Journal of Vascular Surgery最新文献

英文中文

Technical aspects and midterm results of retrograde open mesenteric stenting for acute mesenteric ischemia 急性肠系膜缺血逆行开放肠系膜支架置入的技术方面和中期结果。

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-14 DOI: 10.1016/j.jvs.2025.11.012

Nathanael Khayat MD , Adriane Mage MD , Iannis Ben Abdallah MD, MhD , Thierry Reix MD, PhD , Yves Castier MD, PhD , Joseph Touma MD, PhD , Arnaud Roussel MD, PhD , Jean Sénémaud MD, PhD

Background

Retrograde open mesenteric stenting (ROMS) may provide satisfactory initial results for the treatment of mesenteric ischemia. However, this procedure remains technically demanding and its complications may lead to significantly higher morbidity, mortality, and reinterventions rates in severely ill patients. This study aimed to report stent-related complications and midterm outcomes of ROMS for acute mesenteric ischemia (AMI).

Methods

Clinical data and outcomes of all consecutive patients treated with ROMS for AMI between February 2014 and December 2021 at three university hospitals were reviewed retrospectively. End points included technical success, in-hospital mortality, postoperative complications, stent-related complications, and reinterventions. Three-year overall survival, freedom from reintervention, primary patency, and assisted primary patency rates were analyzed using the Kaplan-Meier time-to-event method.

Results

Sixty-five patients presenting with AMI were included, of which 27 (40.5%) had a history of chronic mesenteric ischemia. All patients presented with mesenteric artery occlusive disease, involving the superior mesenteric artery (in situ thrombosis, n = 46; >70% stenosis, n =19). Overall technical success rate of the ROMS procedure in the cohort was 88%. The overall intestinal resection rate in the cohort was 35.4% (n = 23 patients). In-hospital mortality rate was 31.2%. Stent-related complications at 30 days were reported in 26.3% of patients, including ROMS occlusion (n = 7), residual superior mesenteric artery lesion (dissection/thrombus, n = 4), distal stent kinking (n = 2), and stent migration (n = 2). The mean follow-up duration was 24.9 months. The estimated 3-year overall survival rate for the cohort was 59.7% (95% confidence interval [CI], 46.7%-70.5%). Eight patients required additional stent-related reinterventions during follow-up, giving an estimate of freedom from stent-related reintervention at three years of 68.2% (95% CI, 50%-81%). The estimated three-year primary patency and assisted primary patency rates were 81.3% (95% CI, 65.4%-90.4%) and 87.6% (95% CI, 72.3%-94.7%), respectively.

Conclusions

ROMS provides acceptable technical success rate and midterm outcomes but is associated with high mortality, bowel resection, and specific stent-related complication rates. Such complications, resulting in frequent reinterventions and additional mortality, could be mitigated by implementing specific technical tips.

简介：逆行开放肠系膜支架（ROMS）治疗肠系膜缺血可提供满意的初步结果。然而，这种手术在技术上仍然要求很高，其并发症可能导致严重患者的发病率、死亡率和再干预率显著增加。本研究旨在报道ROMS治疗急性肠系膜缺血的支架相关并发症和中期预后。方法：回顾性分析2014年2月至2021年12月在三所大学附属医院连续接受ROMS治疗急性肠系膜缺血患者的临床资料和结局。终点包括技术成功、住院死亡率、术后并发症、支架相关并发症和再干预。使用Kaplan-Meier时间到事件法分析三年总生存率、无再干预、原发性通畅率和辅助原发性通畅率。结果：共纳入急性肠系膜缺血患者65例，其中有慢性肠系膜缺血史的患者27例（40.5%）。所有患者均表现为肠系膜动脉闭塞性疾病，累及肠系膜上动脉（SMA，原位血栓形成，n = 46， bb0 70%狭窄n =19）。队列中ROMS程序的总体技术成功率为88%。该队列的总体肠切除术率为35.4% （n = 23例）。住院死亡率为31.2%。26.3%的患者报告了30天支架相关并发症，包括ROMS闭塞（n = 7），残余SMA病变（剥离/血栓，n = 4），远端支架扭结（n = 2）和支架移位（n = 2）。平均随访时间为24.9个月。该队列的三年总生存率估计为59.7%（95%可信区间- ci - 46.7-70.5）。8名患者在随访期间需要额外的支架相关再干预，估计三年内支架相关再干预的自由度为68.2% （95% CI: 50-81）。估计三年原发性通畅率和辅助原发性通畅率分别为81.3% （95% CI: 65.4-90.4）和87.6% （95% CI: 72.3-94.7）。结论：ROMS提供了可接受的技术成功率和中期结果，但被认为具有较高的死亡率、肠切除术和特定支架相关并发症发生率。这种并发症导致频繁的再干预和更高的死亡率，可通过具体的技术提示加以缓解。

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引用次数: 0

Pediatric aortic trauma: A review of the literature 儿童主动脉创伤：文献综述。

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-10-30 DOI: 10.1016/j.jvs.2025.10.036

Malachi Sheahan MD , Sarah Lauve MD , Amanda Tullos MD , John White MD , Regan Williams MD , Dawn Coleman MD , Claudie M. Sheahan MD

Background

The patterns of pediatric aortic injury have changed and the incidence of penetrating aortic trauma, secondary to ballistic injuries, is increasing. Patterns of treatment have also changed, with fewer open aortic repairs as more endovascular technologies evolve and are able to be applied to the pediatric population.

Methods

This is a review of the current available literature regarding pediatric aortic injury both penetrating and blunt in the abdominal and thoracic aorta.

Results

When comparing thoracic aortic injuries (TAIs) to abdominal aortic injuries (AAIs), TAI is associated with higher mortality rates. Overall, blunt injuries are more common than penetrating injuries, and there are higher mortality rates associated with penetrating mechanisms. Improvements in endovascular repair have facilitated improved outcomes and survival rates for blunt TAIs. Compared with blunt TAIs, blunt AAIs are more rare, and open repair is the mainstay of treatment in symptomatic or life-threatening cases.

Conclusions

Much of the data regarding the management of pediatric aortic injuries comes from limited series and case reports. Future research efforts should aim at tracking these repairs, their outcomes, and technical pitfalls to serve as a foundation for future guidelines.

关于儿童主动脉损伤的处理，目前还没有强有力的循证指南。儿童主动脉损伤的模式已经改变，穿透性主动脉损伤继发于弹道损伤的发生率正在增加。治疗模式也发生了变化，随着更多血管内技术的发展，越来越少的主动脉切开修复术能够应用于儿科人群。对于成人人群的可用数据虽然有帮助，但不一定能推断到儿科人群。患者的体型、解剖因素和生长潜力限制了这种方法的适用性。此外，研究对儿科人群的定义不同，儿童、青少年和成年儿科患者的年龄标准差异很大。在创伤人群中，长期随访数据很少甚至不存在。大多数研究是单一机构的评论或病例报告。为了建立治疗儿童主动脉损伤的最佳方法，需要进行更多的研究。这是一篇关于儿童腹主动脉和胸主动脉穿透性和钝性损伤的文献综述。

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引用次数: 0

If you're not at the table, you're part of the meal 如果你不在餐桌上，你就是这顿饭的一部分

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jvs.2025.10.027

Richard J. Powell MD

引用次数: 0

Air Pollution, Genetic Susceptibility, and Risk of Symptomatic Peripheral Arterial Disease: A Cohort Study of the UK Biobank 空气污染、遗传易感性和症状性外周动脉疾病的风险：英国生物库的一项队列研究

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jvs.2025.12.167

C. Li, P. Qiu, H. Guo, X. Ying, K. Liu, P. Sun, H. Wu, Y. Zhan, R. Wang, Z. Zhou

引用次数: 0

Effects of Repeated Remote Ischaemic Preconditioning on Arterial Stiffness, Organ Damage, and Oxidative Stress in Patients with Intermittent Claudication: A Sham Controlled Randomised Trial 反复远程缺血预处理对间歇性跛行患者动脉僵硬、器官损伤和氧化应激的影响：一项假对照随机试验

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI: 10.1016/j.jvs.2025.12.166

K. Eerik, T. Kasepalu, H. Post, J. Eha, M. Kals, M. Björck, J. Kals

引用次数: 0

Vascular surgery residents and fellows graduate at higher levels of proficiency in endovascular as compared to open aortic operations 与主动脉切开手术相比，血管外科住院医师和研究员在血管内手术方面的熟练程度更高。

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-06 DOI: 10.1016/j.jvs.2025.10.045

Erin Buchanan MD , Ting Sun PhD , Nathan Droz MD , Benjamin S. Brooke MD, PhD , Brigitte K. Smith MD, MHPE , M. Libby Weaver MD, MHPE

Objective

Practice patterns regarding the surgical management of aortic pathologies have evolved over time, with a shift in care toward endovascular interventions and increasingly complex endovascular techniques. This raises concern for inadequate experience with aortic surgery, both open and endovascular, in vascular surgery training. Although numerous studies have explored trends in the volume of aortic cases completed during training, none have examined graduating proficiency in aortic surgery. We sought to examine the competence and autonomy of graduating vascular surgery trainees performing aortic operations using a multi-institutional sample of trainees.

Methods

Operative performance and autonomy ratings of post-graduate year 4-5 residents and all fellows performing aortic interventions from the Society for Improving Medical Professional Learning application database were collected for vascular surgery participating institutions from 2018 to 2023. ‘Supervision only’ and ‘passive help’ ratings were coded as ‘autonomous,’ whereas ‘exceptional performance’ and ‘practice ready’ were coded as ‘competent.’ Descriptive statistics were calculated for open and endovascular abdominal aortic aneurysm repair. Mixed effects logistic regressions were conducted to estimate the predictive association between procedure type and graduating trainee proficiency for all aortic procedures.

Results

A total of 54 trainees and 50 faculty from 19 programs completed 579 assessments (n = 394 endovascular; n = 185 open). For infrarenal aortic aneurysm repair, in the final year of training residents and fellows were assessed as ‘autonomous’ for 60.9% of endovascular and 21.1% of open procedures and were assessed as competent for independent practice in 50% of endovascular and 22.2% of open procedures. Regarding all aortic procedures, trainees were assessed as autonomous for 58.0% of endovascular and 41% of open procedures, and competent for 49.0% of endovascular and 37.0% of open procedures in their final year. There were no differences when comparing graduating integrated residents and fellows. However, trainees were less likely to achieve autonomous and competent ratings for open, as compared with endovascular, cases by graduation on both faculty (odds ratio, 0.25; 95% confidence interval, 0.11-0.53) and trainee self-assessment (odds ratio, 0.39; 95% confidence interval, 0.19-0.77).

Conclusions

Vascular surgery trainees are more likely to achieve proficient levels of autonomy and competence in endovascular aortic cases by graduation, regardless of training paradigm. Trainees are also more likely to perceive themselves as achieving higher levels of proficiency than their faculty assessors rate them in open aortic procedures. These findings highlight the importance of developing innovative solutions to enhance aortic surgical skills in training.

目的：随着时间的推移，随着对血管内介入治疗和越来越复杂的血管内技术的转变，主动脉病变手术治疗的实践模式已经发生了变化。这引起了对血管外科培训中主动脉手术经验不足的关注，无论是开放手术还是血管内手术。尽管有许多研究探讨了在培训期间完成的主动脉病例量的趋势，但没有一个研究考察了主动脉手术的毕业熟练程度。我们试图通过多机构的受训者样本来检验毕业血管外科受训者进行主动脉手术的能力和自主性。方法：收集2018-2023年血管外科参与机构中来自美国医学专业学习改善学会（SIMPL）应用数据库的研究生年级（PGY） 4-5名住院医师和所有进行主动脉介入治疗的研究员的手术表现和自主评分。“仅监督”和“被动帮助”评级被编码为“自主”，而“卓越表现”和“实践就绪”被编码为“胜任”。对切开和血管内腹主动脉瘤修复进行描述性统计。对所有主动脉手术进行混合效应logistic回归来估计手术类型和受训人员熟练程度之间的预测关联。结果：来自19个项目的54名学员和50名教师完成了579项评估（n=394, n=185）。对于肾下动脉瘤修复，在培训的最后一年，住院医师和研究员在60.9%的血管内手术和21.1%的开放手术中被评估为“自主”，在50%的血管内手术和22.2%的开放手术中被评估为“胜任”。在所有主动脉手术中，受训者在最后一年被评估为58.0%的血管内手术和41%的开放手术是自主的，在49.0%的血管内手术和37.0%的开放手术中是合格的。当比较毕业的综合住院医师和研究员时，没有差异。然而，与血管内病例相比，在毕业时，受训者在教师（OR 0.25±0.11-0.53）和受训者自我评估（OR 0.39±0.19-0.77）两方面都不太可能达到自主和称职的开放性评分。结论：血管外科学员在毕业时更有可能在血管内主动脉病例中达到熟练的自主和能力水平，无论训练模式如何。受训者也更有可能认为自己在主动脉开腹手术中的熟练程度高于他们的教师评估者对他们的评估。这些发现强调了在培训中开发创新解决方案以提高主动脉手术技能的重要性。

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引用次数: 0

Physical activity is associated with positive patient and clinical outcomes following dysvascular major lower limb amputation 体育活动与血管障碍下肢截肢后的积极患者和临床结果相关。

IF 3.6 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery

Pub Date : 2026-03-01 Epub Date: 2025-11-04 DOI: 10.1016/j.jvs.2025.10.040

Leonie A. Krops PhD , Harriët Jager-Wittenaar RD, PhD , Wim P. Krijnen PhD , Martijn L. Dijkstra MD, PhD , B. Paul J.A. Keller MD, PhD , Jacques Oskam MD, PhD , Bastiaan Vierhout MD, PhD , Jean-Paul P.M. de Vries MD, PhD , Laurens van Walraven MD , Jan H.B. Geertzen MD, PhD , Rienk Dekker MD, PhD , Aniek M. Kolen MSc

Objective

To determine the association between physical activity (PA; duration and intensity) and patient and clinical outcomes at various measurement occasions post dysvascular major lower limb amputation (LLA).

Methods

In this multicenter longitudinal observational study, the PA levels of adults who underwent dysvascular major LLA (n = 81) were assessed using the adapted Short Questionnaire to Assess Health-enhancing Physical Activity questionnaire (total hours, hours of moderate/vigorous, and metabolic equivalent of task-hours/week), at <12 days, 5 weeks, 6 months, and 9 months post-LLA. (Reamputation-free) Survival and quality of life (Brief Version of the World Health Organization Quality of Life Questionnaire) were assessed at 5 weeks, 6 months, and 9 months, wound healing at 5 weeks, mobility (K-level) at 6 and 9 months, and work status at 9 months post LLA.

Results

Total PA was positively associated with survival (P = .034), but not after adjusting for covariates (hazard ratio, 0.84 per hour/week; P = .075). PA levels were positively associated with physical and psychological quality of life (QoL) domains, and with overall QoL and health (P =<.001-.022), but not with social or environmental domains (P = .118-.517). Total PA was also positively associated with wound healing (odds ratio, 1.06 per hour/week; P = .044). No significant associations were found between PA levels and reamputation-free survival (P = .272-.321), mobility (P = .671-.994), or work status (P = .682-.908).

Conclusions

PA is positively associated with survival, QoL, and wound healing. These findings underscore the relevance of PA and the need for PA interventions for individuals post LLA to potentially optimize health, patient, and clinical outcomes.

目的：探讨血管障碍下肢截肢（LLA）术后不同测量时段体力活动（PA、持续时间和强度）与患者及临床预后的关系。方法：在这项多中心纵向观察研究中，采用适应性squash问卷（总小时数、中等/剧烈运动小时数和met小时数/周）评估了81例血管功能障碍下肢截肢患者的PA水平，结果显示：总PA与生存率呈正相关（p=0.034），但在调整协变量后没有出现相关（HR=0.84 /小时/周，p=0.075）。PA水平与生理和心理生活质量域呈正相关，与总体生活质量和健康呈正相关(p=结论：PA与生存、生活质量和伤口愈合呈正相关。这些发现强调了PA的相关性以及对lla后个体进行PA干预的必要性，以潜在地优化健康、患者和临床结果。

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