Pub Date : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.jvs.2025.07.062
Luis Morales Ojeda MD , Stefania Montero Arcila MD , Victor Andrade Nunes MD , Cristiano Marciano Duarte BA , Melina Papi MD , Donald L. Jacobs MD, MSC , Emily A. Malgor MD , Rafael D. Malgor MD, MBA
Background
Vascular surgeons are crucial in modern health care, offering indispensable support across surgical services. Despite their clinical and economic contributions, their full value often goes unrecognized. This systematic review and meta-analysis aimed to assess the interdisciplinary and financial impact of vascular surgeons within contemporary health care systems.
Methods
A systematic search was conducted in August 2024 across MEDLINE, PubMed, the Cochrane Vascular Registers, and other databases. The studies included randomized controlled trials, cohort studies, and economic evaluations published from 2010 onward. Dual reviewer screening and data extraction followed PRISMA guidelines, and the study protocol was registered with PROSPERO (CRD42024589273). Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analyses employed random effects models, with heterogeneity assessed via I2 and Cochran's Q tests.
Results
Of 3031 screened records, 29 studies involving 6557 patients met the inclusion criteria. Vascular surgery consultations were most frequently requested by emergency medicine (15.3%), orthopedics (14.1%), trauma (12.2%), and neurosurgery (10.1%). Hemorrhage control (16.4%) and ischemia (14.1%) were the primary reasons for consultations. Vascular surgeons performed 928 procedures, predominantly primary repairs (49.2%) and graft placements (17.7%). Multidisciplinary collaboration, particularly in surgical oncology and podiatry, significantly improved outcomes, including revascularization success in cases of acute limb ischemia and intraoperative arterial injuries (94%), decreased amputation rates, and enhanced margin-negative resections. Financial analyses revealed that vascular surgery contributes substantial work relative value units (wRVUs) and revenue, with some services generating >$130 million over 5 years. Meta-analysis identified pooled consultation proportions of 22% among urology, orthopedics, and general surgery, with significant heterogeneity (I2 = 98.7%). Meta-regression confirmed consultation volume as a significant predictor of pooled effect size.
Conclusions
Vascular surgeons play a crucial role in interdisciplinary health care and are a valuable financial resource in medical services. Their participation improves surgical results, decreases complications, and enhances hospital profitability. It is essential to strategically incorporate and acknowledge vascular surgery within multidisciplinary teams and institutional planning to optimize patient care, revenue generation, and system efficiency.
{"title":"The value of vascular surgeons in modern health care systems: A systematic review and meta-analysis","authors":"Luis Morales Ojeda MD , Stefania Montero Arcila MD , Victor Andrade Nunes MD , Cristiano Marciano Duarte BA , Melina Papi MD , Donald L. Jacobs MD, MSC , Emily A. Malgor MD , Rafael D. Malgor MD, MBA","doi":"10.1016/j.jvs.2025.07.062","DOIUrl":"10.1016/j.jvs.2025.07.062","url":null,"abstract":"<div><h3>Background</h3><div>Vascular surgeons are crucial in modern health care, offering indispensable support across surgical services. Despite their clinical and economic contributions, their full value often goes unrecognized. This systematic review and meta-analysis aimed to assess the interdisciplinary and financial impact of vascular surgeons within contemporary health care systems.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in August 2024 across MEDLINE, PubMed, the Cochrane Vascular Registers, and other databases. The studies included randomized controlled trials, cohort studies, and economic evaluations published from 2010 onward. Dual reviewer screening and data extraction followed PRISMA guidelines, and the study protocol was registered with PROSPERO (CRD42024589273). Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analyses employed random effects models, with heterogeneity assessed via I<sup>2</sup> and Cochran's Q tests.</div></div><div><h3>Results</h3><div>Of 3031 screened records, 29 studies involving 6557 patients met the inclusion criteria. Vascular surgery consultations were most frequently requested by emergency medicine (15.3%), orthopedics (14.1%), trauma (12.2%), and neurosurgery (10.1%). Hemorrhage control (16.4%) and ischemia (14.1%) were the primary reasons for consultations. Vascular surgeons performed 928 procedures, predominantly primary repairs (49.2%) and graft placements (17.7%). Multidisciplinary collaboration, particularly in surgical oncology and podiatry, significantly improved outcomes, including revascularization success in cases of acute limb ischemia and intraoperative arterial injuries (94%), decreased amputation rates, and enhanced margin-negative resections. Financial analyses revealed that vascular surgery contributes substantial work relative value units (wRVUs) and revenue, with some services generating >$130 million over 5 years. Meta-analysis identified pooled consultation proportions of 22% among urology, orthopedics, and general surgery, with significant heterogeneity (I<sup>2</sup> = 98.7%). Meta-regression confirmed consultation volume as a significant predictor of pooled effect size.</div></div><div><h3>Conclusions</h3><div>Vascular surgeons play a crucial role in interdisciplinary health care and are a valuable financial resource in medical services. Their participation improves surgical results, decreases complications, and enhances hospital profitability. It is essential to strategically incorporate and acknowledge vascular surgery within multidisciplinary teams and institutional planning to optimize patient care, revenue generation, and system efficiency.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 933-951"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409129","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 : 2026-03-01Epub Date: 2025-11-11DOI: 10.1016/j.jvs.2025.11.004
Maram Abuajamieh MBBCh , Mohammed S. Beshr MBBS , Abdelaziz H. Salama MD , Dua Rajab Khalleefah MBBCh , Eman Basheer MBBCh , Maram Darwish MD , David C. Bosanquet MD , Muhammed Elhadi MBBCh, MSC
Objective
This meta-analysis compares clinical outcomes and procedural complications of endovascular vs open surgical techniques for the treatment of acute limb ischemia.
Methods
PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception to March 1, 2025. Studies comparing endovascular interventions with open surgical techniques for acute limb ischemia were included. Primary outcomes were amputation and mortality rates (early and long term). Secondary outcomes included reintervention, 30-day technical success, hospital stay, and procedural complications. Risk ratios (RRs) and mean differences were calculated using a random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A P value of <.05 was considered statistically significant.
Results
Twenty-six studies (4 randomized controlled trials and 22 cohort studies) involving 214,683 patients were included. No significant differences were observed in early amputation rates (RR, 0.93; 95% CI, 0.80-1.09; P = .39; GRADE, very low) or long-term amputation rates. Early mortality (RR, 0.75; 95% CI, 0.56-0.99; P = .05; GRADE, very low) and 6-month mortality (RR, 1.37; 95% CI, 0.70-2.70; P = .45; GRADE, very low) were also similar. However, long-term mortality was significantly lower with the endovascular group at 1, 2, 3, 4, and 5 years. Technical success and 30-day reintervention rates were comparable. Hospital stay was shorter with endovascular treatment (mean difference, −2.43 days; 95% CI, −3.84 to −1.02; GRADE, low). Myocardial infarction, stroke, fasciotomy, and nonintracranial bleeding were similar between groups. However, endovascular therapy was associated with higher intracranial hemorrhage (RR, 1.89; 95% confidence interval, 1.13-3.15; GRADE, low) and lower infection rates (RR, 0.33; 95% CI, 0.15-0.73; GRADE, moderate).
Conclusions
Endovascular and open revascularization yielded comparable early outcomes. Endovascular treatment offered modest improvements in long-term survival, shorter hospital stays, and fewer infections, but with an increased risk of intracranial hemorrhage. Given the heterogeneity and limited number of randomized trials, further high-quality evidence is needed.
目的：本荟萃分析比较了血管内与开放手术技术治疗急性肢体缺血（ALI）的临床结果和手术并发症。方法：检索PubMed， Embase, Cochrane Library， Scopus和ClinicalTrials.gov从成立到2025年3月1日。比较血管内介入和开放手术技术治疗ALI的研究被纳入。主要结局是截肢和死亡率（早期和长期）。次要结局包括再干预、30天技术成功、住院时间和手术并发症。采用随机效应模型计算风险比（rr）和平均差异（md）。使用GRADE框架评估证据的确定性。P值< 0.05为差异有统计学意义。结果：纳入26项研究（4项随机对照试验和22个队列），涉及214,683例患者。早期截肢率和长期截肢率无显著差异（RR 0.93, 95% CI 0.80-1.09, p 0.39； GRADE：非常低）。早期死亡率（RR 0.75, 95% CI 0.56-0.99, p 0.05； GRADE：非常低）和6个月死亡率（RR 1.37, 95% CI 0.70-2.70, p 0.45； GRADE：非常低）也相似。然而，血管内组在1、2、3、4和5年时的长期死亡率明显较低。技术成功率与30天再干预率相当。血管内治疗的住院时间较短（MD -2.43天，95% CI -3.84至-1.02；分级：低）。心肌梗死、脑卒中、筋膜切开术和非颅内出血在两组间相似。然而，血管内治疗与较高的颅内出血（RR 1.89, 95% CI 1.13-3.15； GRADE：低）和较低的感染率（RR 0.33, 95% CI 0.15-0.73； GRADE：中等）相关。结论：血管内和开放血管重建术的早期结果相当。血管内治疗在长期生存、缩短住院时间和减少感染方面有一定的改善，但颅内出血的风险增加。考虑到异质性和有限数量的随机试验，需要进一步的高质量证据。报名：普洛斯彼罗：CRD42024628586。
{"title":"Endovascular versus open surgical approach in patients with acute limb ischemia: A systematic review and meta-analysis","authors":"Maram Abuajamieh MBBCh , Mohammed S. Beshr MBBS , Abdelaziz H. Salama MD , Dua Rajab Khalleefah MBBCh , Eman Basheer MBBCh , Maram Darwish MD , David C. Bosanquet MD , Muhammed Elhadi MBBCh, MSC","doi":"10.1016/j.jvs.2025.11.004","DOIUrl":"10.1016/j.jvs.2025.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>This meta-analysis compares clinical outcomes and procedural complications of endovascular vs open surgical techniques for the treatment of acute limb ischemia.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Cochrane Library, Scopus, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> were searched from inception to March 1, 2025. Studies comparing endovascular interventions with open surgical techniques for acute limb ischemia were included. Primary outcomes were amputation and mortality rates (early and long term). Secondary outcomes included reintervention, 30-day technical success, hospital stay, and procedural complications. Risk ratios (RRs) and mean differences were calculated using a random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A <em>P</em> value of <.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Twenty-six studies (4 randomized controlled trials and 22 cohort studies) involving 214,683 patients were included. No significant differences were observed in early amputation rates (RR, 0.93; 95% CI, 0.80-1.09; <em>P</em> = .39; GRADE, very low) or long-term amputation rates. Early mortality (RR, 0.75; 95% CI, 0.56-0.99; <em>P</em> = .05; GRADE, very low) and 6-month mortality (RR, 1.37; 95% CI, 0.70-2.70; <em>P</em> = .45; GRADE, very low) were also similar. However, long-term mortality was significantly lower with the endovascular group at 1, 2, 3, 4, and 5 years. Technical success and 30-day reintervention rates were comparable. Hospital stay was shorter with endovascular treatment (mean difference, −2.43 days; 95% CI, −3.84 to −1.02; GRADE, low). Myocardial infarction, stroke, fasciotomy, and nonintracranial bleeding were similar between groups. However, endovascular therapy was associated with higher intracranial hemorrhage (RR, 1.89; 95% confidence interval, 1.13-3.15; GRADE, low) and lower infection rates (RR, 0.33; 95% CI, 0.15-0.73; GRADE, moderate).</div></div><div><h3>Conclusions</h3><div>Endovascular and open revascularization yielded comparable early outcomes. Endovascular treatment offered modest improvements in long-term survival, shorter hospital stays, and fewer infections, but with an increased risk of intracranial hemorrhage. Given the heterogeneity and limited number of randomized trials, further high-quality evidence is needed.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 826-838.e24"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513181","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 : 2026-03-01Epub Date: 2025-11-12DOI: 10.1016/j.jvs.2025.11.003
Camila Esquetini-Vernon MD , Camilo Polania-Sandoval MD , James F. Meschia MD , Tara Brigham MLIS , Josephine Huang MD , Kevin M. Barrett MD , Christopher W. Fox MD , David A. Miller MD , Christopher Jacobs MD , Richard D. Beegle MD , Houssam Farres MD , Sukhwinder J.S. Sandhu MD , Young Erben MD
<div><h3>Objective</h3><div>To evaluate the association between 3.0 T Magnetic resonance angiography with vessel wall imaging (MRA-VWI) detected vulnerable plaque features and the risk of symptomatic presentation and first-ever neurovascular events.</div></div><div><h3>Methods</h3><div>This study followed PRISMA guidelines and was registered in PROSPERO. We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, Epistemonikos, and the gray literature up to July 2024. Eligible studies included five or more adult patients undergoing 3.0 T MRA-VWI for carotid plaque characterization with reporting outcomes of stroke or transient ischemic attack. Exclusion criteria were recurrent or post-revascularization events, animal studies, and reviews. Data were extracted from cross-sectional, case-control, and prospective cohort studies. Pooled odds ratios (OR) were recorded for symptomatic presentation, and hazard ratios (HR) for incident first-ever events. Random-effects models were applied, and heterogeneity was assessed using I<sup>2</sup>. A parallel analysis was performed for cohort studies to assess incident risk of asymptomatic patients including 1.5 T and 3.0 T strength fields.</div></div><div><h3>Results</h3><div>Thirteen studies met the inclusion criteria, of which 11 contributed to the quantitative analysis. In unadjusted meta-analyses of 3.0 T case-control/cross-sectional studies, type VI plaques (including intraplaque hemorrhage [IPH], ruptured cap, or surface thrombus) showed a strong association with symptoms (pooled OR, 5.03; 95% confidence interval [CI], 3.22-7.85; I<sup>2</sup> = 0%), as did IPH with or without thrombus (OR, 5.31; 95% CI, 3.10-9.11; I<sup>2</sup> = 8%) and IPH alone (OR, 4.88; 95% CI, 1.90-12.50; I<sup>2</sup> = 43.6%). Ruptured fibrous cap showed a large but nonsignificant association unadjusted (OR, 4.59; 95% CI, 0.77-27.32; I<sup>2</sup> = 15.2%), and type IV/V plaques showed no association (OR, 0.50; 95% CI, 0.12-2.01; I<sup>2</sup> = 6.6%). After adjustment, the associations remained and were significant for type VI (pooled adjusted OR, 3.56; 95% CI, 2.04-6.24; I<sup>2</sup> = 0%), IPH with or without thrombus (OR, 4.92; 95% CI, 1.56-15.53; I<sup>2</sup> = 19.8%), and ruptured cap (OR, 2.85; 95% CI, 2.28-3.56; I<sup>2</sup> = 0%); IPH alone remained strong but imprecise (OR, 5.36; 95% CI, 0.56-51.46; I<sup>2</sup> = 43.5%). In the parallel analysis, results remained consistent after including three additional cohorts of 1.5 T with one of 3.0 T, as type VI (pooled HR, 3.61; 95% CI, 2.32-5.62; I<sup>2</sup> = 0.4%) and IPH (HR, 3.51; 95% CI, 2.42-5.10; I<sup>2</sup> = 0%) predicted first-ever events in both 1.5 T and 3.0 T strength fields. Lipid-rich necrotic core was inconsistent and overall nonsignificant with high heterogeneity (HR, 2.38; 95% CI, 0.15-38.76; I<sup>2</sup> = 65.8%).</div></div><div><h3>Conclusions</h3><div>We found the3.0 T MRA-VWI detection of vulnerable plaque was consistently associated wit
{"title":"Magnetic resonance angiography-detected vulnerable plaque features at 3.0 T field strength are associated with symptomatic presentation in carotid artery disease: A systematic review and meta-analysis","authors":"Camila Esquetini-Vernon MD , Camilo Polania-Sandoval MD , James F. Meschia MD , Tara Brigham MLIS , Josephine Huang MD , Kevin M. Barrett MD , Christopher W. Fox MD , David A. Miller MD , Christopher Jacobs MD , Richard D. Beegle MD , Houssam Farres MD , Sukhwinder J.S. Sandhu MD , Young Erben MD","doi":"10.1016/j.jvs.2025.11.003","DOIUrl":"10.1016/j.jvs.2025.11.003","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between 3.0 T Magnetic resonance angiography with vessel wall imaging (MRA-VWI) detected vulnerable plaque features and the risk of symptomatic presentation and first-ever neurovascular events.</div></div><div><h3>Methods</h3><div>This study followed PRISMA guidelines and was registered in PROSPERO. We systematically searched MEDLINE, Embase, CENTRAL, Web of Science, Epistemonikos, and the gray literature up to July 2024. Eligible studies included five or more adult patients undergoing 3.0 T MRA-VWI for carotid plaque characterization with reporting outcomes of stroke or transient ischemic attack. Exclusion criteria were recurrent or post-revascularization events, animal studies, and reviews. Data were extracted from cross-sectional, case-control, and prospective cohort studies. Pooled odds ratios (OR) were recorded for symptomatic presentation, and hazard ratios (HR) for incident first-ever events. Random-effects models were applied, and heterogeneity was assessed using I<sup>2</sup>. A parallel analysis was performed for cohort studies to assess incident risk of asymptomatic patients including 1.5 T and 3.0 T strength fields.</div></div><div><h3>Results</h3><div>Thirteen studies met the inclusion criteria, of which 11 contributed to the quantitative analysis. In unadjusted meta-analyses of 3.0 T case-control/cross-sectional studies, type VI plaques (including intraplaque hemorrhage [IPH], ruptured cap, or surface thrombus) showed a strong association with symptoms (pooled OR, 5.03; 95% confidence interval [CI], 3.22-7.85; I<sup>2</sup> = 0%), as did IPH with or without thrombus (OR, 5.31; 95% CI, 3.10-9.11; I<sup>2</sup> = 8%) and IPH alone (OR, 4.88; 95% CI, 1.90-12.50; I<sup>2</sup> = 43.6%). Ruptured fibrous cap showed a large but nonsignificant association unadjusted (OR, 4.59; 95% CI, 0.77-27.32; I<sup>2</sup> = 15.2%), and type IV/V plaques showed no association (OR, 0.50; 95% CI, 0.12-2.01; I<sup>2</sup> = 6.6%). After adjustment, the associations remained and were significant for type VI (pooled adjusted OR, 3.56; 95% CI, 2.04-6.24; I<sup>2</sup> = 0%), IPH with or without thrombus (OR, 4.92; 95% CI, 1.56-15.53; I<sup>2</sup> = 19.8%), and ruptured cap (OR, 2.85; 95% CI, 2.28-3.56; I<sup>2</sup> = 0%); IPH alone remained strong but imprecise (OR, 5.36; 95% CI, 0.56-51.46; I<sup>2</sup> = 43.5%). In the parallel analysis, results remained consistent after including three additional cohorts of 1.5 T with one of 3.0 T, as type VI (pooled HR, 3.61; 95% CI, 2.32-5.62; I<sup>2</sup> = 0.4%) and IPH (HR, 3.51; 95% CI, 2.42-5.10; I<sup>2</sup> = 0%) predicted first-ever events in both 1.5 T and 3.0 T strength fields. Lipid-rich necrotic core was inconsistent and overall nonsignificant with high heterogeneity (HR, 2.38; 95% CI, 0.15-38.76; I<sup>2</sup> = 65.8%).</div></div><div><h3>Conclusions</h3><div>We found the3.0 T MRA-VWI detection of vulnerable plaque was consistently associated wit","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 747-758.e2"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513187","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 : 2026-03-01Epub Date: 2025-11-14DOI: 10.1016/j.jvs.2025.11.013
Hassan Chamseddine MD , Mouhammad Halabi MD , Hadi Hamdan MD , Loay Kabbani MD , Jeffrey L. Johnson MD , Anthony Falvo DO , Timothy Nypaver MD , Mitchell Weaver MD , Andi Peshkepija MD , Kevin Onofrey MD , Yasaman Kavousi MD , Alexander Shepard MD
<div><h3>Objective</h3><div>Acute mesenteric ischemia (AMI) is a highly lethal presentation associated with significant perioperative morbidity. Unlike other acute cardiovascular emergencies, outcomes of AMI have shown minimal improvement over time. Among the strategies explored to decrease AMI-related mortality, early diagnosis and prompt surgical revascularization remain most critical for improving both short- and long-term AMI outcomes. This study aims to investigate the impact of time from acute symptom onset to operative intervention on AMI outcomes.</div></div><div><h3>Methods</h3><div>All patients who underwent revascularization for AMI between January 2014 and December 2024 at our quaternary medical center were identified. AMI was defined as mesenteric ischemia with acute symptom onset of ≤2 weeks duration. Patients with AMI secondary to mechanical bowel obstruction, trauma, aortic dissection, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia were excluded. Patients were then categorized and compared based on the time interval from acute symptom onset to revascularization, etiology of AMI, and revascularization strategy. Kaplan-Meier and Cox regression analyses were used to estimate long-term event rates and evaluate the independent association between exposure variables and long-term outcomes or survival, AMI recurrence, and reintervention.</div></div><div><h3>Results</h3><div>There were 92 patients who met the inclusion criteria. An inflection point at 48 hours was identified (sensitivity 81%, specificity 63%), where patients treated >48 hours after symptom onset had significantly higher rates of perioperative mortality (39% vs 14%; <em>P</em> = .012) and short bowel syndrome (39% vs 12%; <em>P</em> = .002) compared with patients treated within 48 hours of symptom onset. Revascularization >48 hours after acute symptom onset was also associated with higher long-term mortality (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.43-6.07; <em>P</em> = .003), AMI recurrence (HR, 6.36; 95% CI, 1.59-25.38; <em>P</em> = .009), and reintervention (HR, 3.89; 95% CI, 1.22-12.36; <em>P</em> = .021) compared with revascularization within 48 hours. AMI secondary to acute thrombosis was associated with an increased risk of AMI recurrence (HR, 5.97; 95% CI, 1.05-25.38; <em>P</em> = .048) and reintervention (HR, 8.02; 95% CI, 1.04-61.95; <em>P</em> = .046) compared with embolic AMI, with no difference observed in long-term mortality (HR, 0.79; 95% CI, 0.34-1.82; <em>P</em> = .577). No difference was observed between open and endovascular/retrograde open mesenteric stenting revascularization in long-term mortality (<em>P</em> = .344), AMI recurrence (<em>P</em> = .268), and reintervention (<em>P</em> = .685). Significant predictors of perioperative mortality were age (<em>P</em> = .049), time from acute symptom onset to revascularization >48 hours (<em>P</em> = .021), and lactate level at presentation (<em>P</em> = .029).</
目的：急性肠系膜缺血（AMI）是一种高致死率的疾病，其围手术期发病率很高。与其他急性心血管急症不同，AMI的预后随着时间的推移几乎没有改善。在降低AMI相关死亡率的策略中，早期诊断和及时的手术血运重建术对于改善短期和长期AMI预后仍然是最关键的。本研究旨在探讨从急性症状出现到手术干预的时间对AMI预后的影响。方法：选取2014年1月至2024年12月在我院第四医学中心接受AMI血运重建术的所有患者。AMI定义为肠系膜缺血，急性症状发作时间≤2周。AMI继发于机械性肠梗阻、外伤、主动脉夹层、肠系膜静脉血栓形成或非闭塞性肠系膜缺血的患者被排除在外。然后根据急性症状发作到血运重建的时间间隔、AMI病因和血运重建策略对患者进行分类和比较。Kaplan Meier和cox回归分析用于估计长期事件发生率，并评估暴露变量与长期结果或生存率、AMI复发和再干预之间的独立关联。结果：92例患者符合纳入标准。确定了48小时的拐点（敏感性81%，特异性63%），与症状出现48小时内治疗的患者相比，在症状出现48小时内治疗的患者围手术期死亡率（39%对14%，p=0.012）和短肠综合征（39%对12%，p=0.002）的发生率显着更高。与48小时内血管重建相比，急性症状出现48小时后进行血运重建术也与更高的长期死亡率（HR 2.95, 95% CI 1.43-6.07, p=0.003）、AMI复发（HR 6.36, 95% CI 1.59-25.38, p=0.009）和再干预（HR 3.89, 95% CI 1.22-12.36, p=0.021）相关。与栓塞性AMI相比，急性血栓性AMI继发与AMI复发（HR 5.97, 95% CI 1.05-25.38, p=0.048）和再干预（HR 8.02, 95% CI 1.04-61.95, p=0.046）的风险增加相关，长期死亡率无差异（HR 0.79, 95% CI 0.34-1.82, p=0.577）。在长期死亡率（p=0.344）、AMI复发率（p=0.268）和再干预（p=0.685）方面，开放和血管内/逆行开放肠系膜支架（ROMS）重建术无差异。围手术期死亡率的重要预测因素是年龄（p=0.049）、从急性症状出现到血运重建的时间（p=0.021）和就诊时的乳酸水平（p=0.029）。结论：及时诊断、及时血运重建可获得最佳预后。根据我们的经验，在48小时内进行诊断和干预可以降低死亡率、复发、再干预、肠切除术和短肠综合征，并提高患者的总体预后。AMI的病因和治疗策略对短期预后没有影响，尽管与栓塞性AMI相比，急性血栓形成与AMI复发和再干预风险增加相关，但长期死亡率没有差异。
{"title":"The impact of intervention timing, etiology, and revascularization strategy on acute mesenteric ischemia outcomes","authors":"Hassan Chamseddine MD , Mouhammad Halabi MD , Hadi Hamdan MD , Loay Kabbani MD , Jeffrey L. Johnson MD , Anthony Falvo DO , Timothy Nypaver MD , Mitchell Weaver MD , Andi Peshkepija MD , Kevin Onofrey MD , Yasaman Kavousi MD , Alexander Shepard MD","doi":"10.1016/j.jvs.2025.11.013","DOIUrl":"10.1016/j.jvs.2025.11.013","url":null,"abstract":"<div><h3>Objective</h3><div>Acute mesenteric ischemia (AMI) is a highly lethal presentation associated with significant perioperative morbidity. Unlike other acute cardiovascular emergencies, outcomes of AMI have shown minimal improvement over time. Among the strategies explored to decrease AMI-related mortality, early diagnosis and prompt surgical revascularization remain most critical for improving both short- and long-term AMI outcomes. This study aims to investigate the impact of time from acute symptom onset to operative intervention on AMI outcomes.</div></div><div><h3>Methods</h3><div>All patients who underwent revascularization for AMI between January 2014 and December 2024 at our quaternary medical center were identified. AMI was defined as mesenteric ischemia with acute symptom onset of ≤2 weeks duration. Patients with AMI secondary to mechanical bowel obstruction, trauma, aortic dissection, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia were excluded. Patients were then categorized and compared based on the time interval from acute symptom onset to revascularization, etiology of AMI, and revascularization strategy. Kaplan-Meier and Cox regression analyses were used to estimate long-term event rates and evaluate the independent association between exposure variables and long-term outcomes or survival, AMI recurrence, and reintervention.</div></div><div><h3>Results</h3><div>There were 92 patients who met the inclusion criteria. An inflection point at 48 hours was identified (sensitivity 81%, specificity 63%), where patients treated >48 hours after symptom onset had significantly higher rates of perioperative mortality (39% vs 14%; <em>P</em> = .012) and short bowel syndrome (39% vs 12%; <em>P</em> = .002) compared with patients treated within 48 hours of symptom onset. Revascularization >48 hours after acute symptom onset was also associated with higher long-term mortality (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.43-6.07; <em>P</em> = .003), AMI recurrence (HR, 6.36; 95% CI, 1.59-25.38; <em>P</em> = .009), and reintervention (HR, 3.89; 95% CI, 1.22-12.36; <em>P</em> = .021) compared with revascularization within 48 hours. AMI secondary to acute thrombosis was associated with an increased risk of AMI recurrence (HR, 5.97; 95% CI, 1.05-25.38; <em>P</em> = .048) and reintervention (HR, 8.02; 95% CI, 1.04-61.95; <em>P</em> = .046) compared with embolic AMI, with no difference observed in long-term mortality (HR, 0.79; 95% CI, 0.34-1.82; <em>P</em> = .577). No difference was observed between open and endovascular/retrograde open mesenteric stenting revascularization in long-term mortality (<em>P</em> = .344), AMI recurrence (<em>P</em> = .268), and reintervention (<em>P</em> = .685). Significant predictors of perioperative mortality were age (<em>P</em> = .049), time from acute symptom onset to revascularization >48 hours (<em>P</em> = .021), and lactate level at presentation (<em>P</em> = .029).</","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 718-728.e4"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534676","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 : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.jvs.2025.10.029
Christina W. Zhou PhD, MS , Margaret Hoch BA , Nikki L.B. Freeman PhD, MA , Matthew T. Menard MD , Alik Farber MD, MBA , Jayer Chung MD, MSc , Michael R. Kosorok PhD , Katharine L. McGinigle MD, MPH
<div><h3>Background</h3><div>Chronic limb-threatening ischemia (CLTI), the most severe form of peripheral artery disease, is associated with a high risk of limb loss. CLTI clinical presentation is highly heterogeneous, ranging from neuropathic ulcers with only mild to moderate ischemia to gangrene resulting from severe ischemia. Understanding the etiology and limb- and systemic-based disease patterns, as well as differential procedural risks and outcomes, is pivotal for making treatment choices over the course of this chronic disease. In other words, accurate staging (and restaging over time) of CLTI that includes limb-based and systemic features is needed to improve the treatment decision-making process and clinical outcomes. Precision medicine analytics can integrate and synthesize multimodal data, in this case anatomy data alongside comorbidities and physical examination findings, offering a more complete staging system from which to make nuanced treatment decisions well-tailored to patient-specific risks.</div></div><div><h3>Methods</h3><div>Using data from the BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) international randomized controlled trial, we used supervised latent topic modeling to identify clusters of patient features associated with amputation-free survival after stratifying for each assigned revascularization type. Patients were assigned to the cluster they belonged to with highest probability; clusters were characterized by analyzing the characteristics of patients within them. Although the clusters were not naturally ordinal, we subsequently organized them to mirror stages of disease progression for clearer clinical interpretation.</div></div><div><h3>Results</h3><div>Based on patient- and limb-focused characteristics, we identified three distinct clusters as disease stages. Across the three stages, rates of 2-year mortality were 11.59%, 20.91%, and 24.73% and rates of 2-year amputation-free survival were 83.26%, 70.03%, and 65.82%, respectively, for patients undergoing open bypass. Patients receiving endovascular therapy had 2-year mortality rates of 15.88%, 22.62%, and 20.32% and 2-year amputation-free survival rates of 77.98%, 66.06%, and 67.74%, respectively, for stages 1, 2, and 3. Stage 1 generally included patients who were less likely to have wounds, diabetes, and renal disease. Stage 2 was primarily driven by diabetes and some foot infection. Stage 3 is characterized by high rates of comorbidities, particularly end-stage renal disease and diabetes, as well as higher Wound, Ischemia, and foot Infection grades.</div></div><div><h3>Conclusions</h3><div>We identified three distinct stages of CLTI using precision medicine methods. The results from this analysis of the BEST-CLI randomized clinical trial dataset are consistent with previous findings in other cohorts. Future research focused on tailored treatment algorithms for each specific stage of CLTI is warranted.</div></div
{"title":"Using precision medicine methods to identify disease stages for chronic limb-threatening ischemia in participants of the BEST-CLI trial","authors":"Christina W. Zhou PhD, MS , Margaret Hoch BA , Nikki L.B. Freeman PhD, MA , Matthew T. Menard MD , Alik Farber MD, MBA , Jayer Chung MD, MSc , Michael R. Kosorok PhD , Katharine L. McGinigle MD, MPH","doi":"10.1016/j.jvs.2025.10.029","DOIUrl":"10.1016/j.jvs.2025.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Chronic limb-threatening ischemia (CLTI), the most severe form of peripheral artery disease, is associated with a high risk of limb loss. CLTI clinical presentation is highly heterogeneous, ranging from neuropathic ulcers with only mild to moderate ischemia to gangrene resulting from severe ischemia. Understanding the etiology and limb- and systemic-based disease patterns, as well as differential procedural risks and outcomes, is pivotal for making treatment choices over the course of this chronic disease. In other words, accurate staging (and restaging over time) of CLTI that includes limb-based and systemic features is needed to improve the treatment decision-making process and clinical outcomes. Precision medicine analytics can integrate and synthesize multimodal data, in this case anatomy data alongside comorbidities and physical examination findings, offering a more complete staging system from which to make nuanced treatment decisions well-tailored to patient-specific risks.</div></div><div><h3>Methods</h3><div>Using data from the BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) international randomized controlled trial, we used supervised latent topic modeling to identify clusters of patient features associated with amputation-free survival after stratifying for each assigned revascularization type. Patients were assigned to the cluster they belonged to with highest probability; clusters were characterized by analyzing the characteristics of patients within them. Although the clusters were not naturally ordinal, we subsequently organized them to mirror stages of disease progression for clearer clinical interpretation.</div></div><div><h3>Results</h3><div>Based on patient- and limb-focused characteristics, we identified three distinct clusters as disease stages. Across the three stages, rates of 2-year mortality were 11.59%, 20.91%, and 24.73% and rates of 2-year amputation-free survival were 83.26%, 70.03%, and 65.82%, respectively, for patients undergoing open bypass. Patients receiving endovascular therapy had 2-year mortality rates of 15.88%, 22.62%, and 20.32% and 2-year amputation-free survival rates of 77.98%, 66.06%, and 67.74%, respectively, for stages 1, 2, and 3. Stage 1 generally included patients who were less likely to have wounds, diabetes, and renal disease. Stage 2 was primarily driven by diabetes and some foot infection. Stage 3 is characterized by high rates of comorbidities, particularly end-stage renal disease and diabetes, as well as higher Wound, Ischemia, and foot Infection grades.</div></div><div><h3>Conclusions</h3><div>We identified three distinct stages of CLTI using precision medicine methods. The results from this analysis of the BEST-CLI randomized clinical trial dataset are consistent with previous findings in other cohorts. Future research focused on tailored treatment algorithms for each specific stage of CLTI is warranted.</div></div","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 784-792.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409135","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 : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/S0741-5214(26)00015-7
{"title":"Information for Readers","authors":"","doi":"10.1016/S0741-5214(26)00015-7","DOIUrl":"10.1016/S0741-5214(26)00015-7","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page A12"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172607","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}
Solid tumors with vascular involvement in pediatric patients are challenging to address. They are rare with limited data to guide treatment recommendations. Multidisciplinary management with a pediatric oncologist, pediatric surgeon, vascular surgeon and on occasion cardiac surgeon is paramount. Below, we review the scope of this problem in specific for treatment of Wilms tumor, hepatoblastoma, hepatocellular carcinoma, neuroblastoma, and sarcoma with involvement of the adjoining major vascular structures. Included in this manuscript is the role of vascular reconstruction principles as it applies to pediatric patients. We highlight the importance of individualized treatment plans taking into consideration the nature of the tumor, histology, and extent of disease; the role of neoadjuvant therapy in minimizing extent of resection; and discuss the variety of options that exist for vascular reconstruction.
{"title":"Interdisciplinary vascular reconstructive considerations for pediatric tumors","authors":"Alyssa Stetson MD, MPH , Ashley Gutwein MD , Alexander Bondoc MD , Roshni Dasgupta MD, MPH , John Maijub MD , Greg Tiao MD , Raghu Motaganahalli MD","doi":"10.1016/j.jvs.2025.10.035","DOIUrl":"10.1016/j.jvs.2025.10.035","url":null,"abstract":"<div><div>Solid tumors with vascular involvement in pediatric patients are challenging to address. They are rare with limited data to guide treatment recommendations. Multidisciplinary management with a pediatric oncologist, pediatric surgeon, vascular surgeon and on occasion cardiac surgeon is paramount. Below, we review the scope of this problem in specific for treatment of Wilms tumor, hepatoblastoma, hepatocellular carcinoma, neuroblastoma, and sarcoma with involvement of the adjoining major vascular structures. Included in this manuscript is the role of vascular reconstruction principles as it applies to pediatric patients. We highlight the importance of individualized treatment plans taking into consideration the nature of the tumor, histology, and extent of disease; the role of neoadjuvant therapy in minimizing extent of resection; and discuss the variety of options that exist for vascular reconstruction.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 920-932"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426911","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 : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.jvs.2025.12.338
A.L. Maia, E.M. Lins, F.A. Rocha, L.C. Mahnke, F.C.M. Pinto, T. de Oliveira Pereira, M.V. Neves, S.B. Palácio, K.V.S. Hodel, J.D.V. Barbosa, S.O. Penello, J.G.M. da Silva, J.L.A. Aguiar
{"title":"Application of bacterial cellulose film as a wound dressing in varicose vein surgery: A randomized clinical trial","authors":"A.L. Maia, E.M. Lins, F.A. Rocha, L.C. Mahnke, F.C.M. Pinto, T. de Oliveira Pereira, M.V. Neves, S.B. Palácio, K.V.S. Hodel, J.D.V. Barbosa, S.O. Penello, J.G.M. da Silva, J.L.A. Aguiar","doi":"10.1016/j.jvs.2025.12.338","DOIUrl":"10.1016/j.jvs.2025.12.338","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page A17"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172609","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 : 2026-03-01Epub Date: 2025-10-28DOI: 10.1016/j.jvs.2025.10.026
Mina Abdelmalak MBChB, MSc, FRCS , Louise M. Finch MBChB, MPhil, MRCS , Haydn Richards MBChB , Mark Tawadrous MBChB , Ragai Makar MBChB, MSc, MD, FRCS
Objective
To evaluate clinical and anatomical factors associated with failure of below-knee amputation (BKA) resulting in revision to a higher level amputation, with the aim of identifying predictors of stump healing and reducing the need for reoperation.
Methods
This retrospective single-center study included all patients who underwent a BKA between April 2014 and October 2021 for peripheral vascular disease excluding other etiologies, such as burns, trauma, or malignancy. Patients were stratified into two groups based on whether revision surgery was required. Demographic characteristics, clinical indications, prior revascularization, arterial imaging, laboratory parameters, and inpatient outcomes were compared between groups. The primary outcome was the need for revision surgery. Statistical analyses were performed using Fisher's exact test for categorical variables and Mann-Whitney U test or t test for continuous variables. Significance was set at a P value of <.05.
Results
A total of 212 patients underwent BKA during the study period using long posterior flaps. Of these, 48 patients (22.6%) required revision surgery, predominantly to above-knee amputation (73%). No significant differences in age, gender, comorbidities, or smoking status were observed between groups. Indications for initial BKA were comparable; however, patients with uncontrolled infection as the primary indication had a significantly lower revision rate (15% vs 30%; P = .04). Revascularization procedures were performed in 42% of patients but were not associated with revision risk. Arterial patency was a key differentiator. Patent profunda femoris artery (PFA) and common iliac artery were significantly more prevalent in the healed group (PFA, 73% vs 35% [P < .0001]; common iliac artery, 84% vs 58% [P = .0003]). A diseased or occluded PFA was significantly more common in patients requiring revision. Unexpectedly, superficial femoral artery occlusion was more common in the healed group (27% vs 8%; P = .006), suggesting collateral-dependent perfusion. Preoperative blood parameters did not correlate with healing. Length of hospital stay was significantly longer in the revision group (31 days vs 22 days; P = .0017).
Conclusions
Approximately one in four patients undergoing BKA required revision. Patency of the PFA emerged as the strongest predictor of stump healing, highlighting the importance of preoperative vascular assessment. Consideration should be given to performing profundoplasty before BKA in cases with compromised profunda flow to improve outcomes and reduce the need for higher-level amputations.
目的：评估与膝下截肢（BKA）失败导致更高水平截肢相关的临床和解剖学因素，旨在确定残端愈合的预测因素并减少再次手术的需要。方法：这项回顾性单中心研究纳入了2014年4月至2021年10月期间因周围血管疾病（不包括烧伤、创伤或恶性肿瘤等其他病因）接受BKA的所有患者。根据是否需要翻修手术将患者分为两组。比较两组患者的人口学特征、临床适应症、既往血运重建、动脉成像、实验室参数和住院结果。主要结果是需要翻修手术。统计分析对分类变量采用Fisher精确检验，对连续变量采用Mann-Whitney U检验或t检验。p < 0.05为显著性。结果：研究期间共有212例患者使用长后瓣进行了BKA。其中，48例（22.6%）患者需要翻修手术，主要是膝关节以上截肢（73%）。各组之间在年龄、性别、合并症或吸烟状况方面无显著差异。初始BKA适应症具有可比性；然而，以感染不受控制为主要指征的患者翻修率明显较低（15%对30%，p = 0.04）。42%的患者进行了血管重建手术，但与翻修风险无关。动脉通畅是一个关键的鉴别指标。股深未闭动脉（PFA）和髂总动脉（CIA）在愈合组中更为普遍（PFA: 73% vs. 35%, p < 0.0001; CIA: 84% vs. 58%, p = 0.0003）。病变或闭塞的PFA在需要翻修的患者中更为常见。出乎意料的是，愈合组的股浅动脉（SFA）闭塞更频繁（27%比8%，p = 0.006），提示侧枝依赖性灌注。术前血液参数与愈合无相关性。改良组住院时间明显更长（31天比22天，p = 0.0017）。结论：大约四分之一的BKA患者需要翻修。PFA通畅成为残端愈合的最强预测指标，强调了术前血管评估的重要性。对于深静脉血流受损的病例，应考虑在BKA之前进行深静脉成形术，以改善结果并减少更高水平截肢的需要。
{"title":"Revision of below-knee amputation stumps to a higher level in patients with peripheral vascular disease","authors":"Mina Abdelmalak MBChB, MSc, FRCS , Louise M. Finch MBChB, MPhil, MRCS , Haydn Richards MBChB , Mark Tawadrous MBChB , Ragai Makar MBChB, MSc, MD, FRCS","doi":"10.1016/j.jvs.2025.10.026","DOIUrl":"10.1016/j.jvs.2025.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate clinical and anatomical factors associated with failure of below-knee amputation (BKA) resulting in revision to a higher level amputation, with the aim of identifying predictors of stump healing and reducing the need for reoperation.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included all patients who underwent a BKA between April 2014 and October 2021 for peripheral vascular disease excluding other etiologies, such as burns, trauma, or malignancy. Patients were stratified into two groups based on whether revision surgery was required. Demographic characteristics, clinical indications, prior revascularization, arterial imaging, laboratory parameters, and inpatient outcomes were compared between groups. The primary outcome was the need for revision surgery. Statistical analyses were performed using Fisher's exact test for categorical variables and Mann-Whitney <em>U</em> test or <em>t</em> test for continuous variables. Significance was set at a <em>P</em> value of <.05.</div></div><div><h3>Results</h3><div>A total of 212 patients underwent BKA during the study period using long posterior flaps. Of these, 48 patients (22.6%) required revision surgery, predominantly to above-knee amputation (73%). No significant differences in age, gender, comorbidities, or smoking status were observed between groups. Indications for initial BKA were comparable; however, patients with uncontrolled infection as the primary indication had a significantly lower revision rate (15% vs 30%; <em>P</em> = .04). Revascularization procedures were performed in 42% of patients but were not associated with revision risk. Arterial patency was a key differentiator. Patent profunda femoris artery (PFA) and common iliac artery were significantly more prevalent in the healed group (PFA, 73% vs 35% [<em>P</em> < .0001]; common iliac artery, 84% vs 58% [<em>P</em> = .0003]). A diseased or occluded PFA was significantly more common in patients requiring revision. Unexpectedly, superficial femoral artery occlusion was more common in the healed group (27% vs 8%; <em>P</em> = .006), suggesting collateral-dependent perfusion. Preoperative blood parameters did not correlate with healing. Length of hospital stay was significantly longer in the revision group (31 days vs 22 days; <em>P</em> = .0017).</div></div><div><h3>Conclusions</h3><div>Approximately one in four patients undergoing BKA required revision. Patency of the PFA emerged as the strongest predictor of stump healing, highlighting the importance of preoperative vascular assessment. Consideration should be given to performing profundoplasty before BKA in cases with compromised profunda flow to improve outcomes and reduce the need for higher-level amputations.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 859-865"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409190","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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