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Graft patency and functional outcome four years after vascular injury of the extremities 四肢血管损伤后四年移植物通畅和功能预后
Pub Date : 2026-01-01 DOI: 10.1016/j.jvsvi.2025.100340
Yvonne Nicole Gosslau MD, Edgar Franklin Hernandez Cancino MD, Tobias Dominik Warm MD, Athinodoros Alvanidis MD, Alexander Hyhlik-Duerr MD, PhD

Objective

This study aimed to assess the long-term follow-up outcomes after vascular trauma of the extremities, focusing on reintervention rates and graft patency as primary endpoints. Secondary aims included evaluation of functional outcomes, quality of life, antithrombotic therapy, and pain management needs.

Methods

Data were derived from the prospective Vascular Trauma Registry Augsburg (vascTR-Aux), including patients with vascular trauma involving the extremities treated at a German Level I trauma center from January 2016 to March 2025. Demographic, clinical, and procedural data were collected. Long-term follow-up included patency assessment, reintervention, functional status, antithrombotic therapy, pain medication, and patient-reported outcomes using the EQ-5D-3L questionnaire. Descriptive and statistical analyses were performed using Python-based tools.

Results

Of 189 enrolled patients, 104 had extremity vascular trauma. The cohort was predominantly male (75.9%) with a mean age of 41.5 years; 21.2% were under 18 years. Surgical intervention was performed in 52.9% of cases, whereas 26% received conservative treatment. Amputation was required in 8.7% of cases. Follow-up data were available for 32.7% of patients, with a mean duration of 51 months in this subgroup. The graft patency rate was 84.6%, and reintervention occurred in 3.8%. Despite this, 50% reported functional impairments, primarily due to concomitant injuries. Analgesic medication was used by 26.9% of patients at time of follow-up. Antiplatelet therapy was ongoing in 43.8%, and 9.4% received anticoagulation. Injuries to the popliteal artery significantly increased the risk of amputation or death (P < .05). Other variables like body mass index, age, and American Society of Anesthesiologists score showed trends toward poorer outcomes but lacked statistical significance.

Conclusions

Long-term graft patency following extremity vascular trauma is high, but functional outcomes remain suboptimal for many patients due to mostly nonvascular conditions. One-half of those followed reported lasting impairments, and nearly 20% required regular pain medication at time of follow-up. These findings emphasize the importance of structured, long-term follow-up protocols and individualized antithrombotic management. Proactive follow-up strategies and dedicated registries are essential to improve evidence-based recommendations and optimize outcomes for this distinct patient population.
目的本研究旨在评估四肢血管创伤后的长期随访结果,重点关注再干预率和移植物通畅度作为主要终点。次要目的包括评估功能结局、生活质量、抗血栓治疗和疼痛管理需求。方法数据来自前瞻性血管创伤登记处奥格斯堡(vasc - aux),包括2016年1月至2025年3月在德国一级创伤中心治疗的涉及四肢的血管创伤患者。收集了人口学、临床和手术数据。长期随访包括通畅评估、再干预、功能状态、抗血栓治疗、止痛药治疗和患者报告的EQ-5D-3L问卷结果。使用基于python的工具进行描述性和统计分析。结果189例患者中,104例有四肢血管损伤。该队列以男性为主(75.9%),平均年龄41.5岁;18岁以下的占21.2%。手术干预占52.9%,保守治疗占26%。8.7%的病例需要截肢。该亚组中32.7%的患者可获得随访数据,平均持续时间为51个月。移植通畅率为84.6%,再干预率为3.8%。尽管如此,仍有50%的患者报告了主要由伴随损伤引起的功能损伤。随访时使用镇痛药物的患者占26.9%。接受抗血小板治疗的占43.8%,接受抗凝治疗的占9.4%。腘动脉损伤显著增加截肢或死亡的风险(P < 0.05)。其他变量如体重指数、年龄和美国麻醉师协会评分显示出较差结果的趋势,但缺乏统计学意义。结论四肢血管损伤后的长期移植物通畅率很高,但由于大多数非血管状况,许多患者的功能预后仍不理想。其中一半的人报告了持续的损伤,近20%的人在随访期间需要定期服用止痛药。这些发现强调了结构化、长期随访方案和个体化抗血栓管理的重要性。积极的随访策略和专门的登记处对于改善循证建议和优化这一独特患者群体的结果至关重要。
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引用次数: 0
A systematic review and meta-analysis of intraoperative intravenous unfractionated heparin bolus in autogenous arteriovenous access surgery 自体动静脉通路手术术中静脉注射肝素的系统回顾和荟萃分析
Pub Date : 2026-01-01 DOI: 10.1016/j.jvsvi.2025.100298
Animesh Singla FRACS (Vasc) , Kajanan Parameshwaran MD , Juanita Noeline Chui MD , Tess Cooper PhD , Ahmer Hameed PhD, FRACS , Angela C. Webster PhD, FRACP, FAHMS , Henry Pleass FRACS , Melanie Wyld PhD, FRACP

Background

There is controversy over the balance of benefit to harm of intravenous (IV) unfractionated heparin (UFH) in the creation of autogenous fistulas. This review aimed to assess the efficacy and safety of intraoperative administration of an IV UFH bolus during creation of autogenous venous access in kidney failure.

Methods

MEDLINE, Embase, and CENTRAL were systematically searched for randomized controlled trials (RCTs) recruiting adults with kidney failure undergoing arteriovenous dialysis access surgery (PROSPERO CRD42022319502). Quality was assessed using the Cochrane Risk of Bias Assessment Tool. Outcomes were fistula patency, bleeding complications, fistula thrombosis, and reintervention rates. Relative and absolute effects were synthesized using a random-effects model as risk ratio (RR) with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE approach.

Results

Seven RCTs (701 participants) were identified. Risk of bias was low or unclear in most domains. Using IV UFH compared with no heparin may decrease the risk of loss of fistula patency (6 studies, 548 participants; RR, 0.49; I2, 0%; low certainty evidence). The greatest benefit was for autogenous radiocephalic fistula compared with other autogenous fistula formation (4 studies, 302 participants; RR, 0.45; I2, 0%; low certainty evidence). The risk of bleeding complications may be higher with IV UFH (7 studies, 698 participants; RR, 2.71; I2, 5%; low certainty evidence). The most common bleeding complications were hematoma formation (57%). Based on very low-certainty evidence, use of IV UFH may also associated with a reduced risk of acute fistula thrombosis (7 studies, 698 participants; RR, 0.49; I2, 54%).

Conclusions

Using an IV UFH bolus (compared with no heparin) during arteriovenous fistula creation, may improve early clinical patency and reduced thrombosis, but may result in more bleeding complications. Owing to the low certainty of evidence, a contemporary multicenter RCT is needed to further assess the validity of this conclusion. This study should provide an update on the existing guideline in the literature.
背景静脉注射(IV)未分离肝素(UFH)治疗自体瘘管的利弊平衡存在争议。本综述旨在评估肾衰竭患者在术中建立自体静脉通路时静脉注射UFH丸的有效性和安全性。方法系统检索medline、Embase和CENTRAL,纳入接受动静脉透析通路手术(PROSPERO CRD42022319502)的肾功能衰竭成人患者的随机对照试验(rct)。使用Cochrane偏倚风险评估工具评估质量。结果是瘘管通畅、出血并发症、瘘管血栓形成和再干预率。采用随机效应模型作为风险比(RR), 95%置信区间(CI)综合相对效应和绝对效应。使用GRADE方法评估证据的确定性。结果共纳入7项随机对照试验(701名受试者)。大多数领域的偏倚风险较低或不明确。与不使用肝素相比,使用IV UFH可降低瘘管通畅丧失的风险(6项研究,548名参与者;RR, 0.49; i2,0%;低确定性证据)。与其他自体瘘管形成相比,自体放射性头瘘管获益最大(4项研究,302名受试者;RR, 0.45; i2,0%;低确定性证据)。静脉UFH出血并发症的风险可能更高(7项研究,698名受试者;RR, 2.71; i2.5 %;低确定性证据)。最常见的出血并发症是血肿形成(57%)。基于非常低确定性的证据,静脉注射UFH也可能与急性瘘管血栓形成风险降低相关(7项研究,698名参与者;RR, 0.49; I2, 54%)。结论在动静脉造瘘术中静脉注射UFH丸(与不使用肝素相比)可改善早期临床通畅,减少血栓形成,但可能导致更多的出血并发症。由于证据的低确定性,需要当代多中心随机对照试验来进一步评估这一结论的有效性。本研究应提供文献中现有指南的更新。
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引用次数: 0
The clinical and financial impact of establishing an office-based vein center within an academic medical system 在学术医疗系统内建立以办公室为基础的静脉中心的临床和财务影响
Pub Date : 2026-01-01 DOI: 10.1016/j.jvsvi.2025.100350
Yancheng Dai MD , Dejah R. Judelson MD , Douglas W. Jones MD , Andres Schanzer MD , Dawn Durocher BA , Francesco A. Aiello MD, MBA

Background

Minimally invasive venous treatments and declining professional reimbursement have shifted superficial venous care from hospitals to office-based practices. This study evaluated the clinical and financial impact of establishing a freestanding, office-based vein center (VC), within an academic medical system.

Methods

A retrospective cohort study was conducted comparing venous services performed by vascular surgeons at an outpatient hospital (OH) facility and at a freestanding office-based vein center (VC). In 2018, venous patients were transitioned from the OH to the VC. OH data from October 1, 2016, to September 30, 2017, were compared with VC data from October 1, 2022, to September 30, 2023. Data collected targeted clinical volume (office visits, vascular lab studies, procedure volume), procedural efficiency (in-facility times) and financial performance (total clinical revenue, net operating margin).

Results

Venous procedures increased by 125%, from 317 at the OH to 713 at the VC; the VC procedures were generated from 3122 clinic visits and 1735 vascular lab studies performed at the VC. Average in-facility time decreased by 73% for endovenous ablation (244 to 65 minutes) and 79% for ambulatory phlebectomies (420 to 87 minutes) when comparing VC with OH. Net operating margin at the VC was $365,955 (18.9% of total revenue), reflecting a total revenue of $1,931,516 and total costs of $1,565,561.

Conclusions

Establishing an office-based vein center within an academic medical system led to higher clinical volume, enhanced efficiency, and positive net operating margin. Vascular surgeons should seek out opportunities to be clinical leaders and financial stakeholders in sites of service outside of traditional hospital settings.
背景:微创静脉治疗和专业报销的下降已经将浅静脉护理从医院转移到办公室。本研究评估了在学术医疗系统内建立独立的办公室静脉中心(VC)的临床和财务影响。方法进行回顾性队列研究,比较门诊医院(OH)和独立办公室静脉中心(VC)血管外科医生的静脉服务。2018年,静脉患者由OH向VC过渡。将2016年10月1日至2017年9月30日的OH数据与2022年10月1日至2023年9月30日的VC数据进行比较。收集的数据针对临床量(办公室访问量、血管实验室研究、手术量)、程序效率(住院时间)和财务绩效(临床总收入、净营业利润率)。结果静脉手术增加125%,从OH组的317例增加到VC组的713例;VC程序是根据在VC进行的3122次临床访问和1735次血管实验室研究生成的。与OH相比,静脉内消融的平均住院时间减少了73%(244 - 65分钟),流动静脉切除术的平均住院时间减少了79%(420 - 87分钟)。VC的净营业利润率为365,955美元(占总收入的18.9%),反映出总收入为1,931,516美元,总成本为1,565,561美元。结论在学术医疗系统内建立办公室静脉中心,临床业务量增加,效率提高,净营业利润为正。血管外科医生应该寻找机会成为临床领导者和财务利益相关者在传统医院设置之外的服务场所。
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引用次数: 0
Clinical evaluation of a device to treat upper extremity lymphedema 一种治疗上肢淋巴水肿装置的临床评价
Pub Date : 2025-11-21 DOI: 10.1016/j.jvsvi.2025.100326
Evgeniya Molotkova BS , Leah R. Thomas MS , Selah Wangler BS , Jennifer Rechani BS , Victoria Tabacchi BS , Cara Spivey MS , Aileen Helsel PhD , Christopher B. Arena PhD , Tara Newberry COTA/L, CLT, OCC , Andre Muelenaer MD , Ralph Brown Jr. MD

Objective

The LymphaVibe is a newly developed medical device that uses vibration to treat upper extremity lymphedema. Previous studies have demonstrated that the device is safe to use in healthy participants. This study aims to assess the preliminary efficacy and safety of this device when used in patients with clinical upper extremity lymphedema.

Methods

This prospective cohort study enrolled 15 patients who were receiving lymphedema therapy through our institution's outpatient program. Participants received treatment with the LymphaVibe before their standard of care therapy and were seen once a week for 4 weeks. End points included upper extremity circumference, upper extremity induration, lymphedema-related patient reported outcomes (Lymphedema Life Impact Scale), and safety.

Results

Treatment with the LymphaVibe resulted in a significant decrease in upper extremity circumference at 30 cm (P = .012; d = 0.34) and 40 cm (P = .011; d = 0.34) above the wrist. This correlated with a significant increase in induration at 30 cm (P = .017; d = −0.32). Treatment with the LymphaVibe was associated with a significant decrease in total Lymphedema Life Impact Score (P < .01; d = 0.70), as well as significant decreases in all subcategories, except upper extremity strength. Out of 60 total visits, a side effect was reported in 2 and an unexpected problem was reported in 2. There were no adverse events, and no patient elected to terminate a study visit or unenroll owing to discomfort with device use.

Conclusions

The LymphaVibe is safe to use in patients with a diagnosis of upper extremity lymphedema. Although limited by the small sample size, the preliminary efficacy results are promising and warrant further investigation.
目的:LymphaVibe是一种利用振动治疗上肢淋巴水肿的新型医疗器械。先前的研究表明,该设备在健康参与者中使用是安全的。本研究旨在初步评估该装置用于临床上肢淋巴水肿患者的有效性和安全性。方法:本前瞻性队列研究纳入了15例通过我院门诊项目接受淋巴水肿治疗的患者。参与者在标准护理治疗前接受LymphaVibe治疗,每周见一次,持续4周。终点包括上肢围度、上肢硬结、淋巴水肿相关患者报告的结果(淋巴水肿生活影响量表)和安全性。结果经LymphaVibe治疗后,腕部以上30 cm (P = 0.012; d = 0.34)和40 cm (P = 0.011; d = 0.34)上肢周长明显缩短。这与30 cm处硬化的显著增加相关(P = 0.017; d = - 0.32)。使用LymphaVibe治疗与总淋巴水肿生命影响评分(P < 0.01; d = 0.70)显著降低相关,除上肢力量外,所有亚类别均显著降低。在总共60次访问中,2次报告了副作用,2次报告了意外问题。没有不良事件发生,也没有患者因设备使用不适而选择终止研究访问或退出研究。结论LymphaVibe用于诊断为上肢淋巴水肿的患者是安全的。虽然受样本量的限制,初步的疗效结果是有希望的,值得进一步的研究。
{"title":"Clinical evaluation of a device to treat upper extremity lymphedema","authors":"Evgeniya Molotkova BS ,&nbsp;Leah R. Thomas MS ,&nbsp;Selah Wangler BS ,&nbsp;Jennifer Rechani BS ,&nbsp;Victoria Tabacchi BS ,&nbsp;Cara Spivey MS ,&nbsp;Aileen Helsel PhD ,&nbsp;Christopher B. Arena PhD ,&nbsp;Tara Newberry COTA/L, CLT, OCC ,&nbsp;Andre Muelenaer MD ,&nbsp;Ralph Brown Jr. MD","doi":"10.1016/j.jvsvi.2025.100326","DOIUrl":"10.1016/j.jvsvi.2025.100326","url":null,"abstract":"<div><h3>Objective</h3><div>The LymphaVibe is a newly developed medical device that uses vibration to treat upper extremity lymphedema. Previous studies have demonstrated that the device is safe to use in healthy participants. This study aims to assess the preliminary efficacy and safety of this device when used in patients with clinical upper extremity lymphedema.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 15 patients who were receiving lymphedema therapy through our institution's outpatient program. Participants received treatment with the LymphaVibe before their standard of care therapy and were seen once a week for 4 weeks. End points included upper extremity circumference, upper extremity induration, lymphedema-related patient reported outcomes (Lymphedema Life Impact Scale), and safety.</div></div><div><h3>Results</h3><div>Treatment with the LymphaVibe resulted in a significant decrease in upper extremity circumference at 30 cm (<em>P</em> = .012; d = 0.34) and 40 cm (<em>P</em> = .011; d = 0.34) above the wrist. This correlated with a significant increase in induration at 30 cm (<em>P</em> = .017; d = −0.32). Treatment with the LymphaVibe was associated with a significant decrease in total Lymphedema Life Impact Score (<em>P</em> &lt; .01; d = 0.70), as well as significant decreases in all subcategories, except upper extremity strength. Out of 60 total visits, a side effect was reported in 2 and an unexpected problem was reported in 2. There were no adverse events, and no patient elected to terminate a study visit or unenroll owing to discomfort with device use.</div></div><div><h3>Conclusions</h3><div>The LymphaVibe is safe to use in patients with a diagnosis of upper extremity lymphedema. Although limited by the small sample size, the preliminary efficacy results are promising and warrant further investigation.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100326"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791039","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}
引用次数: 0
Multi-omics analysis identified spermidine as a potential compound against aortic aneurysm rupture 多组学分析发现亚精胺是一种潜在的抗主动脉瘤破裂的化合物
Pub Date : 2025-11-21 DOI: 10.1016/j.jvsvi.2025.100324
Jiani Zhao MD , Shuai Liu MD , Yacheng Xiong MD , Yu Liu MD , Tinghua Liu MD , Jinjian Sun PhD , Wei Wang PhD

Background

Abdominal aortic aneurysm (AAA) is a life-threatening aortic disease with a high mortality rate in cases of rupture, accompanied by abnormalities in metabolic processes. However, how polyamine metabolism is involved in AAA development remains largely unknown.

Methods

We used single-cell RNA sequencing (scRNA-seq) to analyze the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples.

Results

scRNA-seq analysis revealed higher activity of the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples. The messenger RNA expression levels of genes related to polyamine metabolism, such as ODC1 and SAT1, were also found to be elevated in various cell clusters of human AAA samples. Immunofluorescence assays confirmed an increased expression of ODC1 in AAA tissues relative to controls. Polyamine metabolomic analysis indicated that spermidine (SPD) levels were positively correlated with the diameters of AAA (R = 0.73; P = .04). In angiotensin II (Ang II)-induced AAA model of Apoe−/− mice, SPD treatment significantly decreased the incidence of aneurysm rupture compared with the control group (27% vs 62.5%; P < .0001). scRNA-seq of mouse aortic aneurysm tissues revealed a higher proportion of smooth muscle cells (SMCs) in the SPD-treated groups. Trajectory analysis suggested that the clusters of SMCs underwent the phenotype switch from the contractile SMCs to synthetic SMCs. Differential expressed gene analysis in the SMCs cluster showed that elastin (Eln) messenger RNA is the most markedly upregulated gene in SPD-treated group compared with controls. In both porcine pancreatic elastase-induced AAA mouse models and mouse vascular SMCs, Eln messenger RNA levels were significantly increased in SPD-treated groups than in control groups.

Conclusions

We found that polyamine metabolism is more active in AAA. As one of polyamines, SPD can prevent rupture of aortic aneurysms. Eln upregulation by SPD in SMCs may be the potential molecular mechanism.
腹主动脉瘤(AAA)是一种危及生命的主动脉疾病,破裂时死亡率高,并伴有代谢过程异常。然而,多胺代谢如何参与AAA的发展在很大程度上仍然未知。方法采用单细胞RNA测序(scRNA-seq)技术分析人AAA多细胞簇与非动脉瘤样本的多胺代谢途径。结果scrna -seq分析显示,与非动脉瘤样本相比,人AAA内多个细胞簇的多胺代谢途径活性更高。与多胺代谢相关的基因,如ODC1和SAT1的信使RNA表达水平在人类AAA样本的各种细胞群中也被发现升高。免疫荧光测定证实,与对照组相比,AAA组织中ODC1的表达增加。多胺代谢组学分析表明,亚精胺(SPD)水平与AAA直径呈正相关(R = 0.73; P = 0.04)。在血管紧张素II (Ang II)诱导的Apoe−/−小鼠AAA模型中,与对照组相比,SPD治疗显著降低了动脉瘤破裂的发生率(27% vs 62.5%; P < .0001)。小鼠主动脉瘤组织scRNA-seq显示,spd处理组平滑肌细胞(SMCs)比例较高。轨迹分析表明,SMCs集群经历了从收缩型SMCs到合成型SMCs的表型转换。SMCs集群差异表达基因分析显示,spd处理组与对照组相比,弹性蛋白(Eln)信使RNA表达上调最为显著。在猪胰腺弹性酶诱导的AAA小鼠模型和小鼠血管SMCs中,spd处理组的Eln信使RNA水平均显著高于对照组。结论多胺代谢在AAA中更为活跃,SPD作为多胺的一种,可以预防动脉瘤破裂。SPD在SMCs中上调Eln可能是潜在的分子机制。
{"title":"Multi-omics analysis identified spermidine as a potential compound against aortic aneurysm rupture","authors":"Jiani Zhao MD ,&nbsp;Shuai Liu MD ,&nbsp;Yacheng Xiong MD ,&nbsp;Yu Liu MD ,&nbsp;Tinghua Liu MD ,&nbsp;Jinjian Sun PhD ,&nbsp;Wei Wang PhD","doi":"10.1016/j.jvsvi.2025.100324","DOIUrl":"10.1016/j.jvsvi.2025.100324","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is a life-threatening aortic disease with a high mortality rate in cases of rupture, accompanied by abnormalities in metabolic processes. However, how polyamine metabolism is involved in AAA development remains largely unknown.</div></div><div><h3>Methods</h3><div>We used single-cell RNA sequencing (scRNA-seq) to analyze the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples.</div></div><div><h3>Results</h3><div>scRNA-seq analysis revealed higher activity of the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples. The messenger RNA expression levels of genes related to polyamine metabolism, such as ODC1 and SAT1, were also found to be elevated in various cell clusters of human AAA samples. Immunofluorescence assays confirmed an increased expression of ODC1 in AAA tissues relative to controls. Polyamine metabolomic analysis indicated that spermidine (SPD) levels were positively correlated with the diameters of AAA (R = 0.73; <em>P</em> = .04). In angiotensin II (Ang II)-induced AAA model of Apoe<sup>−/−</sup> mice, SPD treatment significantly decreased the incidence of aneurysm rupture compared with the control group (27% vs 62.5%; <em>P</em> &lt; .0001). scRNA-seq of mouse aortic aneurysm tissues revealed a higher proportion of smooth muscle cells (SMCs) in the SPD-treated groups. Trajectory analysis suggested that the clusters of SMCs underwent the phenotype switch from the contractile SMCs to synthetic SMCs. Differential expressed gene analysis in the SMCs cluster showed that elastin (Eln) messenger RNA is the most markedly upregulated gene in SPD-treated group compared with controls. In both porcine pancreatic elastase-induced AAA mouse models and mouse vascular SMCs, Eln messenger RNA levels were significantly increased in SPD-treated groups than in control groups.</div></div><div><h3>Conclusions</h3><div>We found that polyamine metabolism is more active in AAA. As one of polyamines, SPD can prevent rupture of aortic aneurysms. Eln upregulation by SPD in SMCs may be the potential molecular mechanism.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100324"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791038","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}
引用次数: 0
A novel framework for structuring sustainable innovation in surgery 构建外科可持续创新的新框架
Pub Date : 2025-11-05 DOI: 10.1016/j.jvsvi.2025.100320
Ryan Gedney MD , Joseph Scalea MD , Mathew D. Wooster MD , Jean M. Ruddy MD , Thomas Brothers MD , David Mahvi MD , Adam Tanious MD

Background

Surgical innovation has offered some of the most remarkable advances in technology in human history, often starting in the clinical setting. Despite unique approaches to problem solving among clinical surgeons, there are few structures for innovation that offer a sustainable pipeline of new technology. We hypothesized that a simple framework addressing four steps would support sustainable innovation.

Methods

To identify unmet needs, we assembled a team of clinical specialists who attended problem-focused quarterly white board sessions. Solutions generated were directed toward a single unmet need, using evidence-based design sketches and prior art assessment in real time. To assess solutions, solution-specific subgroups were built with direct institutional availability to engineering, intellectual property, and business expertise. Entrepreneurs and team leaders then built business models for each opportunity.

Results

Unmet need identification was achieved within the first meeting, and the structured framework rapidly yielded innovative solutions in seven different categories, including surgical training, vascular access, improved ergonomics and patient positioning, visualization enhancement, and workflow optimization. Each project was prioritized for development based on achievable timelines. Within 1 year, this resulted in three patent applications, one issued patent, two funded in-house development projects, and one funded clinician-led startup enrolled in a nationally recognized accelerator program, with a combined total addressable market of $9.8 billion.

Conclusions

We present a successful, innovative structure for a multidisciplinary group within a large academic surgical department focused on education of the innovation process. This clinician-centered, stepwise approach provided a pathway for commercialization that is absent in most surgical environments and facilitates rapid generation of highly valuable ideas.
外科创新提供了人类历史上一些最显著的技术进步,通常始于临床环境。尽管临床外科医生解决问题的方法独特,但很少有创新结构提供可持续的新技术管道。我们假设一个包含四个步骤的简单框架将支持可持续创新。方法为了确定未满足的需求,我们召集了一组临床专家,他们参加了以问题为重点的季度白板会议。生成的解决方案针对单个未满足的需求,使用基于证据的设计草图和现有技术实时评估。为了评估解决方案,特定于解决方案的子组被建立起来,并具有工程、知识产权和业务专业知识的直接机构可用性。然后,企业家和团队领导者为每个机会建立商业模式。结果在第一次会议中就实现了满足需求的识别,结构化框架迅速产生了七个不同类别的创新解决方案,包括手术培训、血管通路、改进的人体工程学和患者定位、可视化增强和工作流程优化。每个项目都是根据可实现的时间表优先发展的。在一年的时间里,该项目获得了三项专利申请,一项专利授权,两项内部开发项目获得资助,一项由临床医生领导的创业公司获得了国家认可的加速器计划的资助,其潜在市场总额达到98亿美元。结论:我们提出了一个成功的,创新的结构,多学科组内的一个大型学术外科部门专注于创新过程的教育。这种以临床医生为中心的循序渐进的方法为商业化提供了一条途径,这在大多数外科环境中是缺乏的,并促进了高价值想法的快速产生。
{"title":"A novel framework for structuring sustainable innovation in surgery","authors":"Ryan Gedney MD ,&nbsp;Joseph Scalea MD ,&nbsp;Mathew D. Wooster MD ,&nbsp;Jean M. Ruddy MD ,&nbsp;Thomas Brothers MD ,&nbsp;David Mahvi MD ,&nbsp;Adam Tanious MD","doi":"10.1016/j.jvsvi.2025.100320","DOIUrl":"10.1016/j.jvsvi.2025.100320","url":null,"abstract":"<div><h3>Background</h3><div>Surgical innovation has offered some of the most remarkable advances in technology in human history, often starting in the clinical setting. Despite unique approaches to problem solving among clinical surgeons, there are few structures for innovation that offer a sustainable pipeline of new technology. We hypothesized that a simple framework addressing four steps would support sustainable innovation.</div></div><div><h3>Methods</h3><div>To identify unmet needs, we assembled a team of clinical specialists who attended problem-focused quarterly white board sessions. Solutions generated were directed toward a single unmet need, using evidence-based design sketches and prior art assessment in real time. To assess solutions, solution-specific subgroups were built with direct institutional availability to engineering, intellectual property, and business expertise. Entrepreneurs and team leaders then built business models for each opportunity.</div></div><div><h3>Results</h3><div>Unmet need identification was achieved within the first meeting, and the structured framework rapidly yielded innovative solutions in seven different categories, including surgical training, vascular access, improved ergonomics and patient positioning, visualization enhancement, and workflow optimization. Each project was prioritized for development based on achievable timelines. Within 1 year, this resulted in three patent applications, one issued patent, two funded in-house development projects, and one funded clinician-led startup enrolled in a nationally recognized accelerator program, with a combined total addressable market of $9.8 billion.</div></div><div><h3>Conclusions</h3><div>We present a successful, innovative structure for a multidisciplinary group within a large academic surgical department focused on education of the innovation process. This clinician-centered, stepwise approach provided a pathway for commercialization that is absent in most surgical environments and facilitates rapid generation of highly valuable ideas.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100320"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651953","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}
引用次数: 0
Assessment of ultrasound criteria for high-grade renal artery stenosis in transplant kidneys 移植肾高级别肾动脉狭窄的超声诊断标准评价
Pub Date : 2025-11-04 DOI: 10.1016/j.jvsvi.2025.100319
Melissa D’Andrea MD , Daniel Nguyen MD , Martina Francis BS , Dylan Joule BS , Kaoru R. Goshima MD, FACS , Wei Zhou MD, FACS
<div><h3>Objective</h3><div>Renal artery stenosis is an uncommon vascular complication following kidney transplantation. Noninvasive renal artery duplex is frequently used for initial screening. However, due to lack of specific criteria for transplanted renal artery, renal artery stenosis is not accurately diagnosed and may result in unnecessary contrast usage for further radiographic evaluation. Given the lack of consensus on duplex criterion, as well as the risks associated with invasive angiography and contrast-enhanced computed tomography angiography, our goal is to identify an accurate ultrasound diagnostic criteria for high grade stenosis in transplanted renal arteries.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of kidney transplant patients managed with duplex screening followed by angiography. Patients underwent renal artery duplex ultrasound on an outpatient basis if there was decline in renal function or uncontrolled hypertension. Upon finding significant stenosis, patients were referred to vascular surgery for intervention. Patients who met >60% stenosis based on the established renal artery duplex criteria were included in the study. Subjects with ≥70% angiographic cross-sectional narrowing or mean pullback pressure gradients of ≥10% underwent intervention. Duplex-derived peak systolic velocities measured along the donor renal artery to iliac artery were correlated with angiographic findings through receiver operating characteristic analysis. Similar calculations were performed for renal-to-iliac artery peak systolic ratios. Student’s <em>t</em>-test and χ<sup>2</sup> analysis were also evaluated.</div></div><div><h3>Results</h3><div>Forty-two patients were evaluated and were deemed to have >60% renal artery stenosis based on the established criteria and underwent angiography. Twenty-one of these surgical patients were transplanted renal patients; however, four did not have angiogram data available. Thus, 17 of those transplant patients who underwent renal angiography between January 2019 and March 2023 were reviewed. Overall mean peak velocity and mean renal-to-iliac peak systolic ratio for the nine subjects treated with balloon angioplasty were 426 ± 34 cm/s and 2.2 ± 0.4, respectively. The eight subjects without angiographic evidence of high-grade stenosis had an overall mean peak velocity of 271 ± 15 cm/s and mean peak ratio of 1.5 ± 0.1. There was a difference in mean peak velocity of the donor renal artery (<em>P</em> = .0049) and overall mean peak velocity across the entire anastomosis (<em>P</em> = .0012). For angiographic stenosis ≥70%, an overall peak velocity of >321 correlated to 88.9% sensitivity, 100% specificity, 100% positive predictive value, and 88.9% negative predictive value with an accuracy of 94.1%. A renal-to-iliac artery peak systolic ratio ≥1.6 corresponded to 85.7% sensitivity, 75.0% specificity, 79.4% positive predictive value, and 82.4% negative predictive value with
目的肾动脉狭窄是肾移植术后少见的血管并发症。无创肾动脉双工常用于初始筛查。然而,由于移植肾动脉缺乏具体的标准,不能准确诊断肾动脉狭窄,并可能导致不必要的造影剂用于进一步的影像学评估。鉴于对双重标准缺乏共识,以及侵入性血管造影和增强ct血管造影相关的风险,我们的目标是确定移植肾动脉高度狭窄的准确超声诊断标准。方法回顾性分析肾移植患者行双重筛查后血管造影的临床资料。如果患者肾功能下降或高血压不受控制,则在门诊接受肾动脉双工超声检查。一旦发现明显的狭窄,患者被转介到血管手术进行干预。根据既定的肾动脉双工标准,狭窄程度达到60%的患者被纳入研究。血管造影截窄≥70%或平均回拉压力梯度≥10%的受试者接受干预。通过受者操作特征分析,测量沿供者肾动脉至髂动脉的双源峰值收缩速度与血管造影结果相关。对肾-髂动脉峰值收缩比进行了类似的计算。并进行学生t检验和χ2分析。结果对42例患者进行评估,根据既定标准认为肾动脉狭窄占60%,并行血管造影。其中21例为肾移植患者;然而,有4名患者没有血管造影数据。因此,对2019年1月至2023年3月期间接受肾血管造影的移植患者中的17例进行了回顾。9例接受球囊血管成形术的患者的平均峰值速度和平均肾-髂峰值收缩比分别为426±34 cm/s和2.2±0.4 cm/s。8名无高级别狭窄血管造影证据的受试者,平均峰值速度为271±15 cm/s,平均峰值比为1.5±0.1。供肾动脉的平均峰值速度(P = 0.0049)和整个吻合口的平均峰值速度(P = 0.0012)有差异。对于血管造影狭窄≥70%,总峰值速度>;321的敏感性为88.9%,特异性为100%,阳性预测值为100%,阴性预测值为88.9%,准确率为94.1%。肾-髂动脉收缩峰值比值≥1.6,敏感性85.7%,特异性75.0%,阳性预测值79.4%,阴性预测值82.4%,准确率80%。接受者工作曲线分析显示,对于检测≥70%的血管造影狭窄,总峰值流速具有最大的判别能力(P = 0.0008)。结论移植肾动脉狭窄可导致移植失败和同种异体移植物丢失。然而,在双重诊断标准上存在广泛的差异,本研究强调了峰值流速>;321 cm/s和肾动脉与髂动脉峰值流速之比≥1.6的参数,用于预测≥70%的血管造影狭窄。
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引用次数: 0
Large language models improve readability of patient education materials on vascular conditions 大型语言模型提高了血管疾病患者教育材料的可读性
Pub Date : 2025-11-04 DOI: 10.1016/j.jvsvi.2025.100318
Melissa Chen Xu BS , Nicola Habash BS , Justin Do BS , Jiaying Bi MA , Dawn Salvatore MD , Paul Dimuzio MD , Michael Nooromid MD , Babak Abai MD

Objective

Patient education materials frequently exceed the recommended sixth-grade reading level. Although large language models (LLMs) have shown inconsistent accuracy in medical query responses, they have demonstrated promise in simplifying complex text. This capability has not yet been studied in vascular patient education materials. This study evaluates whether ChatGPT-4o and Gemini 1.5 Pro can improve the readability of Society for Vascular Surgery (SVS) patient education flyers.

Methods

SVS health flyers were selected based on five common vascular conditions: abdominal aortic aneurysm, carotid artery disease, deep vein thrombosis, peripheral artery disease, and varicose veins. Each flyer was submitted to ChatGPT-4o and Gemini 1.5 Pro, which generated simplified versions using structured Extensible Markup Language prompts to guide consistent editing. Vascular surgeons, who were blinded to the source of each flyer, independently scored the original and LLM-modified flyers on accuracy, comprehensiveness, and understandability using a 0 to 10 Likert scale. Readability was assessed using the Average Reading Level Consensus tool, and textual features—including word count, sentence count, syllables per word, and percentage of complex words—were quantified. Paired t-tests were used to analyze differences in readability scores. Analysis of variance with Tukey honestly significant difference post hoc testing was used to assess textual characteristics.

Results

The original SVS flyers had an average reading grade level of 10.61 (standard deviation [SD], 0.88). Gemini and ChatGPT-4o significantly reduced the reading level to 8.18 (SD, 1.24; P = .012) and 8.37 (SD, 0.88; P = .00013), respectively. SVS flyers averaged 605 words, 29.8 sentences, 1.7 syllables per word, and 20.4% complex words. Both LLMs significantly reduced syllables per word (Gemini: 1.52; P < .0001; ChatGPT: 1.53; P < .0001) and the proportion of complex words (Gemini: 12.7%; P < .0001; ChatGPT: 13.6%; P < .0001). There were no significant differences between the Gemini and ChatGPT outputs in readability or textual metrics. Physician scores for accuracy, comprehensiveness, and understandability showed no significant differences between SVS and either LLM model, nor between the two LLMs.

Conclusions

LLMs significantly improved the readability of SVS patient education materials by approximately two grade levels without compromising content accuracy. These findings support the use of LLMs to enhance the accessibility of medical information when grounded in trusted source material, rather than relying on unprompted content generation.
目的患者教育材料经常超过推荐的六年级阅读水平。尽管大型语言模型(llm)在医疗查询响应中显示出不一致的准确性,但它们在简化复杂文本方面表现出了希望。这种能力尚未在血管患者教育材料中进行研究。本研究评估chatgpt - 40和Gemini 1.5 Pro是否可以提高血管外科学会(SVS)患者教育传单的可读性。方法根据腹主动脉瘤、颈动脉疾病、深静脉血栓形成、外周动脉疾病和静脉曲张等5种常见血管疾病,选择ssvs健康飞行员。每个传单都提交给chatgpt - 40和Gemini 1.5 Pro,后者使用结构化的可扩展标记语言提示生成简化版本,以指导一致的编辑。血管外科医生对每个传单的来源不知情,使用0到10的李克特量表独立地对原始传单和llm修改传单的准确性、全全性和可理解性进行评分。使用平均阅读水平共识工具评估可读性,并对文本特征(包括单词计数、句子计数、每个单词的音节数和复杂单词的百分比)进行量化。配对t检验用于分析可读性评分的差异。方差分析采用Tukey诚实显著差异事后检验来评估文本特征。结果原始SVS传单的平均阅读等级水平为10.61(标准差[SD], 0.88)。Gemini和chatgpt - 40分别显著降低阅读水平至8.18 (SD, 1.24; P = 0.012)和8.37 (SD, 0.88; P = 0.00013)。SVS传单平均605个单词,29.8个句子,每个单词1.7个音节,20.4%的复杂单词。两个LLMs都显著减少了每个单词的音节数(Gemini: 1.52; P < .0001; ChatGPT: 1.53; P < .0001)和复杂单词的比例(Gemini: 12.7%; P < .0001; ChatGPT: 13.6%; P < .0001)。Gemini和ChatGPT输出在可读性或文本度量方面没有显著差异。医生对准确性、全面性和可理解性的评分在SVS和任何LLM模型之间没有显著差异,在两个LLM模型之间也没有显著差异。结论sllm显著提高了SVS患者教育材料的可读性,在不影响内容准确性的情况下提高了约两个等级。这些发现支持使用法学硕士来增强基于可信源材料的医学信息的可访问性,而不是依赖于未经提示的内容生成。
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引用次数: 0
Digital ischemic manifestations by tablet tapentadol intravascular abuse: A case series exploring clinical outcomes 他他多血管内滥用引起的手指缺血表现:一个探讨临床结果的病例系列
Pub Date : 2025-10-10 DOI: 10.1016/j.jvsvi.2025.100309
Kalyanaraman Elancheralathan MS, Mch, Vikraman Gurusamy MS, DNB, MCh, Ashok Kumar MS, Mch, Thangavel Rajkumar MS, Mch, Sharath Rajkumar MS, Mch

Objective

Acute ischemia after intra-arterial injection of crushed tablets remains an under-reported phenomenon with no established medical interventions to halt its progression. Tapentadol, a synthetic opioid, has been increasingly misused, leading to vascular complications. This study aimed to present a case series of patients who developed digital ischemia following intra-arterial injection of crushed tablet tapentadol, highlighting clinical presentation, diagnostic findings, and treatment outcomes.

Methods

This was a prospective case series conducted at Government Stanley Medical College Hospital, specifically in the vascular surgery department. The study focused on patients presenting with digital ischemia following intra-arterial injection of crushed tapentadol tablets.

Results

A total of 11 cases were documented, primarily young males (18-29 years). Patients presented with symptoms ranging from cyanotic changes to gangrene of the distal phalanges. Angiography revealed distal arterial occlusions, with absent distal flow in necrotic digits and partial flow in cyanotic fingers. Treatment involved systemic anticoagulation with heparin, calcium channel blockers, and intravenous prostaglandin therapy. Eight patients recovered completely, and three experienced autoamputation of necrotic fingertips. No major infections or limb-threatening complications were observed.

Conclusions

This case series underscores the emerging public health concern of tapentadol abuse and its potential to cause digital ischemia. The ischemic manifestations are hypothesized to result from microcrystalline cellulose embolism rather than the pharmacological properties of the drug itself. A structured approach to diagnosis and treatment, including early anticoagulation and vasodilatory therapy, may improve patient outcomes. Further research is necessary to establish definitive treatment protocols and enhance awareness among health care providers.
目的动脉注射碾碎片剂后的急性缺血仍然是一个未被报道的现象,没有建立的医学干预措施来阻止其进展。塔他他多是一种合成阿片类药物,被越来越多地滥用,导致血管并发症。本研究旨在报道动脉内注射他他多碾碎片后出现手指缺血的病例系列,重点介绍临床表现、诊断结果和治疗结果。方法本研究是在赤柱政府医学院医院进行的前瞻性病例系列研究,特别是在血管外科。本研究主要针对动脉注射他他多碾碎片后出现手指缺血的患者。结果本组病例共11例,以18 ~ 29岁的年轻男性为主。患者的症状从远端指骨的紫变到坏疽不等。血管造影显示远端动脉闭塞,坏死指端无远端血流,青紫指端有部分血流。治疗包括全身抗凝肝素,钙通道阻滞剂和静脉前列腺素治疗。8例患者完全康复,3例患者进行了坏死指尖自动截肢。未见重大感染或危及肢体的并发症。结论本病例系列强调了他他多滥用及其可能导致手指缺血的公共卫生问题。缺血表现被认为是由微晶纤维素栓塞引起的,而不是药物本身的药理学性质。结构化的诊断和治疗方法,包括早期抗凝和血管扩张治疗,可能会改善患者的预后。有必要进行进一步的研究,以建立明确的治疗方案,并提高卫生保健提供者的认识。
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引用次数: 0
Wake up! This is the 21st century! 醒醒吧!这是21世纪!
Pub Date : 2025-09-30 DOI: 10.1016/j.jvsvi.2025.100308
Darwin Eton MD, FACS, DFSVS
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引用次数: 0
期刊
JVS-vascular insights
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