Annals of vascular surgery最新文献

{"title":"Do Not Mix It up! Long-Term Outcomes of Different Proximal Aortic Cuffs with the AFX Endograft","authors":"Giulio Accarino ,&nbsp;Aniello Enrico Puca ,&nbsp;Antonia Rinaldi ,&nbsp;Giovanni Fornino ,&nbsp;Giancarlo Accarino ,&nbsp;Davide Turchino ,&nbsp;Raffaele Serra ,&nbsp;Sergio Furgiuele ,&nbsp;Carmine Vecchione ,&nbsp;Umberto Marcello Bracale","doi":"10.1016/j.avsg.2024.10.024","DOIUrl":"10.1016/j.avsg.2024.10.024","url":null,"abstract":"<div><h3>Background</h3><div>The AFX unibody endograft offers advantages in treating abdominal aortic aneurysms (AAAs) with narrow aortic bifurcations due to its unique design, where the flow divider sits at the native aortic bifurcation. However, its limited length options may limit complete proximal neck utilization. As per device instruction for use, the implant should be completed with an aortic cuff. This study aims to evaluate the long-term outcomes of patients treated with an all-Endologix implant versus a combination of Endologix and Medtronic devices.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study included 134 consecutive AAA patients who underwent endovascular aneurysm repair (EVAR) using the AFX unibody endograft paired with suprarenal aortic cuffs from Endologix (<em>n</em> = 86) or Medtronic (<em>n</em> = 48) between November 2011 and November 2022. Patients were divided into 2 groups based on the type of aortic cuff used. The primary outcome was the occurrence of type 3A endoleaks at the longest available follow-up. Secondary outcomes included any endoleak, reintervention rates, all-cause mortality, and aneurysm-related death.</div></div><div><h3>Results</h3><div>The median follow-up was 41 months, and type 3A endoleaks occurred after a mean 34.8 months in 6 patients (4.5%), which is significantly more frequent in the mixed-device group (12.8%) (<em>P</em> &lt; 0.001). Type 3A endoleak occurred regardless of overlap and developed over time. Endoleaks of any type were reported in 17 patients. Reinterventions were needed in 12 patients. The use of an Endurant cuff was associated with a significantly increased risk of type 3A endoleaks (hazard ratio [HR] 16.5; 95% [CI] 1.9–143; <em>P</em> = 0.011) and reinterventions (HR 9.67; 95% CI 1.9–49.6; <em>P</em> = 0.006).</div></div><div><h3>Conclusions</h3><div>Combining endografts from different manufacturers, especially those with differing materials and sealing mechanisms, may compromise the long-term integrity of certain EVAR repairs. Clinicians should exercise caution when considering mixed-device configurations and ensure rigorous follow-up for patients with such implants.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 122-130"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Endovascular Interventions via Percutaneous Access to the Axillary Artery","authors":"Caleb D. Alterman,&nbsp;Anton D. Perera,&nbsp;Prateek K. Gupta,&nbsp;Daniel M. Alterman","doi":"10.1016/j.avsg.2024.10.018","DOIUrl":"10.1016/j.avsg.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular treatment of peripheral arterial disease requires safe and reliable arterial access. This study evaluates the feasibility and safety of percutaneous axillary artery access for endovascular therapy. A variety of anatomic and logistic obstacles can be overcome with upper extremity access. In this retrospective case review, we describe our experience with percutaneous trans-axillary access for lower extremity peripheral arterial disease intervention.</div></div><div><h3>Methods</h3><div>Medical records of all patients undergoing axillary artery percutaneous access from December 2021 to August 2024 were reviewed. Demographic data, procedural details, and complications such as pseudoaneurysm, hematoma, nerve injury, and closure device success were analyzed. Technical success and perioperative complications—including bruising, edema, hematoma, nerve injury, infection, thrombosis, and pseudoaneurysm—were assessed. Clinical outcomes were analyzed via follow-up clinic records.</div></div><div><h3>Results</h3><div>During the study period, 79 axillary artery accesses were performed on 64 patients. The patients were 55% male and had typical vascular comorbidities: hypertension (87%), hyperlipidemia (68%), coronary artery disease (27%), stroke (19%), and diabetes (16%); 58% were active tobacco users, and 80% were former tobacco users. Axillary access facilitated peripheral endovascular procedures, including iliac intervention (55), femoral (44), mesenteric (16), tibial (11), and embolization or visceral aneurysm treatments. A 6F sheath and ultrasound-guided Angio-Seal closure device were uniformly employed, with no major complications, perioperative deaths, or reoperations required. Minor complications of bruising and edema were present in 11 patients (14%). Other minor complications such as hematoma, nerve injury, thrombosis, dissection, pseudoaneurysm, or limb ischemia were absent.</div></div><div><h3>Conclusions</h3><div>Percutaneous axillary artery access demonstrates promise for complex endovascular interventions with a favorable safety profile. Advantages include avoidance of unfavorable femoral anatomy, improved working length compared with radial access, and enhanced control of visceral therapy. Bilateral iliac and lower extremity therapy is feasible in a single treatment as well. Percutaneous axillary artery access is a safe, reliable adjunct for enhancing endovascular arterial intervention capabilities.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 194-202"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Thrombotic Syndrome Morbidity in Mechanical Thrombectomy Versus Pharmacomechanical Catheter-Directed Thrombolysis of Iliofemoral Deep Venous Thrombosis","authors":"Jack K. Donohue ,&nbsp;Kevin Li ,&nbsp;Anthony Tang ,&nbsp;Rachel J. Kann ,&nbsp;Lena Vodovotz ,&nbsp;Adham N. Abou Ali ,&nbsp;Rabih A. Chaer ,&nbsp;Natalie D. Sridharan","doi":"10.1016/j.avsg.2024.11.007","DOIUrl":"10.1016/j.avsg.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Iliofemoral deep venous thrombosis is strongly associated with post-thrombotic syndrome (PTS). Interventional treatment options include catheter-directed thrombolysis and pharmacomechanical thrombectomy. More recently, there has been a wide dissemination of large-bore devices for mechanical thrombectomy (MT). Both treatment types have been shown to be effective in clinical practice; however, the rates of PTS after MT are poorly characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of patients with acute iliofemoral deep venous thrombosis from 2007 to 2022. Patients were divided into 2 treatment groups: pharmacomechanical catheter-directed thrombolysis (PCDT) and MT with large-bore devices. Our primary endpoint was PTS (Villalta score &gt;4). Secondary outcomes included vessel patency, mortality, and moderate/severe PTS (Villalta score &gt;9). Predictors of PTS were analyzed using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The median age of our cohort (<em>n</em> = 349) was 49 (interquartile range 35–63) years, 54.2% were female. There were 294 (84.2%) patients treated with PCDT. There were no significant baseline characteristic differences between patients treated with PCDT versus MT aside from increased preoperative anticoagulant use in the MT cohort. The overall rate of PTS was 19.1%. There were no differences in rates of PTS, moderate-severe PTS, stent patency, mortality between groups, or hospital length of stay. However, patients treated with MT had higher rates of single operating room visit during their admission treatment relative to patients that underwent PCDT (33.3% vs. 9.0%, <em>P</em> &lt; 0.01) and decreased intensive care unit length of stay (2 (1–3) vs. 0.5 (0–2), <em>P</em> &lt; 0.01). MT treatment was not a risk factor for the development of PTS (adjusted odds ratio [aOR] 0.73; [95% confidence interval {CI} 0.30, 1.74]; <em>P</em> = 0.47) or associated with increased Villalta score (β: −0.34; [95% CI–1.28, 0.60]; <em>P</em> = 0.47). Infrainguinal deep venous thrombosis extension (aOR 2.18; [95% CI 1.16, 4.09]; <em>P</em> = 0.02), prior deep venous thrombosis (aOR 2.67; [95% CI 1.38, 5.13]; <em>P</em> &lt; 0.01), and a hypercoagulable state (aOR 2.32; [95% CI 1.19, 4.50]; <em>P</em> = 0.01) were associated with increased risk of PTS.</div></div><div><h3>Conclusions</h3><div>Treatment with large-bore MT was not a significant predictor for the development of PTS. MT appears safe, durable, and associated with greater rates of single operating room visit relative to PCDT, which suggests that rapid thrombus removal may be of value.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 55-62"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resistance Index as a Prognostic Factor for Patency in Distal Lower Limb Arterial Revascularization","authors":"Isadora Ísis Fernandes Vieira ,&nbsp;Emmanuelle Tenório Albuquerque Godoi Berenguer de Barros E. Silva ,&nbsp;Gabriela de Oliveira Buril ,&nbsp;Carlos Henrique Nascimento Domingues da Silva ,&nbsp;Esdras Marques Lins","doi":"10.1016/j.avsg.2024.10.019","DOIUrl":"10.1016/j.avsg.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Critical limb ischemia (CLI) of the lower limbs (LLs) is a severe condition caused by peripheral arterial obstructive disease (PAOD). Surgical planning for CLI requires the study of limb circulation, and the vascular resistance index (RI) measured by Doppler ultrasound (US) has been used to aid in surgical decision-making. The objective is to correlate the RI of recipient arteries with the patency of LL revascularization surgeries in patients with CLI.</div></div><div><h3>Methods</h3><div>Prospective cohort study conducted from July 2021 to March 2023. The RI of the recipient arteries was evaluated preoperatively by US in 58 patients with CLI who underwent infrainguinal open or endovascular revascularizations, hospitalized in the Vascular Surgery Department of the Hospital das Clínicas of Empresa Brasileira de Serviços Hospitalares/Universidade Federal de Pernambuco. After 30 days of surgery, all patients were evaluated for the presence of pulses in the revascularized limb and the ankle brachial index (ABI) was measured in all cases. Statistical analysis was conducted with a 95% confidence level, and the Student's <em>t</em>-test was used to compare 2 independent samples.</div></div><div><h3>Results</h3><div>Clinical evaluation and ABI assessment of revascularization patency after 30 days revealed that infragenicular revascularizations that occluded had an average RI of 0.72 (SD ± 0.16), while patent revascularizations had a mean RI of 0.69 (SD ± 0.17) without statistical significance (<em>P</em> = 0.658).</div></div><div><h3>Conclusions</h3><div>Despite the lack of statistical significance, the study observed that a lower preoperative RI of the distal recipient artery was associated with greater patency of the revascularization surgery after 30 days.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 360-366"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Diagnosing and Managing Vascular Surgery Patients: An Experimental Study Using the GPT-4 Model","authors":"Vangelis G. Alexiou ,&nbsp;Bauer E. Sumpio ,&nbsp;Areti Vassiliou ,&nbsp;Stavros K. Kakkos ,&nbsp;George Geroulakos","doi":"10.1016/j.avsg.2024.11.014","DOIUrl":"10.1016/j.avsg.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>The introduction of artificial intelligence (AI) has led to groundbreaking advancements across many scientific fields. Machine learning algorithms have enabled AI models to learn, adapt, and solve complex problems in previously unimaginable ways. Natural language processing allows these models to comprehend and respond to inquiries in a natural and humanly understandable way. We sought to investigate the application and performance of an AI chatbot in the diagnosis and management of vascular surgery patients.</div></div><div><h3>Methods</h3><div>An experimental study to evaluate the performance of GPT-4 AI model across 57 clinical scenarios derived from a textbook in vascular surgery. Specific prompts were devised to address the AI model and task it to identify symptoms, diagnose conditions, and select appropriate therapeutic approaches. Answers were scored, descriptive statistics were produced, and means were compared across topics. The reasoning and evidence used in the cases in which AI performed poorly were critically reviewed.</div></div><div><h3>Results</h3><div>The AI model correctly answered over 65% of the 385 questions. Performance variation between and within 13 vascular surgery topics did not show any statistically significant differences. Analysis of the questions where the model failed by more than 50% suggests a gap in the ability to interpret and process multifaceted medical information. Twenty-seven percent of these errors were attributed to potential lack of understanding of complex clinical scenarios. The AI model also quoted incorrect or outdated information in 14% of cases and showed an inability to comprehend context, nuances, and medical classification systems in 11% of the cases.</div></div><div><h3>Conclusions</h3><div>GPT-4 demonstrated potential to provide clinically relevant answers for most of the tested scenarios. However, its reasoning must still be carefully analyzed for exactitude and clinical validity. While language models show promise as valuable tools for clinicians, it is essential to recognize their role as supportive mechanisms rather than standalone solutions.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 260-267"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open Revascularization for Acute Mesenteric Ischemia is Associated with Increased Morbidity and Mortality when Compared to Endovascular Intervention","authors":"Andrew S. Warren ,&nbsp;Blake Murphy ,&nbsp;Nallely Saldana-Ruiz ,&nbsp;Kirsten Dansey ,&nbsp;Sara L. Zettervall","doi":"10.1016/j.avsg.2024.10.013","DOIUrl":"10.1016/j.avsg.2024.10.013","url":null,"abstract":"<div><h3>Objectives</h3><div>Historically, open approaches have been considered the primary treatment for acute mesenteric ischemia (AMI) due to the potential for bowel resection. However, the use of endovascular therapy is increasing. Given the paucity of current data, this study aims to compare outcomes between open and endovascular interventions for AMI.</div></div><div><h3>Methods</h3><div>Patients treated for AMI between 2011 and 2022 were identified in the National Surgical Quality Improvement Program (NSQIP) by ICD-9 and ICD-10 codes. Intervention type (open vs. endovascular) was obtained from CPT codes. Demographics, comorbidities, pre-operative laboratory values, and 30-day outcomes were compared between intervention types. Multivariable analysis was utilized to adjust for differences between groups with a patient's need for bowel resection included to account for disease severity.</div></div><div><h3>Results</h3><div>A total of 1,172 patients underwent revascularization for AMI (1,023 open, 149 endovascular). Among those treated with open revascularization, 577 (56%) underwent thrombectomies/embolectomy, 125 (12%) underwent thromboendarterectomy, and 321 (31%) received bypasses. Of the patients who underwent endovascular revascularizations, 101 (68%) received a stent, 23 (15%) underwent angioplasty without stenting, and 25 (17%) underwent lysis/thrombectomy. Patients who underwent endovascular revascularization had higher rates of smoking (36% open vs. 47% endovascular; <em>P</em> &lt; 0.01), were more likely to have an eGFR less than 30 (6% open vs. 15% endovascular; <em>P</em> &lt; 0.01), and underwent more bowel resections at the time of the initial operation (33% open vs. 48% endovascular; <em>P</em> &lt; 0.01). For outcomes, patients who underwent open repair had longer median hospital stays (10 days vs. 7 days; <em>P</em> &lt; 0.01). All other outcomes including 30-day mortality were similar on univariate analysis. Following adjustment for the need for bowel resection and comorbidities, 30-day-mortality (OR 1.96, 95% CI: 1.28–3.02), failure to wean from ventilator (OR 1.56 95% CI: 1.05–2.34), and length of hospital stay (β 3.7 days, 95% CI: 1.8–5.6) were higher among patients treated with open surgery.</div></div><div><h3>Conclusions</h3><div>After accounting for the need for bowel resection and comorbidities, open revascularization for AMI is associated with higher peri-operative morbidity and mortality compared to endovascular intervention. Thus, the need for bowel resection should not preclude endovascular treatment for AMI.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 386-392"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Diagnostic Comparison Study between Maximal Systolic Acceleration and Acceleration Time to Detect Peripheral Arterial Disease","authors":"Siem A. Willems,&nbsp;Obrecht O. van Bennekom,&nbsp;Abbey Schepers,&nbsp;Jan van Schaik,&nbsp;Joost R. van der Vorst,&nbsp;Jaap F. Hamming,&nbsp;Jeroen J.W.M. Brouwers","doi":"10.1016/j.avsg.2024.10.021","DOIUrl":"10.1016/j.avsg.2024.10.021","url":null,"abstract":"<div><h3>Background</h3><div>Detecting peripheral arterial disease (PAD) can be particularly challenging in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) due to medial arterial calcification (MAC). Current bedside tests, such as the ankle-brachial index, are less accurate in these patient groups. The primary aim of this study is to evaluate the diagnostic accuracy of point-of-care duplex ultrasound parameters maximal systolic acceleration (ACC_max) and acceleration time (AT) to detect PAD, including a comparison of both metrics.</div></div><div><h3>Methods</h3><div>Patients suspected of having PAD, who underwent point-of-care duplex ultrasound measurements (ACC_max and AT) of the posterior tibial artery (PTA) and/or anterior tibial artery (ATA) at ankle level along with computed tomography angiography were eligible for inclusion. PAD was defined as a stenosis &gt;50% on computed tomography angiography. Diagnostic accuracy of AT was evaluated at calculated (Youden index) and prespecified cut-off values (121 ms), using the sensitivity, specificity, positive likelihood ratio, negative likelihood ratios, and area under the curve. The McNemar test compared ACC_max with AT at prespecified and calculated cut-off values. Subgroup analyses of patients prone to MAC (i.e., those with DM and/or CKD) were also performed.</div></div><div><h3>Results</h3><div>This study included 184 patients (267 legs) with a high prevalence of DM (53%) and CKD (36%). The diagnostic accuracy of AT to identify PAD for PTA showed a sensitivity of 84%, specificity of 98%, positive likelihood ratio of 42.00, negative likelihood ratio of 0.16 and area under the curve of 0.96. Regarding the ATA, the results were 81%, 93%, 11.57, 0.20, and 0.92, respectively. Statistical comparisons favored ACC_max over AT in detecting PAD at prespecified and calculated cut-off values for both the PTA and ATA (<em>P</em> &lt; 0.001). Additionally, in patients prone to MAC, ACC_max also outperformed AT in detecting PAD (<em>P</em> values ranging from &lt;0.001 to 0.039). For patients without PAD, no significant differences were observed in the ability to rule out the disease.</div></div><div><h3>Conclusions</h3><div>ACC_max proved to be more accurate than AT in detecting PAD, also in patients prone to MAC. While no significant difference was found between ACC_max and AT in their diagnostic accuracy to exclude PAD, ACC_max should be favored in the diagnostic work-up in patients suspected of PAD due to its superior ability to detect an arterial stenosis.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 203-211"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off the Cover","authors":"T.M. Sullivan","doi":"10.1016/j.avsg.2025.01.008","DOIUrl":"10.1016/j.avsg.2025.01.008","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 409-410"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Impairment is Common and Unrecognized in Vascular Surgery Patients","authors":"Emily J. Draper ,&nbsp;Tam B. Nguyen ,&nbsp;Amin A. Mirzaie ,&nbsp;Dan Neal ,&nbsp;Salvatore T. Scali ,&nbsp;Thomas S. Huber ,&nbsp;Scott A. Berceli ,&nbsp;Gilbert R. Upchurch Jr. ,&nbsp;Samir K. Shah","doi":"10.1016/j.avsg.2024.11.003","DOIUrl":"10.1016/j.avsg.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Patients’ capacities to understand and act upon healthcare information is crucial to decision-making and high-quality care. Cognitive impairment (CI) has been associated with adverse outcomes across a range of diseases and surgeries. Despite the importance of CI, there is little to no information on its prevalence and severity in vascular surgery patients in the United States. We therefore conducted a prospective observational study to better characterize the prevalence and severity of CI in a contemporary vascular surgery practice.</div></div><div><h3>Methods</h3><div>We enrolled 111 outpatients attending a vascular surgery clinic using pragmatic consecutive sampling. Patients were excluded if they had a previous diagnosis of blindness, deafness, or dementia. Subjects completed a demographic survey and the Montreal Cognitive Assessment (MoCA), which was administered by a trained proctor. Chart review was used to assess comorbidities. The MoCA is a validated tool consisting of tasks such as clock drawing for assessing CI. It has a lower educational bias and higher sensitivity for detecting mild impairment compared to other examinations. The MoCA is scored from 0–30 based on an objective grading system. Scores between 0–9, 10–17, 18–25, and 26–30 indicate severe, moderate, mild, and no CI, respectively. Statistical analysis, including multivariable modeling, was performed using SAS (SAS Institute, Cary, NC).</div></div><div><h3>Results</h3><div>Of 163 patients, our analysis included 111 consecutive vascular patients who completed the MoCA. The average age of the entire cohort was 64.1 years, and 58.6% were male. The majority of the patients in the study were White (80.1%). The mean MoCA score of the entire cohort was 22.6 (mild CI). Of all subjects, 77% had CI: 68% with mild and 9% with moderate CI. Hypertension (<em>P</em> = 0.024), congestive heart failure (CHF) (<em>P</em> = 0.028), fewer years of education (<em>P</em> = 0.032), and Medicaid enrollment (<em>P</em> = 0.046) all had significant univariate associations with CI. There was no statistically significant difference between age (<em>P</em> = 0.11) or the primary vascular diagnosis disease for which the patient sought treatment and CI (<em>P</em> = 0.49). Multivariable models demonstrated that only CHF (odds ratio 3.8, <em>P</em> = 0.046) was statistically significantly associated with risk of CI.</div></div><div><h3>Conclusions</h3><div>In this first-time prospective study of the entire spectrum of vascular patients in the United States, we found that nearly 4 of every 5 vascular surgery patients have undiagnosed CI. Furthermore, we found that having CHF was associated with a higher likelihood of CI. Given the implications on consent, decision-making, and postoperative care, future work should focus on enrollment of a larger cohort along with an examination of the impact of CI on mortality, length of stay, and other outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 187-193"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors Driving Positive Awake Test in Carotid Endarterectomy Using Machine Learning","authors":"Juliana Pereira-Macedo ,&nbsp;Ana Daniela Pias ,&nbsp;Luís Duarte-Gamas ,&nbsp;Piotr Myrcha ,&nbsp;José P. Andrade ,&nbsp;Nuno António ,&nbsp;Ana Marreiros ,&nbsp;João Rocha-Neves","doi":"10.1016/j.avsg.2024.10.011","DOIUrl":"10.1016/j.avsg.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Positive neurologic awake testing during the carotid cross-clamping may be present in around 8% of patients undergoing carotid endarterectomy (CEA). The present work aimed to assess the accuracy of an artificial intelligence (AI)-powered risk calculator in predicting intraoperative neurologic deficits (INDs).</div></div><div><h3>Methods</h3><div>Data was collected from carotid interventions performed between January 2012 and January 2023 under regional anesthesia. Patients with IND were selected along with consecutive controls without IND in a case-control study design. A predictive model for IND was developed using machine learning, specifically Extreme Gradient Boosting (XGBoost) model, and its performance was assessed and compared to an existing predictive model. Shapley Additive exPlanations (SHAP) analysis was employed for the model interpretation.</div></div><div><h3>Results</h3><div>Among 216 patients, 108 experienced IND during CEA. The AI-based predictive model achieved a robust area under the curve of 0.82, with an accuracy of 0.75, precision of 0.88, sensitivity of 0.59, and F1Score of 0.71. High body mass index (BMI) increased contralateral carotid stenosis, and a history of limb paresis or plegia were significant IND risk factors. Elevated preoperative platelet and hemoglobin levels were associated with reduced IND risk.</div></div><div><h3>Conclusions</h3><div>This AI model provides precise IND prediction in CEA, enabling tailored interventions for high-risk patients and ultimately improving surgical outcomes. BMI, contralateral stenosis, and selected blood parameters emerged as pivotal predictors, bringing significant advancements to decision-making in CEA procedures. Further validation in larger cohorts is essential for broader clinical implementation.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"111 ","pages":"Pages 110-121"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}