Annals of vascular surgery最新文献

Background: Ruptured aortic aneurysm (rAA) is a life-threatening vascular emergency, often fatal before reaching medical care. Despite advances in screening, endovascular repair, and cardiovascular risk control, mortality from rAA remains high. This study aimed to evaluate national trends and disparities in rAA-related mortality among the US adults from 1999 to 2020.

Methods: A retrospective population-based analysis was performed using Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research mortality data for adults aged ≥25 years. Deaths were identified using International Statistical Classification of Diseases and Related Health Problems, 10th revision codes I71.1, I71.3, I71.5, and I71.8. Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 US standard population. Temporal trends were assessed with Joinpoint regression to estimate annual percent change and average annual percent change (AAPC) with 95% confidence intervals.

Results: rAA led to 118,211 deaths in the United States from 1999 to 2020. The overall AAMR was 2.50 per 100,000, declining from 4.87 in 1999 to 1.15 in 2020 (AAPC = -6.51%). Mortality was higher in men (3.70) than women (1.62) and in rural (3.04) compared to urban areas (2.37). Non-Hispanic (NH) Whites had the highest rates (2.74), while NH Asians showed the steepest decline (AAPC = -7.02%). Regionally, the Midwest recorded the highest AAMR (2.94), whereas the Northeast showed the fastest decline (AAPC = -6.83%). Mortality increased sharply with age, peaking in adults ≥85 years.

Conclusion: The US mortality due to rAA has decreased significantly over a period of 20 years, although the underlying factors for this decline cannot be determined from mortality data alone. Nevertheless, this reduction was not even, as women, older adults, and rural residents continue to face disproportionately higher mortality. Ongoing surveillance and targeted efforts to address disparities in access to care are needed to maintain and extend these gains.

Background: Chronic limb-threatening ischemia (CLTI) represents a severe condition associated with high morbidity and mortality, particularly in patients lacking optimal autologous vein. The prevalence of CLTI accentuates the need to find a different conduit. Biological prostheses have emerged as a viable alternative given the limitations of conventional synthetic grafts for the treatment of CLTI patients. The objective of this study was to evaluate the clinical outcomes, patency, and limb salvage rates of the Omniflow II biosynthetic prosthesis (LeMaitre Vascular, Inc., Burlington, MA) in infrainguinal bypass procedures among CLTI patients.

Methods: This was a national, prospective, multicenter study conducted between 2019 and 2023, including patients with CLTI who underwent femoropopliteal bypass using Omniflow II. Patency, reintervention, postoperative complications (including graft degeneration or infection), and limb salvage rates were assessed.

Results: A total of 83 patients were included: 28 underwent above-knee femoropopliteal bypass (AK group), and 55 underwent below-knee femoropopliteal bypass (BK group). The mean follow-up was 18 ± 12 months. At 2 years, primary and secondary patency rates were 51% and 71% in the AK group, and 60% and 70% in the BK group, respectively. An amputation-free survival rate of 81,4% at 2 years was observed. Prosthetic infection requiring explantation occurred in 4 patients (4.8%), and aneurysmal degeneration was reported in one case (1.2%) that did not require surgical intervention.

Conclusion: The use of Omniflow II in patients with CLTI demonstrated favorable midterm outcomes, particularly regarding patency in bypasses with distal infragenicular anastomosis. These findings support its consideration as an alternative in patients without available autologous vein.

Background: Ionizing radiation exposure is inherent to endovascular surgery and is associated with adverse health effects. This systematic review and meta-analysis compared patient radiation exposure during endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR), focusing on fluoroscopy time (FT), kerma-area product (KAP), and cumulative air kerma (CAK).

Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of MEDLINE, Scopus, and the Cochrane Library (June 2015-June 2025) identified English-language studies with ≥20 patients reporting FT, KAP, or CAK during elective EVAR or TEVAR. Pooled means with 95% confidence intervals were calculated using random-effects modeling. Risk of bias was assessed with ROBINS-I version 2 and publication bias with Egger's test and funnel plots.

Results: Seventy-eight studies (73 EVAR and 5 TEVAR) met inclusion criteria. TEVAR demonstrated significantly shorter FT than EVAR (15.25 vs. 28.50 min; P < 0.001). No significant differences were observed in KAP (151.08 vs. 147.46 Gycm²; P = 0.970) or CAK (804.92 vs. 1,091.03 mGy; P = 0.090). Heterogeneity was high across all outcomes (I² > 85%). Only 11.5% of studies reported explicit as low as reasonably achievable compliance, and fusion imaging was used in 9%, more frequently in TEVAR. Publication bias was evident for all radiation metrics.

Conclusion: Radiation exposure during EVAR and TEVAR varies substantially, reflecting anatomical complexity, imaging technology, and procedural practice. TEVAR required shorter FT but produced similar or higher KAP values, likely related to thoracic imaging geometry. Limited TEVAR data restrict the strength of comparative conclusions.

Background: A significant proportion of arteriovenous fistulas (AVFs) and grafts for hemodialysis fail due to early thrombosis, necessitating reintervention. The role of systemic heparinization in improving perioperative patency remains uncertain. This meta-analysis aims to evaluate the efficacy and safety of perioperative systemic heparin on the patency of upper-limb vascular access creations (fistulas or grafts placement).

Methods: We searched PubMed, Embase, and Cochrane databases for randomized trials comparing heparinization versus standard care in adults undergoing arm AVF or graft placement. Data were pooled using a random-effects model to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. All statistical analyses were conducted using Review Manager 5.4.

Results: Six studies comprising 1,265 patients were included, of whom 731 (58%) underwent heparinization. Systemic heparinization significantly reduced the odds of early patency loss compared to standard care (OR: 0.58; 95% CI: 0.37-0.92; P = 0.02; I² = 14%). However, heparin was associated with an increased risk of bleeding complications (OR: 4.24; 95% CI: 1.13-15.9; P = 0.13; I² = 47%).

Conclusion: Perioperative systemic heparinization significantly improves early patency rates for hemodialysis vascular access in adults undergoing arm fistulization or graft placement; however, there is a risk of increased bleeding events. Heparin may be considered a viable preventive strategy against early thrombosis, though its use should be balanced against individual patient bleeding risk and surgical considerations.

Background: Peripheral artery disease (PAD) is characterized by chronic inflammation and endothelial dysfunction. Percutaneous transluminal balloon angioplasty (PTA) restores limb perfusion, but its effects on systemic inflammatory burden are not fully defined. The objective of the study was to evaluate the effects of PTA on 30-day inflammatory biomarkers and hematological parameters in patients with lower extremity PAD.

Methods: In this prospective observational study, 47 adults with newly diagnosed PAD (lower extremity stenosis ≥50%, ankle-brachial index [ABI] <0.90) underwent PTA. Venous blood samples were collected 1 week before and 30 days after the intervention. Plasma interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-13, transforming growth factor-beta, and tumor necrosis factor-alpha (TNF-α) were measured by sandwich enzyme-linked immunosorbent assay. C-reactive protein (CRP), procalcitonin, fibrinogen, and complete blood count were performed to calculate the neutrophil-to-lymphocyte ratio (NLR). Paired tests were used, and P < 0.05 was considered significant.

Results: Proinflammatory cytokines (IL-1β, IL-2, IL-6, IL-8, and TNF-α) decreased significantly (all P < 0.001), IL-10 increased (P = 0.002) and IL-13 and transforming growth factor-beta remained unchanged. CRP and fibrinogen decreased (both P < 0.001), procalcitonin slightly increased (P = 0.018), and NLR decreased from 2.8 ± 0.9 to 2.1 ± 0.5 (P < 0.001). ΔABI was inversely correlated with ΔCRP (r = -0.334, P = 0.022) and Δfibrinogen (r = -0.315, P = 0.031). ABI improvement was greater in men, TNF-α reduction was greater in infrainguinal lesions, and IL-8 and NLR responses differed by smoking status.

Conclusion: PTA leads to a significant short-term improvement in limb perfusion and a concomitant reduction in systemic inflammatory burden, suggesting beneficial immunomodulatory effects beyond mechanical revascularization.

Background: To assess perioperative safety and mid-term durability of open surgical repair (OSR) as a salvage therapy for endoleaks after failed endovascular aneurysm repair.

Methods: A single-center retrospective analysis was performed on 23 consecutive patients (21 males, 2 females; mean age 65.6 ± 10.6 years) undergoing OSR for persistent endoleaks at Nanjing Drum Tower Hospital between May 2018 and July 2023. Endoleak subtypes included type I (n = 7), type II (n = 14), type III (n = 1), and type IV (n = 1). Primary end points were 30-day mortality and major adverse events, with secondary end points encompassing 3-year survival and reintervention rate.

Results: The 30-day mortality of the cohort reached 13.0% (3/23), attributed to pulmonary infection (n = 1), circulatory collapse (n = 1), and septic shock (n = 1). Notably, 34.8% (8/23) developed pulmonary complications, whereas 21.7% (5/23) experienced acute kidney injury. At a median follow-up of 30.6 months (interquartile range 25.4-38.9), the 3-year overall survival rate was 86.9%. No aorta-related deaths occurred during the follow-up; only 1 patient (4.3%) required secondary intervention for distal iliac artery redilation.

Conclusion: OSR constitutes a definitive solution for endoleak management postendovascular aneurysm repair , demonstrating acceptable perioperative risk and durable mid-term outcomes. Although pulmonary and renal complications remain noteworthy short-term concerns, the technique offers low reintervention rates and stable survival trajectories, particularly in the absence of aorta-related mortality.