Annals of vascular surgery最新文献

{"title":"HeRO's Don't Always Win: Evaluating HeRO Grafts in Contemporary Dialysis Access.","authors":"Thomas Munro, Joanna Shaw, Jesus G Ulloa, Jessica B O'Connell, David A Rigberg, Hugh A Gelabert","doi":"10.1016/j.avsg.2026.01.008","DOIUrl":"10.1016/j.avsg.2026.01.008","url":null,"abstract":"<p><strong>Background: </strong>The introduction of the hemodialysis reliable outflow (HeRO) graft in 2009 presented an alternative upper extremity access for hemodialysis (HD) patients with failing access sites. Despite initial enthusiasm, experience has revealed strengths and limitations of HeRO access. This study's objective is to assess the contemporary use of HeRO grafts at 2 tertiary care centers.</p><p><strong>Methods: </strong>The operative logs for patients undergoing HD access procedures were retrospectively reviewed at 2 tertiary care sites between January 2012 and July 2024. Only patients that underwent placement of a HeRO graft were abstracted for analysis. The average patient age, HeRO graft indication, HeRO graft technical construct, use of post-HeRO systemic anticoagulation, and HD interventions pre-/post-HeRO access procedure were abstracted. All other patients who did not undergo a HeRO graft intervention were excluded.</p><p><strong>Results: </strong>Eighteen patients with end-stage kidney disease were identified as having undergone placement of a HeRO graft. Prior to HeRO placement, patients underwent 4.61 ± 3.91 HD access maintenance procedures. The most common construct for HeRO graft inflow was brachial artery to polytetrafluoroethylene (PTFE), 55%, followed by arteriovenous outflow vein to PTFE, 33%, and PTFE graft to graft, 11%. After HeRO placement, patients underwent 1.94 ± 1.77 HD access maintenance procedures. The primary patency rates at 6 months and 1 year were 50% and 47%, while secondary patency at 1 and 5 years were 80% and 27%, respectively. The most common post-HERO complication was graft thrombosis. Ultimately, 72% of patients required systemic anticoagulation to maintain HeRO graft patency.</p><p><strong>Conclusion: </strong>This contemporary analysis of HeRO graft use indicates the value of HeRO access: a lower number of reinterventions to maintain graft function, and relatively low incidence of access complications. Anticoagulation was required in the majority of HeRO patients. There was a statistically significant reduction in the number of HD access interventions after HeRO placement.</p>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"65-69"},"PeriodicalIF":1.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958342","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":"When Infections Hurt More: Black Patients Experience More Severe Surgical Site Infections Following Lower Extremity Bypass","authors":"Anthony N. Eze ,&nbsp;Junette Yu ,&nbsp;Christina L. Cui ,&nbsp;Young Kim","doi":"10.1016/j.avsg.2025.12.042","DOIUrl":"10.1016/j.avsg.2025.12.042","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSIs) are common complications following lower extremity bypass (LEB). Previous studies have reported that recognition of SSIs may be delayed among patients with darker skin tones, leading to more severe presentations. We examined whether patients of Black race experienced increased severity of SSIs following LEB surgery.</div></div><div><h3>Methods</h3><div>A single-center, retrospective review of patients undergoing LEB surgery from January 2018 to December 2022 was performed. Patients were categorized as Black or non-Black. Postoperative SSI was stratified per Southampton wound score (grade 2–5), with severe SSI defined as grades 4 or 5.</div></div><div><h3>Results</h3><div>Among 505 LEB patients, 216 (42.8%) self-identified as Black and 289 (57.2%) were non-Black. Median age was 65 y (interquartile range [IQR] 59–72 years). Age, smoking status, and body mass index were similar between groups. Black patients more frequently underwent bypass for chronic limb-threatening ischemia compared with non-Black patients (57.4% vs. 40.8% tissue loss, 25.5% vs. 21.5% rest pain, <em>P</em> &lt; 0.001). Surgical technique and time to SSI diagnosis was similar between groups. Incidence of SSI was lower among Black patients (15.3% vs. 28.7%, <em>P</em> &lt; 0.001). Black patients had more severe SSI at the time of diagnosis (30.4% vs. 18.3% grade 4, 15.2% vs. 6.1% grade 5; <em>P</em> = 0.03). Black race was independently associated with severe SSI (odds ratio 1.64, <em>P</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>Postoperative SSI is less frequent among Black patients undergoing LEB surgery but presents with increased severity, which may reflect a delay in diagnosis. These findings underscore the importance of vigilance and early recognition in this patient population.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 259-264"},"PeriodicalIF":1.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958307","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":"Contemporary Results of Open Surgery for Aortoiliac Occlusive Disease","authors":"Georgios S. Sfyroeras,&nbsp;Christos Pitros,&nbsp;Georgios Plakas,&nbsp;Aristotelis Yfantis,&nbsp;Constantinos N. Antonopoulos,&nbsp;Konstantinos G. Moulakakis,&nbsp;Andreas M. Lazaris,&nbsp;John D. Kakisis","doi":"10.1016/j.avsg.2025.12.035","DOIUrl":"10.1016/j.avsg.2025.12.035","url":null,"abstract":"<div><h3>Background</h3><div>Despite the enduring importance of open surgical repair for complex aortoiliac occlusive disease (AIOD), advanced ischemia, or cases with failed endovascular therapy, there remains a notable gap in the current literature regarding contemporary outcomes of open surgery for AIOD. This study retrospectively analyzed 6 years of open revascularization procedures at our institution to evaluate perioperative outcomes, complications, and the influence of disease severity and procedure type.</div></div><div><h3>Method</h3><div>A total of 60 patients (mean age 64.8 years; predominantly male) underwent open AIOD repair, with most classified as TransAtlantic Inter-Society Consensus D lesions. Most of them (72%) presented with advanced ischemia classified as Rutherford categories 4, 5, or 6. The majority received aortobifemoral bypass (<em>n</em> = 39), while others underwent axillobifemoral (<em>n</em> = 8), axillofemoral (<em>n</em> = 6), or iliofemoral (<em>n</em> = 8) bypass procedures.</div></div><div><h3>Results</h3><div>Acute kidney injury (AKI) occurred in 20% of patients, primarily following aortobifemoral bypass (28%). Postoperative AKI was associated with significantly lower preoperative renal function. Dialysis and major cardiovascular events each affected 3.3% of the cohort. Fourteen percent required amputation, predominantly among those with higher Rutherford classifications (up to 67% in stage 6). The mean hospital length of stay was 21.5 days;intensive care unit admission was necessary in 44% of cases (mean duration 1.8 days). Thirty-day mortality was 1.7%. Aortobifemoral bypasses were more frequently performed in younger, patients and were associated with increased complication rates. In contrast, axillobifemoral and axillofemoral bypasses, performed in older and high-risk populations, were linked to fewer complications. Iliofemoral bypasses were associated with the longest hospital stays but minimal complications. Statistical analysis demonstrated significant differences among the groups (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>At our center, open surgical management of AIOD yielded low perioperative mortality and acceptable morbidity rates. AKI was frequent, particularly in patients undergoing aortobifemoral bypass and those with less advanced ischemia. Amputation rates and hospital stays increased with greater disease severity. Both the revascularization technique and Rutherford classification significantly impacted perioperative outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 265-269"},"PeriodicalIF":1.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958253","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":"On the Independence Assumption in Meta-Analyses of Registry-Derived TCAR and TFCAS Outcomes.","authors":"Pooria Nakhaei, Mahmoud Malas","doi":"10.1016/j.avsg.2025.12.032","DOIUrl":"10.1016/j.avsg.2025.12.032","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":" ","pages":"138"},"PeriodicalIF":1.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145942237","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":"The Impact of Common Thromboprophylactic Regimens on Thrombin Generation in Patients with Peripheral Artery Disease Postrevascularization","authors":"Shria Bucha ,&nbsp;Isabella Ferlini Cieri ,&nbsp;Adriana A. Rodriguez ,&nbsp;Mounika Naidu Boya ,&nbsp;Shiv Patel ,&nbsp;Anahita Dua","doi":"10.1016/j.avsg.2025.12.026","DOIUrl":"10.1016/j.avsg.2025.12.026","url":null,"abstract":"<div><h3>Background</h3><div>Antithrombotic therapy reduces thrombotic risk in patients with peripheral artery disease (PAD) by targeting thrombin generation, a key hypercoagulability factor. However, the specific effects of different antithrombotic combinations on thrombin generation dynamics remain poorly understood. This study uses calibrated automated thrombogram (CAT) to objectively measure and compare patient responses to various common thromboprophylactic regimens.</div></div><div><h3>Methods</h3><div>We prospectively enrolled patients with PAD aged 60+ years who underwent revascularization between January 2021 and December 2022. Whole blood samples were collected preoperatively and at 1, 3, and 6 months postintervention, with 1-year clinical follow-up. Analysis focused on 1-month samples using CAT to quantify thrombin generation parameters: lag time, peak thrombin concentration, endogenous thrombin potential, and thrombin generation rate. Patients were stratified by antithrombotic regimen: mono antiplatelet therapy (MAPT), dual antiplatelet therapy (DAPT), MAPT + direct oral anticoagulant (DOAC), and DAPT + DOAC. Statistical analysis used Mann–Whitney <em>U</em> and <em>t</em>-tests.</div></div><div><h3>Results</h3><div>Among 56 PAD patients analyzed, DOAC addition produced notable thrombin generation changes, with more pronounced effects in patients on MAPT. MAPT + DOAC showed significant reductions in thrombin generation rate (−38.2 nM/min, <em>P</em> = 0.014), increased lag time (+5.4 min, <em>P</em> = 0.019), and decreased peak thrombin (−111 nM, <em>P</em> = 0.013). DAPT + DOAC produced smaller, nonsignificant reductions. One-year adverse events occurred in 38.5% of DAPT patients, 20.0% DAPT + DOAC, 17.6% MAPT + DOAC, and 0% MAPT patients. Large standard deviations indicated substantial interpatient variability.</div></div><div><h3>Conclusion</h3><div>PAD patients demonstrate marked thrombin generation variability, with DOAC addition to MAPT producing the most significant thrombin generation changes. These findings highlight biological response heterogeneity in PAD and support individualized antithrombotic strategies.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 112-121"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931535","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":"Comparison of the Efficacy and Safety of Endovascular Treatment for Isolated Popliteal Lesions in Peripheral Artery Disease: A Network Meta-Analysis","authors":"Fei Mei ,&nbsp;Peng Jiang ,&nbsp;Wenfei Guan ,&nbsp;Yongpan Cui ,&nbsp;Jian He ,&nbsp;Zihan Zhang ,&nbsp;Wayne W. Zhang","doi":"10.1016/j.avsg.2025.12.028","DOIUrl":"10.1016/j.avsg.2025.12.028","url":null,"abstract":"<div><h3>Background</h3><div>This study employed a network meta-analysis to systematically compare the efficacy and safety of different endovascular interventions for treating isolated popliteal lesions in peripheral arterial disease.</div></div><div><h3>Methods</h3><div>A systematic search was conducted across the Cochrane Library, Embase, and PubMed databases (2010–2025), identifying 11 studies involving 4,179 patients. A network meta-analysis was performed using R software to compare the efficacy of percutaneous transluminal angioplasty (PTA), drug-coated balloon (DCB), atherectomy, and stenting. Primary outcomes included all-cause mortality, major amputation rate, and overall amputation rate, while secondary outcomes comprised primary patency rate, freedom from target lesion revascularization, and technical success rate.</div></div><div><h3>Results</h3><div>In terms of 1-year all-cause mortality, atherectomy demonstrated significantly lower rates compared to both the PTA group (odds ratio [OR] = 0.61, 95% credible interval [CrI]: 0.41–0.87) and the stenting group (OR = 0.66, 95% CrI: 0.44–0.97). Regarding 1-year major amputation and overall amputation rates, stenting significantly outperformed PTA (OR = 0.64 and 0.65, respectively), while no significant differences were observed between atherectomy, DCB, and PTA groups. For 1-year primary patency rates, both atherectomy and stenting significantly outperformed PTA (OR = 2.21 and 2.23, respectively). Furthermore, the technical success rate of atherectomy was significantly higher than that of the other 3 interventions.</div></div><div><h3>Conclusion</h3><div>Atherectomy demonstrates advantages in reducing all-cause mortality and improving technical success rates, while stenting yields superior outcomes in lowering amputation risk. Both atherectomy and stenting significantly outperform PTA in achieving 1-year primary patency rates. Although DCB demonstrates superior efficacy and safety compared with plain PTA, the differences did not reach statistical significance.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 159-171"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931441","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":"Optimizing Femoral Access in EVAR: A Multicentric Comparison of Percutaneous and Surgical Approaches in Elective and Urgent Settings","authors":"Chiara Barillà ,&nbsp;Giulia Colonna ,&nbsp;Filippo Benedetto ,&nbsp;Maurizio Taurino ,&nbsp;Pasqualino Sirignano","doi":"10.1016/j.avsg.2025.12.018","DOIUrl":"10.1016/j.avsg.2025.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Endovascular aneurysm repair (EVAR) has become the preferred alternative to open repair for infrarenal abdominal aortic aneurysm, offering lower short-term mortality and morbidity. This study investigates the impact of percutaneous femoral access versus surgical cutdown in elective and urgent/emergent EVAR procedures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on all femoral access procedure performed between 2015 and 2023 from 2 referral academic centers. Primary outcomes were technical success, access site complications, and major adverse events rates. Length of intensive care unit (ICU) stay, and hospital stay, bleeding requiring transfusion, and wound infection rates were also collected. Moreover, anatomical and clinical factors potentially influencing the type of access were investigated.</div></div><div><h3>Results</h3><div>The study included 711 EVAR procedures and 1,422 femoral access. One hundred two procedures (14.3%) were performed in an emergent/urgent setting. Percutaneous approach was performed in 636 (44.7%) cases, while surgical exposure was performed in 786 cases (55.3%). Percutaneous access was associated with lower rates of bleeding (<em>P</em> &lt; 0.001), in-hospital mortality (<em>P</em> &lt; 0.001), both in elective and urgent settings, as well as shorter hospital stays (<em>P</em> &lt; 0.001) and less need for ICU (<em>P</em> &lt; 0.001). Age (<em>P</em> &lt; 0.001), body mass index (<em>P</em> &lt; 0.001), and sheath size (Fr &gt; 16) (<em>P</em> &lt; 0.001) were factors that influenced the choice of percutaneous or surgical approach, both in univariate and multivariate analysis.</div></div><div><h3>Conclusion</h3><div>The present study suggests that percutaneous approach achieves better short-term outcomes than surgical cutdown. However, these findings should be interpreted in light of the study's limitations, including its retrospective design and potential selection bias in access type allocation. Moreover, the success of percutaneous technique remains highly dependent on operator expertise and anatomical challenges. Therefore, the choice of approach should always be tailored for each patient.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 181-188"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931496","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":"Efficacy of Bioresorbable Vascular Scaffolds in Below-the-Knee Arterial Disease: A Single-Arm Systematic Review and Meta-Analysis","authors":"Hong-Jie Cui ,&nbsp;Meng-Long Li ,&nbsp;Ying-Feng Wu","doi":"10.1016/j.avsg.2025.12.027","DOIUrl":"10.1016/j.avsg.2025.12.027","url":null,"abstract":"<div><h3>Background</h3><div>Below-the-knee (BTK) lesions in peripheral artery disease (PAD) are associated with high restenosis rates and poor limb outcomes. Bioresorbable vascular scaffolds (BVS) have emerged as temporary vessel support that may overcome the limitations of balloon angioplasty and metallic stents. However, their efficacy and safety in BTK revascularization remain uncertain.</div></div><div><h3>Methods</h3><div>A systematic review and single-arm meta-analysis were performed by searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus from inception to October 2025. Studies reporting at least 1-year outcomes after BVS implantation in BTK lesions were included. Primary efficacy end points were 1-year patency, freedom from target lesion revascularization (TLR), and clinical remission; safety end points included all-cause mortality and perioperative complications. Random- or fixed-effects models were applied according to heterogeneity.</div></div><div><h3>Results</h3><div>Eleven studies with 591 patients were included (1 randomized, 3 prospectives, 6 retrospectives, and 1 conference abstract). The average lesion length across included studies ranged from 20.1 mm to 43.8 mm. The pooled 1-year patency, freedom from TLR, and clinical remission rates were 90% (95% confidence interval (CI): 0.85–0.95, I² = 63.8%), 94% (95% CI: 0.92–0.96, I² = 0.0%), and 83% (95% CI: 0.79–0.86, I² = 0.0%), respectively. The pooled perioperative complication and 1-year mortality rates were 3% and 9%. Sensitivity analysis confirmed the robustness of pooled estimates, while heterogeneity remained moderate for patency. The overall quality of evidence was low due to the observational design of most studies.</div></div><div><h3>Conclusion</h3><div>BVS demonstrate favorable short-term safety and efficacy in BTK revascularization. However, as this single-arm meta-analysis lacks comparator data and includes mostly small, nonrandomized studies, the results should be interpreted as exploratory. Larger, randomized controlled trials with long-term follow-up are warranted to validate these findings and define the role of BVS in BTK arterial disease.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 206-217"},"PeriodicalIF":1.6,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916729","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":"Drug-Coated Balloon Angioplasty for Femoropopliteal Disease in Diabetic versus Non-Diabetic Patients: A Propensity Score-Matched Analysis","authors":"Ye Du ,&nbsp;Youpeng Zhu ,&nbsp;Xinyuan Wang ,&nbsp;Meng Ye ,&nbsp;Lianrui Guo ,&nbsp;Ziheng Wu ,&nbsp;Xin Fang ,&nbsp;Chunshui He ,&nbsp;Wenbo Yang ,&nbsp;Hongsheng Cai ,&nbsp;Zibo Feng","doi":"10.1016/j.avsg.2025.12.025","DOIUrl":"10.1016/j.avsg.2025.12.025","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate drug-coated balloon (DCB) effectiveness for femoropopliteal disease in diabetic versus non-diabetic patients, using propensity score matching.</div></div><div><h3>Methods</h3><div>This multicenter registry analyzed 1,779 patients completing one-year follow-up from 2,356 enrolled patients undergoing DCB treatment. Propensity matching, based on diabetes status, created 597 matched pairs balanced across 23 demographic and lesion characteristics. Primary endpoints included freedom from clinically driven target lesion revascularization and major adverse events at 12 months. Amputation-free survival and freedom from amputation outcomes were specifically analyzed in the chronic limb-threatening ischemia (CLTI) subgroup.</div></div><div><h3>Results</h3><div>Freedom from clinically driven target lesion revascularization (CD-TLR) rates were equivalent between diabetic and non-diabetic patients (93.63% vs 93.84%, p=0.912), confirming consistent DCB efficacy. Technical success exceeded 98% in both cohorts. Overall survival was 91.68% in diabetic patients versus 95.74% in non-diabetic patients (p=0.009). In the CLTI subgroup (n=431; diabetic patients n=220, non-diabetic patients n=211), amputation-free survival demonstrated significant risk stratification between diabetic and non-diabetic patients (81.39% vs 90.19%, p=0.022, HR 1.895, 95%CI 1.117-3.214), while freedom from amputation remained excellent without significant difference between diabetic and non-diabetic patients (99.02% vs 97.92%, p=0.397, HR 0.488, 95%CI 0.098-2.418).</div></div><div><h3>Conclusions</h3><div>DCB angioplasty demonstrates comparable technical success and freedom from target lesion revascularization in diabetic and non-diabetic patients. However, diabetic patients exhibited significantly lower overall survival and, in the CLTI subgroup, reduced amputation-free survival, despite similar freedom from amputation rates.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905391","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":"Risk Factors for Plaque Vulnerability in a Community Population: Endothelial Function and Arterial Stiffness Indexes","authors":"Yan Zhang ,&nbsp;Shiyu Lei ,&nbsp;Fangfang Liu ,&nbsp;Xi Huang ,&nbsp;Xuejun Xu ,&nbsp;Lanying He ,&nbsp;Jian Wang ,&nbsp;Fan Xu","doi":"10.1016/j.avsg.2025.12.021","DOIUrl":"10.1016/j.avsg.2025.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Rupture of atherosclerotic plaques and subsequent acute cardiovascular complications remain a major cause of morbidity and mortality throughout the world. Despite recent advances in treatment, we have not yet identified the means to prevent atherosclerotic vascular disease has not been met. It remains a challenge to determine at an early stage whether an atherosclerotic plaque will become unstable and vulnerable. Therefore, this study aim to identify key risk factors associated with the stability and vulnerability of carotid artery plaques, which may offer valuable insights for the early prevention of cardiovascular and cerebrovascular diseases.</div></div><div><h3>Methods</h3><div>We enrolled a total of 136 patients with stable atherosclerotic plaques and 635 with vulnerable plaques. Arterial stiffness and endothelial dysfunction were assessed using a cardiovascular function monitor and the Endo-PAT2000 device (Itamar Medical Ltd.), respectively. Differences between groups were compared using the Student's <em>t</em>-test for normally distributed data and the chi-squared test for non-normally distributed data. We developed a logistic regression to analyzed the association of these factors with carotid plaque stability.</div></div><div><h3>Results</h3><div>Carotid-femoral pulse wave velocity (cf-PWV) and the reactive hyperemia index (RHI) were not different between the stable and unstable plaque groups (cf-PWV: 9.48 ± 2.07, 9.59 ± 1.79, <em>P</em> &gt; 0.05; RHI: 1.58 ± 0.57, 1.62 ± 0.39, <em>P</em> &gt; 0.05). The male sex, a smoke history, ejection, and duration were risk factors for plaque stability. Correlation analysis showed that lipids were not correlated with plaque stability and aortic hemodynamic parameters were correlated with plaque vulnerability. Multivariate logistic regression analysis demonstrated that the sex (OR: 0.1759, <em>P</em> &lt; 0.001, 95% CI: 0.1077–0.2874), aortic augmentation index (OR: 1.0366, <em>P</em> &lt; 0.001, 95% CI: 1.0175–1.0560), subendocardial viability ratio (OR: 0.9626, <em>P</em> &lt; 0.001, 95% CI: 0.9535–0.9717), and distance (OR: 0.9854, <em>P</em> &lt; 0.001, 95% CI: 0.9804–0.9903) presented significant correlation with plaque vulnerability.</div></div><div><h3>Conclusion</h3><div>There was insufficient evidence to indicate that RHI, cf-PWV were related to plaque stability. However, male, decreased of subendocardial viability ratio, increased of aortic augmentation index, and the shorter the distance between carotid-femoral arteries had the greater the possibility of vulnerable plaque, which provides a reference for the early prevention of cardiovascular and cerebrovascular diseases.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 172-180"},"PeriodicalIF":1.6,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145899113","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}