria. Mean age was 71.9 years (range 52-92), with 52.1% male. Indications included intermittent claudication (62.5%) and chronic limb-threatening ischemia (37.5%). TASC II lesion classifications were: Type A (8.3%), Type B (35.4%), Type C (37.5%), and Type D (18.8%). Treatment strategies included angioplasty alone (37.5%), angioplasty with stenting (60.4%) and one patient (2.1%) who received atherectomy adjunctive to drug-coated ballooning. The primary composite endpoint occurred in 18 patients (37.5%) over 24 months. CONCLUSIONS: In this contemporary cohort, the composite endpoint of target vessel occlusion, major adverse limb event, or death occurred in over a third of patients within 24 months. These data support proceeding with the planned SURVEIL randomized controlled trial (ACTRN12625000889459p) and inform its eligibility criteria, endpoint selection, and sample size estimation.
Endovascular Stenting for Atherosclerotic Chronic Mesenteric Ischaemia: Technical and Midterm Outcomes.
Türksayar O, Cingöz M, Tütüncüoğlu B … +6 more , Arslan MF, Dablan A, Erdim Ç, Güzelbey T, Cingoz E, Kılıçkesmez O
Ann Vasc Surg · 2026 Jun · PMID 42362018 · Publisher ↗
BACKGROUND: To evaluate technical outcomes, early symptom relief, midterm patency, and periprocedural safety after attempted endovascular superior mesenteric artery (SMA) revascularisation for atherosclerotic chronic mes...
BACKGROUND: To evaluate technical outcomes, early symptom relief, midterm patency, and periprocedural safety after attempted endovascular superior mesenteric artery (SMA) revascularisation for atherosclerotic chronic mesenteric ischaemia (CMI). METHODS: This retrospective single-centre study included adults who underwent attempted endovascular SMA revascularisation between September 2020 and September 2025. After exclusion of vasculitis-associated mesenteric disease, 27 patients with atherosclerotic CMI formed the intention-to-treat cohort. Technical success was defined as residual stenosis <30% with antegrade flow. Pain burden was assessed using a 10-point VAS at baseline and 4 weeks. Stent patency was assessed by duplex ultrasound, with computed tomography angiography when indicated, and estimated using Kaplan-Meier analysis. RESULTS: Technical success was achieved in 25 of 27 patients (92.6%), including 10 of 10 stenoses and 15 of 17 occlusions. Paired VAS data were available in 23 patients. Median VAS score decreased from 8 (IQR, 8-9.5) at baseline to 1 (IQR, 0-2) at 4 weeks (p < 0.001), with a Hodges-Lehmann median reduction of 7.5 points (95% CI, 6.5-8.0). Median follow-up was 16 months (IQR, 12-20). Kaplan-Meier estimated primary patency was 90.7% at 12 months. Assisted primary and secondary patency were 92.0% and 100%, respectively. No major mesenteric arterial complications, bowel resection, CMI-related death, or stent occlusion-related death occurred. CONCLUSIONS: In patients with atherosclerotic CMI, attempted endovascular SMA revascularisation achieved high technical success, substantial early symptom relief, and favourable midterm patency. VAS assessment may provide a quantitative patient-centred measure that complements imaging-based follow-up.
Physician-Modified Fenestrated Stent Grafts Planned Using Three-Dimensional Techniques for Complex Aortic Pathology: A Systematic Review and Meta-Analysis.
Skórka P, Miler K, Ziętara M … +3 more , Gutowski P, Kazimierczak A, Rynio P
Ann Vasc Surg · 2026 Jun · PMID 42362017 · Publisher ↗
BACKGROUND: Complex aortic pathology involving the visceral arteries remains a significant therapeutic challenge. Open repair is associated with considerable perioperative risk, particularly in patients with multiple com...
BACKGROUND: Complex aortic pathology involving the visceral arteries remains a significant therapeutic challenge. Open repair is associated with considerable perioperative risk, particularly in patients with multiple comorbidities, while standard EVAR is often not feasible because of inadequate proximal sealing zones. Fenestrated and branched endovascular repair (F/BEVAR) represents an established treatment strategy; however, the use of custom-made devices is limited by manufacturing time and availability. Physician-modified stent-grafts (PMSG) have therefore emerged as a pragmatic alternative. Three-dimensional planning techniques have been increasingly used to facilitate accurate graft modification. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of PMSG procedures planned with three-dimensional techniques. Technical success, target vessel patency, early mortality, endoleak occurrence, and reintervention rates were analyzed. METHODS: A systematic search was conducted in the PubMed/MEDLINE and Embase databases. Studies describing the use of physician-modified fenestrated stent grafts planned with three-dimensional tools were included. Meta-analyses were performed using a random-effects model with REML estimation. A logit transformation was used for the analysis of proportions. RESULTS: The analysis included five studies involving 172 patients. The estimated weighted mean follow-up duration was 14.9 months. The overall technical success rate was 92.9% (95% CI: 84.5-96.9%), with low-to-moderate heterogeneity. Target vessel patency was 96.9% (95% CI: 93.6-98.5%). Early mortality was 5.5% (95% CI: 2.1-13.3%). The incidence of endoleaks was 13.3% (95% CI: 5.8-27.4%), with significant heterogeneity among studies. Reinterventions were reported in 6.6% of patients (95% CI: 2.3-17.5%). CONCLUSIONS: The results indicate that PMSG procedures planned with three-dimensional techniques are associated with a high rate of technical success and preserved patency of target vessels in patients with complex aortic pathology. The observed variability in endoleak and reintervention rates likely reflects differences in anatomical complexity and patient selection among studies. Further prospective studies are needed to confirm long-term outcomes.
Aligning Credentialing With the Complexity of Endovascular Aortic Repair.
Foteh M, Malgor RD
Ann Vasc Surg · 2026 Jun · PMID 42362016 · Publisher ↗
Abstract loading — click title to view on PubMed.
A Mechanism-Based Classification of Mechanical Compression of the Extracranial Carotid Arteries: A Narrative Review.
Keshelava G
Ann Vasc Surg · 2026 Jun · PMID 42362015 · Publisher ↗
BACKGROUND: Mechanical external compression of the extracranial carotid arteries is a rare but potentially treatable cause of cerebral ischemia. Despite increasing reports of individual mechanisms, a unified and clinical...
BACKGROUND: Mechanical external compression of the extracranial carotid arteries is a rare but potentially treatable cause of cerebral ischemia. Despite increasing reports of individual mechanisms, a unified and clinically applicable classification system is currently lacking. OBJECTIVE: To propose a mechanism-based classification of mechanical carotid artery compression and to review the literature on diagnosis and management of this condition. METHODS: A narrative review of the literature was performed using PubMed/MEDLINE, Web of Science, and Google Scholar databases. Articles describing mechanical (extrinsic) compression of the extracranial carotid arteries were included. Cases were categorized according to the proposed mechanism-based classification: positional compression, compression by anatomical elements, and compression by volumetric formations. Our own previously published cases were incorporated as illustrative examples. The review primarily addresses compression of the internal carotid artery, with an additional discussion on common carotid artery compression. RESULTS: A total of 55 articles were included. The proposed classification divides mechanical carotid compression into three main categories. Representative cases from each category, including our institutional experience, are presented along with diagnostic approaches and treatment strategies. Key clinical and imaging features of each mechanism are summarized. CONCLUSIONS: Mechanical compression of the carotid arteries can be systematically classified according to the underlying mechanism. This classification may facilitate clinical recognition, diagnostic work-up, and individualized management. Increased awareness of these rare entities can lead to timely intervention and improved patient outcomes.
Analysis of Patient Presentation to the ED within 90-days of Infra-inguinal Bypass.
Knight D, Ghouti L, Casey P … +6 more , Smith M, McDonald J, Mordhorst A, Abdelmasih M, Gill HL, Jessula S
Ann Vasc Surg · 2026 Jun · PMID 42349648 · Publisher ↗
BACKGROUND: Postoperative re-presentation to healthcare causes distress to patients and increases resource utilization. However, patients that re-present but do not require readmission are often not factored in tradition...
BACKGROUND: Postoperative re-presentation to healthcare causes distress to patients and increases resource utilization. However, patients that re-present but do not require readmission are often not factored in traditional quality improvement datasets. This study aimed to identify risk factors for emergency department (ED) visits without readmission following infra-inguinal bypass. METHODS: A retrospective cohort study was conducted, reviewing infra-inguinal bypass performed at QEII Health Sciences Centre between January 1, 2020, and December 31, 2021 in Halifax, Nova Scotia. Data from the Vascular Quality Initiative (VQI) database was merged with provincial ED records to identify patients presenting to the ED within 90 days postoperatively. Descriptive statistics and multivariable logistic regression were used to identify predictors of ED visits without readmission. RESULTS: Of 232 infra-inguinal bypasses performed, 29% re-presented to the ED within 90 days. 84% of ED visits did not result in readmission. Indications for re-presentation included non-infectious wound complications (33.1%), surgical site infections (19.7%), and non-wound complications (18.3%). Complaints unrelated to the primary procedure accounted for 26.1% of all ED visits. Discharge on dual antiplatelet therapy (DAPT) (OR 3.55, 95% CI 1.30-9.68) or anticoagulants (OR 2.58, 95% CI 1.04-6.37) was associated with increased odds of re-presentation. Medication-controlled diabetes (OR 0.25, 95% CI 0.10-0.65) and urgent repair (OR 0.15, 95% CI 0.04-0.62) were associated with decreased odds of re-presentation. CONCLUSION: A considerable proportion of patients re-present to the ED without readmission after infra-inguinal bypass, most frequently for wound complications. Targeted quality improvement initiatives addressing this group could reduce unnecessary healthcare use and improve outcomes.
The current state of ambulatory surgery centers and future trends.
Satiani B, Hingorani A, Bailey-Wheaton JL … +2 more , Zigrang TA, Jain K
Ann Vasc Surg · 2026 Jun · PMID 42349647 · Publisher ↗
Surgical volumes continue to shift from inpatient and hospital outpatient departments to independent and co-owned Ambulatory Surgery Centers (ASCs). Consumer preferences, payer pressure, lower cost, possibility of site-n...
Surgical volumes continue to shift from inpatient and hospital outpatient departments to independent and co-owned Ambulatory Surgery Centers (ASCs). Consumer preferences, payer pressure, lower cost, possibility of site-neutral payments, equivalent safety, and clinical innovation have caused this outmigration. Physicians have embraced the shift due to dissatisfaction with current employment models, more professional autonomy, a sense of purpose, the ability to drive efficiency and quality of care, and the option to invest and benefit financially. Vascular surgeons can utilize their existing experience delivering outpatient care to grow their practices. The unique challenges and business structure of this care model, regulatory roadblocks, arbitrary reimbursement adjustments, and new corporate entrants to ASCs need to be understood. New models of outpatient care will likely include shifting higher-acuity procedures to ASCs. The care will be delivered by independent vascular surgeons or through alignment between physicians and hospital systems to provide optimal care to patients in convenient, secure, and cost-effective settings.
Socioeconomic Disadvantage Association with Disease Severity and Adverse Outcomes After Interhospital Transfer for Vascular Care.
Lasanta-Gorbea F, Díaz-Sepúlveda C, Castañer-Colberg S … +3 more , Toro D, Martinez-Trabal J, Santini-Dominguez R
Ann Vasc Surg · 2026 Jun · PMID 42349646 · Publisher ↗
INTRODUCTION: Interhospital transfer is a key pathway to specialized vascular care, but the relationship between socioeconomic disadvantage and disease severity and outcomes among transferred patients remains unclear. We...
INTRODUCTION: Interhospital transfer is a key pathway to specialized vascular care, but the relationship between socioeconomic disadvantage and disease severity and outcomes among transferred patients remains unclear. We evaluated transfer characteristics, clinical outcomes, and the association between residence-level socioeconomic factors and post-transfer outcomes, with disease-specific analysis in chronic limb-threatening ischemia (CLTI). METHODS: We conducted a retrospective cohort study of adult patients transferred to a major regional referral center for vascular surgical evaluation between January 2023 and September 2025. Patient addresses were geocoded and linked to U.S. Census tract-level socioeconomic variables, including poverty, education, income, uninsured rate, unemployment, no vehicle rate, and a composite deprivation score. Outcomes included hospital admission, ICU admission, in-hospital mortality, and hospital length of stay (LOS). CLTI-specific analyses evaluated Rutherford stage and amputation rates. RESULTS: A total of 675 patients were included; 69.8% underwent intervention, and 37.6% required ICU care. Mean LOS was 9.54 days. Average travel time to the receiving center was approximately 60 minutes. Socioeconomic disadvantage was associated with ICU admission, mortality, and longer LOS (p<0.05). In CLTI patients, unemployment and composite deprivation differed across Rutherford categories (p<0.05), with greater disadvantage in advanced stages. Patients undergoing amputation (n=59) resided in areas with lower income, higher poverty, lower education, and higher deprivation (all p<0.05). CONCLUSION: Socioeconomic disadvantage is associated with worse outcomes among transferred vascular patients and with greater ischemic severity and limb loss in CLTI. These findings suggest that access-related barriers contribute to disease progression prior to transfer.
Preoperative Inflammatory Indices Have Limited Predictive Value in Patients With Ruptured Abdominal Aortic Aneurysm.
Jovanovic K, Jovanovic N, Dabovic L … +6 more , Radovanovic N, Savic M, Koncar I, Ilic N, Dragas M, Cvetkovic S
Ann Vasc Surg · 2026 Jun · PMID 42349645 · Publisher ↗
OBJECTIVE: To assess the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI), for short-term morbidity and mortality in patients u...
OBJECTIVE: To assess the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammatory response index (SIRI), for short-term morbidity and mortality in patients undergoing ruptured abdominal aortic aneurysm (rAAA) open repair. METHODS: This single-center retrospective study included consecutive patients who underwent surgery between June 2024 and June 2025. The primary outcome was short-term mortality, evaluated at one and six months postoperatively. Secondary outcome was 30-day morbidity. Baseline inflammatory indices were calculated from the first preoperative venous blood sample. Associations between inflammatory indices and markers of clinical severity were explored. Univariate and multivariate analyses were performed to evaluate their predictive value for 30-day morbidity and short-term mortality. RESULTS: Seventy-four rAAA patients were included (82.4% male, mean age 73.7 ± 8.9 years). Inflammatory indices did not significantly differ according to preoperative or intraoperative clinical severity. PLR was significantly lower in patients who experienced 30-day morbidity compared with those without complications (p = 0.032), while non-survivors had significantly lower baseline NLR, PLR, and SIRI values at both follow-up time points (all p < 0.05). Receiver operating characteristic analysis showed modest predictive performance for all indices. Age >74 years, hemoglobin ≤97 g/L, PLR <84.3, and SIRI ≤6.15 were significantly associated with 30-day mortality, while NLR ≤8.49 and PLR ≤131.67 were associated with 30-day morbidity. Multivariate analysis demonstrated that preoperative loss of consciousness was an independent predictor of 30-day morbidity (OR 0.173, 95% CI 0.035-0.863, p = 0.032). CONCLUSIONS: Preoperative inflammatory indices have limited predictive value for short-term morbidity and mortality in rAAA patients. Their interpretation should be integrated with clinical and hemodynamic parameters, as clinical severity remains the dominant determinant of early outcomes.
Type II Endoleak After EVAR: The Sac Behavior-Anatomy Driven Management (SADM) Framework.
Błaszyk M, Fryska Z, Waliszewski J … +2 more , Juszkat R, Krasiński Z
Ann Vasc Surg · 2026 Jun · PMID 42349644 · Publisher ↗
Type II endoleak (T2EL) is the most common complication following endovascular abdominal aortic aneurysm repair (EVAR), although its clinical significance remains debated. While often benign, a subset of cases is associa...
Type II endoleak (T2EL) is the most common complication following endovascular abdominal aortic aneurysm repair (EVAR), although its clinical significance remains debated. While often benign, a subset of cases is associated with aneurysm sac enlargement and may require intervention. This review summarizes current evidence on the diagnosis, surveillance, and management of T2EL, with emphasis on decision-making guided by aneurysm sac behavior. Beyond summarizing available evidence, this review introduces and operationalizes the Sac Behavior-Anatomy Driven Management (SADM) framework that integrates heterogeneous guideline recommendations and anatomical considerations into a unified, clinically applicable decision-support strategy for T2EL management. T2EL occurs in approximately 10-30% of patients after EVAR, but only a minority demonstrate clinically relevant sac enlargement. Surveillance strategies are primarily driven by sac dynamics rather than the presence of T2EL alone. Intervention should be considered in cases of persistent endoleak with sac enlargement. Endovascular embolization remains the main treatment approach, although no single technique has demonstrated clear superiority in the absence of high-quality comparative data, and recent randomized evidence has not demonstrated a clear benefit for routine prophylactic inferior mesenteric artery embolization during EVAR. The proposed SADM framework provides a practical, clinically applicable approach to T2EL management by separating treatment indication from procedural strategy and aligning decision-making with aneurysm sac behavior and anatomical feasibility.
Impact of multidisciplinary team meetings on management and outcomes for aortic disease: A scoping review of the literature.
Bhat S, D'Oria M, Khashram M
Ann Vasc Surg · 2026 Jun · PMID 42349643 · Publisher ↗
BACKGROUND: Multidisciplinary team (MDT) meetings have enhanced shared decision-making in the oncology setting due to the complexity of available treatment options. In view of the expanding endovascular and hybrid interv...
BACKGROUND: Multidisciplinary team (MDT) meetings have enhanced shared decision-making in the oncology setting due to the complexity of available treatment options. In view of the expanding endovascular and hybrid interventions, their evaluation in the vascular surgery setting is warranted. This scoping review summarised the current evidence on MDT meetings in patients with any aortic disease. METHODS: Comprehensive systematic searches of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and Google Scholar databases were performed in December 2025. Studies implementing MDT meetings for consensus on management strategies among patients with any aortic disease were included. Data were synthesised thematically. RESULTS: A total of 2,244 patients with aortic conditions were discussed at MDT meetings within six studies. All were retrospective cohort studies and reflected both contemporary and historic management practices (2010 until 2024). Aortic aneurysms were most frequently reviewed. MDT composition, meeting structure and processes were inconsistent and lacked standardisation. After MDT meetings were instituted, significant increases in aortic case volume and complexity were observed, together with reductions in time to definitive treatment and mortality. CONCLUSIONS: MDT meetings are emerging as a means of facilitating complex decision-making across a range of aortic conditions, and particularly among patients with aneurysmal disease. Despite the substantial variability in MDT frameworks, several improvements in clinical outcomes were recognised. Future efforts should aim to standardise MDT meeting processes and validate these systems-level changes through larger studies capturing a uniform set of outcomes.
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