Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.07.109
Joseph Patrick Hart MD, MHL, FACS, DFSVS
{"title":"Cilostazol following endovascular therapy in peripheral arterial disease: Patient adherence (to yet another medication) could prove to be a bridge too far","authors":"Joseph Patrick Hart MD, MHL, FACS, DFSVS","doi":"10.1016/j.jvs.2024.07.109","DOIUrl":"10.1016/j.jvs.2024.07.109","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Pages 775-776"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2025.02.016
Blake Murphy, Gerald Anderson, Alexandra Phocas, Jasleen Bains, Allison Larimore, Niten Singh, Benjamin W Starnes, Sara L Zettervall
<p><strong>Objective: </strong>The use of physician modified endografts (PMEGs) to treat juxtarenal aortic aneurysms has increased significantly over the past 10 years. However, there exists a paucity of data beyond 5-years. This study compares long-term outcomes and cause of death between patients who did and did not survive beyond 5-years following PMEG for juxtarenal aneurysm.</p><p><strong>Methods: </strong>All patients, with more than 5-years of follow-up data enrolled in a prospective, physician-sponsored IDE clinical trial treated with PMEG for juxtarenal aneurysm were included. Univariate analysis was used to compare demographics, anatomic/operative characteristics, late outcomes, and cause of death between patients who survived beyond 5-years and those who did not. Death on hospice, clinical follow-up status, and whether patients declined a secondary intervention were also evaluated. Survival was assessed with Kaplan-Meier analysis. Predictors of overall mortality and mortality before 5-years were determined using Cox regression analysis.</p><p><strong>Results: </strong>98 patients with juxtarenal aneurysm underwent PMEG from 2011-2018; 64 (65.3%) survived beyond 5-years and 34 (34.7%) did not. Patients who survived beyond 5-years were younger (73 vs. 78 years, p=0.04) with a higher prevalence of preoperative antiplatelet use (81.3% vs. 61.8%, p=0.047). There were no differences in comorbidities, symptomatic presentation, anatomic or operative characteristics. Patients who survived beyond 5-years were less likely to experience a perioperative adverse event (10.9% vs 38.2%, p<0.01) and pulmonary complication (1.6% vs. 17.7%, p=0.01). There were no differences in late outcomes including reintervention, aortic sac behavior, endoleak, or visceral patency. Patients who survived beyond 5-years more frequently died on hospice (58.6% vs. 17.6%, p<0.01), were lost to aortic-specific clinical follow-up (48.4% vs 5.9%, p<0.01), and declined a secondary intervention (9.4% vs. 2.9%, p=0.04). For the entire study cohort, aortic-related mortality was 9.5%. Survival was 87% at 1-year, 65% at 5-years, and 10% at 10-years. Cardiac comorbidities (15.9%), systemic decline (15.9%), stroke (14.2%), and cancer (12.9%) accounted for the leading causes of death, with no differences between the two cohorts. On adjusted analysis, sac regression was associated with reduced mortality for the entire patient cohort (HR 0.37, 95% CI 0.18-0.76) and those who died before 5-years (HR 0.37, 95% CI 0.16-0.92). Meanwhile, congestive heart failure (6.02, 95% CI 1.60-22.65) was associated with increased mortality for patients who did not survive beyond 5-years.</p><p><strong>Conclusions: </strong>Patients who undergo PMEG for juxtarenal aneurysm are more likely to die from underlying medical comorbidities, while aortic-related mortality accounts for less than 10% of total deaths. Patients who do not survive beyond five years are older and experience more perioperative complica
{"title":"Cause of death among patients following repair of juxtarenal aneurysm with physician modified endografts.","authors":"Blake Murphy, Gerald Anderson, Alexandra Phocas, Jasleen Bains, Allison Larimore, Niten Singh, Benjamin W Starnes, Sara L Zettervall","doi":"10.1016/j.jvs.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.02.016","url":null,"abstract":"<p><strong>Objective: </strong>The use of physician modified endografts (PMEGs) to treat juxtarenal aortic aneurysms has increased significantly over the past 10 years. However, there exists a paucity of data beyond 5-years. This study compares long-term outcomes and cause of death between patients who did and did not survive beyond 5-years following PMEG for juxtarenal aneurysm.</p><p><strong>Methods: </strong>All patients, with more than 5-years of follow-up data enrolled in a prospective, physician-sponsored IDE clinical trial treated with PMEG for juxtarenal aneurysm were included. Univariate analysis was used to compare demographics, anatomic/operative characteristics, late outcomes, and cause of death between patients who survived beyond 5-years and those who did not. Death on hospice, clinical follow-up status, and whether patients declined a secondary intervention were also evaluated. Survival was assessed with Kaplan-Meier analysis. Predictors of overall mortality and mortality before 5-years were determined using Cox regression analysis.</p><p><strong>Results: </strong>98 patients with juxtarenal aneurysm underwent PMEG from 2011-2018; 64 (65.3%) survived beyond 5-years and 34 (34.7%) did not. Patients who survived beyond 5-years were younger (73 vs. 78 years, p=0.04) with a higher prevalence of preoperative antiplatelet use (81.3% vs. 61.8%, p=0.047). There were no differences in comorbidities, symptomatic presentation, anatomic or operative characteristics. Patients who survived beyond 5-years were less likely to experience a perioperative adverse event (10.9% vs 38.2%, p<0.01) and pulmonary complication (1.6% vs. 17.7%, p=0.01). There were no differences in late outcomes including reintervention, aortic sac behavior, endoleak, or visceral patency. Patients who survived beyond 5-years more frequently died on hospice (58.6% vs. 17.6%, p<0.01), were lost to aortic-specific clinical follow-up (48.4% vs 5.9%, p<0.01), and declined a secondary intervention (9.4% vs. 2.9%, p=0.04). For the entire study cohort, aortic-related mortality was 9.5%. Survival was 87% at 1-year, 65% at 5-years, and 10% at 10-years. Cardiac comorbidities (15.9%), systemic decline (15.9%), stroke (14.2%), and cancer (12.9%) accounted for the leading causes of death, with no differences between the two cohorts. On adjusted analysis, sac regression was associated with reduced mortality for the entire patient cohort (HR 0.37, 95% CI 0.18-0.76) and those who died before 5-years (HR 0.37, 95% CI 0.16-0.92). Meanwhile, congestive heart failure (6.02, 95% CI 1.60-22.65) was associated with increased mortality for patients who did not survive beyond 5-years.</p><p><strong>Conclusions: </strong>Patients who undergo PMEG for juxtarenal aneurysm are more likely to die from underlying medical comorbidities, while aortic-related mortality accounts for less than 10% of total deaths. Patients who do not survive beyond five years are older and experience more perioperative complica","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2025.02.013
Mikayla Kricfalusi, Mohammed Hamouda, Ahmed Abdelkarim, Alik Farber, Joseph P Hart, Mahmoud B Malas
Objectives: Obese patients have higher rates of cardiovascular disease and associated risk factors, but lower rates of peripheral artery disease (PAD) and better outcomes following revascularization. This results in an obesity paradox, where obese patients have the lowest risk of adverse outcomes following treatment, while underweight and morbidly obese patients are at the highest risk. No previous studies have compared outcomes of endovascular vs open bypass within each body mass index (BMI) group. Our study aims to compare outcomes of [Peripheral Vascular Intervention (PVI) to infrainguinal bypass (IIB)] stratified by patient BMI group.
Methods: The Vascular Quality Initiative database was queried for patients presenting with Claudication or Chronic Limb Threatening Ischemia (CLTI) undergoing PVI or IIB (using great saphenous vein) from 2012 to 2023. Patients were categorized into five BMI groups: underweight (BMI ≤ 18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), obese (BMI 30-39.9 kg/m2), and morbidly obese (BMI 40-49.9 kg/m2). Multivariable logistic compared 30-day mortality for IIB versus PVI within each BMI group. Cox regression, Kaplan-Meier survival analysis, and Log Rank tests assessed 1-year mortality, 1-year amputation, and 1-year amputation/death. Subgroup analysis was performed by indication (CLTI or claudication).
Results: There were 118,622 patients meeting the study criteria, including 3,542 underweight (3%), 33,009 normal weight (28%), 40,582 overweight (34%), 36,494 obese (31%), and 4,995 morbidly obese (4%) patients. There was no significant difference in 30-day mortality between PVI and IIB in underweight patients. IIB was associated with lower 30-day mortality in normal weight [aOR 0.45, 95% CI (0.33,0.62)] and obese [aOR 0.78, (0.24,0.75)] patients. Bypass was associated with lower 1-year mortality in all BMI groups except for morbidly obese patients. It was also associated with a lower risk of 1-year amputation for normal weight [aOR 0.82, (0.70,0.96)] and a reduced risk of 1-year amputation/death for normal weight, overweight, and obese patients. Among CLTI patients, bypass was associated with decreased 30-day and 1-year mortality risks in all but underweight patients.
Conclusions: This study shows significant differences in 30-day and 1-year mortality, amputation, and amputation/death between PVI and IIB based on BMI depending on patient BMI. Bypass was associated with better outcomes for normal weight and obese patients, and for CLTI patients across most BMI groups. This suggests a long-term survival benefit following IIB compared to PVI, an effect potentiated by symptom severity, except for patients otherwise at a higher operative risk regardless of procedure choice.
{"title":"Mortality and Amputation Outcomes of Infrainguinal Bypass Versus Endovascular Therapy Based on Body Mass Index.","authors":"Mikayla Kricfalusi, Mohammed Hamouda, Ahmed Abdelkarim, Alik Farber, Joseph P Hart, Mahmoud B Malas","doi":"10.1016/j.jvs.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.jvs.2025.02.013","url":null,"abstract":"<p><strong>Objectives: </strong>Obese patients have higher rates of cardiovascular disease and associated risk factors, but lower rates of peripheral artery disease (PAD) and better outcomes following revascularization. This results in an obesity paradox, where obese patients have the lowest risk of adverse outcomes following treatment, while underweight and morbidly obese patients are at the highest risk. No previous studies have compared outcomes of endovascular vs open bypass within each body mass index (BMI) group. Our study aims to compare outcomes of [Peripheral Vascular Intervention (PVI) to infrainguinal bypass (IIB)] stratified by patient BMI group.</p><p><strong>Methods: </strong>The Vascular Quality Initiative database was queried for patients presenting with Claudication or Chronic Limb Threatening Ischemia (CLTI) undergoing PVI or IIB (using great saphenous vein) from 2012 to 2023. Patients were categorized into five BMI groups: underweight (BMI ≤ 18.5 kg/m<sup>2</sup>), normal weight (BMI 18.5-24.9 kg/m<sup>2</sup>), overweight (BMI 25-29.9 kg/m<sup>2</sup>), obese (BMI 30-39.9 kg/m<sup>2</sup>), and morbidly obese (BMI 40-49.9 kg/m<sup>2</sup>). Multivariable logistic compared 30-day mortality for IIB versus PVI within each BMI group. Cox regression, Kaplan-Meier survival analysis, and Log Rank tests assessed 1-year mortality, 1-year amputation, and 1-year amputation/death. Subgroup analysis was performed by indication (CLTI or claudication).</p><p><strong>Results: </strong>There were 118,622 patients meeting the study criteria, including 3,542 underweight (3%), 33,009 normal weight (28%), 40,582 overweight (34%), 36,494 obese (31%), and 4,995 morbidly obese (4%) patients. There was no significant difference in 30-day mortality between PVI and IIB in underweight patients. IIB was associated with lower 30-day mortality in normal weight [aOR 0.45, 95% CI (0.33,0.62)] and obese [aOR 0.78, (0.24,0.75)] patients. Bypass was associated with lower 1-year mortality in all BMI groups except for morbidly obese patients. It was also associated with a lower risk of 1-year amputation for normal weight [aOR 0.82, (0.70,0.96)] and a reduced risk of 1-year amputation/death for normal weight, overweight, and obese patients. Among CLTI patients, bypass was associated with decreased 30-day and 1-year mortality risks in all but underweight patients.</p><p><strong>Conclusions: </strong>This study shows significant differences in 30-day and 1-year mortality, amputation, and amputation/death between PVI and IIB based on BMI depending on patient BMI. Bypass was associated with better outcomes for normal weight and obese patients, and for CLTI patients across most BMI groups. This suggests a long-term survival benefit following IIB compared to PVI, an effect potentiated by symptom severity, except for patients otherwise at a higher operative risk regardless of procedure choice.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.11.024
Robert Y. Rhee MD
{"title":"Early results from the Pivotal Trial Substudy of the GORE EXCLUDER conformable endoprosthesis in angulated necks","authors":"Robert Y. Rhee MD","doi":"10.1016/j.jvs.2024.11.024","DOIUrl":"10.1016/j.jvs.2024.11.024","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Pages 794-795"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.11.035
H. Nakayama, M. Toma, T. Kobayashi, R. Hara, Y. Sato
{"title":"Pre-constrain technique using the Gore Excluder Conformable endograft for abdominal aortic aneurysm with severely angulated proximal neck","authors":"H. Nakayama, M. Toma, T. Kobayashi, R. Hara, Y. Sato","doi":"10.1016/j.jvs.2024.11.035","DOIUrl":"10.1016/j.jvs.2024.11.035","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page A17"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.11.036
M. Panagrosso, K. Björse, T. Resch
{"title":"A type II endoleak from an accessory renal artery treated with laser assisted, transgraft coil embolization: A case report","authors":"M. Panagrosso, K. Björse, T. Resch","doi":"10.1016/j.jvs.2024.11.036","DOIUrl":"10.1016/j.jvs.2024.11.036","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page A17"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.11.032
Russell H. Samson MD, FACS, DFSVS
{"title":"The Vascular Quality Initiative coughs up smoking data, but must we inhale the smoke?","authors":"Russell H. Samson MD, FACS, DFSVS","doi":"10.1016/j.jvs.2024.11.032","DOIUrl":"10.1016/j.jvs.2024.11.032","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page 664"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.12.013
S. Chawla, Q. Zhang, A.M. Gwozdz, J. Wijaya, B. Tiwana, L. Tincknell, B.R.H. Turner, S. Black
{"title":"A Systematic Review and Meta-analysis of 24 Month Patency After Endovenous Stenting of Superior Vena Cava, Subclavian, and Brachiocephalic Vein Stenosis","authors":"S. Chawla, Q. Zhang, A.M. Gwozdz, J. Wijaya, B. Tiwana, L. Tincknell, B.R.H. Turner, S. Black","doi":"10.1016/j.jvs.2024.12.013","DOIUrl":"10.1016/j.jvs.2024.12.013","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page 793"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/S0741-5214(25)00285-X
{"title":"Events of Interest","authors":"","doi":"10.1016/S0741-5214(25)00285-X","DOIUrl":"10.1016/S0741-5214(25)00285-X","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page A14"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-19DOI: 10.1016/j.jvs.2024.12.011
S. Bose, C. Dun, A.J. Solomon, J.H. Black, M.S. Conte, C.A. Kalbaugh, K. Woo, M.A. Makary, C.W. Hicks
{"title":"Infrapopliteal Peripheral Vascular Interventions for Claudication are Performed Frequently in the USA and Are Associated with Poor Long Term Outcomes","authors":"S. Bose, C. Dun, A.J. Solomon, J.H. Black, M.S. Conte, C.A. Kalbaugh, K. Woo, M.A. Makary, C.W. Hicks","doi":"10.1016/j.jvs.2024.12.011","DOIUrl":"10.1016/j.jvs.2024.12.011","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 3","pages":"Page 792"},"PeriodicalIF":3.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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