Pub Date : 2026-02-02DOI: 10.1016/j.ejvs.2026.01.053
Pablo Marques de Marino, Drosos Kotelis, Alexander Gombert, Tilo Kölbel, Karin Pfister, Philipp Geisbüsch, Martin Austermann, Johannes Kalder, Martin Czerny, Eric L Verhoeven, Nikolaos Tsilimparis
Objective: To report the early results of a physician initiated clinical trial evaluating the safety and performance of the BeGraft Stent Graft (Bentley InnoMed, Hechingen, Germany) in fenestrated endovascular aneurysm repair (FEVAR).
Methods: This prospective, multicentre, single arm, physician initiated trial enrolled patients undergoing FEVAR for complex aortic aneurysms between March 2021 and September 2023 in nine high volume German centres. The BeGraft Stent Graft was used outside its initial intention for use as a bridging stent graft (BSG) for FEVAR. Primary endpoints were technical success, BSG patency, and absence of procedure related complications and BSG related endoleaks at 12 months.
Results: One hundred and three patients were prospectively enrolled. Three hundred and fifty BSGs were implanted as investigational devices and included in the analysis. Technical success was 98.3%. Two BSG occlusions were reported in the first 12 months. Primary patency at 12 months was 99.3%. The absence of procedure related complications was 88%. Freedom from BSG related endoleaks at 12 months was 99.6%. Freedom from BSG related re-interventions was 97%. Two device deficiencies occurred in two patients: one disconnection between the BSG and the balloon before deployment and one fracture of the BSG at one year. No migration > 10 mm of the BSG was recorded during the trial period.
Conclusion: This study shows favourable short term outcomes of the BeGraft Stent Graft as a BSG in FEVAR with good primary patency and low rates of BSG related complications.
{"title":"Prospective, Multicentre Physician Initiated Trial Investigating the BeGraft Stent Graft as Bridging Stent in Fenestrated Endovascular Aneurysm Repair for Complex Aortic Aneurysms.","authors":"Pablo Marques de Marino, Drosos Kotelis, Alexander Gombert, Tilo Kölbel, Karin Pfister, Philipp Geisbüsch, Martin Austermann, Johannes Kalder, Martin Czerny, Eric L Verhoeven, Nikolaos Tsilimparis","doi":"10.1016/j.ejvs.2026.01.053","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.053","url":null,"abstract":"<p><strong>Objective: </strong>To report the early results of a physician initiated clinical trial evaluating the safety and performance of the BeGraft Stent Graft (Bentley InnoMed, Hechingen, Germany) in fenestrated endovascular aneurysm repair (FEVAR).</p><p><strong>Methods: </strong>This prospective, multicentre, single arm, physician initiated trial enrolled patients undergoing FEVAR for complex aortic aneurysms between March 2021 and September 2023 in nine high volume German centres. The BeGraft Stent Graft was used outside its initial intention for use as a bridging stent graft (BSG) for FEVAR. Primary endpoints were technical success, BSG patency, and absence of procedure related complications and BSG related endoleaks at 12 months.</p><p><strong>Results: </strong>One hundred and three patients were prospectively enrolled. Three hundred and fifty BSGs were implanted as investigational devices and included in the analysis. Technical success was 98.3%. Two BSG occlusions were reported in the first 12 months. Primary patency at 12 months was 99.3%. The absence of procedure related complications was 88%. Freedom from BSG related endoleaks at 12 months was 99.6%. Freedom from BSG related re-interventions was 97%. Two device deficiencies occurred in two patients: one disconnection between the BSG and the balloon before deployment and one fracture of the BSG at one year. No migration > 10 mm of the BSG was recorded during the trial period.</p><p><strong>Conclusion: </strong>This study shows favourable short term outcomes of the BeGraft Stent Graft as a BSG in FEVAR with good primary patency and low rates of BSG related complications.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.ejvs.2026.01.056
Tasnuva Rahman, Katariina Noronen, Sari M Vähäaho, Karoliina Halmesmäki, Maarit Venermo
Objective: To compare high ligation and stripping (HLS), endovenous laser ablation (EVLA), and ultrasound guided foam sclerotherapy (UGFS) for symptomatic great saphenous vein (GSV) reflux in the long term, given the limited comparative data beyond ten years.
Methods: Patients with symptomatic GSV reflux were randomised (1:1:1) to undergo HLS, EVLA, or UGFS. One hundred and ninety-six patients treated at Helsinki University Hospital were invited to 14 year follow up. Primary outcomes were above knee GSV reflux and GSV re-intervention rates. Secondary outcomes included quality of life.
Results: Of 233 randomised patients, 214 were included. UGFS increased the risk of GSV reflux recurrence compared with both HLS (risk ratio [RR] 11.7, 95% confidence interval [CI] 1.6 - 85.6) and EVLA (RR 5.0, 95% CI 1.5 - 16.6; 30.8% [12 of 39] after UGFS vs. 2.6% [1 of 38] and 6.1% [3 of 49] after HLS and EVLA, respectively; overall p < .001). UGFS was associated with a higher risk of GSV re-interventions compared with HLS (RR 4.3, 95% CI 1.8 - 10.2) and EVLA (RR 6.9, 95% CI 2.6 - 18.4; 56.4% for UGFS vs. 13.2% for HLS and 8.2% for EVLA; overall p < .001). Neovascularisation rates did not differ between the treatments (29.0%, 22.5%, and 23.1% for HLS, EVLA, and UGFS, respectively; overall p = .76). Aberdeen Varicose Vein Questionnaire scores were comparable across the groups (median [interquartile range] 8.9 [3.7, 13.3] in HLS, 6.1 [0.8, 12.2] in EVLA, and 8.8 [4.1, 13.4] in UGFS, with median differences of +2.8 [HLS vs. EVLA], +0.1 [HLS vs. UGFS], and -2.7 [EVLA vs. UGFS]; overall p = .21).
Conclusion: UGFS demonstrated inferior outcomes in terms of GSV recurrent reflux and re-intervention rates compared with both HLS and EVLA, whereas HLS and EVLA showed comparable performance across these outcomes. Long term quality of life was comparable across all groups.
目的:比较高位结扎剥脱(HLS)、静脉内激光消融(EVLA)和超声引导泡沫硬化治疗(UGFS)治疗症状性大隐静脉(GSV)反流的长期疗效,因为10年以上的比较数据有限。方法:有症状的GSV反流患者随机(1:1:1)接受HLS、EVLA或UGFS。在赫尔辛基大学医院接受治疗的196名患者被邀请进行了14年的随访。主要结局是膝关节以上GSV反流和GSV再干预率。次要结果包括生活质量。结果:在233例随机患者中,214例纳入研究。与HLS和EVLA相比,UGFS增加了GSV反流复发的风险(风险比[RR] 11.7, 95%可信区间[CI] 1.6 - 85.6)和EVLA (RR 5.0, 95% CI 1.5 - 16.6; UGFS组30.8% [39 / 12],HLS和EVLA组分别为2.6%[38 / 1]和6.1%[49 / 3],总p < .001)。与HLS (RR 4.3, 95% CI 1.8 - 10.2)和EVLA (RR 6.9, 95% CI 2.6 - 18.4; UGFS为56.4%,HLS为13.2%,EVLA为8.2%,总体p < 0.001)相比,UGFS与GSV再干预的风险更高。新血管成形率在处理之间没有差异(HLS, EVLA和UGFS分别为29.0%,22.5%和23.1%;总体p = 0.76)。阿伯丁静脉曲张问卷评分在各组间具有可比性(HLS组中位数为8.9 [3.7,13.3],EVLA组中位数为6.1 [0.8,12.2],UGFS组中位数为8.8[4.1,13.4],中位数差异为+2.8 [HLS vs. EVLA], +0.1 [HLS vs. UGFS], -2.7 [EVLA vs. UGFS],总p = 0.21)。结论:与HLS和EVLA相比,UGFS在GSV复发性反流和再干预率方面表现较差,而HLS和EVLA在这些结果方面表现相当。所有组的长期生活质量具有可比性。
{"title":"Fourteen Year Outcomes of a Randomised Controlled Trial Comparing Endovenous Laser Ablation, High Ligation and Stripping, and Ultrasound Guided Foam Sclerotherapy for Great Saphenous Varicose Veins.","authors":"Tasnuva Rahman, Katariina Noronen, Sari M Vähäaho, Karoliina Halmesmäki, Maarit Venermo","doi":"10.1016/j.ejvs.2026.01.056","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.056","url":null,"abstract":"<p><strong>Objective: </strong>To compare high ligation and stripping (HLS), endovenous laser ablation (EVLA), and ultrasound guided foam sclerotherapy (UGFS) for symptomatic great saphenous vein (GSV) reflux in the long term, given the limited comparative data beyond ten years.</p><p><strong>Methods: </strong>Patients with symptomatic GSV reflux were randomised (1:1:1) to undergo HLS, EVLA, or UGFS. One hundred and ninety-six patients treated at Helsinki University Hospital were invited to 14 year follow up. Primary outcomes were above knee GSV reflux and GSV re-intervention rates. Secondary outcomes included quality of life.</p><p><strong>Results: </strong>Of 233 randomised patients, 214 were included. UGFS increased the risk of GSV reflux recurrence compared with both HLS (risk ratio [RR] 11.7, 95% confidence interval [CI] 1.6 - 85.6) and EVLA (RR 5.0, 95% CI 1.5 - 16.6; 30.8% [12 of 39] after UGFS vs. 2.6% [1 of 38] and 6.1% [3 of 49] after HLS and EVLA, respectively; overall p < .001). UGFS was associated with a higher risk of GSV re-interventions compared with HLS (RR 4.3, 95% CI 1.8 - 10.2) and EVLA (RR 6.9, 95% CI 2.6 - 18.4; 56.4% for UGFS vs. 13.2% for HLS and 8.2% for EVLA; overall p < .001). Neovascularisation rates did not differ between the treatments (29.0%, 22.5%, and 23.1% for HLS, EVLA, and UGFS, respectively; overall p = .76). Aberdeen Varicose Vein Questionnaire scores were comparable across the groups (median [interquartile range] 8.9 [3.7, 13.3] in HLS, 6.1 [0.8, 12.2] in EVLA, and 8.8 [4.1, 13.4] in UGFS, with median differences of +2.8 [HLS vs. EVLA], +0.1 [HLS vs. UGFS], and -2.7 [EVLA vs. UGFS]; overall p = .21).</p><p><strong>Conclusion: </strong>UGFS demonstrated inferior outcomes in terms of GSV recurrent reflux and re-intervention rates compared with both HLS and EVLA, whereas HLS and EVLA showed comparable performance across these outcomes. Long term quality of life was comparable across all groups.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-31DOI: 10.1016/j.ejvs.2026.01.052
Salvatore T Scali, Adam W Beck
{"title":"Survival Is No Longer Enough: Rethinking Quality in Complex Aortic Surgery.","authors":"Salvatore T Scali, Adam W Beck","doi":"10.1016/j.ejvs.2026.01.052","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.052","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.048
Martin Altreuther, Arne Seternes
{"title":"Don't Forget the Heart: Surgical Excellence Alone Is Not Enough.","authors":"Martin Altreuther, Arne Seternes","doi":"10.1016/j.ejvs.2026.01.048","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.048","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.054
Morgan T McLoughlin, Gergely Gosi
{"title":"Life Expectancy in Abdominal Aortic Aneurysm: A Need for a Validated Prognostic Score.","authors":"Morgan T McLoughlin, Gergely Gosi","doi":"10.1016/j.ejvs.2026.01.054","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.054","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.050
Binshan Zha, Zhiyong Chen
{"title":"Fibromuscular Dysplasia of the Brachial Artery: An Incidental Finding during Mechanical Rotational Thrombectomy.","authors":"Binshan Zha, Zhiyong Chen","doi":"10.1016/j.ejvs.2026.01.050","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.050","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.046
Jürg Schmidli, Salome Weiss
{"title":"Motor Evoked Potential Monitoring: An Imperative during Open Thoracoabdominal Aortic Aneurysm Repair.","authors":"Jürg Schmidli, Salome Weiss","doi":"10.1016/j.ejvs.2026.01.046","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.046","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.049
Alexander Gombert
{"title":"Some Glimpse of Evidence in the Venous Fog of War.","authors":"Alexander Gombert","doi":"10.1016/j.ejvs.2026.01.049","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.049","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-30DOI: 10.1016/j.ejvs.2026.01.047
Guilherme Pena, Robert Fitridge
{"title":"Physiology over Patency: Redefining Success in Venous Arterialisation.","authors":"Guilherme Pena, Robert Fitridge","doi":"10.1016/j.ejvs.2026.01.047","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.047","url":null,"abstract":"","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146101088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.ejvs.2026.01.039
Charlotte M Lentz, Kevin Mani, Gerdine C I von Meijenfeldt, Maarten J van der Laan, Anders Wanhainen, Giuseppe Asciutto, Clark J Zeebregts
Objective: Juxtarenal abdominal aortic aneurysms (JRAAAs) are anatomically complex and technically challenging to treat. Traditional metrics such as mortality or complication rates may not adequately reflect care quality. Composite measures such as failure to rescue (FTR) and textbook outcome (TO) offer a more comprehensive, patient centred assessment, capturing complication management and peri-operative course. TO reflects an ideal post-operative course, and FTR represents the proportion of patients who die after a major complication. This study assessed the feasibility and added value of TO and FTR as quality indicators in elective JRAAA repair using national registry data from the Netherlands and Sweden.
Methods: This retrospective cohort study used prospectively collected data from the Dutch Surgical Aneurysm Audit (DSAA) and the Swedish Swedvasc registry. Patients undergoing elective JRAAA repair with open surgical repair (OSR) or complex endovascular aneurysm repair (cEVAR) between 2016 and 2023 were included. TO reflected an ideal post-operative course; FTR captured death after major complications (Clavien-Dindo ≥ IV). Multivariable logistic regression was used to assess associations between surgical approach and outcomes.
Results: This study included 1 925 patients from the Netherlands and 775 from Sweden. In the Dutch cohort, cEVAR was associated with statistically significantly lower FTR rates (1.6% vs. 4.3%; p < .001), 30 day mortality (2.6% vs. 6.1%; p < .001), severe complications (5.8% vs. 14.8%; p < .001), and higher TO achievement (81.4% vs. 73.6%; p < .001) compared with OSR. No statistically significant differences in FTR (1.6% vs. 1.8%; p = .83) or TO (92.5% vs. 88.4%; p = .086) were found between OSR and cEVAR in the Swedvasc cohort. The main structural difference between the registries was the absence of re-admission data in Swedvasc.
Conclusion: TO and FTR show future promise as standardised metrics to evaluate surgical quality in JRAAA repair. Their added value is conceptual and requires further validation. Registry differences and incomplete data remain limitations. Implementing key variables with standardised definitions will enable benchmarking and support international quality improvement.
目的:腹主动脉瘤(JRAAAs)解剖结构复杂,治疗技术困难。死亡率或并发症发生率等传统指标可能无法充分反映护理质量。抢救失败(FTR)和教科书预后(to)等综合措施提供了更全面、以患者为中心的评估,包括并发症管理和围手术期过程。TO反映了理想的术后病程,FTR代表了因主要并发症而死亡的患者比例。本研究利用荷兰和瑞典的国家注册数据,评估了TO和FTR作为选择性JRAAA修复质量指标的可行性和附加值。方法:这项回顾性队列研究前瞻性地收集了荷兰外科动脉瘤审计(DSAA)和瑞典Swedvasc登记处的数据。在2016年至2023年期间接受选择性JRAAA修复与开放手术修复(OSR)或复杂血管内动脉瘤修复(cEVAR)的患者。TO反映了理想的术后过程;主要并发症后FTR捕获死亡(Clavien-Dindo≥IV)。采用多变量logistic回归评估手术入路与预后之间的关系。结果:本研究纳入荷兰1925例患者和瑞典775例患者。在荷兰队列中,cEVAR与具有统计学意义的较低的FTR率相关(1.6% vs. 4.3%)。结论:TO和FTR作为评价JRAAA修复手术质量的标准化指标具有前景。它们的附加价值是概念性的,需要进一步验证。注册表差异和不完整的数据仍然是限制。以标准化定义实施关键变量将使基准和支持国际质量改进成为可能。
{"title":"Feasibility and Added Value of Textbook Outcome and Failure to Rescue in Elective Juxtarenal Abdominal Aortic Aneurysm Repair: Insights from Two National Registries.","authors":"Charlotte M Lentz, Kevin Mani, Gerdine C I von Meijenfeldt, Maarten J van der Laan, Anders Wanhainen, Giuseppe Asciutto, Clark J Zeebregts","doi":"10.1016/j.ejvs.2026.01.039","DOIUrl":"https://doi.org/10.1016/j.ejvs.2026.01.039","url":null,"abstract":"<p><strong>Objective: </strong>Juxtarenal abdominal aortic aneurysms (JRAAAs) are anatomically complex and technically challenging to treat. Traditional metrics such as mortality or complication rates may not adequately reflect care quality. Composite measures such as failure to rescue (FTR) and textbook outcome (TO) offer a more comprehensive, patient centred assessment, capturing complication management and peri-operative course. TO reflects an ideal post-operative course, and FTR represents the proportion of patients who die after a major complication. This study assessed the feasibility and added value of TO and FTR as quality indicators in elective JRAAA repair using national registry data from the Netherlands and Sweden.</p><p><strong>Methods: </strong>This retrospective cohort study used prospectively collected data from the Dutch Surgical Aneurysm Audit (DSAA) and the Swedish Swedvasc registry. Patients undergoing elective JRAAA repair with open surgical repair (OSR) or complex endovascular aneurysm repair (cEVAR) between 2016 and 2023 were included. TO reflected an ideal post-operative course; FTR captured death after major complications (Clavien-Dindo ≥ IV). Multivariable logistic regression was used to assess associations between surgical approach and outcomes.</p><p><strong>Results: </strong>This study included 1 925 patients from the Netherlands and 775 from Sweden. In the Dutch cohort, cEVAR was associated with statistically significantly lower FTR rates (1.6% vs. 4.3%; p < .001), 30 day mortality (2.6% vs. 6.1%; p < .001), severe complications (5.8% vs. 14.8%; p < .001), and higher TO achievement (81.4% vs. 73.6%; p < .001) compared with OSR. No statistically significant differences in FTR (1.6% vs. 1.8%; p = .83) or TO (92.5% vs. 88.4%; p = .086) were found between OSR and cEVAR in the Swedvasc cohort. The main structural difference between the registries was the absence of re-admission data in Swedvasc.</p><p><strong>Conclusion: </strong>TO and FTR show future promise as standardised metrics to evaluate surgical quality in JRAAA repair. Their added value is conceptual and requires further validation. Registry differences and incomplete data remain limitations. Implementing key variables with standardised definitions will enable benchmarking and support international quality improvement.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":6.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}