Journal of Vascular Surgery最新文献

{"title":"Employing magnetic resonance histology for precision chronic limb-threatening ischemia treatment planning","authors":"Judit Csore MD, PhD ,&nbsp;Madeline Drake MD ,&nbsp;Christof Karmonik PhD ,&nbsp;Bright Benfor MD ,&nbsp;Peter Osztrogonacz MD ,&nbsp;Alan B. Lumsden MD ,&nbsp;Trisha L. Roy MD, PhD","doi":"10.1016/j.jvs.2024.08.054","DOIUrl":"10.1016/j.jvs.2024.08.054","url":null,"abstract":"<div><h3>Objective</h3><div>Recent randomized controlled trials have demonstrated a notable prevalence of immediate technical failures in percutaneous vascular interventions (PVIs) for complex arterial lesions associated with chronic limb-threatening ischemia. Current imaging modalities present inherent limitations in identifying these lesions, making it challenging to determine the most suitable candidates for PVI. We present a novel preprocedural magnetic resonance imaging (MRI) histology protocol for identifying lesions that might present a higher rate of immediate and midterm PVI failure.</div></div><div><h3>Methods</h3><div>We enrolled 22 patients (13 females, average age 65.8 ± 9.72 years) scheduled for PVI were prospectively and underwent 3T MRI using ultrashort echo time and steady-state free precession contrasts to characterize target lesions before PVI. Lesions were scored as hard if &gt;50% of the lumen was occluded by hard components (calcium/dense collagen) on MRI in the hardest cross-section. Two readers evaluated MRI datasets. Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC)/Global Limb Anatomic Staging System (GLASS)/Wound, Ischemia and Foot infection scoring was performed based on intraprocedural angiograms and chart review. The relationship between MRI scoring, TASC/GLASS scoring, and procedural outcomes was investigated using univariate analysis. Midterm follow-up (revascularization and amputation rates) was recorded at 3 and 6 months after the intervention.</div></div><div><h3>Results</h3><div>Our cohort of 22 patients yielded 40 target lesions. Five lesions were excluded (two for nondiagnostic image quality; three PVIs were ultimately diagnostic only). Six lesions (17%) were scored as hard. MRI-scored hard lesions had a higher proportion of immediate technical failure (hard vs soft 83% [5/6] vs 3% [1/29]; <em>P</em> &lt; .001). Hard vs soft MRI scoring was the only factor significantly associated with immediate PVI technical success (<em>P</em> &lt; .001), as opposed to TASC/GLASS scoring. Both at 3 months and 6 months after PVI, the reintervention rate was significantly higher among those lesions which were scored hard on MRI (3 months hard, 80% vs soft, 16% [<em>P</em> =.011]; 6 months hard, 80% vs soft, 27%; <em>P</em> = .047).</div></div><div><h3>Conclusions</h3><div>MRI histology could be a valuable tool for optimizing PVI patient selection and treatment strategies.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 351-363.e3"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of balloon and self-expandable stents for common femoral artery stenosis","authors":"Camil-Cassien Bamdé MD ,&nbsp;Yann Goueffic MD, PhD ,&nbsp;Comlan Blitti MD ,&nbsp;Julien Die Loucou MD ,&nbsp;Alain Lalande MD, PhD ,&nbsp;Aline Laubriet-Jazayeri PhD ,&nbsp;Charles Guenancia MD, PhD ,&nbsp;Eric Steinmetz MD, PhD","doi":"10.1016/j.jvs.2024.09.017","DOIUrl":"10.1016/j.jvs.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular treatment of the common femoral artery (CFA) and its bifurcation is currently recommended for patients with hostile groin (prior femoral bifurcation open surgery, history of radiotherapy) or severe comorbidities (advanced age, frailty, obesity). Preliminary results have shown favorable outcomes. Among the different endovascular techniques (atherectomy, intravascular lithotripsy, plain balloon angioplasty, drug-coated balloon angioplasty, stenting), stents are mainly used but the best type of stent to use is still debated. The aim of this study was to assess the value of balloon-expandable stents (BES) and self-expandable stents (SES) for stenosis of the femoral bifurcation.</div></div><div><h3>Methods</h3><div>Consecutive patients with stenosis of the CFA and its bifurcation were included from 2016 to 2022. Demographic data, the type of stent used, procedural data, and angiographic variables were collected. Groups were defined according to the type of stent implanted. Primary patency was defined as a binary end point based on a duplex ultrasound peak systolic velocity ratio of ≤2.4 as assessed by duplex ultrasound examination, in the absence of clinically driven target lesion revascularization (TLR) or bypass of the target lesion. Secondary outcomes were clinical sustained improvement, freedom from TLR at 12 months, mean ankle-brachial index improvement, primary-assisted patency, and secondary patency.</div></div><div><h3>Results</h3><div>A total of 90 procedures conducted in 77 patients were included in this study, 26 in the SES group and 64 in the BES group. The most common symptomatology according to the Rutherford classification was class 2, 3, and 4 (28%, 48%, and 8%, respectively). The type of lesions in the CFA, assessed using the Azema classification, were comparable between both groups (SES/BES group type 2: 31%/27%; type 3: 54%/62%). At 12 months, the primary patency rates for SES and BES were 88% (26/26 patients) and 72% (58/64 patients) (<em>P</em> = .10). At 12 months, freedom from TLR rates for SES and BES were 97% vs 81%, respectively (<em>P</em> = .13).</div></div><div><h3>Conclusions</h3><div>SES for CFA stenosis show a trend toward better patency and freedom from TLR rates at 12 months. However, controlled studies are warranted to further investigate the significance of this trend.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 397-407"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349236","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}

{"title":"Midterm single-center results with the use of custom-made endografts with inner branches, a call for attention","authors":"Jose I. Torrealba MD ,&nbsp;Giuseppe Panuccio MD, PhD ,&nbsp;Petroula Nana PhD ,&nbsp;Antonino Giordano MD ,&nbsp;Daour Yousef Al Sarhan MD ,&nbsp;Tilo Kölbel MD, PhD","doi":"10.1016/j.jvs.2024.09.039","DOIUrl":"10.1016/j.jvs.2024.09.039","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate the patency of bridging covered stents (BCS) bridged to inner branches in custom-made thoracoabdominal endografts.</div></div><div><h3>Methods</h3><div>This was a single-center retrospective study identifying all patients undergoing fenestrated or branched endovascular aortic repair (f/b EVAR) in whom the reno-visceral target vessels (TVs) were bridged with a BCS to an inner branch of a custom-made (CMD) endograft. Technical success and perioperative complications were noted. Follow-up BCS patencies were evaluated, and in patients with follow-up, two groups based on BCS were created, a group with BCS occlusion and a group with BCS patent. Univariable and multivariable analyses were performed to analyze factors related to visceral and renal bridging stent occlusion.</div></div><div><h3>Results</h3><div>From 2019 through 2022, 69 patients undergoing complex aortic repair had at least one TV bridged to an inner branch built into a CMD endograft. Eighty-six percent of the grafts had only inner branches, whereas 14% had a mix of fenestrations for the visceral TVs and inner branches for the renal arteries. Twenty-five percent of patients presented as urgent and received an endograft originally designed for another patient and available on our shelf at the time. A total of 245 TVs were connected to inner branches: celiac trunk (CT), 54; superior mesenteric artery (SMA), 59; and renal artery (RA), 132. Technical success was 99%. There was a 23% complication and 9% perioperative mortality rate. At follow-up, we identified 6% of visceral and 14% of renal BCS occlusions. The primary patency for RA BCS was 83% at 12 months and 58% at 24 months. For the CT-SMA BCS, Kaplan-Maier showed a patency of 99% and 96% at 12 and 24 months. In the univariate analysis, a misaligned TV ostium (<em>P</em> = .001), the postoperative BCS diameter on postoperative computed tomography angiography (<em>P</em> = .02), and the preoperative infrarenal aortic angle &gt;60° (<em>P</em> = .007) were correlated with RA BCS occlusion. In the multivariate analysis, only the misaligned TV ostium (<em>P</em> = .002) and infrarenal angle &gt;60° (<em>P</em> = .01) were significantly correlated.</div></div><div><h3>Conclusions</h3><div>In our series of complex aortic repair, the incorporation of inner branches to bridge TVs is associated with a high renal BCS occlusion rate. Improper alignment of the branches with the TV ostium and acute aortic angles might play a significant role. Further research on this technology is needed.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 310-317"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of open and endovascular repair of complex abdominal aortic aneurysms","authors":"Sai Divya Yadavalli MD ,&nbsp;Vinamr Rastogi MD ,&nbsp;Ambar Mehta MD ,&nbsp;Sara Allievi MD ,&nbsp;Yoel Solomon MD ,&nbsp;Jorg L. de Bruin MD, PhD ,&nbsp;Shipra Arya MD, SM ,&nbsp;Lars Stangenberg MD, PhD ,&nbsp;Hence J.M. Verhagen MD, PhD ,&nbsp;Marc L. Schermerhorn MD","doi":"10.1016/j.jvs.2024.10.016","DOIUrl":"10.1016/j.jvs.2024.10.016","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to compare perioperative and 5-year outcomes following endovascular (FEVAR) and open repair (OAR) of complex abdominal aortic aneurysms (cAAAs) in males and females separately, given the known sex-related differences in perioperative outcomes.</div></div><div><h3>Methods</h3><div>We studied all elective cAAA repairs between 2014 and 2019 in the Vascular Implant Surveillance and Interventional Outcomes Network (VISION) registry. We stratified patients based on sex. We calculated propensity scores for assignment to either OAR or FEVAR. Covariates including age, race, diameter, baseline comorbidities, proximal extent of repair, annual center volumes, and annual surgeon volumes were introduced into the model for estimating propensity scores. Within matched cohorts, perioperative outcomes and 5-year outcomes (mortality, reinterventions, and ruptures) were evaluated using multivariable logistic and Cox regression models.</div></div><div><h3>Results</h3><div>We identified 2825 patients, of whom 29% were female. Within both the sexes, OAR was more commonly performed (OAR vs FEVAR: males: 53% vs 47%; females: 63% vs 37%). After matching, among males (n = 1326), FEVAR was associated with lower perioperative mortality (FEVAR vs OAR: 2.3% vs 5.1%; <em>P</em> &lt; .001). However, FEVAR was associated with comparable 5-year mortality (38% vs 28%; hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.92-1.4; <em>P</em> = .22) and a higher hazard of 5-year reintervention (19% vs 3.7%; adjusted HR, 4.5; 95% CI, 2.6-7.6; <em>P</em> &lt; .001). Among females (n = 456), FEVAR and OAR showed similar perioperative mortality (8.3% vs 7.0%; <em>P</em> = .73). At 5 years, FEVAR was associated with higher hazards of mortality (43% vs 32%; adjusted HR, 1.5; 95% CI, 1.03-2.2; <em>P</em> = .034) and reintervention (20% vs 3.0%; adjusted HR, 4.8; 95% CI, 2.1-11; <em>P</em> &lt; .001) compared with OAR.</div></div><div><h3>Conclusions</h3><div>Among males, FEVAR was associated with favorable perioperative outcomes compared with OAR, although these advantages attenuate over time. However, among females, FEVAR was associated with similar perioperative outcomes, eventually leading to higher reinterventions and possibly higher mortality within 5 years. Future efforts should focus on determining the factors associated with these sex disparities to improve outcomes following FEVAR in females. Based on current evidence, females undergoing elective cAAA repair should be selected with due caution, especially for endovascular repair.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 287-297.e2"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468809","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}

{"title":"Endovascular strategies for the short distance between the lowest renal artery and aortic bifurcation","authors":"Mitri K. Khoury MD,&nbsp;Adam W. Beck MD,&nbsp;Mark A. Farber MD,&nbsp;F. Ezequiel Parodi MD,&nbsp;Warren Gasper MD,&nbsp;W. Anthony Lee MD,&nbsp;Gustavo Oderich MD,&nbsp;Andres Schanzer MD,&nbsp;Darren Schneider MD,&nbsp;Mathew Sweet MD,&nbsp;Carlos H. Timaran MD,&nbsp;Matthew J. Eagleton MD","doi":"10.1016/j.jvs.2024.09.010","DOIUrl":"10.1016/j.jvs.2024.09.010","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 508-509"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007683","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}

{"title":"Open thoracic aortic aneurysm sac exploration following thoracic endovascular aortic repair and fenestrated branched endovascular aortic repair: New hybrid approach to fixing the Achilles heel of endovascular repair, while raising new questions","authors":"Sukgu M. Han MD, MS","doi":"10.1016/j.jvs.2024.09.032","DOIUrl":"10.1016/j.jvs.2024.09.032","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 308-309"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007698","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}

{"title":"Reflections on innovation, excellence and service in clinical vascular surgery","authors":"M. Ashraf Mansour MD, MBA, FACS","doi":"10.1016/j.jvs.2024.10.066","DOIUrl":"10.1016/j.jvs.2024.10.066","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 273-279"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007716","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}

{"title":"Racial, biological sex, and geographic disparities of venous thromboembolism in the United States, 2016 to 2019","authors":"A.M. Afifi,&nbsp;M. Leverich,&nbsp;K. Tadrousse,&nbsp;G. Ren,&nbsp;M. Nazzal","doi":"10.1016/j.jvs.2024.10.079","DOIUrl":"10.1016/j.jvs.2024.10.079","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Page A15"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143127984","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}

{"title":"Comparison of the treatment strategies for symptomatic chronic internal carotid artery occlusion","authors":"Fei Mei MD, PhD ,&nbsp;Wuming Zhang MD ,&nbsp;Peng Jiang MD ,&nbsp;Chengpeng Tan MD ,&nbsp;Yongpan Cui MD ,&nbsp;Jiawei Fan MD ,&nbsp;Wayne W. Zhang MD","doi":"10.1016/j.jvs.2024.05.062","DOIUrl":"10.1016/j.jvs.2024.05.062","url":null,"abstract":"<div><h3>Objective</h3><div>The best management of symptomatic chronic internal carotid artery occlusion (CICAO) has been controversial. This systematic review and meta-analysis were to compare the outcomes of different treatment strategies for symptomatic CICAO.</div></div><div><h3>Methods</h3><div>Two independent researchers conducted a search of articles on the treatment of CICAO published between January 2000 and October 2023 in PubMed, Web of Science, Embase, and The Cochrane Library. Twenty-two articles were eligible for meta-analysis using a random effects model to combine and analyze the data for the pooled rates of stroke and death, and the rates of procedural success and significant restenosis/occlusion.</div></div><div><h3>Results</h3><div>A total of 1193 patients from 22 publications were included in this study. Six of them had bilateral internal carotid artery occlusion. The 30-day stroke and death rates were 1.1% (95% confidence interval [CI], 0%-4.4%) in the best medical treatment (BMT) group, 4.1% (95% CI, 0.7%-9.3%; I² = 71.4%) in the extracranial-intracranial (EC-IC) bypass group, 4.4% (95% CI, 2.4%-6.8%; I² = 0%) in the carotid artery stenting (CAS) group, and 1.2% (95% CI, 0%-3.4%; I² = 0%) in the combined carotid endarterectomy (CEA) and stenting (CEA + CAS) group. During follow-up of 16.5 (±16.3) months, the stroke and death rates were 19.5%, 1.2%, 6.6%, and 2.4% in the BMT, EC-IC, CAS, and CEA + CAS groups respectively. The surgical success rate was 99.7% (95% CI, 98.5%-100%; I² = 0%) in the EC-IC group, 70.1% (95% CI, 62.3%-77.5%; I² = 64%) in the CAS group, and 86.4% (95% CI, 78.8%-92.7%; I² = 60%) in the CEA + CAS group. The rate of post-procedural significant restenosis or occlusion was 3.6% in the EC-IC group, 18.7% in the CAS group, and 5.7% in the CEA + CSA group. The surgical success rate was negatively associated by the length of internal carotid artery (ICA) occlusion. Surgical success rate was significantly higher in the patients with occlusive lesion within C1 to C4 segments, compared with those with occlusion distal to C4 segment (odds ratio, 11.3; 95% CI, 5.0-25.53; <em>P</em> &lt; .001). A proximal stump of ICA is a favorable sign for CAS. The success rate of CAS was significantly higher in the patients with an ICA stump than that in the patients without (odds ratio, 11.36; 95% CI, 4.84-26.64; <em>P</em> &lt; .01). However, the success rate of CEA + CAS was not affected by the proximal ICA stump.</div></div><div><h3>Conclusions</h3><div>For the management of symptomatic CICAO, BMT alone is associated with the highest risk of mid- and long-term stroke and death. EC-IC bypass surgery and CEA + CAS should be considered as the choice of treatment based on operator’s expertise and patient’s anatomy. CAS may be employed as an alternative option in high surgical risk patients, especially when proximal ICA stump exists.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 494-504.e2"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734485","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}

{"title":"Controversies in the management strategy for symptomatic chronic internal carotid artery occlusion","authors":"Ali F. AbuRahma MD","doi":"10.1016/j.jvs.2024.07.029","DOIUrl":"10.1016/j.jvs.2024.07.029","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Page 505"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007679","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}