Pub Date : 2025-02-01DOI: 10.1016/j.jvs.2024.09.030
Leigh Ann O’Banion MD
{"title":"How do we afford the BEST care for females with chronic limb-threatening ischemia?","authors":"Leigh Ann O’Banion MD","doi":"10.1016/j.jvs.2024.09.030","DOIUrl":"10.1016/j.jvs.2024.09.030","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 374-375"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007688","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 : 2025-02-01DOI: 10.1016/j.jvs.2024.09.012
Andrew W. Hoel MD , Tanvi Nayak BA , Aravind S. Ponukumati MD , Neel A. Mansukhani MD , David H. Stone MD , David P. Kuwayama MD , Brian Nolan MD, MS , Bjoern D. Suckow MD, MS
Objectives
Fenestrated-branched endovascular technology (F/B-EVAR) is increasingly used to repair complex aortic aneurysms. While reintervention, morbidity and mortality after F/B-EVAR have been well-characterized, studies on patient-reported quality of life (QOL) after F/B-EVAR have been limited in their use of non-specific instruments and measures. We report on disease-specific QOL in patients that underwent F/B-EVAR using a validated QOL survey for aortic aneurysms.
Methods
Prospectively maintained databases were used to contact living patients that underwent F/B-EVAR for pararenal or thoracoabdominal aortic aneurysms at two institutions. Eligible patients (n = 286) were asked to complete a disease-specific QOL survey previously validated in patients that underwent repair of an infrarenal abdominal aortic aneurysm. An emotional impact score (EIS) from 0-100 was derived from the survey with higher scores indicating more emotional impact and worse QOL. Respondent behavior change following F/B-EVAR was evaluated in four domains (strenuous activity, travel, heavy lifting, and sexual activity) previously identified by patients to be most impacted by an aortic aneurysm.
Results
In total, 234 patients (82%) completed surveys. Mean post-operative interval to survey completion was 3.4 ± 2.8 years. Mean EIS was 16 (range 0-91) for all patients surveyed, with higher mean EIS among those within the first year after F/B-EVAR (20 vs 14). Most respondents demonstrated limited adverse emotional impact after F/B-EVAR. However, the 4th quartile of EIS was broad (22-91), indicating that a subset of respondents had significantly worse QOL after repair. While most patients reported no post-procedure change in each of the activity domains, over 40% of patients did report decrease in strenuous activity and heavy lifting after F/B-EVAR. Those with decreased activity after repair had corresponding deficiencies in disease-specific knowledge for the domains of heavy lifting (P <.001) and sexual activity (P = .17).
Conclusions
The majority of patients who underwent F/B-EVAR in this cohort had low emotional impact on their QOL after repair. One-quarter of patients did report significant post-procedure anxiety about their aneurysm, with improvement observed beyond one year after repair. Most patients reported unchanged or decreased activity levels following F/B-EVAR, and less aneurysm-specific patient knowledge was associated with decreased activity after repair. These findings are similar to those seen in prior work using this survey instrument in patients that underwent infrarenal aneurysm repair. This work confirms the feasibility of using this survey to evaluate QOL in patients with complex aortic disease. Longitudinal evaluation in these patients may identify those at high-risk for worse QOL after F/B-EVAR.
目的：穿孔-分支血管内技术（F/B-EVAR）越来越多地用于修复复杂的主动脉瘤。虽然对 F/B-EVAR 术后的再介入、发病率和死亡率已经有了很好的描述，但对 F/B-EVAR 术后患者报告的生活质量（QOL）的研究却因使用非特异性工具和测量方法而受到限制。我们采用针对主动脉瘤的有效 QOL 调查报告了接受 F/B-EVAR 手术患者的疾病特异性 QOL：方法：利用前瞻性维护的数据库，联系两家医疗机构中接受过F/B-EVAR手术的主动脉旁或胸腹主动脉瘤在世患者。符合条件的患者（n=286）被要求完成一项疾病特异性 QOL 调查，该调查之前已在接受肾下腹主动脉瘤修复术的患者中得到验证。调查得出了 0-100 分的情绪影响评分（EIS），分数越高，表示情绪影响越大，QOL 越差。受访者在 F/B-EVAR 术后的行为变化在四个领域（剧烈活动、旅行、提重物和性活动）进行了评估，这四个领域是患者以前认为受主动脉瘤影响最大的领域：共有 234 名患者（82%）完成了调查。术后到完成调查的平均间隔时间为 3.4±2.8 年。所有受访患者的平均EIS为16（范围0-91），其中F/B-EVAR术后第一年内的患者平均EIS更高（20 vs 14）。大多数受访者在 F/B-EVAR 术后的不良情绪影响有限。然而，EIS 的第四四分位数很宽（22-91），这表明一部分受访者在修复术后的 QOL 明显较差。虽然大多数患者表示术后各活动领域均无变化，但超过 40% 的患者表示 F/B-EVAR 术后剧烈活动和提重物的次数减少。修复后活动减少的患者在提重物方面的疾病相关知识也有相应的缺陷（结论）：在这组患者中，大多数接受 F/B-EVAR 的患者在修复后对其 QOL 的情绪影响较小。四分之一的患者确实在术后对动脉瘤产生了明显的焦虑，但在修复术后一年后情况有所改善。大多数患者在接受 F/B-EVAR 手术后活动量保持不变或有所减少，而患者对动脉瘤的了解较少与修复后活动量减少有关。这些发现与之前在接受肾下动脉瘤修补术的患者中使用该调查工具的结果相似。这项研究证实了使用该调查工具评估复杂主动脉疾病患者 QOL 的可行性。对这些患者进行纵向评估可能会发现 F/B-EVAR 术后 QOL 变差的高危人群。
{"title":"Disease-specific patient-reported quality of life after fenestrated/branched endovascular aortic aneurysm repair","authors":"Andrew W. Hoel MD , Tanvi Nayak BA , Aravind S. Ponukumati MD , Neel A. Mansukhani MD , David H. Stone MD , David P. Kuwayama MD , Brian Nolan MD, MS , Bjoern D. Suckow MD, MS","doi":"10.1016/j.jvs.2024.09.012","DOIUrl":"10.1016/j.jvs.2024.09.012","url":null,"abstract":"<div><h3>Objectives</h3><div>Fenestrated-branched endovascular technology (F/B-EVAR) is increasingly used to repair complex aortic aneurysms. While reintervention, morbidity and mortality after F/B-EVAR have been well-characterized, studies on patient-reported quality of life (QOL) after F/B-EVAR have been limited in their use of non-specific instruments and measures. We report on disease-specific QOL in patients that underwent F/B-EVAR using a validated QOL survey for aortic aneurysms.</div></div><div><h3>Methods</h3><div>Prospectively maintained databases were used to contact living patients that underwent F/B-EVAR for pararenal or thoracoabdominal aortic aneurysms at two institutions. Eligible patients (n = 286) were asked to complete a disease-specific QOL survey previously validated in patients that underwent repair of an infrarenal abdominal aortic aneurysm. An emotional impact score (EIS) from 0-100 was derived from the survey with higher scores indicating more emotional impact and worse QOL. Respondent behavior change following F/B-EVAR was evaluated in four domains (strenuous activity, travel, heavy lifting, and sexual activity) previously identified by patients to be most impacted by an aortic aneurysm.</div></div><div><h3>Results</h3><div>In total, 234 patients (82%) completed surveys. Mean post-operative interval to survey completion was 3.4 ± 2.8 years. Mean EIS was 16 (range 0-91) for all patients surveyed, with higher mean EIS among those within the first year after F/B-EVAR (20 vs 14). Most respondents demonstrated limited adverse emotional impact after F/B-EVAR. However, the 4<sup>th</sup> quartile of EIS was broad (22-91), indicating that a subset of respondents had significantly worse QOL after repair. While most patients reported no post-procedure change in each of the activity domains, over 40% of patients did report decrease in strenuous activity and heavy lifting after F/B-EVAR. Those with decreased activity after repair had corresponding deficiencies in disease-specific knowledge for the domains of heavy lifting (<em>P</em> <.001) and sexual activity (<em>P</em> = .17).</div></div><div><h3>Conclusions</h3><div>The majority of patients who underwent F/B-EVAR in this cohort had low emotional impact on their QOL after repair. One-quarter of patients did report significant post-procedure anxiety about their aneurysm, with improvement observed beyond one year after repair. Most patients reported unchanged or decreased activity levels following F/B-EVAR, and less aneurysm-specific patient knowledge was associated with decreased activity after repair. These findings are similar to those seen in prior work using this survey instrument in patients that underwent infrarenal aneurysm repair. This work confirms the feasibility of using this survey to evaluate QOL in patients with complex aortic disease. Longitudinal evaluation in these patients may identify those at high-risk for worse QOL after F/B-EVAR.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 280-286.e3"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290039","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 : 2025-02-01DOI: 10.1016/j.jvs.2024.09.037
Erin Buchanan MD , Ting Sun PhD , Brigitte K. Smith MD, MHPE , M. Libby Weaver MD
<div><h3>Background</h3><div>Endovascular interventions for peripheral artery disease have increased in prevalence over time given the inherent benefits of minimally invasive approaches. Although it is essential that vascular surgery graduates are facile with endovascular techniques, the results of the BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) trial highlight the equivalent importance of ensuring trainee competence in open skills. Recent studies demonstrate increasing case volume of both endovascular and open procedures during vascular surgery training. Case volume is merely a surrogate marker for competence, however, and the objective competence attained by trainees at the time of graduation is unknown. We sought to investigate operative autonomy and competence of graduating vascular surgery trainees performing endovascular as compared with open peripheral vascular revascularization procedures.</div></div><div><h3>Methods</h3><div>Operative performance and autonomy ratings for infrainguinal endovascular and open revascularizations from the Society for Improving Professional Learning Operative application database were collected for all vascular surgery participating institutions from 2018 to 2023. The distribution for autonomy and performance ratings were determined by training level for endovascular and open procedures, respectively. Mixed effects logistic regressions were conducted to estimate the predictive association between procedure type and autonomy and performance assessment, adjusting for training level and case complexity. Subsequently, the estimated model was applied to predict the probability of a graduating trainee being rated as meaningfully autonomous or competent while performing endovascular and open procedures across various case complexities.</div></div><div><h3>Results</h3><div>Sixty-nine residents from 23 programs (12 fellowship, 11 residency) were assessed on 706 revascularization procedures (n = 383 endovascular; n = 323 open). When controlling for training level and case complexity, there were no differences in autonomy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.62-1.99) or competency assessment (OR, 0.86; 95% CI, 0.46-1.59) for endovascular, as compared with open, peripheral revascularization procedures. For average complexity procedures, the predicted probability of a trainee being assessed as competent and autonomous at the time of graduation was high (competent: 88% endovascular, 86% open; autonomous: 96% endovascular, 97% open). The predicted probability of competence and autonomy for complex procedures was lower, but remained similar between groups (competent: 73% endovascular, 70% open; autonomous: 92% endovascular, 92% open).</div></div><div><h3>Conclusions</h3><div>There is no difference in the graduating level of autonomy and competence of endovascular as compared with open peripheral revascularization procedures for vascular surgery trainees. Th
{"title":"Graduating vascular surgery trainee proficiency in endovascular and open peripheral revascularization procedures","authors":"Erin Buchanan MD , Ting Sun PhD , Brigitte K. Smith MD, MHPE , M. Libby Weaver MD","doi":"10.1016/j.jvs.2024.09.037","DOIUrl":"10.1016/j.jvs.2024.09.037","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular interventions for peripheral artery disease have increased in prevalence over time given the inherent benefits of minimally invasive approaches. Although it is essential that vascular surgery graduates are facile with endovascular techniques, the results of the BEST-CLI (Best Endovascular vs. Best Surgical Therapy in Patients With Critical Limb Ischemia) trial highlight the equivalent importance of ensuring trainee competence in open skills. Recent studies demonstrate increasing case volume of both endovascular and open procedures during vascular surgery training. Case volume is merely a surrogate marker for competence, however, and the objective competence attained by trainees at the time of graduation is unknown. We sought to investigate operative autonomy and competence of graduating vascular surgery trainees performing endovascular as compared with open peripheral vascular revascularization procedures.</div></div><div><h3>Methods</h3><div>Operative performance and autonomy ratings for infrainguinal endovascular and open revascularizations from the Society for Improving Professional Learning Operative application database were collected for all vascular surgery participating institutions from 2018 to 2023. The distribution for autonomy and performance ratings were determined by training level for endovascular and open procedures, respectively. Mixed effects logistic regressions were conducted to estimate the predictive association between procedure type and autonomy and performance assessment, adjusting for training level and case complexity. Subsequently, the estimated model was applied to predict the probability of a graduating trainee being rated as meaningfully autonomous or competent while performing endovascular and open procedures across various case complexities.</div></div><div><h3>Results</h3><div>Sixty-nine residents from 23 programs (12 fellowship, 11 residency) were assessed on 706 revascularization procedures (n = 383 endovascular; n = 323 open). When controlling for training level and case complexity, there were no differences in autonomy (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.62-1.99) or competency assessment (OR, 0.86; 95% CI, 0.46-1.59) for endovascular, as compared with open, peripheral revascularization procedures. For average complexity procedures, the predicted probability of a trainee being assessed as competent and autonomous at the time of graduation was high (competent: 88% endovascular, 86% open; autonomous: 96% endovascular, 97% open). The predicted probability of competence and autonomy for complex procedures was lower, but remained similar between groups (competent: 73% endovascular, 70% open; autonomous: 92% endovascular, 92% open).</div></div><div><h3>Conclusions</h3><div>There is no difference in the graduating level of autonomy and competence of endovascular as compared with open peripheral revascularization procedures for vascular surgery trainees. Th","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 472-479.e2"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391463","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}
Proximal ExTension to Induce COmplete ATtachment (PETTICOAT), which uses downstream bare metal stents for structural support, demonstrates potential, yet its adoption is limited by variable outcomes. This study elucidates the potential of PETTICOAT in aortic dissection, emphasizing the determinants that guide patient selection.
Methods
A retrospective analysis of 60 patients who underwent full PETTICOAT for aortic dissections was conducted. A multivariate logistic regression model identified predictors of favorable aortic remodeling. Patients underwent standardized follow-up with computed tomography scans to assess size, volumetric changes, and anatomical conditions. Selection criteria included full PETTICOAT application and a minimum of 3 months of follow-up. Demographics, preoperative conditions, and procedural details were collected and analyzed.
Results
The analysis identified predictors of favorable aortic remodeling, including age >60 years, a larger downstream aorta stent graft, a smaller abdominal aorta (<450 mm2), and oral angiotensin II receptor blocker administration. Over a median 47.5 months of follow-up, survival rates in the favorable remodeling (97.3%) and unfavorable groups (100%) were similar. Downstream aortic event-free survival rates did not differ significantly (89.2% vs 73.9%), although the unfavorable group had a relatively higher incidence of distal stent-induced new entries (26.1% vs 8.1%).
Conclusions
The PETTICOAT concept effectively enhances aortic remodeling in complex aortic dissections. Predictors for favorable remodeling, including age, stent graft sizing, aortic diameter, and angiotensin II receptor blocker therapy, offer insights for optimizing patient selection. This approach improves survival outcomes, mitigates risks associated with untreated aortic segments, and provides a minimally invasive solution for aortic dissections. Despite some outcome variations, the technique holds promise for addressing the challenges of aortic dissections, with the potential for further refinement in patient selection and technique application.
{"title":"Successful factors for improving aortic remodeling with thoracic endovascular repair and bare stent extension","authors":"Mio Kasai MD , Kenichi Hashizume MD, PhD , Tadashi Matsuoka MD, PhD , Mitsuharu Mori MD, PhD , Toshiaki Yagami MD, PhD , Kiyoshi Koizumi MD, PhD , Hiroaki Kaneyama MD , Yuika Kameda MD , Tsutomu Nara MD , Mayu Nishida MD , Misato Tokioka MD , Hideyuki Shimizu MD, PhD","doi":"10.1016/j.jvs.2024.10.025","DOIUrl":"10.1016/j.jvs.2024.10.025","url":null,"abstract":"<div><h3>Objective</h3><div>Proximal ExTension to Induce COmplete ATtachment (PETTICOAT), which uses downstream bare metal stents for structural support, demonstrates potential, yet its adoption is limited by variable outcomes. This study elucidates the potential of PETTICOAT in aortic dissection, emphasizing the determinants that guide patient selection.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 60 patients who underwent full PETTICOAT for aortic dissections was conducted. A multivariate logistic regression model identified predictors of favorable aortic remodeling. Patients underwent standardized follow-up with computed tomography scans to assess size, volumetric changes, and anatomical conditions. Selection criteria included full PETTICOAT application and a minimum of 3 months of follow-up. Demographics, preoperative conditions, and procedural details were collected and analyzed.</div></div><div><h3>Results</h3><div>The analysis identified predictors of favorable aortic remodeling, including age >60 years, a larger downstream aorta stent graft, a smaller abdominal aorta (<450 mm<sup>2</sup>), and oral angiotensin II receptor blocker administration. Over a median 47.5 months of follow-up, survival rates in the favorable remodeling (97.3%) and unfavorable groups (100%) were similar. Downstream aortic event-free survival rates did not differ significantly (89.2% vs 73.9%), although the unfavorable group had a relatively higher incidence of distal stent-induced new entries (26.1% vs 8.1%).</div></div><div><h3>Conclusions</h3><div>The PETTICOAT concept effectively enhances aortic remodeling in complex aortic dissections. Predictors for favorable remodeling, including age, stent graft sizing, aortic diameter, and angiotensin II receptor blocker therapy, offer insights for optimizing patient selection. This approach improves survival outcomes, mitigates risks associated with untreated aortic segments, and provides a minimally invasive solution for aortic dissections. Despite some outcome variations, the technique holds promise for addressing the challenges of aortic dissections, with the potential for further refinement in patient selection and technique application.</div></div>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 324-334"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468758","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 : 2025-02-01DOI: 10.1016/S0741-5214(24)02163-3
{"title":"Information for Readers","authors":"","doi":"10.1016/S0741-5214(24)02163-3","DOIUrl":"10.1016/S0741-5214(24)02163-3","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Page A13"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143136535","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 : 2025-02-01DOI: 10.1016/j.jvs.2024.10.081
S.M. Han, A. Pyun, G.S. Oderich
{"title":"Technical strategies and pitfalls for total transfemoral implantation of off-the-shelf four vessel thoracoabdominal multibranch endoprosthesis with or without utilization of preloaded wires","authors":"S.M. Han, A. Pyun, G.S. Oderich","doi":"10.1016/j.jvs.2024.10.081","DOIUrl":"10.1016/j.jvs.2024.10.081","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":"143136538","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 : 2025-02-01DOI: 10.1016/j.jvs.2024.09.016
Alik Farber MD, MBA , Matthew T. Menard MD , Michael S. Conte MD , Kenneth Rosenfield MD , Marc Schermerhorn MD , Andres Schanzer MD , Richard J. Powell MD , Cassius Iyad Ochoa Chaar MD , Caitlin W. Hicks MD, MS , Gheorghe Doros PhD, MBA , Michael B. Strong MA , Steven A. Leers MD , Raghu Motaganahalli MD , Lars Stangenberg MD, PhD , Jeffrey J. Siracuse MD, MBA
<div><h3>Objective</h3><div>Single segment great saphenous vein (SSGSV) traditionally has been considered the gold standard conduit for infrainguinal bypass. There are data supporting similar outcomes with prosthetic femoral-popliteal bypass. Moreover, some investigators have advocated for prosthetic conduit for femoral tibial bypass when GSV is inadequate or unavailable. We sought to evaluate long-term outcomes of infrainguinal bypass based on conduit type for treating chronic limb-threatening ischemia (CLTI).</div></div><div><h3>Methods</h3><div>Data from the Best Endovascular vs Best Surgical Therapy of Patients with CLTI multicenter, prospective, randomized controlled trial, comparing infrainguinal bypass with endovascular therapy in patients with CLTI, were evaluated. In this as-treated analysis, we compared outcomes of infrainguinal bypass using prosthetic, alternative autogenous vein (AAV), and cryopreserved vein (Cryo) with SSGSV bypass. Kaplan-Meier and multivariable analyses were performed to examine the associations of conduit type with major adverse limb events (MALE), reinterventions, above-ankle amputations, and all-cause death rates.</div></div><div><h3>Results</h3><div>In total, 784 bypasses were analyzed (120 prosthetic, 33 AAV, 21 Cryo, AND 610 SSGSV). For prosthetic and SSGSV, the distribution was 357 femoropopliteal (93 prosthetic and 264 GSV) and 373 infrapopliteal (27 prosthetic and 346 GSV). The mean age for the overall cohort was 67.1 years; 27.4% were female, 29.9% were non-White, and 11.5% were of Hispanic ethnicity. Patients undergoing prosthetic bypass were older (69.2 years vs 66.7 years); more likely to have chronic obstructive pulmonary disease (22.5% vs 14.0%), prior coronary artery bypass grafting (88.9% vs 66.5%), and prior stroke (23.3% vs 14%); but less often were of Hispanic ethnicity (5.8% vs 12.6%) and had diabetes (59.2% vs 71.3%) (<em>P</em> < .05 for all). For femoropopliteal bypass, use of prosthetic conduit was associated with increased major reinterventions at 3 years overall (19.0% vs 11.5%; <em>P</em> = .06) and on risk-adjusted analysis (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.09-4.2; <em>P</em> = .028). No significant differences in MALE or death, above-ankle amputation, or death were observed. Outcomes were similar for bypasses to above-knee popliteal targets and below-knee popliteal targets. For infrapopliteal bypass, the use of a prosthetic conduit was associated with increased major reintervention (25.3% vs 10.3%; <em>P</em> = .005), death (68.6% vs 34.8%; <em>P</em> < .001), and MALE or death (90.0% vs 48.1%; <em>P</em> < .001) at 3 years. After risk adjustment, infrapopliteal bypass with prosthetic conduit was associated with higher major reintervention (HR, 4.14; 95% CI, 1.36-12.6; <em>P</em> = .012), above-ankle amputation (HR, 4.64; 95% CI, 1.59-13.5; <em>P</em> = .005), death (HR, 2.96; 95% CI, 1.4-6.2; <em>P</em> = .004), and MALE or death (HR, 3.59; 95% CI, 1.6
{"title":"Prosthetic conduits have worse outcomes compared with great saphenous vein conduits in femoropopliteal and infrapopliteal bypass in patients with chronic limb-threatening ischemia","authors":"Alik Farber MD, MBA , Matthew T. Menard MD , Michael S. Conte MD , Kenneth Rosenfield MD , Marc Schermerhorn MD , Andres Schanzer MD , Richard J. Powell MD , Cassius Iyad Ochoa Chaar MD , Caitlin W. Hicks MD, MS , Gheorghe Doros PhD, MBA , Michael B. Strong MA , Steven A. Leers MD , Raghu Motaganahalli MD , Lars Stangenberg MD, PhD , Jeffrey J. Siracuse MD, MBA","doi":"10.1016/j.jvs.2024.09.016","DOIUrl":"10.1016/j.jvs.2024.09.016","url":null,"abstract":"<div><h3>Objective</h3><div>Single segment great saphenous vein (SSGSV) traditionally has been considered the gold standard conduit for infrainguinal bypass. There are data supporting similar outcomes with prosthetic femoral-popliteal bypass. Moreover, some investigators have advocated for prosthetic conduit for femoral tibial bypass when GSV is inadequate or unavailable. We sought to evaluate long-term outcomes of infrainguinal bypass based on conduit type for treating chronic limb-threatening ischemia (CLTI).</div></div><div><h3>Methods</h3><div>Data from the Best Endovascular vs Best Surgical Therapy of Patients with CLTI multicenter, prospective, randomized controlled trial, comparing infrainguinal bypass with endovascular therapy in patients with CLTI, were evaluated. In this as-treated analysis, we compared outcomes of infrainguinal bypass using prosthetic, alternative autogenous vein (AAV), and cryopreserved vein (Cryo) with SSGSV bypass. Kaplan-Meier and multivariable analyses were performed to examine the associations of conduit type with major adverse limb events (MALE), reinterventions, above-ankle amputations, and all-cause death rates.</div></div><div><h3>Results</h3><div>In total, 784 bypasses were analyzed (120 prosthetic, 33 AAV, 21 Cryo, AND 610 SSGSV). For prosthetic and SSGSV, the distribution was 357 femoropopliteal (93 prosthetic and 264 GSV) and 373 infrapopliteal (27 prosthetic and 346 GSV). The mean age for the overall cohort was 67.1 years; 27.4% were female, 29.9% were non-White, and 11.5% were of Hispanic ethnicity. Patients undergoing prosthetic bypass were older (69.2 years vs 66.7 years); more likely to have chronic obstructive pulmonary disease (22.5% vs 14.0%), prior coronary artery bypass grafting (88.9% vs 66.5%), and prior stroke (23.3% vs 14%); but less often were of Hispanic ethnicity (5.8% vs 12.6%) and had diabetes (59.2% vs 71.3%) (<em>P</em> < .05 for all). For femoropopliteal bypass, use of prosthetic conduit was associated with increased major reinterventions at 3 years overall (19.0% vs 11.5%; <em>P</em> = .06) and on risk-adjusted analysis (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.09-4.2; <em>P</em> = .028). No significant differences in MALE or death, above-ankle amputation, or death were observed. Outcomes were similar for bypasses to above-knee popliteal targets and below-knee popliteal targets. For infrapopliteal bypass, the use of a prosthetic conduit was associated with increased major reintervention (25.3% vs 10.3%; <em>P</em> = .005), death (68.6% vs 34.8%; <em>P</em> < .001), and MALE or death (90.0% vs 48.1%; <em>P</em> < .001) at 3 years. After risk adjustment, infrapopliteal bypass with prosthetic conduit was associated with higher major reintervention (HR, 4.14; 95% CI, 1.36-12.6; <em>P</em> = .012), above-ankle amputation (HR, 4.64; 95% CI, 1.59-13.5; <em>P</em> = .005), death (HR, 2.96; 95% CI, 1.4-6.2; <em>P</em> = .004), and MALE or death (HR, 3.59; 95% CI, 1.6","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Pages 408-416.e2"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349238","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 : 2025-02-01DOI: 10.1016/j.jvs.2024.09.036
John D. Corson MB, ChB
{"title":"Stop the steal","authors":"John D. Corson MB, ChB","doi":"10.1016/j.jvs.2024.09.036","DOIUrl":"10.1016/j.jvs.2024.09.036","url":null,"abstract":"","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":"81 2","pages":"Page 465"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391465","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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