Pub Date : 2026-03-01Epub Date: 2025-10-14DOI: 10.1016/j.jvs.2025.10.011
Silvia Chen BS , Elizabeth Ramirez BS , Blake E. Murphy MD , Anjali Sribalaskandarajah BS , Martin Bunker BS , Joel Kruger MD, MPH , Karina A. Newhall MD, MS , Rebecca A. Sorber MD , Sara L. Zettervall MD, MPH , Matthew P. Sweet MD, MS
<div><h3>Objective</h3><div>Clinical frailty is associated with reduced long-term survival after fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for thoracoabdominal aortic aneurysm.</div></div><div><h3>Methods</h3><div>Patients who underwent F/BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS) was used to determine phenotypic frailty. Patients with a preoperative CFS of ≥4 (vulnerable) and a CFS of <4 were compared. We used χ<sup>2</sup> and Fischer exact tests to compare patient demographics, anatomical and operative characteristics, and perioperative outcomes. Fine-Gray analysis was used to compare cause of death between groups. Long-term survival and reintervention were assessed with Kaplan-Meier and Cox regression analyses.</div></div><div><h3>Results</h3><div>We included 233 patients; 60 (25.8%) had a CFS of ≥4 and 173 (74.2%) had a CFS of <4. Patients with a CFS of ≥4 were more likely to have chronic obstructive pulmonary disease (53% vs 27%) and were treated for slightly larger aneurysms (72 mm vs 68 mm; <em>P</em> = .04). There were no differences in symptomatic presentation, aneurysm extent, or operative complexity between patient groups. Additionally, there were no differences in perioperative complications including 30-day mortality, stroke, and spinal cord ischemia. Patients with a CFS of ≥4 had an increased length of hospitalization (11.3 days vs 6.9 days; <em>P</em> < .01) and were less likely to return to preoperative functional status (62.7% vs 86.1%; <em>P</em> < .01). The 3-year all-cause and aortic-related mortality rates were 35.2% and 5.7%, respectively. Patients with a CFS of ≥4 had a lower survival at 1 year (74% vs 89%), 3 years (39% vs 73%), and 5 years (25% vs 56%), compared with patients with a CFS of <4 (<em>P</em> < .01). The most common causes of death among both groups were pulmonary comorbidities (14.0%), oncologic conditions (14.0%), cardiovascular comorbidities (11.2%), and procedure-related complications (11.2%). Patients with a CFS of ≥4 were more likely to die from aortic-related mortality (10.3% vs 5.9%; <em>P</em> = .02), pulmonary comorbidities (15.4 vs 13.2%; <em>P</em> = .04), systemic decline (7.7% vs 1.5%; <em>P</em> = .02), and infection (12.8% vs 7.4%; <em>P</em> = .03). Aortic-related mortality for the entire patient cohort was 2.2% and 5.7% at 1 year and 3 years, respectively. Aortic-related deaths among clinically frail patients were often due to an inability to tolerate further aortic operations (eg, arch repair), and secondary to follow-up nonadherence in patients with a CFS of <4.</div></div><div><h3>Conclusions</h3><div>In an expanded cohort of patients, clinical frailty was associated with lower long-term survival and an increased risk for aortic-related mortality after F/BEVAR for the tr
{"title":"Increased clinical frailty is associated with aortic-related mortality following fenestrated and branched endovascular repair for thoracoabdominal aortic aneurysm","authors":"Silvia Chen BS , Elizabeth Ramirez BS , Blake E. Murphy MD , Anjali Sribalaskandarajah BS , Martin Bunker BS , Joel Kruger MD, MPH , Karina A. Newhall MD, MS , Rebecca A. Sorber MD , Sara L. Zettervall MD, MPH , Matthew P. Sweet MD, MS","doi":"10.1016/j.jvs.2025.10.011","DOIUrl":"10.1016/j.jvs.2025.10.011","url":null,"abstract":"<div><h3>Objective</h3><div>Clinical frailty is associated with reduced long-term survival after fenestrated and branched endovascular aortic repair (F/BEVAR). This study assesses the impact of phenotypic clinical frailty on perioperative outcomes and cause of death following F/BEVAR for thoracoabdominal aortic aneurysm.</div></div><div><h3>Methods</h3><div>Patients who underwent F/BEVAR at a single institution from 2012 to 2024 were identified. The clinical frailty scale (CFS) was used to determine phenotypic frailty. Patients with a preoperative CFS of ≥4 (vulnerable) and a CFS of <4 were compared. We used χ<sup>2</sup> and Fischer exact tests to compare patient demographics, anatomical and operative characteristics, and perioperative outcomes. Fine-Gray analysis was used to compare cause of death between groups. Long-term survival and reintervention were assessed with Kaplan-Meier and Cox regression analyses.</div></div><div><h3>Results</h3><div>We included 233 patients; 60 (25.8%) had a CFS of ≥4 and 173 (74.2%) had a CFS of <4. Patients with a CFS of ≥4 were more likely to have chronic obstructive pulmonary disease (53% vs 27%) and were treated for slightly larger aneurysms (72 mm vs 68 mm; <em>P</em> = .04). There were no differences in symptomatic presentation, aneurysm extent, or operative complexity between patient groups. Additionally, there were no differences in perioperative complications including 30-day mortality, stroke, and spinal cord ischemia. Patients with a CFS of ≥4 had an increased length of hospitalization (11.3 days vs 6.9 days; <em>P</em> < .01) and were less likely to return to preoperative functional status (62.7% vs 86.1%; <em>P</em> < .01). The 3-year all-cause and aortic-related mortality rates were 35.2% and 5.7%, respectively. Patients with a CFS of ≥4 had a lower survival at 1 year (74% vs 89%), 3 years (39% vs 73%), and 5 years (25% vs 56%), compared with patients with a CFS of <4 (<em>P</em> < .01). The most common causes of death among both groups were pulmonary comorbidities (14.0%), oncologic conditions (14.0%), cardiovascular comorbidities (11.2%), and procedure-related complications (11.2%). Patients with a CFS of ≥4 were more likely to die from aortic-related mortality (10.3% vs 5.9%; <em>P</em> = .02), pulmonary comorbidities (15.4 vs 13.2%; <em>P</em> = .04), systemic decline (7.7% vs 1.5%; <em>P</em> = .02), and infection (12.8% vs 7.4%; <em>P</em> = .03). Aortic-related mortality for the entire patient cohort was 2.2% and 5.7% at 1 year and 3 years, respectively. Aortic-related deaths among clinically frail patients were often due to an inability to tolerate further aortic operations (eg, arch repair), and secondary to follow-up nonadherence in patients with a CFS of <4.</div></div><div><h3>Conclusions</h3><div>In an expanded cohort of patients, clinical frailty was associated with lower long-term survival and an increased risk for aortic-related mortality after F/BEVAR for the tr","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 688-698"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308579","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.2025.11.009
Tze-Woei Tan MBBS, MPH , Kirsten D. Dansey MD, MPH , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Matthew T. Menard MD , Kenneth Rosenfield MD , Michael S. Conte MD , Maarit Venermo MD, PhD , Philippe Kolh MD, PhD , Michael B. Strong MA , Niten Singh MD
<div><h3>Objective</h3><div>To evaluate the incidence and risk factors associated with nonindex limb (NIL) above-ankle amputations among BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) trial participants.</div></div><div><h3>Background</h3><div>BEST-CLI compared endovascular therapy and infrainguinal bypass for patients with chronic limb-threatening ischemia (CLTI), focusing on the ipsilateral index limb. However, it is recognized that peripheral artery disease (PAD) can also impact the contralateral limb. We sought to evaluate the incidence and risk factors associated with NIL above-ankle amputations among BEST-CLI trial participants.</div></div><div><h3>Methods</h3><div>We analyzed data from 1400 participants in BEST-CLI. The primary outcome was the occurrence of above-ankle amputation in the NIL. Secondary outcomes included revascularization in the NIL, above-ankle amputation in the index limb, and mortality at the 3-year follow-up for the cohort that underwent NIL above-ankle amputations. Multivariable Cox regression was used to identify factors associated with above-ankle amputation in the NIL.</div></div><div><h3>Results</h3><div>Ninety-six participants (6.9%) underwent a NIL above-ankle amputation over the course of follow-up. These patients were more likely to be younger at enrollment (63 vs 67 years; <em>P</em> < .001), have diabetes mellitus (81.3% vs 66.1%; <em>P</em> = .002), end-stage renal disease (ESRD) (28.1% vs 9.0%; <em>P</em> < .001), and lower NIL toe pressure at enrollment (52 ± 31.6 mm Hg vs 64 ± 32.2 mm Hg; <em>P</em> = .015). Participants who underwent NIL amputation had significantly higher rates of open or endovascular revascularization in NIL (90.6% vs 17.7%; hazard ratio [HR], 10.95; 95% CI, 8.56-14.01; <em>P</em> < .001) and above-ankle amputations in the index limb (45.8% vs 12.1%; HR, 4.62; 95% CI, 3.28-6.50; <em>P</em> < .001). On 3-year Kaplan-Meier analysis, there was no significant difference in all-cause mortality between participants with and without NIL amputations (26.2% vs 28.2%; HR, 1.28; 95% CI, 0.92-1.77; <em>P</em> = .15). In multivariable Cox regression, NIL above-ankle amputation was associated with younger age at baseline (HR, 0.94; 95% CI, 0.89-1.00; <em>P</em> = .047), ESRD (HR, 10.73; 95% CI, 3.09-37.30; <em>P</em> < .001), and lower NIL toe pressure at baseline (HR, 0.98; 95% CI, 0.97-1.00; <em>P</em> = .049).</div></div><div><h3>Conclusions</h3><div>In the BEST-CLI trial cohort, NIL above-ankle amputations were associated with ESRD, lower NIL toe pressure, and younger age. A significant proportion of patients who had a NIL above-ankle amputation also underwent revascularization of NIL and an index limb above-ankle amputation within 3 years. Our findings highlight the need for targeted preventive strategies that focus on both limbs in high-risk populations to enhance limb preservation after revascularization for peripheral artery diseas
{"title":"High rates of nonindex limb amputation in the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) trial","authors":"Tze-Woei Tan MBBS, MPH , Kirsten D. Dansey MD, MPH , Alik Farber MD, MBA , Gheorghe Doros PhD, MBA , Matthew T. Menard MD , Kenneth Rosenfield MD , Michael S. Conte MD , Maarit Venermo MD, PhD , Philippe Kolh MD, PhD , Michael B. Strong MA , Niten Singh MD","doi":"10.1016/j.jvs.2025.11.009","DOIUrl":"10.1016/j.jvs.2025.11.009","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence and risk factors associated with nonindex limb (NIL) above-ankle amputations among BEST-CLI (Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia) trial participants.</div></div><div><h3>Background</h3><div>BEST-CLI compared endovascular therapy and infrainguinal bypass for patients with chronic limb-threatening ischemia (CLTI), focusing on the ipsilateral index limb. However, it is recognized that peripheral artery disease (PAD) can also impact the contralateral limb. We sought to evaluate the incidence and risk factors associated with NIL above-ankle amputations among BEST-CLI trial participants.</div></div><div><h3>Methods</h3><div>We analyzed data from 1400 participants in BEST-CLI. The primary outcome was the occurrence of above-ankle amputation in the NIL. Secondary outcomes included revascularization in the NIL, above-ankle amputation in the index limb, and mortality at the 3-year follow-up for the cohort that underwent NIL above-ankle amputations. Multivariable Cox regression was used to identify factors associated with above-ankle amputation in the NIL.</div></div><div><h3>Results</h3><div>Ninety-six participants (6.9%) underwent a NIL above-ankle amputation over the course of follow-up. These patients were more likely to be younger at enrollment (63 vs 67 years; <em>P</em> < .001), have diabetes mellitus (81.3% vs 66.1%; <em>P</em> = .002), end-stage renal disease (ESRD) (28.1% vs 9.0%; <em>P</em> < .001), and lower NIL toe pressure at enrollment (52 ± 31.6 mm Hg vs 64 ± 32.2 mm Hg; <em>P</em> = .015). Participants who underwent NIL amputation had significantly higher rates of open or endovascular revascularization in NIL (90.6% vs 17.7%; hazard ratio [HR], 10.95; 95% CI, 8.56-14.01; <em>P</em> < .001) and above-ankle amputations in the index limb (45.8% vs 12.1%; HR, 4.62; 95% CI, 3.28-6.50; <em>P</em> < .001). On 3-year Kaplan-Meier analysis, there was no significant difference in all-cause mortality between participants with and without NIL amputations (26.2% vs 28.2%; HR, 1.28; 95% CI, 0.92-1.77; <em>P</em> = .15). In multivariable Cox regression, NIL above-ankle amputation was associated with younger age at baseline (HR, 0.94; 95% CI, 0.89-1.00; <em>P</em> = .047), ESRD (HR, 10.73; 95% CI, 3.09-37.30; <em>P</em> < .001), and lower NIL toe pressure at baseline (HR, 0.98; 95% CI, 0.97-1.00; <em>P</em> = .049).</div></div><div><h3>Conclusions</h3><div>In the BEST-CLI trial cohort, NIL above-ankle amputations were associated with ESRD, lower NIL toe pressure, and younger age. A significant proportion of patients who had a NIL above-ankle amputation also underwent revascularization of NIL and an index limb above-ankle amputation within 3 years. Our findings highlight the need for targeted preventive strategies that focus on both limbs in high-risk populations to enhance limb preservation after revascularization for peripheral artery diseas","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 905-913"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534692","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.2025.12.164
M. Kawka, C. Caradu, R. Scicluna, C. Bicknell, M. Bown, M. Gohel, A.L. Pouncey
{"title":"Editor’s Choice – Sex Specific Differences in Abdominal Aortic Aneurysm Morphology Based on Fully Automated Volume Segmented Imaging: A Multicentre Cohort Study and Propensity Score Matched Analysis","authors":"M. Kawka, C. Caradu, R. Scicluna, C. Bicknell, M. Bown, M. Gohel, A.L. Pouncey","doi":"10.1016/j.jvs.2025.12.164","DOIUrl":"10.1016/j.jvs.2025.12.164","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page 965"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146170067","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.2025.10.042
Thomas Lindsay MDCM, MSc, FRCS
{"title":"Percutaneous carotid access for endovascular arch repair: Can it simplify and minimize complication of the repair?","authors":"Thomas Lindsay MDCM, MSc, FRCS","doi":"10.1016/j.jvs.2025.10.042","DOIUrl":"10.1016/j.jvs.2025.10.042","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 662-663"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146172612","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.2025.12.168
S. Oud, T. Alozai, F.S. Jamaludin, S. van Dieren, M.A. Schreve, M.C. Mooij, R. Balm, Ç. Ünlü
{"title":"Anatomic Success of Treatment Modalities for Small Saphenous Vein Incompetence: A Systematic Review and Network Meta-analysis","authors":"S. Oud, T. Alozai, F.S. Jamaludin, S. van Dieren, M.A. Schreve, M.C. Mooij, R. Balm, Ç. Ünlü","doi":"10.1016/j.jvs.2025.12.168","DOIUrl":"10.1016/j.jvs.2025.12.168","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Page 966"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173081","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.2025.10.034
Alexander B. Crichton MBChB, MSc , Judit Csore MD, PhD , Eniko Pomozi MD , Bright Benfor MD , Janak Lamichhane MD , Christof Karmonik PhD , Alan B. Lumsden MD , Trisha Roy MD, PhD
<div><h3>Background</h3><div>The endovascular treatment of peripheral artery disease in the below knee arteries has high rates of immediate technical failure, most commonly owing to an inability to cross the lesion with a guidewire. Noncontrast magnetic resonance imaging (MRI) is able to characterize plaque composition and may identify patients at high risk for failed endovascular crossing. This study evaluates a novel noncontrast MRI protocol in an amputated limb model to identify impenetrable plaques, offering clinicians a tool for improved patient selection and procedural planning.</div></div><div><h3>Methods</h3><div>Patients with chronic limb-threatening ischemia undergoing major limb amputation were included and underwent 3T noncontrast MRI. Lesions with >75% stenosis or occlusion in the below the knee arteries were evaluated and defined as either hard (>50% calcium/collagen) or soft (<50%). Hard lesions were then further delineated into two groups: minimally calcific hard (<50% calcium) and significantly calcific hard lesions (>50% calcium). Lesions were also scored using Trans-Atlantic Inter-Society Consensus Score (TASC) II and Global Limb Anatomic Severity Score (GLASS) systems. Amputated limbs then underwent percutaneous vascular intervention to cross each lesion. The primary end point was to compare crossing success in MRI-defined hard vs soft lesions. Secondary outcomes included comparing TASC C/D with TASC A/B lesions, GLASS III/IV and I/II lesions, ability to cross in minimally vs significantly calcified hard lesions, and stenotic vs total occlusions.</div></div><div><h3>Results</h3><div>The study included 27 patients with 46 arterial lesions. Twelve (26%) lesions were defined as soft and 34 (74%) were hard. MRI plaque characteristics demonstrated a strong predictive value: hard lesions were significantly less likely to be crossable compared with soft lesions (91% vs 8%; <em>P</em> < .001). TASC C/D lesions had significantly higher crossing failure rates compared with TASC A/B lesions (77% vs 33%; <em>P</em> = .039), whereas GLASS III/IV lesions did not achieve statistical significance when compared with GLASS I/II lesions (73% vs 44%; <em>P</em> = .129). Among hard lesions, there was no significant difference in ability to cross between minimally calcific and significantly calcific lesions (92% vs 90%; <em>P</em> > .99). There was also no significant difference in the ability to cross occluded vs stenotic lesions (67% vs 80%; <em>P</em> = .70).</div></div><div><h3>Conclusions</h3><div>Ultrashort echo timeUTE)/steady-state free precession (SSFP) noncontrast MRI identifies critical plaque components that predict crossing failure, including dense collagen, which is not visible on conventional imaging yet appears to play a critical role in crossing failure that is independent of calcium burden. This MRI protocol could transform decision-making. Its implementation in clinical practice offers an evidence-based appro
导读：血管内治疗膝下动脉外周动脉疾病有很高的立即技术失败率，最常见的原因是无法用导丝穿过病变。非对比MRI能够表征斑块组成，并可能识别出血管内穿越失败的高风险患者。本研究评估了一种新的非对比MRI方案在截肢肢模型中识别不可穿透斑块，为临床医生提供了改进患者选择和手术计划的工具。方法：选择行大肢体截肢的CLTI患者行3T非对比MRI检查。评估膝下动脉狭窄或闭塞的病变，并将其定义为硬（>50%钙/胶原）或软（50%钙）。病变也使用TASC II和GLASS系统进行评分。然后，截肢肢体行经皮血管介入治疗，穿过每个病变。主要终点是比较mri定义的硬和软病变的交叉成功率。次要结果包括比较TASC C/D与TASC A/B病变、GLASS III/IV和I/II病变、在轻度钙化硬病变与明显钙化硬病变中交叉的能力、狭窄与完全闭塞。结果：纳入27例患者46例动脉病变。12例（26%）病灶为软病灶，34例（74%）为硬病灶。MRI斑块特征显示出很强的预测价值：与软性病变相比，硬性病变明显不太可能交叉（91% vs 8%, p0.99）。通过闭塞病变和狭窄病变的能力也无显著差异（67% vs 80%, p=0.70）。结论：UTE/SSFP非对比MRI识别出预测交叉失败的关键斑块成分，包括致密胶原蛋白，它在常规成像中不可见，但似乎在独立于钙负荷的交叉失败中起关键作用。这种核磁共振成像方案可以改变决策。它在临床实践中的实施提供了一种基于证据的方法，可以潜在地减少血管内失败，确保先进的交叉装置可用于复杂病变，并指导搭桥手术与血管内治疗的治疗选择。
{"title":"Clinical magnetic resonance imaging-defined plaque morphology predicts guidewire crossing failure in below-the-knee occlusions in a translational model using amputated lower limbs","authors":"Alexander B. Crichton MBChB, MSc , Judit Csore MD, PhD , Eniko Pomozi MD , Bright Benfor MD , Janak Lamichhane MD , Christof Karmonik PhD , Alan B. Lumsden MD , Trisha Roy MD, PhD","doi":"10.1016/j.jvs.2025.10.034","DOIUrl":"10.1016/j.jvs.2025.10.034","url":null,"abstract":"<div><h3>Background</h3><div>The endovascular treatment of peripheral artery disease in the below knee arteries has high rates of immediate technical failure, most commonly owing to an inability to cross the lesion with a guidewire. Noncontrast magnetic resonance imaging (MRI) is able to characterize plaque composition and may identify patients at high risk for failed endovascular crossing. This study evaluates a novel noncontrast MRI protocol in an amputated limb model to identify impenetrable plaques, offering clinicians a tool for improved patient selection and procedural planning.</div></div><div><h3>Methods</h3><div>Patients with chronic limb-threatening ischemia undergoing major limb amputation were included and underwent 3T noncontrast MRI. Lesions with >75% stenosis or occlusion in the below the knee arteries were evaluated and defined as either hard (>50% calcium/collagen) or soft (<50%). Hard lesions were then further delineated into two groups: minimally calcific hard (<50% calcium) and significantly calcific hard lesions (>50% calcium). Lesions were also scored using Trans-Atlantic Inter-Society Consensus Score (TASC) II and Global Limb Anatomic Severity Score (GLASS) systems. Amputated limbs then underwent percutaneous vascular intervention to cross each lesion. The primary end point was to compare crossing success in MRI-defined hard vs soft lesions. Secondary outcomes included comparing TASC C/D with TASC A/B lesions, GLASS III/IV and I/II lesions, ability to cross in minimally vs significantly calcified hard lesions, and stenotic vs total occlusions.</div></div><div><h3>Results</h3><div>The study included 27 patients with 46 arterial lesions. Twelve (26%) lesions were defined as soft and 34 (74%) were hard. MRI plaque characteristics demonstrated a strong predictive value: hard lesions were significantly less likely to be crossable compared with soft lesions (91% vs 8%; <em>P</em> < .001). TASC C/D lesions had significantly higher crossing failure rates compared with TASC A/B lesions (77% vs 33%; <em>P</em> = .039), whereas GLASS III/IV lesions did not achieve statistical significance when compared with GLASS I/II lesions (73% vs 44%; <em>P</em> = .129). Among hard lesions, there was no significant difference in ability to cross between minimally calcific and significantly calcific lesions (92% vs 90%; <em>P</em> > .99). There was also no significant difference in the ability to cross occluded vs stenotic lesions (67% vs 80%; <em>P</em> = .70).</div></div><div><h3>Conclusions</h3><div>Ultrashort echo timeUTE)/steady-state free precession (SSFP) noncontrast MRI identifies critical plaque components that predict crossing failure, including dense collagen, which is not visible on conventional imaging yet appears to play a critical role in crossing failure that is independent of calcium burden. This MRI protocol could transform decision-making. Its implementation in clinical practice offers an evidence-based appro","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 803-813"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409574","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.2025.10.025
Sai Divya Yadavalli MD , Elisa Caron MD , Daniel Colome BS , Lucas Souza-Mota MD , Winona W. Wu MD , Carla Moreira MD , Jeffrey J. Siracuse MD , Marc L. Schermerhorn MD , Lars Stangenberg MD, PhD
Objective
In patients with chronic limb-threatening ischemia (CLTI), extra-anatomical bypasses are viable options to establish inflow when aortic cross-clamping necessary for anatomical reconstruction cannot be tolerated or in those with a hostile abdomen. Given their infrequent use, direct comparisons between unilateral axillofemoral bypass (AxFB) vs cross-over femorofemoral bypass (FFB) for CLTI remain scarce. We evaluated postoperative and 5-year outcomes after AxFB vs FFB for CLTI.
Methods
Patients undergoing nonemergent unilateral AxFB and FFB in the Vascular Quality Initiative linked to Medicare claims between 2014 and 2019 were identified, excluding procedures with other concomitant bypasses/interventions. We performed 1:2 (AxFB:FFB) propensity score matching for baseline demographics, comorbidities, urgency, ipsilateral presentation, and contralateral symptoms (rest pain vs ulcer/gangrene), and prior interventions/bypass procedures. Perioperative and 5-year outcomes were analyzed using logistic regression and Cox regression models.
Results
We included 1185 patients (27% AxFB), of whom 224 AxFBs matched with 374 FFBs. After matching, perioperative mortality was comparable between the AxFB and FFB bypass groups (15% vs 10%; P = .12). However, AxFB patients had higher rates of any postoperative complication (30% vs 15%; P < .01) as well as ipsilateral major amputations (below knee, 1.8% vs 0.5%; above knee, 5.4% vs 2.4%; P = .05), in-hospital reintervention (13% vs 7.2%; P = .04), and surgical site infections (5.8% vs 1.6%; P = .01). Patency rates at discharge were similar between the two groups. Postoperative length of stay was higher in the AxFB patients (6.9 ± 5.3 vs 6.2 ± 20; P < .01), and rates for discharge to home were lower (57% vs 68%; P = .07). At 5 years, AxFB was associated with lower rates of 5-year overall survival (41% vs 46%; adjusted hazard ratio [aHR]. 1.3; 95% confidence interval [CI], 1.0-1.7; P = .046), and comparable reintervention free survival (49% vs 45%; aHR, 0.86; 95% CI, 0.59-1.2; P = .40). There was a suggestion of lower major amputation-free survival (69% vs 89%; aHR, 1.7; 95% CI, 0.92-3.1; P = .089), albeit not significantly.
Conclusions
Unilateral AxFB for CLTI was associated with lower 5-year survival rates and similar amputation-free survival and reintervention free-survival rates, alongside similar perioperative mortality and higher postoperative complication rates when compared with FFB. Our data confirm that, among the extra-anatomical bypass options, FFB remains first-line therapy and unilateral AxFB is an alternative option for the treatment of aortoiliac occlusive disease in select CLTI patients with acceptable outcomes.
目的：在慢性肢体威胁缺血（CLTI）患者中，当解剖重建所需的主动脉交叉夹持不能耐受时，或在腹部有敌意的患者中，解剖外旁路是建立血流的可行选择。由于单侧腋股旁路（AxFB）与跨股股旁路（FFB）治疗CLTI的直接比较并不多见。我们评估了AxFB与FFB治疗CLTI的术后和5年预后。方法：确定2014-2019年期间与医疗保险索赔相关的VQI中接受非紧急单侧AxFB和FFB的患者，不包括其他伴随旁路/干预的手术。1:2 （AxFB: FFB）倾向评分匹配基线人口统计学、合并症、急症、同侧表现和对侧症状（静息性疼痛vs溃疡/坏疽）以及既往干预/旁路手术。采用logistic回归和cox回归模型分析围手术期和5年预后。结果：纳入1185例患者（27%为AxFB），其中224例AxFB与374例ffb匹配。配对后，AxFB组和FFB组围手术期死亡率相当（15% vs. 10%； P=.12）。然而，AxFB患者的术后并发症发生率较高（30% vs 15%）；结论：与FFB相比，单侧AxFB治疗CLTI的5年生存率较低，无截肢生存率和无再干预生存率相似，围手术期死亡率相似，术后并发症较高。我们的数据证实，在解剖外旁路选择中，FFB仍然是一线治疗，而单侧AxFB是治疗主动脉-髂闭塞性疾病的另一种选择，在选择的CLTI患者中具有可接受的结果。
{"title":"Outcomes following unilateral axillofemoral bypass versus crossover femorofemoral bypass in chronic limb-threatening ischemia patients","authors":"Sai Divya Yadavalli MD , Elisa Caron MD , Daniel Colome BS , Lucas Souza-Mota MD , Winona W. Wu MD , Carla Moreira MD , Jeffrey J. Siracuse MD , Marc L. Schermerhorn MD , Lars Stangenberg MD, PhD","doi":"10.1016/j.jvs.2025.10.025","DOIUrl":"10.1016/j.jvs.2025.10.025","url":null,"abstract":"<div><h3>Objective</h3><div>In patients with chronic limb-threatening ischemia (CLTI), extra-anatomical bypasses are viable options to establish inflow when aortic cross-clamping necessary for anatomical reconstruction cannot be tolerated or in those with a hostile abdomen. Given their infrequent use, direct comparisons between unilateral axillofemoral bypass (AxFB) vs cross-over femorofemoral bypass (FFB) for CLTI remain scarce. We evaluated postoperative and 5-year outcomes after AxFB vs FFB for CLTI.</div></div><div><h3>Methods</h3><div>Patients undergoing nonemergent unilateral AxFB and FFB in the Vascular Quality Initiative linked to Medicare claims between 2014 and 2019 were identified, excluding procedures with other concomitant bypasses/interventions. We performed 1:2 (AxFB:FFB) propensity score matching for baseline demographics, comorbidities, urgency, ipsilateral presentation, and contralateral symptoms (rest pain vs ulcer/gangrene), and prior interventions/bypass procedures. Perioperative and 5-year outcomes were analyzed using logistic regression and Cox regression models.</div></div><div><h3>Results</h3><div>We included 1185 patients (27% AxFB), of whom 224 AxFBs matched with 374 FFBs. After matching, perioperative mortality was comparable between the AxFB and FFB bypass groups (15% vs 10%; <em>P</em> = .12). However, AxFB patients had higher rates of any postoperative complication (30% vs 15%; <em>P</em> < .01) as well as ipsilateral major amputations (below knee, 1.8% vs 0.5%; above knee, 5.4% vs 2.4%; <em>P</em> = .05), in-hospital reintervention (13% vs 7.2%; <em>P</em> = .04), and surgical site infections (5.8% vs 1.6%; <em>P</em> = .01). Patency rates at discharge were similar between the two groups. Postoperative length of stay was higher in the AxFB patients (6.9 ± 5.3 vs 6.2 ± 20; <em>P</em> < .01), and rates for discharge to home were lower (57% vs 68%; <em>P</em> = .07). At 5 years, AxFB was associated with lower rates of 5-year overall survival (41% vs 46%; adjusted hazard ratio [aHR]. 1.3; 95% confidence interval [CI], 1.0-1.7; <em>P</em> = .046), and comparable reintervention free survival (49% vs 45%; aHR, 0.86; 95% CI, 0.59-1.2; <em>P</em> = .40). There was a suggestion of lower major amputation-free survival (69% vs 89%; aHR, 1.7; 95% CI, 0.92-3.1; <em>P</em> = .089), albeit not significantly.</div></div><div><h3>Conclusions</h3><div>Unilateral AxFB for CLTI was associated with lower 5-year survival rates and similar amputation-free survival and reintervention free-survival rates, alongside similar perioperative mortality and higher postoperative complication rates when compared with FFB. Our data confirm that, among the extra-anatomical bypass options, FFB remains first-line therapy and unilateral AxFB is an alternative option for the treatment of aortoiliac occlusive disease in select CLTI patients with acceptable outcomes.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 793-802.e1"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145409222","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.2025.11.011
Natalie V. Hmeluk BS , Martina Jelley MD, MSPH, FACP , Juell Homco PhD, MPH , Wato Nsa MD, PhD , Peter R. Nelson MD, MS, FACS , Julie Miller-Cribbs MSW, PhD , Arad Abadi MD , Kelly Kempe MD, MS, FACS
<div><h3>Background</h3><div>Childhood abuse, neglect, and household dysfunction, collectively known as adverse childhood experiences (ACEs), are strongly associated with the development of severe outcomes from chronic diseases, including ischemic heart attacks and stroke. ACEs also contribute to a higher risk of adult hardships, which increases the risk of health risk behaviors, chronic disease, and social problems. In this study, we describe the period prevalence of ACEs in a patient population with peripheral artery disease (PAD) and explore the relationship between childhood adversity, adult hardships, and PAD severity, such as the need for surgical procedures, among patients with PAD.</div></div><div><h3>Methods</h3><div>In this survey-based, cross-sectional study, individuals with PAD were recruited at an academic outpatient vascular surgery clinic (2022-2025). The survey included five questions about adult hardships—self-reported financial, food, medical, and housing insecurity in the past year—and 10 questions based on the original Centers for Disease Control and Prevention-Kaiser Permanente ACE study. We collected cardiovascular disease-related and amputation surgical procedure data from patient charts. PAD severity was determined by minor (eg, peripheral stent) or major (eg, amputation) surgical procedures and ankle-brachial index and toe-brachial index scores. The Wilcoxon rank-sum test and Fisher exact and χ<sup>2</sup> tests were used to assess differences in ACE or adult hardship scores as either continuous or categorical variables, respectively, in relation to cardiovascular disease-related surgical procedures.</div></div><div><h3>Results</h3><div>A total of 138 participants with PAD were included in the final analysis. Most respondents identified as male (55.8%, n = 77) and White (65.9%, n = 91). For childhood adversity, 37.0% (n = 51) reported experiencing no ACEs, 24.6% (n = 34) reported one ACE, 10.9% (n = 15) reported two ACEs, 10.1% (n = 14) reported three ACEs, and 17.4% (n = 24) reported at least four ACEs. The patient characteristics associated with a high number of ACEs included women, single individuals, Black individuals, and those living in poverty. The median ACE score was significantly higher for those who reported the following adult hardships compared with those who did not: not getting enough to eat (median, 3.0 vs 1.0; <em>P</em> < .001), being behind on bills (median, 2.0 vs 0.0; <em>P</em> < .001), and experiencing disconnected utilities (median, 3.0 vs 1.0; <em>P</em> = .001). No statistically significant association was noted between reporting ACEs and PAD severity or adult hardships and PAD severity.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that a greater number of ACEs may indirectly contribute to an individual's risk for adult hardships in the PAD population, potentially placing these patients at higher risk of poor health outcomes. We did not find evidence to support a significa
童年虐待、忽视和家庭功能障碍，统称为不良童年经历（ace），与慢性疾病（包括缺血性心脏病发作和中风）的严重后果发展密切相关。不良经历还会增加成年后生活困难的风险，从而增加健康风险行为、慢性病和社会问题的风险。在这项研究中，我们描述了在PAD患者群体中ace的时期患病率，并探讨了PAD患者中童年逆境、成年困难和PAD严重程度（如需要手术治疗）之间的关系。方法：在这项基于调查的横断面研究中，在学术门诊血管外科诊所招募了PAD患者（2022-2025）。该调查包括5个关于成年人困难的问题——过去一年里自我报告的财务、食物、医疗和住房不安全状况，以及10个基于CDC-Kaiser Permanente ACE研究的问题。我们从患者图表中收集心血管疾病相关和截肢手术的数据。PAD的严重程度由轻微（如外周支架）或主要（如截肢）外科手术以及踝肱指数（ABI）和脚趾肱指数（TBI）评分来确定。使用Wilcoxon秩和检验和Fisher精确卡方检验分别评估与心血管疾病相关外科手术相关的ACE或成人困难评分作为连续变量或分类变量的差异。结果：共有138名PAD患者被纳入最终分析。大多数被调查者为男性（55.8%,n=77）和白人（65.9%,n=91）。对于童年逆境，37.0% （n=51）报告没有经历过ACE， 24.6% （n=34）报告一次ACE， 10.9% （n=15）报告两次ACE， 10.1% （n=14）报告三次ACE， 17.4% （n=24）报告至少四次ACE。与ace发生率高相关的患者特征包括女性、单身个体、黑人和贫困人群。与那些没有报告以下成年困难的人相比，报告以下成年困难的人的ACE得分中位数显着更高：吃不饱（中位数=3.0 vs. 1.0, p < 0.001），拖欠账单（中位数=2.0 vs. 0.0, p < 0.001），经历中断公用事业（中位数=3.0 vs. 1.0, p = 0.001）。报告ace与PAD严重程度或成人生活困难与PAD严重程度之间没有统计学意义的关联。结论：我们的研究结果表明，在PAD人群中，较高数量的ace可能间接增加了个人成年后的困难风险，可能使这些患者面临更高的不良健康结果风险。我们没有发现证据支持ace和pad严重程度之间的显著关系。其他可改变的危险因素值得持续分析，以改善PAD患者的管理。
{"title":"Adverse childhood experiences, adult hardships, and disease severity in peripheral artery disease","authors":"Natalie V. Hmeluk BS , Martina Jelley MD, MSPH, FACP , Juell Homco PhD, MPH , Wato Nsa MD, PhD , Peter R. Nelson MD, MS, FACS , Julie Miller-Cribbs MSW, PhD , Arad Abadi MD , Kelly Kempe MD, MS, FACS","doi":"10.1016/j.jvs.2025.11.011","DOIUrl":"10.1016/j.jvs.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Childhood abuse, neglect, and household dysfunction, collectively known as adverse childhood experiences (ACEs), are strongly associated with the development of severe outcomes from chronic diseases, including ischemic heart attacks and stroke. ACEs also contribute to a higher risk of adult hardships, which increases the risk of health risk behaviors, chronic disease, and social problems. In this study, we describe the period prevalence of ACEs in a patient population with peripheral artery disease (PAD) and explore the relationship between childhood adversity, adult hardships, and PAD severity, such as the need for surgical procedures, among patients with PAD.</div></div><div><h3>Methods</h3><div>In this survey-based, cross-sectional study, individuals with PAD were recruited at an academic outpatient vascular surgery clinic (2022-2025). The survey included five questions about adult hardships—self-reported financial, food, medical, and housing insecurity in the past year—and 10 questions based on the original Centers for Disease Control and Prevention-Kaiser Permanente ACE study. We collected cardiovascular disease-related and amputation surgical procedure data from patient charts. PAD severity was determined by minor (eg, peripheral stent) or major (eg, amputation) surgical procedures and ankle-brachial index and toe-brachial index scores. The Wilcoxon rank-sum test and Fisher exact and χ<sup>2</sup> tests were used to assess differences in ACE or adult hardship scores as either continuous or categorical variables, respectively, in relation to cardiovascular disease-related surgical procedures.</div></div><div><h3>Results</h3><div>A total of 138 participants with PAD were included in the final analysis. Most respondents identified as male (55.8%, n = 77) and White (65.9%, n = 91). For childhood adversity, 37.0% (n = 51) reported experiencing no ACEs, 24.6% (n = 34) reported one ACE, 10.9% (n = 15) reported two ACEs, 10.1% (n = 14) reported three ACEs, and 17.4% (n = 24) reported at least four ACEs. The patient characteristics associated with a high number of ACEs included women, single individuals, Black individuals, and those living in poverty. The median ACE score was significantly higher for those who reported the following adult hardships compared with those who did not: not getting enough to eat (median, 3.0 vs 1.0; <em>P</em> < .001), being behind on bills (median, 2.0 vs 0.0; <em>P</em> < .001), and experiencing disconnected utilities (median, 3.0 vs 1.0; <em>P</em> = .001). No statistically significant association was noted between reporting ACEs and PAD severity or adult hardships and PAD severity.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that a greater number of ACEs may indirectly contribute to an individual's risk for adult hardships in the PAD population, potentially placing these patients at higher risk of poor health outcomes. We did not find evidence to support a significa","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 848-858.e4"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534684","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}
It is reported that the preprocedural ambulatory status is an important factor of clinical outcomes after endovascular therapy (EVT) in chronic limb-threatening ischemia (CLTI). However, it is not completely understood the impact of preprocedural ambulatory status on clinical outcomes after EVT in patients with CLTI because there are available scarce papers directly comparing among the subgroups according to preprocedural ambulatory status using the data from the real world. This study aimed to evaluate the outcomes by directly comparing among the subgroups based on preprocedural ambulatory status.
Methods
We identified 690 consecutive patients with de novo (which means the first episode of CLTI) CLTI treated with EVT between January 2010 and December 2019 at the New Tokyo Hospital in Japan. The study population was divided into two groups: the ambulatory group (n = 356) and the nonambulatory group (n = 334). In addition, each ambulatory and nonambulatory group was divided into additional two groups. The ambulatory group was divided into ambulatory with and without assistance, and the nonambulatory group was divided into wheel chair users and bedridden patients. The primary end point was major adverse limb event (MALE) at 3 years after EVT. MALE was defined as the composite of all-cause death and major lower limb amputation.
Results
There was an increased risk of MALE in the nonambulatory group (adjusted hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.89-2.95; P < .001). The worse the preprocedural ambulatory status, the higher the risk of MALE for bedridden patients (adjusted HR, 4.42; 95% CI, 3.03-6.46; P < .001), wheel chair users (adjusted HR, 2.57; 95% CI, 1.92-3.44; P < .001), and ambulatory patients with assistance (adjusted HR, 1.49; 95% CI, 1.07-2.08; P = .008) compared with those without assistance.
Conclusions
In patients with CLTI, the worse the preprocedural ambulatory status, the higher the risk of adverse events after EVT for bedridden patients, wheel chair users, and ambulatory patients with assistance compared with those without assistance.
{"title":"Impact of preprocedural ambulatory status on clinical outcomes after endovascular revascularization in patients with chronic limb-threatening ischemia","authors":"Yusuke Watanabe MD, Toru Naganuma PhD, Satoshi Matsuoka PhD, Koji Hozawa MD","doi":"10.1016/j.jvs.2025.09.049","DOIUrl":"10.1016/j.jvs.2025.09.049","url":null,"abstract":"<div><h3>Background</h3><div>It is reported that the preprocedural ambulatory status is an important factor of clinical outcomes after endovascular therapy (EVT) in chronic limb-threatening ischemia (CLTI). However, it is not completely understood the impact of preprocedural ambulatory status on clinical outcomes after EVT in patients with CLTI because there are available scarce papers directly comparing among the subgroups according to preprocedural ambulatory status using the data from the real world. This study aimed to evaluate the outcomes by directly comparing among the subgroups based on preprocedural ambulatory status.</div></div><div><h3>Methods</h3><div>We identified 690 consecutive patients with de novo (which means the first episode of CLTI) CLTI treated with EVT between January 2010 and December 2019 at the New Tokyo Hospital in Japan. The study population was divided into two groups: the ambulatory group (n = 356) and the nonambulatory group (n = 334). In addition, each ambulatory and nonambulatory group was divided into additional two groups. The ambulatory group was divided into ambulatory with and without assistance, and the nonambulatory group was divided into wheel chair users and bedridden patients. The primary end point was major adverse limb event (MALE) at 3 years after EVT. MALE was defined as the composite of all-cause death and major lower limb amputation.</div></div><div><h3>Results</h3><div>There was an increased risk of MALE in the nonambulatory group (adjusted hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.89-2.95; <em>P</em> < .001). The worse the preprocedural ambulatory status, the higher the risk of MALE for bedridden patients (adjusted HR, 4.42; 95% CI, 3.03-6.46; <em>P</em> < .001), wheel chair users (adjusted HR, 2.57; 95% CI, 1.92-3.44; <em>P</em> < .001), and ambulatory patients with assistance (adjusted HR, 1.49; 95% CI, 1.07-2.08; <em>P</em> = .008) compared with those without assistance.</div></div><div><h3>Conclusions</h3><div>In patients with CLTI, the worse the preprocedural ambulatory status, the higher the risk of adverse events after EVT for bedridden patients, wheel chair users, and ambulatory patients with assistance compared with those without assistance.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 775-783.e3"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258556","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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