JVS-vascular insights最新文献

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100350"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146472094","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","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":"146472105","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":"A systematic review and meta-analysis of intraoperative intravenous unfractionated heparin bolus in autogenous arteriovenous access surgery","authors":"Animesh Singla FRACS (Vasc) ,&nbsp;Kajanan Parameshwaran MD ,&nbsp;Juanita Noeline Chui MD ,&nbsp;Tess Cooper PhD ,&nbsp;Ahmer Hameed PhD, FRACS ,&nbsp;Angela C. Webster PhD, FRACP, FAHMS ,&nbsp;Henry Pleass FRACS ,&nbsp;Melanie Wyld PhD, FRACP","doi":"10.1016/j.jvsvi.2025.100298","DOIUrl":"10.1016/j.jvsvi.2025.100298","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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%).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100298"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173322","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":"The clinical and financial impact of establishing an office-based vein center within an academic medical system","authors":"Yancheng Dai MD ,&nbsp;Dejah R. Judelson MD ,&nbsp;Douglas W. Jones MD ,&nbsp;Andres Schanzer MD ,&nbsp;Dawn Durocher BA ,&nbsp;Francesco A. Aiello MD, MBA","doi":"10.1016/j.jvsvi.2025.100350","DOIUrl":"10.1016/j.jvsvi.2025.100350","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100350"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146173353","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":"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}

{"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^−/− 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}

{"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}

{"title":"Assessment of ultrasound criteria for high-grade renal artery stenosis in transplant kidneys","authors":"Melissa D’Andrea MD ,&nbsp;Daniel Nguyen MD ,&nbsp;Martina Francis BS ,&nbsp;Dylan Joule BS ,&nbsp;Kaoru R. Goshima MD, FACS ,&nbsp;Wei Zhou MD, FACS","doi":"10.1016/j.jvsvi.2025.100319","DOIUrl":"10.1016/j.jvsvi.2025.100319","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;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 &gt;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 &lt;em&gt;t&lt;/em&gt;-test and χ&lt;sup&gt;2&lt;/sup&gt; analysis were also evaluated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Forty-two patients were evaluated and were deemed to have &gt;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 (&lt;em&gt;P&lt;/em&gt; = .0049) and overall mean peak velocity across the entire anastomosis (&lt;em&gt;P&lt;/em&gt; = .0012). For angiographic stenosis ≥70%, an overall peak velocity of &gt;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 ","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685970","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":"Large language models improve readability of patient education materials on vascular conditions","authors":"Melissa Chen Xu BS ,&nbsp;Nicola Habash BS ,&nbsp;Justin Do BS ,&nbsp;Jiaying Bi MA ,&nbsp;Dawn Salvatore MD ,&nbsp;Paul Dimuzio MD ,&nbsp;Michael Nooromid MD ,&nbsp;Babak Abai MD","doi":"10.1016/j.jvsvi.2025.100318","DOIUrl":"10.1016/j.jvsvi.2025.100318","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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 <em>t</em>-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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = .012) and 8.37 (SD, 0.88; <em>P</em> = .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; <em>P</em> &lt; .0001; ChatGPT: 1.53; <em>P</em> &lt; .0001) and the proportion of complex words (Gemini: 12.7%; <em>P</em> &lt; .0001; ChatGPT: 13.6%; <em>P</em> &lt; .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100318"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651951","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":"Digital ischemic manifestations by tablet tapentadol intravascular abuse: A case series exploring clinical outcomes","authors":"Kalyanaraman Elancheralathan MS, Mch,&nbsp;Vikraman Gurusamy MS, DNB, MCh,&nbsp;Ashok Kumar MS, Mch,&nbsp;Thangavel Rajkumar MS, Mch,&nbsp;Sharath Rajkumar MS, Mch","doi":"10.1016/j.jvsvi.2025.100309","DOIUrl":"10.1016/j.jvsvi.2025.100309","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651952","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}