Pub Date : 2025-12-26DOI: 10.1016/j.avsg.2025.12.017
Rohan Basu, Payton Miller, Alexa Hughes, Andres Fajardo
Anatomic suitability for endovascular aortic surgery has rapidly expanded to include the juxtarenal and paravisceral segment. Traditional infrarenal endovascular devices are not suitable for use in short neck, angulated, or complex aneurysms that involve the visceral-renal segment of the aorta due to lack of appropriate seal zones or coverage of visceral-renal arteries. There are few commercially available devices in the United States approved for treatment of these complex abdominal aortic aneurysms, one of which requires a 6–8 week waiting period for patient-specific custom fabrication. Physician-modified endografts (PMEGs) have been increasingly adopted as readily available solutions to offer expeditious repair of these anatomically complex aneurysms. PMEG can incorporate various modifications, including fenestrations and directional branches, to accommodate a wide range of anatomies, without need for waiting periods for device fabrication. The authors describe modern planning and technical methods for incorporation of visceral and renal arteries using PMEG created from commercially available endografts.
{"title":"Modern Physician-Modified Endograft Techniques for Renal and Mesenteric Vessel Incorporation","authors":"Rohan Basu, Payton Miller, Alexa Hughes, Andres Fajardo","doi":"10.1016/j.avsg.2025.12.017","DOIUrl":"10.1016/j.avsg.2025.12.017","url":null,"abstract":"<div><div>Anatomic suitability for endovascular aortic surgery has rapidly expanded to include the juxtarenal and paravisceral segment. Traditional infrarenal endovascular devices are not suitable for use in short neck, angulated, or complex aneurysms that involve the visceral-renal segment of the aorta due to lack of appropriate seal zones or coverage of visceral-renal arteries. There are few commercially available devices in the United States approved for treatment of these complex abdominal aortic aneurysms, one of which requires a 6–8 week waiting period for patient-specific custom fabrication. Physician-modified endografts (PMEGs) have been increasingly adopted as readily available solutions to offer expeditious repair of these anatomically complex aneurysms. PMEG can incorporate various modifications, including fenestrations and directional branches, to accommodate a wide range of anatomies, without need for waiting periods for device fabrication. The authors describe modern planning and technical methods for incorporation of visceral and renal arteries using PMEG created from commercially available endografts.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 91-101"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848804","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}
Pub Date : 2025-12-26DOI: 10.1016/j.avsg.2025.12.011
Gemma Pace , Martin Hossack , Francesco Torella , Jillian Madine , Riaz Akhtar
<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is less common in women than in men; however, when present, women appear to follow a more aggressive disease course, rupturing at smaller diameters and experiencing worse operative outcomes. The United Kingdom provides a unique environment in which to evaluate sex-specific outcomes, as national screening invitations are extended to men only and National Institute for Health and Care Excellence guidance applies a uniform 5.5 cm threshold for elective repair irrespective of sex.</div></div><div><h3>Methods</h3><div>A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, EMBASE, and the Cochrane Library were searched to September 2025. Eligible studies reported sex-stratified outcomes for AAA in the United Kingdom. Gray literature was included through review of the National Vascular Registry, National Health Service AAA Screening Program reports, and National Institute for Health and Care Excellence guidance. Where sex-stratified numerators and denominators were available, crude odds ratios (ORs) were calculated and pooled using Der Simonian–Laird random-effects models. A separate adjusted-effects meta-analysis was performed using the generic inverse-variance method for studies reporting multivariable-adjusted ORs (adjORs).</div></div><div><h3>Results</h3><div>Five peer-reviewed studies met inclusion, supported by national reports. Women had significantly higher perioperative mortality after elective endovascular repair (pooled OR 1.61, 95% confidence interval [CI] 1.31–1.97) and elective open repair (pooled OR 1.37, 95% CI 1.16–1.63). After ruptured repair, mortality was similar between sexes following endovascular aneurysm repair (EVAR) (pooled OR 1.11, 95% CI 0.89–1.39), but higher in women after open surgery (pooled OR 1.53, 95% CI 1.24–1.89), although with substantial heterogeneity. Adjusted-effects synthesis confirmed higher mortality for women after elective EVAR (summary adjOR ≈1.55, 95% CI 1.25–1.80) and open repair (adjOR 1.39, 95% CI 1.25–1.56). Women were less likely to undergo surgery following rupture, more likely to be readmitted after elective EVAR, had longer hospital stays, and higher long-term aortic-related mortality.</div></div><div><h3>Conclusion</h3><div>Women with AAA in the United Kingdom remain disadvantaged at every stage of care: they are less likely to be screened, rupture at smaller diameters, less often selected for repair, and when treated, face higher perioperative and long-term mortality. These disparities reflect a combination of anatomical and biomechanical differences, together with systemic factors. Current UK policy, based on male-only screening and a sex-neutral 5.5 cm threshold, does not reflect this reality. Sex-specific thresholds for repair, targeted female screening, and the development of devices optimized for female anatomy are needed to address inequity.</div></di
背景：腹主动脉瘤（AAA）在女性中较男性少见，但当出现时，女性似乎遵循更具侵袭性的病程，在较小直径处破裂，经历较差的手术结果。英国提供了一个独特的环境来评估性别特异性的结果，因为国家筛查邀请仅适用于男性，NICE指南适用于不分性别的统一5.5厘米的选择性修复阈值。方法：根据PRISMA 2020进行系统评价。检索到2025年9月的MEDLINE、EMBASE和Cochrane图书馆。符合条件的研究报告了英国AAA患者的性别分层结局。灰色文献通过审查国家血管登记处（NVR）、NHS AAA筛查计划报告和NICE指南纳入。在分子和分母有性别分层的情况下，使用Der simonan - laird随机效应模型计算和汇总粗比值比（or）。使用通用反方差法对报告多变量调整后的or的研究进行单独的调整后效应荟萃分析。结果：五项同行评议的研究符合纳入标准，并得到国家报告的支持。择期血管内修复术后女性围手术期死亡率显著高于择期血管内修复（合并OR为1.61,95% CI为1.31-1.97）和择期开放式修复（合并OR为1.37,95% CI为1.16-1.63）。在破裂修复后，EVAR术后的死亡率在性别之间相似（合并OR为1.11,95% CI为0.89-1.39），但女性在开放手术后的死亡率更高（合并OR为1.53,95% CI为1.24-1.89），尽管存在很大的异质性。调整效应综合证实，女性择期EVAR（总校正OR≈1.55,95% CI 1.25-1.80）和开放式修复（校正OR 1.39, 95% CI 1.25-1.56）后死亡率更高。女性在破裂后接受手术的可能性较小，在选择性EVAR后再次入院的可能性更大，住院时间更长，长期主动脉相关死亡率更高。结论：在英国，患有AAA的女性在每个护理阶段都处于不利地位：她们不太可能被筛查，直径较小的破裂，很少被选择修复，并且在治疗时，面临更高的围手术期和长期死亡率。这些差异反映了解剖学和生物力学的差异，以及系统因素。英国目前的政策，基于男性筛查和性别中立的5.5厘米门槛，并没有反映出这一现实。为了解决不平等问题，需要针对性别的修复阈值、有针对性的女性筛查以及针对女性解剖结构优化的设备开发。
{"title":"Abdominal Aortic Aneurysm in Women and Men: A Systematic Review of Sex-Specific Outcomes in the United Kingdom","authors":"Gemma Pace , Martin Hossack , Francesco Torella , Jillian Madine , Riaz Akhtar","doi":"10.1016/j.avsg.2025.12.011","DOIUrl":"10.1016/j.avsg.2025.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is less common in women than in men; however, when present, women appear to follow a more aggressive disease course, rupturing at smaller diameters and experiencing worse operative outcomes. The United Kingdom provides a unique environment in which to evaluate sex-specific outcomes, as national screening invitations are extended to men only and National Institute for Health and Care Excellence guidance applies a uniform 5.5 cm threshold for elective repair irrespective of sex.</div></div><div><h3>Methods</h3><div>A systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. MEDLINE, EMBASE, and the Cochrane Library were searched to September 2025. Eligible studies reported sex-stratified outcomes for AAA in the United Kingdom. Gray literature was included through review of the National Vascular Registry, National Health Service AAA Screening Program reports, and National Institute for Health and Care Excellence guidance. Where sex-stratified numerators and denominators were available, crude odds ratios (ORs) were calculated and pooled using Der Simonian–Laird random-effects models. A separate adjusted-effects meta-analysis was performed using the generic inverse-variance method for studies reporting multivariable-adjusted ORs (adjORs).</div></div><div><h3>Results</h3><div>Five peer-reviewed studies met inclusion, supported by national reports. Women had significantly higher perioperative mortality after elective endovascular repair (pooled OR 1.61, 95% confidence interval [CI] 1.31–1.97) and elective open repair (pooled OR 1.37, 95% CI 1.16–1.63). After ruptured repair, mortality was similar between sexes following endovascular aneurysm repair (EVAR) (pooled OR 1.11, 95% CI 0.89–1.39), but higher in women after open surgery (pooled OR 1.53, 95% CI 1.24–1.89), although with substantial heterogeneity. Adjusted-effects synthesis confirmed higher mortality for women after elective EVAR (summary adjOR ≈1.55, 95% CI 1.25–1.80) and open repair (adjOR 1.39, 95% CI 1.25–1.56). Women were less likely to undergo surgery following rupture, more likely to be readmitted after elective EVAR, had longer hospital stays, and higher long-term aortic-related mortality.</div></div><div><h3>Conclusion</h3><div>Women with AAA in the United Kingdom remain disadvantaged at every stage of care: they are less likely to be screened, rupture at smaller diameters, less often selected for repair, and when treated, face higher perioperative and long-term mortality. These disparities reflect a combination of anatomical and biomechanical differences, together with systemic factors. Current UK policy, based on male-only screening and a sex-neutral 5.5 cm threshold, does not reflect this reality. Sex-specific thresholds for repair, targeted female screening, and the development of devices optimized for female anatomy are needed to address inequity.</div></di","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 40-53"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848783","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}
Pub Date : 2025-12-26DOI: 10.1016/j.avsg.2025.12.001
Mohamad Bashir, Matti Jubouri, Damian Bailey, Ian Williams
{"title":"Uncomplicated Type B Aortic Dissection: The Time for Reassessment is now","authors":"Mohamad Bashir, Matti Jubouri, Damian Bailey, Ian Williams","doi":"10.1016/j.avsg.2025.12.001","DOIUrl":"10.1016/j.avsg.2025.12.001","url":null,"abstract":"","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"124 ","pages":"Pages 318-321"},"PeriodicalIF":1.6,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837459","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}
Pub Date : 2025-12-22DOI: 10.1016/j.avsg.2025.12.005
Simon Roisin , Simon Soudet , Mage Adriane , Florent Briffa , Marie-Albane Bensussan , Thierry Reix
Objectives
Supraceliac clamping may be required during repair of short-neck or juxtarenal abdominal aortic aneurysms (AAAs). Its use remains controversial, mainly due to potential renal risks. This study reports the outcomes of its routine use in the surgical management of these complex aneurysms.
Methods
Between January 2008 and December 2024, 207 patients underwent open repair of short-neck or juxtarenal AAAs. Data were retrospectively analyzed, including demographic variables, aneurysm characteristics, intraoperative details, and early morbidity and mortality outcomes. The primary end point was postoperative acute kidney injury (AKI) according to the Risk, Injury, Failure, Loss, End-stage kidney disease classification. Secondary end points included early morbidity and mortality, as well as overall survival at 1 and 5 years.
Results
During the study period, 114 patients required an infrarenal clamp and 93 a supraceliac clamp. The median age was 67 years. Early morbidity and mortality outcomes were compared between the infrarenal and supraceliac clamping groups. No increased risk of postoperative AKI was observed (23% vs. 32%, P = 0.22). The 30-day mortality rate was 2% and did not differ according to clamp level. In multivariate analysis, preexisting chronic kidney disease, greater blood loss, and the presence of atheroma in the proximal neck were independently associated with postoperative AKI (odds ratio 7.0, P = 0.01).
Conclusion
Routine use of supraceliac clamping for the repair of short-neck or juxtarenal AAAs appears to be an efficient and rapid technique, without increasing short-term morbidity or mortality, particularly regarding renal outcomes.
目的：在短颈或脐旁腹主动脉瘤（AAA）的修复中，可能需要在腹腔上夹持。它的使用仍然存在争议，主要是由于潜在的肾脏风险。本研究报告了其在这些复杂动脉瘤的外科治疗中的常规应用的结果。方法：2008年1月至2024年12月，207例患者行短颈或肾旁AAAs开放性修复术。回顾性分析数据，包括人口统计学变量、动脉瘤特征、术中细节、早期发病率和死亡率结果。主要终点是术后急性肾损伤（AKI）。次要终点包括早期发病率和死亡率，以及1年和5年的总生存率。结果：在研究期间，114例患者需要肾下夹，93例患者需要腹腔上夹。中位年龄为67岁。比较肾下夹紧组和腹腔上夹紧组的早期发病率和死亡率。未观察到术后AKI风险增加（23%对32%，p = 0.22）。30天死亡率为2%，并无不同钳位水平的差异。在多变量分析中，先前存在的慢性肾脏疾病、大量失血和颈部近端存在动脉粥样硬化与术后AKI独立相关（OR 7.0, p = 0.01）。结论：常规使用乳糜上夹持术修复短颈或肾旁动脉粥样硬化是一种高效、快速的技术，不会增加短期发病率或死亡率，特别是在肾脏方面。
{"title":"Retrospective Cohort Study: Supraceliac Cross Clamping Does Not Affect Early Outcomes After Juxtarenal Aneurysm Repair","authors":"Simon Roisin , Simon Soudet , Mage Adriane , Florent Briffa , Marie-Albane Bensussan , Thierry Reix","doi":"10.1016/j.avsg.2025.12.005","DOIUrl":"10.1016/j.avsg.2025.12.005","url":null,"abstract":"<div><h3>Objectives</h3><div>Supraceliac clamping may be required during repair of short-neck or juxtarenal abdominal aortic aneurysms (AAAs). Its use remains controversial, mainly due to potential renal risks. This study reports the outcomes of its routine use in the surgical management of these complex aneurysms.</div></div><div><h3>Methods</h3><div>Between January 2008 and December 2024, 207 patients underwent open repair of short-neck or juxtarenal AAAs. Data were retrospectively analyzed, including demographic variables, aneurysm characteristics, intraoperative details, and early morbidity and mortality outcomes. The primary end point was postoperative acute kidney injury (AKI) according to the Risk, Injury, Failure, Loss, End-stage kidney disease classification. Secondary end points included early morbidity and mortality, as well as overall survival at 1 and 5 years.</div></div><div><h3>Results</h3><div>During the study period, 114 patients required an infrarenal clamp and 93 a supraceliac clamp. The median age was 67 years. Early morbidity and mortality outcomes were compared between the infrarenal and supraceliac clamping groups. No increased risk of postoperative AKI was observed (23% vs. 32%, <em>P</em> = 0.22). The 30-day mortality rate was 2% and did not differ according to clamp level. In multivariate analysis, preexisting chronic kidney disease, greater blood loss, and the presence of atheroma in the proximal neck were independently associated with postoperative AKI (odds ratio 7.0, <em>P</em> = 0.01).</div></div><div><h3>Conclusion</h3><div>Routine use of supraceliac clamping for the repair of short-neck or juxtarenal AAAs appears to be an efficient and rapid technique, without increasing short-term morbidity or mortality, particularly regarding renal outcomes.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 282-288"},"PeriodicalIF":1.6,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826794","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}
Pub Date : 2025-12-22DOI: 10.1016/j.avsg.2025.12.015
Sabine Kischkel , Carsten M. Bünger , David P. Martin , Simon F. Williams , Anja Püschel , Wolfgang Schareck , Niels Grabow
Background
This study aims to assess the technical feasibility and biocompatibility of interventional application of a fully absorbable stent in renal arteries (RAs) of healthy pigs.
Methods
Absorbable poly(L-lactide) (PLLA)/poly(4-hydroxybutyrate) scaffolds either loaded with sirolimus (SIR) coating or unloaded and permanent bare metal stents (BMSs) served as control were implanted interventionally into RAs of 16 female pigs via the left common iliac artery (8F-sheath). Peroral dual antiplatelet therapy was administered throughout the study. Stented RA segments were explanted after 4 weeks and assessed histomorphometrically.
Results
The polymer scaffolds showed a decreased residual lumen area and higher stenosis after 4 weeks (unloaded PLLA-based: 6.5 ± 1.0 mm2 and 44.1 ± 7.4%; SIR-PLLA-based: 8.6 ± 0.5 mm2 and 32.7 ± 0.7%) compared to BMS (11.8 ± 4.3 mm2 and 23.0 ± 4.5%). Incorporation of SIR reduced the significantly higher inflammation of unloaded scaffolds; however, not to a level compared to BMS (unloaded PLLA-based: 1.3 ± 0.3; SIR-PLLA-based: 0.9 ± 0.3; BMS: 0.5 ± 0.1). In contrast, BMS showed a slightly elevated vascular injury score (0.8 ± 0.1) compared to the unloaded PLLA-based (0.6 ± 0.2) and the SIR-PLLA-based (0.4 ± 0.04) groups.
Conclusion
Absorbable scaffolds showed sufficient mechanical stability after porcine RA stenting. By incorporation of SIR, a significant reduction of the inflammatory and neointimal response to the unloaded polymer scaffolds was seen without systemic toxicity or thrombotic complications. However, the greater strut height of the polymer scaffold is a major limitation and need to be addressed in future work on the stent design.
{"title":"Vascular Response After Stenting of the Renal Arteries in Pigs Using an Absorbable Sirolimus-Eluting Polymer Scaffold","authors":"Sabine Kischkel , Carsten M. Bünger , David P. Martin , Simon F. Williams , Anja Püschel , Wolfgang Schareck , Niels Grabow","doi":"10.1016/j.avsg.2025.12.015","DOIUrl":"10.1016/j.avsg.2025.12.015","url":null,"abstract":"<div><h3>Background</h3><div>This study aims to assess the technical feasibility and biocompatibility of interventional application of a fully absorbable stent in renal arteries (RAs) of healthy pigs.</div></div><div><h3>Methods</h3><div>Absorbable poly(L-lactide) (PLLA)/poly(4-hydroxybutyrate) scaffolds either loaded with sirolimus (SIR) coating or unloaded and permanent bare metal stents (BMSs) served as control were implanted interventionally into RAs of 16 female pigs via the left common iliac artery (8F-sheath). Peroral dual antiplatelet therapy was administered throughout the study. Stented RA segments were explanted after 4 weeks and assessed histomorphometrically.</div></div><div><h3>Results</h3><div>The polymer scaffolds showed a decreased residual lumen area and higher stenosis after 4 weeks (unloaded PLLA-based: 6.5 ± 1.0 mm<sup>2</sup> and 44.1 ± 7.4%; SIR-PLLA-based: 8.6 ± 0.5 mm<sup>2</sup> and 32.7 ± 0.7%) compared to BMS (11.8 ± 4.3 mm<sup>2</sup> and 23.0 ± 4.5%). Incorporation of SIR reduced the significantly higher inflammation of unloaded scaffolds; however, not to a level compared to BMS (unloaded PLLA-based: 1.3 ± 0.3; SIR-PLLA-based: 0.9 ± 0.3; BMS: 0.5 ± 0.1). In contrast, BMS showed a slightly elevated vascular injury score (0.8 ± 0.1) compared to the unloaded PLLA-based (0.6 ± 0.2) and the SIR-PLLA-based (0.4 ± 0.04) groups.</div></div><div><h3>Conclusion</h3><div>Absorbable scaffolds showed sufficient mechanical stability after porcine RA stenting. By incorporation of SIR, a significant reduction of the inflammatory and neointimal response to the unloaded polymer scaffolds was seen without systemic toxicity or thrombotic complications. However, the greater strut height of the polymer scaffold is a major limitation and need to be addressed in future work on the stent design.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 13-22"},"PeriodicalIF":1.6,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826809","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}
Pub Date : 2025-12-20DOI: 10.1016/j.avsg.2025.12.013
Zackery Aldaher, Michelle Patel, Sweta Munagapati, Bhargav Doddala, Gautam Agarwal, William Jordan, Omar El Shazly
Background
Standard catheter-directed thrombolysis (CDT) (S-CDT) is widely accepted as a safer alternative to open surgery for acute limb ischemia (ALI), but data on ultrasound-enhanced CDT (UE-CDT) for limb salvage are limited. This study compares outcomes of UE-CDT versus S-CDT.
Methods
A 10-year single institution retrospective review identified 68 adult patients who underwent 93 CDT events for ALI, including 62 with UE-CDT and 22 with S-CDT. Following intervention, inpatient, 30 day, and 90 day outcomes were compared; one outcome for comparison was major adverse limb events (MALEs) defined as amputation of any type.
Results
No significant differences were observed between UE-CDT and S-CDT in hospital stay (5.6 vs. 7.1 days, P = 0.31), intensive care unit stay (2.5 vs. 2.9 days, P = 0.26), or duration of thrombolysis (24.2 vs. 29.6 hours, P = 0.39). Technical success was achieved in 92% of UE-CDT cases and 95% of S-CDT cases. At 30 days, UE-CDT patients had significantly fewer MALEs compared to S-CDT (6.5% vs. 31.8%; P = 0.01). However, when amputation type was stratified between digit amputation versus above/below knee amputation, there was only a significant difference between digit amputations in the S-CDT compared to UE-CDT at 30 days (P = 0.004). Otherwise, there was no significant difference between the groups at 30 and 90 days when comparing rates of above ankle amputations.
Conclusion
UE-CDT and S-CDT for ALI show similar hospital and procedural outcomes. However, UE-CDT is associated with lower 30-day MALE, driven by reduced digit amputations, and becomes nonsignificant when stratifying by above ankle amputations.
背景：标准导管定向溶栓（S-CDT）被广泛接受为急性肢体缺血（ALI）的开放手术更安全的替代方案，但超声增强CDT （UE-CDT）用于肢体保留的数据有限。本研究比较了UE-CDT和S-CDT的结果。方法：一项为期10年的单机构回顾性研究确定了68名因ALI接受了93次CDT事件的成年患者，其中62例为UE-CDT， 22例为S-CDT。干预后，比较住院、30天和90天的结果；比较的一个结果是主要肢体不良事件（MALE），定义为任何类型的截肢。结果：UE-CDT和S-CDT在住院时间（5.6天对7.1天，p=0.31）、ICU住院时间（2.5天对2.9天，p=0.26）和溶栓时间（24.2小时对29.6小时，p=0.39）方面均无显著差异。92%的UE-CDT病例和95%的S-CDT病例取得了技术上的成功。在30天，与S-CDT患者相比，UE-CDT患者的MALE显著减少（6.5% vs. 31.8%; p=0.01）。然而，当截肢类型在手指截肢与膝盖上下截肢之间分层时，30天手指截肢与UE-CDT相比，S-CDT只有显著差异（p=0.004）。另外，30天和90天时，两组间比较踝关节以上截肢率无显著差异。结论：UE-CDT和S-CDT对ALI的医院和手术结果相似。然而，UE-CDT与较低的30天MALE相关，由手指复位截肢驱动，并且在踝关节以上截肢分层时变得不显著。
{"title":"Comparative Outcomes of Infusion Catheter-Directed Thrombolysis and Ultrasound-Enhanced Catheter-Directed Thrombolysis in Acute Limb Ischemia: A 10-Year Single Institution Retrospective Analysis","authors":"Zackery Aldaher, Michelle Patel, Sweta Munagapati, Bhargav Doddala, Gautam Agarwal, William Jordan, Omar El Shazly","doi":"10.1016/j.avsg.2025.12.013","DOIUrl":"10.1016/j.avsg.2025.12.013","url":null,"abstract":"<div><h3>Background</h3><div>Standard catheter-directed thrombolysis (CDT) (S-CDT) is widely accepted as a safer alternative to open surgery for acute limb ischemia (ALI), but data on ultrasound-enhanced CDT (UE-CDT) for limb salvage are limited. This study compares outcomes of UE-CDT versus S-CDT.</div></div><div><h3>Methods</h3><div>A 10-year single institution retrospective review identified 68 adult patients who underwent 93 CDT events for ALI, including 62 with UE-CDT and 22 with S-CDT. Following intervention, inpatient, 30 day, and 90 day outcomes were compared; one outcome for comparison was major adverse limb events (MALEs) defined as amputation of any type.</div></div><div><h3>Results</h3><div>No significant differences were observed between UE-CDT and S-CDT in hospital stay (5.6 vs. 7.1 days, <em>P</em> = 0.31), intensive care unit stay (2.5 vs. 2.9 days, <em>P</em> = 0.26), or duration of thrombolysis (24.2 vs. 29.6 hours, <em>P</em> = 0.39). Technical success was achieved in 92% of UE-CDT cases and 95% of S-CDT cases. At 30 days, UE-CDT patients had significantly fewer MALEs compared to S-CDT (6.5% vs. 31.8%; <em>P</em> = 0.01). However, when amputation type was stratified between digit amputation versus above/below knee amputation, there was only a significant difference between digit amputations in the S-CDT compared to UE-CDT at 30 days (<em>P</em> = 0.004). Otherwise, there was no significant difference between the groups at 30 and 90 days when comparing rates of above ankle amputations.</div></div><div><h3>Conclusion</h3><div>UE-CDT and S-CDT for ALI show similar hospital and procedural outcomes. However, UE-CDT is associated with lower 30-day MALE, driven by reduced digit amputations, and becomes nonsignificant when stratifying by above ankle amputations.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 33-39"},"PeriodicalIF":1.6,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809033","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}
Pub Date : 2025-12-19DOI: 10.1016/j.avsg.2025.12.012
Drew J. Braet , Beckett Peterson , Luciano Delbono , Chris Johnson-Harwitz , Peter K. Henke , Dawn M. Coleman , C. Alberto Figueroa , James C. Stanley , Nicholas S. Burris
Background
Risk factors for renal artery aneurysm (RAA) growth are poorly understood. Vascular deformation mapping (VDM) is known to accurately depict 3-dimensional (3D) growth patterns of aortic aneurysms. This study investigates the feasibility of VDM to accurately define 3D growth of RAAs and the relationship of RAA diameter alone to 3D growth.
Methods
Fifty-five RAAs having ≥2 computed tomography angiograms with ≤2.5 mm slice thickness, ≥2 months apart, were studied. RAAs were segmented and their volumes (including calcium, thrombus, lumen, and total) were determined. Change in RAA diameter (ΔDiameter) and volume (ΔVolume) over time were calculated. VDM was used to quantify 3D growth. ΔVolume and mean 3D growth were compared between RAAs having stable diameters and those with increased diameters (≥0.1 cm ΔDiameter) and the relationship between ΔDiameter, ΔVolume, and 3D growth was examined.
Results
Twenty-five of the 55 RAAs studied had successful VDM analyses. The affected patients’ mean age was 60.1 ± 8.7 years and 56% were female. One RAA was symptomatic, with no ruptures. The overall ΔDiameter was 0.86 ± 1.25 mm/year (mean CT interval of 43.1 months). Nine (36.0%) RAAs exhibited diameter increases, and when compared to the 16 stable RAAs, there were no differences in ΔVolume or 3D growth. There was no correlation of ΔDiameter with 3D growth or ΔVolume (r < 0.4, P > 0.05). RAA 3D growth strongly correlated with ΔTotal Volume (r = 0.653, P < 0.001) and ΔLumen Volume (r = 0.695, P < 0.001).
Conclusion
VDM is an accurate method for assessing RAA growth, yields additional metrics not provided by diameter alone, and provides a more comprehensive assessment of RAA morphology changes that correlate with ΔVolume.
目的：肾动脉动脉瘤（RAA）生长的危险因素尚不清楚。血管变形映射（VDM）是已知的准确描绘三维生长模式的主动脉瘤。本研究探讨了VDM精确定义RAA三维生长的可行性，以及RAA直径单独与三维生长的关系。方法：对55例≥2层CTA (ct)，层厚≤2.5 mm，间隔≥2个月的raa进行研究。对raa进行分割，测定其体积（包括钙、血栓、管腔和总体积）。计算RAA直径（ΔDiameter）和体积（ΔVolume）随时间的变化。VDM用于量化3d生长。比较直径稳定的raa和直径增加（≥0.1 cm ΔDiameter）的raa的ΔVolume和平均3d生长，并检验ΔDiameter、ΔVolume和3d生长之间的关系。结果：55例raa中有25例VDM分析成功。患者平均年龄为60.1±8.7岁，女性占56%。一个RAA有症状，没有破裂。总体ΔDiameter为0.86±1.25 mm/年（平均CT间隔43.1个月）。9个（36.0%）raa表现出直径增加，与16个稳定的raa相比，ΔVolume或3d生长没有差异。ΔDiameter与3D-growth、ΔVolume无相关性（r0.05）。结论：VDM是一种准确的评估RAA生长的方法，可以获得不单独由直径提供的额外指标，并且可以更全面地评估与ΔVolume相关的RAA形态变化。
{"title":"Three-Dimensional Assessment of Renal Artery Aneurysm Growth Using Vascular Deformation Mapping","authors":"Drew J. Braet , Beckett Peterson , Luciano Delbono , Chris Johnson-Harwitz , Peter K. Henke , Dawn M. Coleman , C. Alberto Figueroa , James C. Stanley , Nicholas S. Burris","doi":"10.1016/j.avsg.2025.12.012","DOIUrl":"10.1016/j.avsg.2025.12.012","url":null,"abstract":"<div><h3>Background</h3><div>Risk factors for renal artery aneurysm (RAA) growth are poorly understood. Vascular deformation mapping (VDM) is known to accurately depict 3-dimensional (3D) growth patterns of aortic aneurysms. This study investigates the feasibility of VDM to accurately define 3D growth of RAAs and the relationship of RAA diameter alone to 3D growth.</div></div><div><h3>Methods</h3><div>Fifty-five RAAs having ≥2 computed tomography angiograms with ≤2.5 mm slice thickness, ≥2 months apart, were studied. RAAs were segmented and their volumes (including calcium, thrombus, lumen, and total) were determined. Change in RAA diameter (ΔDiameter) and volume (ΔVolume) over time were calculated. VDM was used to quantify 3D growth. ΔVolume and mean 3D growth were compared between RAAs having stable diameters and those with increased diameters (≥0.1 cm ΔDiameter) and the relationship between ΔDiameter, ΔVolume, and 3D growth was examined.</div></div><div><h3>Results</h3><div>Twenty-five of the 55 RAAs studied had successful VDM analyses. The affected patients’ mean age was 60.1 ± 8.7 years and 56% were female. One RAA was symptomatic, with no ruptures. The overall ΔDiameter was 0.86 ± 1.25 mm/year (mean CT interval of 43.1 months). Nine (36.0%) RAAs exhibited diameter increases, and when compared to the 16 stable RAAs, there were no differences in ΔVolume or 3D growth. There was no correlation of ΔDiameter with 3D growth or ΔVolume (<em>r</em> < 0.4, <em>P</em> > 0.05). RAA 3D growth strongly correlated with ΔTotal Volume (<em>r</em> = 0.653, <em>P</em> < 0.001) and ΔLumen Volume (<em>r</em> = 0.695, <em>P</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>VDM is an accurate method for assessing RAA growth, yields additional metrics not provided by diameter alone, and provides a more comprehensive assessment of RAA morphology changes that correlate with ΔVolume.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 23-32"},"PeriodicalIF":1.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802945","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}
Pub Date : 2025-12-19DOI: 10.1016/j.avsg.2025.12.006
Rishab Agarwal BSBA , Nicholas A. Messina BA , Serena Zhang BA , Nuverah Mohsin MD , William D. Jordan MD , Andrew Jay Soo Hoo MD
Objectives
Carotid endarterectomy (CEA) and transcarotid artery revascularization (TCAR) are established treatments for carotid artery disease, but non-clinical procedural differences are important in determining patient selection for either procedure. The objective of this study was to evaluate and compare in-hospital costs for elective CEA and TCAR procedures and to identify demographic and clinical factors associated with cost variation.
Methods
A retrospective cohort study was conducted using the 2019–2022 National Inpatient Sample (NIS), identifying patients who underwent elective CEA or TCAR via ICD-10 procedure codes. Patients admitted emergently were excluded to control for confounding related to pre-hospital stroke. Demographic variables, comorbidity burden (via Elixhauser Comorbidity Index with van Walraven weighting), and hospital charges, were extracted. Hospital costs were calculated using hospital-specific cost-to-charge ratios and utilized in secondary analyses. Group-wise comparisons were performed using Mann-Whitney U and Kruskal-Wallis H tests due to non-normality of data. Multivariable linear regression was used to assess predictors of hospital charges, with post-hoc models evaluating significant interactions.
Results
A total of 36,363 patients were included (34,606 CEA; 1,756 TCAR). Average total charges were significantly higher for TCAR than for CEA ($76,324.50 ± 47,866.06 vs. $52,367.17 ± 43,028.88, p < .001). Higher in-hospital charges were associated with female sex, Hispanic ethnicity, public insurance coverage, and higher income quartile (all p < .05). Linear regression confirmed significant effects of age, comorbidity score, procedure type, sex, race, and insurance status on hospital charges (p < .001). Secondary analyses yielded significantly higher costs for individuals undergoing TCAR, as well as for Asian/Pacific Islander Individuals.
Conclusion
In this national analysis, TCAR was associated with higher in-hospital charges and costs than CEA, even after adjustment for demographic and clinical factors. Charges also varied significantly based on race, insurance type, comorbidity burden, and income. These findings provide valuable insight into the economic impact of carotid revascularization and may inform cost-conscious procedural decision-making.
{"title":"Cost and Demographic Disparities in Elective TCAR and CEA: A National Inpatient Sample Study","authors":"Rishab Agarwal BSBA , Nicholas A. Messina BA , Serena Zhang BA , Nuverah Mohsin MD , William D. Jordan MD , Andrew Jay Soo Hoo MD","doi":"10.1016/j.avsg.2025.12.006","DOIUrl":"10.1016/j.avsg.2025.12.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Carotid endarterectomy (CEA) and transcarotid artery revascularization (TCAR) are established treatments for carotid artery disease, but non-clinical procedural differences are important in determining patient selection for either procedure. The objective of this study was to evaluate and compare in-hospital costs for elective CEA and TCAR procedures and to identify demographic and clinical factors associated with cost variation.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the 2019–2022 National Inpatient Sample (NIS), identifying patients who underwent elective CEA or TCAR via ICD-10 procedure codes. Patients admitted emergently were excluded to control for confounding related to pre-hospital stroke. Demographic variables, comorbidity burden (via Elixhauser Comorbidity Index with van Walraven weighting), and hospital charges, were extracted. Hospital costs were calculated using hospital-specific cost-to-charge ratios and utilized in secondary analyses. Group-wise comparisons were performed using Mann-Whitney U and Kruskal-Wallis H tests due to non-normality of data. Multivariable linear regression was used to assess predictors of hospital charges, with post-hoc models evaluating significant interactions.</div></div><div><h3>Results</h3><div>A total of 36,363 patients were included (34,606 CEA; 1,756 TCAR). Average total charges were significantly higher for TCAR than for CEA ($76,324.50 ± 47,866.06 vs. $52,367.17 ± 43,028.88, p < .001). Higher in-hospital charges were associated with female sex, Hispanic ethnicity, public insurance coverage, and higher income quartile (all p < .05). Linear regression confirmed significant effects of age, comorbidity score, procedure type, sex, race, and insurance status on hospital charges (p < .001). Secondary analyses yielded significantly higher costs for individuals undergoing TCAR, as well as for Asian/Pacific Islander Individuals.</div></div><div><h3>Conclusion</h3><div>In this national analysis, TCAR was associated with higher in-hospital charges and costs than CEA, even after adjustment for demographic and clinical factors. Charges also varied significantly based on race, insurance type, comorbidity burden, and income. These findings provide valuable insight into the economic impact of carotid revascularization and may inform cost-conscious procedural decision-making.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802947","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}
Pub Date : 2025-12-19DOI: 10.1016/j.avsg.2025.11.144
Bliss Jaggers, Charles Shirley, Oleksiy Gudz, Mohammed Moursi
Background
The purpose of this study is to review all type B aortic dissection (TBAD) cases treated at a single institution to identify any significant differences in clinical outcomes during long-term follow-up between younger (<55) and older (≥55) patients.
Methods
Data were collected from patients admitted to a single center with a diagnosis of TBAD over a 10-year period 2012 to 2022. Data collected included demographics, comorbidities (e.g. genetic conditions, smoking, drug abuse, diabetes, renal disease, hyperlipidemia, and hypertension), level of entry tear, treatment type, and patient outcomes. Major end points included survival, progression of dissection or aneurysmal degeneration, and need for follow-up intervention.
Results
One hundred seventy-five TBAD patients were identified (<55, n = 71; ≥55, n = 104). Patients aged ≥55 years had a significantly higher prevalence of chronic obstructive pulmonary disease (30.6% vs. 16.9%, P = 0.0394), while younger (<55) patients more frequently reported drug abuse (22.1% vs. 8.7%, P = 0.0131). No significant difference in overall survival was noted between age groups. The survival curves are similar for the first three to 4 years following dissection, with the younger cohort having improved survival rates over the next several years, until the curves meet again at 10 years following dissection. However, among patients <55 years, those treated with thoracic endovascular aortic repair (TEVAR) had significantly higher survival compared with those treated conservatively (P = 0.0365).
Conclusion
In this retrospective cohort, TEVAR—used selectively for symptomatic or high-risk TBAD—was associated with better long-term survival in younger (<55-year) patients compared with medical therapy alone. These hypothesis-generating data suggest that early endovascular repair may be beneficial in carefully selected young patients but do not justify broad prophylactic expansion of TEVAR indications; prospective studies are required.
{"title":"Long-Term Outcomes of Type B Aortic Dissections in Younger (<55 years) Patients","authors":"Bliss Jaggers, Charles Shirley, Oleksiy Gudz, Mohammed Moursi","doi":"10.1016/j.avsg.2025.11.144","DOIUrl":"10.1016/j.avsg.2025.11.144","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to review all type B aortic dissection (TBAD) cases treated at a single institution to identify any significant differences in clinical outcomes during long-term follow-up between younger (<55) and older (≥55) patients.</div></div><div><h3>Methods</h3><div>Data were collected from patients admitted to a single center with a diagnosis of TBAD over a 10-year period 2012 to 2022. Data collected included demographics, comorbidities (e.g. genetic conditions, smoking, drug abuse, diabetes, renal disease, hyperlipidemia, and hypertension), level of entry tear, treatment type, and patient outcomes. Major end points included survival, progression of dissection or aneurysmal degeneration, and need for follow-up intervention.</div></div><div><h3>Results</h3><div>One hundred seventy-five TBAD patients were identified (<55, <em>n</em> = 71; ≥55, <em>n</em> = 104). Patients aged ≥55 years had a significantly higher prevalence of chronic obstructive pulmonary disease (30.6% vs. 16.9%, <em>P</em> = 0.0394), while younger (<55) patients more frequently reported drug abuse (22.1% vs. 8.7%, <em>P</em> = 0.0131). No significant difference in overall survival was noted between age groups. The survival curves are similar for the first three to 4 years following dissection, with the younger cohort having improved survival rates over the next several years, until the curves meet again at 10 years following dissection. However, among patients <55 years, those treated with thoracic endovascular aortic repair (TEVAR) had significantly higher survival compared with those treated conservatively (<em>P</em> = 0.0365).</div></div><div><h3>Conclusion</h3><div>In this retrospective cohort, TEVAR—used selectively for symptomatic or high-risk TBAD—was associated with better long-term survival in younger (<55-year) patients compared with medical therapy alone. These hypothesis-generating data suggest that early endovascular repair may be beneficial in carefully selected young patients but do not justify broad prophylactic expansion of TEVAR indications; prospective studies are required.</div></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":"125 ","pages":"Pages 62-69"},"PeriodicalIF":1.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802996","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}
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