Pub Date : 2026-03-01Epub Date: 2025-11-04DOI: 10.1016/j.jvs.2025.09.061
Alessandro Grandi MD , Nuno V. Dias MD , Stephan Haulon MD , Timothy Resch MD , Gustavo S. Oderich MD , Michele Piazza MD , Giovanni Pratesi MD , Luca Bertoglio MD
Objective
To report the use of a percutaneous carotid access with vessel closure devices (VCDs) during complex endovascular aortic arch repair.
Methods
Seven international high-volume centers conducted a retrospective review of all patients receiving percutaneous carotid access with VCD during endovascular aortic arch procedures to investigate its feasibility and safety. The primary end point was the closure success defined according to the modified Valve Academic Research Consortium-2 definition (no need for adjunctive surgical or endovascular procedures to obtain vessel closure and no hemorrhagic/stenotic complications).
Results
A total of 46 patients (27 males [59%]; mean age, 74 years; range, 68-78 years) treated between January 2022 and September 2024 underwent endovascular arch procedures (eight urgent/emergent cases [19%]), all under general anesthesia and ultrasound guidance, using a micropuncture set in 32 cases (70%). The left common carotid artery was punctured in 41 cases (89%). The median introducer sheath inner diameter was 7F (range, 6F-8F). Only 1 VCD was used per access, with 19 cases (41%) using the preclose technique and 27 cases (59%) using the VCD after introduced sheath removal (all but one case treated with PerClose ProGlide [Abbott Vascular]). Closure success was achieved in 44 patients (96%): 1 patient required an intraoperative covered stent placement to cover the puncture site, and 1 patient required an open conversion 2 days after the procedure owing to a pseudoaneurysm diagnosed at the postoperative computed tomography scan. Four patients (9%) required prolonged manual compression after VCD tightening owing to oozing from the puncture site. The prolonged manual compression was correlated to the use of anticoagulants (40 vs 7%; P = .043). One case of a non-flow-limiting dissection was left untreated conservatively. Four patients (9%) suffered from postoperative stroke, two ischemic and two hemorrhagic, two on the same side of the carotid puncture and two on the contralateral side. No other complications were reported.
Conclusions
Percutaneous carotid access with a VCD appeared to be feasible and safe, with a high closure success rate. Further investigations are needed to compare open cutdown vs percutaneous access outcomes.
目的：报道经皮颈动脉通路（PCA）与血管闭合装置（VCD）在复杂血管内主动脉弓修复中的应用。方法：七个国际大容量中心对所有在主动脉弓内手术中接受PCA合并VCD的患者进行回顾性分析，以探讨其可行性和安全性。主要终点是根据修改后的VARC-2定义定义的闭合成功（不需要辅助手术或血管内手术来获得血管闭合，无出血/狭窄并发症）。结果：在2022年1月至2024年9月期间，共有46例患者（27例男性，59%，74岁（68-78））接受了血管内弓手术（8例紧急/急诊病例占19%），均在全身麻醉和超声引导下进行，32例（70%）使用微穿刺装置。穿刺左颈总动脉41例（89%）。内侧鞘内径为7F（6-8）。每次入路仅使用一个VCD，其中19例（41%）使用预闭合技术，27例（59%）使用鞘移除后的VCD（除一例外，其余均使用PerClose ProGlide (Abbott Vascular, Santa Clara, California)）。44例患者（96%）成功闭合：1例患者需要术中放置覆盖支架以覆盖穿刺部位，1例患者由于术后计算机断层扫描诊断为假性动脉瘤，术后2天需要开放转换。4例患者（9%）由于穿刺部位渗出，在VCD收紧后需要长时间的手动按压。长时间的手压与抗凝剂的使用相关（40% vs 7%; p= 0.043）。1例非限流性夹层保守治疗。术后发生脑卒中4例（9%），缺血性2例，出血性2例，颈动脉穿刺同侧2例，对侧2例。无其他并发症报道。结论：经皮颈动脉VCD通路可行、安全，闭合成功率高。需要进一步的研究来比较切开切开和经皮通路的结果。
{"title":"Carotid artery percutaneous access with vessel closure devices in endovascular aortic arch repairs","authors":"Alessandro Grandi MD , Nuno V. Dias MD , Stephan Haulon MD , Timothy Resch MD , Gustavo S. Oderich MD , Michele Piazza MD , Giovanni Pratesi MD , Luca Bertoglio MD","doi":"10.1016/j.jvs.2025.09.061","DOIUrl":"10.1016/j.jvs.2025.09.061","url":null,"abstract":"<div><h3>Objective</h3><div>To report the use of a percutaneous carotid access with vessel closure devices (VCDs) during complex endovascular aortic arch repair.</div></div><div><h3>Methods</h3><div>Seven international high-volume centers conducted a retrospective review of all patients receiving percutaneous carotid access with VCD during endovascular aortic arch procedures to investigate its feasibility and safety. The primary end point was the closure success defined according to the modified Valve Academic Research Consortium-2 definition (no need for adjunctive surgical or endovascular procedures to obtain vessel closure and no hemorrhagic/stenotic complications).</div></div><div><h3>Results</h3><div>A total of 46 patients (27 males [59%]; mean age, 74 years; range, 68-78 years) treated between January 2022 and September 2024 underwent endovascular arch procedures (eight urgent/emergent cases [19%]), all under general anesthesia and ultrasound guidance, using a micropuncture set in 32 cases (70%). The left common carotid artery was punctured in 41 cases (89%). The median introducer sheath inner diameter was 7F (range, 6F-8F). Only 1 VCD was used per access, with 19 cases (41%) using the preclose technique and 27 cases (59%) using the VCD after introduced sheath removal (all but one case treated with PerClose ProGlide [Abbott Vascular]). Closure success was achieved in 44 patients (96%): 1 patient required an intraoperative covered stent placement to cover the puncture site, and 1 patient required an open conversion 2 days after the procedure owing to a pseudoaneurysm diagnosed at the postoperative computed tomography scan. Four patients (9%) required prolonged manual compression after VCD tightening owing to oozing from the puncture site. The prolonged manual compression was correlated to the use of anticoagulants (40 vs 7%; <em>P</em> = .043). One case of a non-flow-limiting dissection was left untreated conservatively. Four patients (9%) suffered from postoperative stroke, two ischemic and two hemorrhagic, two on the same side of the carotid puncture and two on the contralateral side. No other complications were reported.</div></div><div><h3>Conclusions</h3><div>Percutaneous carotid access with a VCD appeared to be feasible and safe, with a high closure success rate. Further investigations are needed to compare open cutdown vs percutaneous access outcomes.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 656-661"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458876","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: 2025-10-09DOI: 10.1016/j.jvs.2025.09.056
Brant W. Ullery MD, MBA , Fanny Alie-Cusson MD, MS , Gregory A. Magee MD , Sukgu M. Han MD , Jordan R. Stern MD , Andrew Barleben MD , Jeromy S. Brink MD , Robert Allen MD , Mark Fugate MD , Kenneth Tran MD , Jason T. Lee MD , Frank R. Arko MD , Chase Schlesselman MPH , Jonathan M. Bath MD
<div><h3>Objective</h3><div>Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent nonelective surgical acuity. The present study aims to assess the feasibility and midterm outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during thoracic endovascular repair (TEVAR).</div></div><div><h3>Methods</h3><div>Patients who underwent LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers, and data were collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions.</div></div><div><h3>Results</h3><div>A total of 82 patients who underwent LIFE with supra-aortic arch involvement were included. The mean age was 62.4 years (29.3% female and 78.0% White). Select demographics of the cohort featured previous stroke in 17.1% of cases, chronic lung disease in 12.2%, and renal insufficiency in 30.5%. Indication(s) for TEVAR included type B aortic dissection in 70.7% of cases, aneurysm in 11.0%, and penetrating atherosclerotic ulcer/intramural hematoma in 4.9%. Repair was performed for nonelective pathologies in 47.9% of cases. Eighty-nine supra-aortic arch branch vessels (innominate, n = 6; left common carotid artery, n = 9; and left subclavian artery, n = 74) were incorporated via LIFE to achieve proximal seal in zone 0 (19%), zone 1 (5%), and zone 2 (75%). LIFE repair was performed for a single-branch vessel in 90% of cases and a double-branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was achieved in 95.1% of cases. Thirty-day mortality was 2.4% (n = 2). Early (<30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range, 1-81 months), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17-1479 days) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months, and reintervention-free survival was 78.0% at 36 months.</div></div><div><h3>Conclusions</h3><div>Results from the multicenter LIFE registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, midterm survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. Although perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durabil
{"title":"Laser in situ fenestrated endograft (LIFE) repair of complex aortic arch pathology: Early outcomes from the multicenter LIFE registry","authors":"Brant W. Ullery MD, MBA , Fanny Alie-Cusson MD, MS , Gregory A. Magee MD , Sukgu M. Han MD , Jordan R. Stern MD , Andrew Barleben MD , Jeromy S. Brink MD , Robert Allen MD , Mark Fugate MD , Kenneth Tran MD , Jason T. Lee MD , Frank R. Arko MD , Chase Schlesselman MPH , Jonathan M. Bath MD","doi":"10.1016/j.jvs.2025.09.056","DOIUrl":"10.1016/j.jvs.2025.09.056","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular repair of aortic arch pathologies is limited by currently available device configurations, variation in aortic arch anatomy, access challenges, and frequent nonelective surgical acuity. The present study aims to assess the feasibility and midterm outcomes of laser in situ fenestrated endograft (LIFE) repair for supra-aortic arch branches during thoracic endovascular repair (TEVAR).</div></div><div><h3>Methods</h3><div>Patients who underwent LIFE during TEVAR for aortic arch pathologies (2017-2022) were retrospectively identified at six high-volume centers, and data were collected in the multicenter LIFE registry. Descriptive statistics and Kaplan-Meier analysis were used. Primary outcomes were technical success, stroke, and target vessel instability. Secondary outcomes included 30-day mortality, spinal cord ischemia, and reinterventions.</div></div><div><h3>Results</h3><div>A total of 82 patients who underwent LIFE with supra-aortic arch involvement were included. The mean age was 62.4 years (29.3% female and 78.0% White). Select demographics of the cohort featured previous stroke in 17.1% of cases, chronic lung disease in 12.2%, and renal insufficiency in 30.5%. Indication(s) for TEVAR included type B aortic dissection in 70.7% of cases, aneurysm in 11.0%, and penetrating atherosclerotic ulcer/intramural hematoma in 4.9%. Repair was performed for nonelective pathologies in 47.9% of cases. Eighty-nine supra-aortic arch branch vessels (innominate, n = 6; left common carotid artery, n = 9; and left subclavian artery, n = 74) were incorporated via LIFE to achieve proximal seal in zone 0 (19%), zone 1 (5%), and zone 2 (75%). LIFE repair was performed for a single-branch vessel in 90% of cases and a double-branch vessel in 10%. Ten patients underwent adjunctive extra-anatomic bypass. Technical success was achieved in 95.1% of cases. Thirty-day mortality was 2.4% (n = 2). Early (<30 days) neurologic outcomes included a stroke and spinal cord ischemia rate of 7.4% and 0%, respectively. At a mean follow-up of 15 months (range, 1-81 months), there were 5 additional late deaths (6.1%). A total of 8 patients (9.8%) required 11 unplanned reinterventions at a mean of 423 ± 555 days (range, 17-1479 days) postoperatively. Kaplan-Meier estimated survival was 94.5% at 36 months, and reintervention-free survival was 78.0% at 36 months.</div></div><div><h3>Conclusions</h3><div>Results from the multicenter LIFE registry demonstrate laser in situ fenestration of complex aortic arch anatomy to be technically feasible with a perioperative mortality and neurologic risk profile that is comparable to standard techniques. Despite a modest reintervention rate in this early experience, midterm survival is excellent, particularly given the high-risk aortic pathologies and patient demographics featured in this cohort. Although perioperative results and midterm outcomes remain promising, longitudinal data are needed to confirm durabil","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"83 3","pages":"Pages 647-655"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274966","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.2025.07.062
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: 2025-10-28DOI: 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: 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: 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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号