JVS-vascular insights最新文献

{"title":"Scalene block as a predictor of surgical success for treatment of thoracic outlet syndrome","authors":"Dorcie Ann Gillette MD ,&nbsp;Linda Peng BS ,&nbsp;Maen Aboul Hosn MD","doi":"10.1016/j.jvsvi.2025.100343","DOIUrl":"10.1016/j.jvsvi.2025.100343","url":null,"abstract":"<div><h3>Background</h3><div>Neurogenic thoracic outlet syndrome (TOS) is a difficult pathology to accurately diagnose given the overlap between multiple causes of neuralgias of the upper extremity. Although scalene blocks are often used as diagnostic tools for brachial plexus compression at the level of the thoracic outlet, they can also be predictive of symptomatic relief after thoracic outlet decompression. Our objective is to evaluate the predictive value of preoperative scalene block for postoperative symptom improvement.</div></div><div><h3>Methods</h3><div>A retrospective review was performed for all patients who underwent a scalene block before first rib resection and at our institution between 2018 and 2023. Data on demographics, presenting symptoms, and preoperative workup were collected. Symptom resolution after scalene block and surgical decompression was assessed through chart review and direct patient contact. These were classified into three categories: complete resolution, partial resolution, and no resolution.</div></div><div><h3>Results</h3><div>A total of 98 patients were referred to the pain clinic for diagnostic scalene blocks after evaluation for TOS. Of these patients, 80 underwent diagnostic scalene block. A total of 63 patients who underwent a scalene block proceeded to undergo first rib resection. All patients experienced partial or complete improvement after the scalene block. Of these patients, 32 (63%) had complete improvement, 18 (35%) had partial improvement, and one patient (2%) had no improvement after first rib resection.</div></div><div><h3>Conclusions</h3><div>Neurogenic TOS is a complex pathology whose diagnosis can be challenging in patients presenting with nonclassical symptoms. Based on our findings, preoperative scalene block is an effective tool to accurately predict postoperative symptomatic improvement after first rib resection. The extent of predicted improvement remains variable and a harder measure to quantify given its subjective nature.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100343"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design of the RadFree randomized controlled study comparing LumiGuide, powered by Fiber Optic RealShape Technology, with conventional fluoroscopy guidance in fenestrated endovascular aortic repair","authors":"Andres Schanzer MD ,&nbsp;Darren B. Schneider MD ,&nbsp;Carlos Timaran MD ,&nbsp;Adam W. Beck MD ,&nbsp;Marc Schermerhorn MD ,&nbsp;Geert Willem Schurink MD ,&nbsp;Joost van Herwaarden MD, PhD ,&nbsp;Bijan Modarai MD, PhD ,&nbsp;Nathalie Moreels MD ,&nbsp;Frédéric Cochennec MD ,&nbsp;Tim Resch MD, PhD ,&nbsp;Tilo Kölbel MD","doi":"10.1016/j.jvsvi.2026.100354","DOIUrl":"10.1016/j.jvsvi.2026.100354","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether the use of LumiGuide, a novel real-time three-dimensional navigation system powered by Fiber Optic RealShape technology (Philips), reduces procedure fluoroscopy time compared with conventional fluoroscopic guidance during fenestrated endovascular aortic repair (FEVAR).</div></div><div><h3>Methods</h3><div>The RadFree study is a prospective, randomized, unblinded, multicenter clinical trial conducted at 11 vascular centers in Europe and the United States. Adults undergoing primary FEVAR with at least two target visceral vessels suitable for LumiGuide are randomized 1:1 to LumiGuide or conventional fluoroscopy. Stratification is performed by aneurysm extent. The primary endpoint is total procedure fluoroscopy time. Secondary outcomes include radiation exposure metrics (fluoroscopy time and rate, dose area product, and air kerma during navigation), cumulative procedural radiation dose, adverse LumiGuide device-related effects, and device deficiencies. Tertiary end points assess navigation efficiency and total procedure duration (first catheter/wire in to last catheter/wire out). The planned sample size of 182 subjects provides ≥80% power to detect a significant reduction in fluoroscopy time at a two-sided α of 0.05. Analyses follow an intention-to-treat approach.</div></div><div><h3>Results</h3><div>This report details the trial rationale, methods, and planned analyses. Enrollment is currently ongoing; interim analysis will occur at 50% recruitment to assess safety and efficacy signals.</div></div><div><h3>Conclusions</h3><div>RadFree is the first prospective, randomized multicenter trial evaluating the impact of LumiGuide on fluoroscopy time, radiation exposure and procedural efficiency in FEVAR. Its results will inform whether advanced three-dimensional navigation can safely and effectively reduce fluoroscopy dependence, improving safety for patients and endovascular teams.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100354"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medications modulating the risk of prolonged length of stay after transcarotid artery revascularization","authors":"Arjun Kumar BS ,&nbsp;Patrick D. Conroy MD ,&nbsp;Alec Schubert MD ,&nbsp;Shivani Raizada BA ,&nbsp;Aakanksha Gupta MD ,&nbsp;Mikael Fadoul MD ,&nbsp;Joseph V. Lombardi MD, MBA ,&nbsp;Philip M. Batista MD","doi":"10.1016/j.jvsvi.2025.100332","DOIUrl":"10.1016/j.jvsvi.2025.100332","url":null,"abstract":"<div><h3>Objective</h3><div>Transcarotid artery revascularization (TCAR) is an increasingly used alternative to carotid endarterectomy. Although the expected length of stay (LOS) after TCAR is typically 1 day, a subset of patients experience prolonged LOS (pLOS), which has important implications for cost, complication risk, and patient recovery. Previous investigations have identified various demographic and clinical risk factors for pLOS after TCAR. However, the role of a preoperative medication regimen is unclear. Our study aims to evaluate the association between specific medication classes, including antihypertensives and antidiabetic agents, and pLOS after TCAR.</div></div><div><h3>Methods</h3><div>We performed a retrospective, single-institution cohort analysis for all patients who underwent TCAR between 2019 and 2024. Of the 194 patients identified, 131 (67.5%) were stratified into normal LOS (≤1 day) and 63 (32.5%) into pLOS (≥2 days). Demographics, comorbidities, and detailed medication profiles were collected. Logistic regression analyses, adjusted for key covariates, were used to determine associations among medication class, dosage, and pLOS. Statistical significance was set at <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>The rate of pLOS was 32.5% (63/194). Baseline demographics and comorbidities were similar between normal LOS and pLOS groups, with the exception that a history of cerebrovascular accident, stroke, transient ischemic attack, or amaurosis fugax was significantly associated with increased odds of pLOS (odds ratio: 1.89, <em>P</em> &lt; .05). No individual class of antihypertensive, antidiabetic, or diuretic medication was independently associated with pLOS. However, subgroup analyses demonstrated that patients on a low-dose β-blocker had significantly lower odds of pLOS (adjusted odds ratio: 0.82, <em>P</em> = .02). In addition, use of a cardioselective β-blocker was found to be protective against pLOS (adjusted odds ratio: 0.87, <em>P</em> = .04). Other classes of antihypertensives, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers, showed no significant associations with pLOS.</div></div><div><h3>Conclusions</h3><div>In this single-center, retrospective analysis, preoperative use of a β-blocker, specifically at a low dose with cardioselective agents, was associated with decreased odds of pLOS after TCAR. These findings suggest that medication management may represent a modifiable factor to optimize perioperative outcomes of TCAR. Further prospective studies are warranted to confirm these associations and inform perioperative risk stratification strategies.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100332"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paclitaxel-based devices in subintimal versus intraluminal angioplasty for chronic total occlusion of the femoropopliteal artery","authors":"Taro Kimura MD,&nbsp;Toshitaka Okabe MD, PhD,&nbsp;Hirotoshi Sato MD,&nbsp;Toshihiko Matsuda MD,&nbsp;Daiki Kato MD,&nbsp;Yui Koyanagi MD,&nbsp;Takeshi Okura MD,&nbsp;Yuma Gibo MD,&nbsp;Yuki Ito MD,&nbsp;Shigehiro Ishigaki MD,&nbsp;Tatsuki Fujioka MD,&nbsp;Suguru Shimazu MD,&nbsp;Yuji Oyama MD, PhD,&nbsp;Naoei Isomura MD, PhD,&nbsp;Masahiko Ochiai MD, PhD","doi":"10.1016/j.jvsvi.2025.100329","DOIUrl":"10.1016/j.jvsvi.2025.100329","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic total occlusion (CTO) of the femoropopliteal artery lesion is a common manifestation of symptomatic lower limb atherosclerosis. However, femoropopliteal chronic total occlusion (FP-CTO) lesions remain a major challenge in endovascular treatment (EVT). Although drug-coated balloons and drug-eluting stents have demonstrated superior outcomes compared with plain old balloon angioplasty and bare nitinol stents in treating femoropopliteal lesions, the optimal strategy for subintimal approaches in FP-CTO remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 62 patients with FP-CTO who underwent EVT using paclitaxel-based devices (drug-eluting stent or drug-coated balloon) at our institution. Patients were assigned to subintimal (n = 15) or intraluminal (n = 47) groups. At 18 months, the primary end point was freedom from clinically driven target lesion revascularization (CD-TLR), and secondary end points included freedom from reocclusion and the composite of CD-TLR and reocclusion.</div></div><div><h3>Results</h3><div>At 18 months, freedom from CD-TLR was higher in the intraluminal group than in the subintimal group (76.6% vs 53.3%, <em>P</em> = .045). Freedom from reocclusion was also higher in the intraluminal group (87.2% vs 53.3%, <em>P</em> = .003) than in the subintimal group. In multivariable Cox proportional hazards analysis, the subintimal approach and lesion length were independent risk factors for CD-TLR.</div></div><div><h3>Conclusions</h3><div>In EVT for FP-CTO, intraluminal paclitaxel-based device therapy was superior to subintimal therapy, with significantly higher rates of freedom from retreatment.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100329"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking advance care planning in chronic limb-threatening ischemia: A narrative review of the literature","authors":"Olivia Fuson MD ,&nbsp;Michelle Yi BS ,&nbsp;Ann Gaffey MD","doi":"10.1016/j.jvsvi.2025.100325","DOIUrl":"10.1016/j.jvsvi.2025.100325","url":null,"abstract":"<div><h3>Objective</h3><div>Although patients with chronic limb-threatening ischemia (CLTI) who undergo major amputation experience greater 1-year mortality risks, data on advance care planning (ACP) in this population are limited. The aim of this review was to summarize the current and evidence-based implementation of ACP among patients with CLTI.</div></div><div><h3>Methods</h3><div>A literature review of ACP among patients with CLTI was performed. The Pubmed and Google Scholar databases were queried for articles on frequency, quality, and outcomes of ACP for patients with CLTI.</div></div><div><h3>Results</h3><div>Among patients who undergo major amputation for CLTI, reported mortality is 30% to 50% at the 1-year follow-up. Reported ACP completion rates before surgical intervention for patients with CLTI ranged from 5% to 30%. Palliative care use was limited, with only 1% to 3% of patients with CLTI receiving palliative care referrals before surgery, and &lt;30% of patients receiving palliative care consultations before death. Advance directives for patients with CLTI were similarly lacking, with 14% to 30% of vascular patients completing advance directives before death.</div></div><div><h3>Conclusions</h3><div>Although ACP has been shown to enhance quality of life for both patients and caregivers and lower health care costs in similar populations, ACP remains underused and poorly characterized in the vascular patient population. Further research is needed to evaluate ACP implementation for patients with CLTI and other life-limiting vascular pathologies.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100325"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cadaveric models for vascular surgery training","authors":"Koyal K. Ansingkar MS ,&nbsp;Maham Rahimi MD, PhD","doi":"10.1016/j.jvsvi.2025.100330","DOIUrl":"10.1016/j.jvsvi.2025.100330","url":null,"abstract":"<div><h3>Objective</h3><div>This review aims to provide a methodology for cadaveric model creation and detail various cadaveric models that have been used in vascular surgery education and can be adapted for further use.</div></div><div><h3>Methods</h3><div>The vascular anatomy of the cadavers was first assessed with diagnostic angiography to ensure adequacy for use in creating a cadaveric training model. Pulsatile flow with a motorized pump was established by accessing the left common carotid artery with an open approach for the inflow and accessing the left common femoral artery using a percutaneous approach to establish an outflow. Models for training various common vascular surgery procedures were then created. The residents themselves were involved in the creation of the models to maximize teaching.</div></div><div><h3>Results</h3><div>These models created include an angiogram model, an infrarenal abdominal aortic aneurysm model, a ruptured abdominal aortic aneurysm model, a Type B aortic dissection model, and a pulmonary embolism model, all with pulsatility that can simulate normal arterial hemodynamics. Angiography, endovascular aneurysm repair, complete proximal balloon control and supraceliac aortic cross-clamping, thoracic endovascular aortic repair, the Provisional Extension to Induce Complete Attachment (PETTICOAT) technique, the Knickerbocker technique, the STABILISE technique, the candy-plug technique, and mechanical thrombectomy in the pulmonary artery were all successfully performed on these models.</div></div><div><h3>Conclusions</h3><div>Cadaveric models have become increasingly important in vascular surgery training, providing realistic environments for procedural practice and team-based learning, with ongoing improvements to enhance their applicability and use. The life-like simulation allows trainees to learn the intricacies of each procedure that may not be thoroughly discussed during real clinical scenarios.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100330"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145977852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence assessment of the jugular venous pulse from ultrasound high-resolution B-mode clips: A proof of concept","authors":"Paolo Zamboni MD ,&nbsp;Anselmo Pagani MSc ,&nbsp;Giulia Baldazzi MD ,&nbsp;Saverio Farsoni MSc, PhD ,&nbsp;Pietro Busi MD ,&nbsp;Chiara Marchesin MD ,&nbsp;Antonino Proto MSc ,&nbsp;Alessandro Bertagnon MSc, PhD","doi":"10.1016/j.jvsvi.2025.100349","DOIUrl":"10.1016/j.jvsvi.2025.100349","url":null,"abstract":"<div><h3>Objective</h3><div>The jugular venous pulse (JVP) is a pivotal clinical parameter that currently can only be invasively measured through jugular catheterization and subsequent central venous pressure measurement. The ultrasound B-mode clip of the internal jugular vein cross-sectional area modifications allows to build a JVP curve that significantly correlates with the central venous pressure. However, this process is time-consuming and not suitable for clinical use. The aim of the present study is to verify whether artificial intelligence (AI) allows a rapid and reliable JVP waveform assessment as compared with a human operator.</div></div><div><h3>Methods</h3><div>High-resolution B-mode internal jugular vein clips (558 frames) of a cohort of six human subjects have been blindly analysed in post-processing by three different researchers and a neural network. Agreement was quantified using two complementary measures: Dice similarity coefficient (Dice) and the Hausdorff distance at the 95th percentile (HD95). Furthermore, a noninferiority test was performed comparing the model with the human raters. The null hypothesis (H0) was that the model performs worse than human raters by at least Δ = 0.055 Dice, a difference that is considered clinically negligible.</div></div><div><h3>Results</h3><div>The average processing time per frame was 19.80 ± 5.08 seconds for human operators, compared with 0.03404 seconds ± 0.01806 seconds for the AI model running on a standard consumer-grade laptop. This represents a difference of nearly three orders of magnitude (a difference that could be quantitatively described as 580 times faster). Agreement between human raters was very high, with median Dice 0.959 (95% confidence interval, 0.958-0.960). Agreement between the model and each rater was slightly lower, with a median Dice of approximately 0.907 (95% confidence interval, 0.904-0.909). Human raters had median HD95 values of &lt;5 pixels, reflecting very small boundary differences. The model-vs-rater comparisons showed somewhat higher HD95 values, with medians or approximately 8 to 10 pixels, but still within a clinically acceptable range given the resolution of the images. The Wilcoxon paired test rejected the null hypothesis H₀ (<em>P</em> = .004169), showing that the model is not inferior to human raters within this clinically acceptable margin.</div></div><div><h3>Conclusions</h3><div>Our study demonstrates an amazing time efficiency of the entire AI segmentation process, with a precision quite comparable with the human researchers' assessment. Our findings, in perspective, support the clinical introduction of ultrasound AI JVP waveform assessment in a variety of potentially interested medical specialties, including cardiology, critical care, neurosciences, and vascular surgery.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100349"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life among patients with carotid body tumors in a retrospective matched-pair observational study","authors":"Hoda Alimohamad MD ,&nbsp;Wienand A. Omta MSc, PhD ,&nbsp;Maaike Verheij BSc ,&nbsp;Jeroen Jansen MD, PhD ,&nbsp;Jaap F. Hamming MD, PhD ,&nbsp;Abbey Schepers MD, PhD","doi":"10.1016/j.jvsvi.2025.100328","DOIUrl":"10.1016/j.jvsvi.2025.100328","url":null,"abstract":"<div><h3>Background</h3><div>The quality of life (QoL) in patients with head and neck paragangliomas, including carotid body tumors (CBTs), is known to be reduced. Currently, there are only a few studies performed on the QoL among patients diagnosed with CBTs during follow-up and after surgery.</div></div><div><h3>Objective</h3><div>This study aims to assess QoL in patients with CBT in follow-up and after surgery and to compare both groups with a control group.</div></div><div><h3>Methods</h3><div>In this retrospective study, patients with CBT who underwent surgery were matched using Euclidean distance scoring with patients in follow-up based on age, gender, tumor size, tumor laterality, and follow-up duration. All matched patients completed the World Health Organization Quality of Life-Brief, Sickness Impact Profile 68, and Short-Form Survey-36 questionnaires. A control group was recruited through an open online survey distributed via public channels.</div></div><div><h3>Results</h3><div>No statistically significant QoL differences were found between resected and non-resected patients with CBT. Comparing non-resected, resected, and control groups, the Short-Form Health Survey-36 showed significant differences in physical function, role-physical, and general health (<em>P</em> = .00). The Sickness Impact Profile 68 indicated a significant difference in mobility between resected and control groups, and the World Health Organization Quality of Life-Brief showed a significant difference in physical function (<em>P</em> &lt; .02). Comorbidities and postoperative complications may contribute to reduced QoL in this population.</div></div><div><h3>Conclusions</h3><div>No significant QoL differences between matched patients with CBT in follow-up and those who underwent resection. Both groups had lower QoL compared with controls in the subscales for physical function, role-physical, and general health. These findings suggest a personalized approach may be more appropriate than assuming surgery improves QoL.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100328"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RECONSTRUCT study protocol for real-world outcomes of covered endovascular reconstruction of the aortic bifurcation using the GORE VIABAHN VBX balloon-expandable endoprosthesis to treat aortoiliac occlusive disease","authors":"Leigh Ann O’Banion MD ,&nbsp;Michele Antonello MD ,&nbsp;Hector Novoa ,&nbsp;Rizwan Afzal ,&nbsp;Jean Bismuth MD","doi":"10.1016/j.jvsvi.2025.100342","DOIUrl":"10.1016/j.jvsvi.2025.100342","url":null,"abstract":"<div><div>Aortoiliac occlusive disease (AIOD) is a common manifestation of peripheral artery disease (PAD) and contributes substantially to global morbidity and mortality. Although open surgical repair provides durable outcomes, its risks have led to a shift toward endovascular-first strategies. The covered endovascular reconstruction of the aortic bifurcation (CERAB) technique has emerged as a promising option for complex AIOD. The objective of this manuscript is to describe the methodology of the RECONTSRUCT study, designed to evaluate the safety and effectiveness of the GORE VIABAHN VBX balloon-expandable endoprosthesis (VBX stent graft) in the CERAB procedure for AIOD. The RECONSTRUCT study is a multicenter, single-arm, retrospective study enrolling at least 158 patients across 35 sites in the United States and Europe. Data collection includes demographics, medical history, procedural details, device characteristics, and clinical follow-up from electronic health records. The primary effectiveness endpoint is 1-year primary patency, defined as uninterrupted blood flow (&lt;50% binary restenosis) through the CERAB devices without target lesion revascularization (TLR). The primary safety endpoint is 30-day morbidity, defined as any major adverse cardiovascular event or procedure-related reintervention. Secondary endpoints include technical success, 30-day mortality, freedom from device fracture, primary assisted and secondary patency, freedom from TLR and clinically driven TLR, and overall survival. The study will provide real-world, multicenter evidence on VBX stent graft use in CERAB for AIOD. Standardized data collection with independent review and adjudication will enhance data reliability, and findings may address an important evidence gap in managing complex aortoiliac disease.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100342"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroneal-only runoff after endovascular revascularization and the impact on limb salvage outcomes","authors":"Francisco Lasanta-Gorbea MD ,&nbsp;Jose Ortiz-Fullana MD, MPH ,&nbsp;Sebastian Castañer-Colberg MD ,&nbsp;Van Acevedo-Vargas MD ,&nbsp;Jorge Martinez-Trabal MD, FACS, RPVI, FSVS ,&nbsp;Rafael Santini-Dominguez MD, FACS, RPVI, FSVS","doi":"10.1016/j.jvsvi.2025.100351","DOIUrl":"10.1016/j.jvsvi.2025.100351","url":null,"abstract":"<div><h3>Background</h3><div>Hispanic patients with chronic limb-threatening ischemia (CLTI) have more advanced infrapopliteal arterial disease compared with other ethnic groups. This pattern often results in fewer available target vessels for revascularization and a greater dependence on a single runoff artery to achieve limb salvage. Among the infrapopliteal vessels, the peroneal artery, typically terminating above the ankle and supplying the foot through collateral branches, has traditionally been considered the least favorable target due to its indirect contribution to pedal perfusion. This study evaluated outcomes of peroneal-only runoff after endovascular revascularization in an exclusively Hispanic CLTI cohort.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at a tertiary medical center in Puerto Rico, including all limbs with post-revascularization arteriograms demonstrating sole peroneal artery runoff (January 2020 to July 2025). Demographics, comorbidities, and outcomes were analyzed. The primary endpoint was limb salvage; secondary outcomes included amputation-free survival (AFS), limb event-free survival (LEFS), and reintervention. The predictive utility of Rutherford classification; Wound, Ischemia, and foot Infection (WIfI) score; and Global Limb Anatomic Staging System (GLASS) staging was assessed.</div></div><div><h3>Results</h3><div>A total of 120 limbs from 117 Hispanic patients (median age, 74 years; 87.5% with diabetes) were included. At 1 year, limb salvage was 78.3%, AFS was 69.2%, and LEFS was 55.8%; 32.5% required reintervention. Rutherford classification, WIfI score, and GLASS stage were not significantly associated with outcomes (all <em>P</em> &gt; .05). In multivariable Cox regression, no variable independently predicted major amputation. Patients with a reintervention in the first year were 2.35 times more likely to have a major amputation or death (hazard ratio, 2.35; <em>P</em> = .031).</div></div><div><h3>Conclusions</h3><div>In this high-risk Hispanic CLTI cohort, peroneal-only runoff revascularization achieved acceptable limb salvage and survival outcomes. Conventional risk stratification systems (Rutherford, WIfI, GLASS) were not good predictors of outcomes, suggesting limited utility in patients with isolated peroneal perfusion. These findings support the peroneal artery as a viable revascularization target when other tibial vessels are unavailable.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100351"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}