Vascular

Aortic diseases, including aneurysms and dissections, represent a significant global health burden, necessitating advancements in surgical and endovascular interventions. This bibliometric analysis examines the evolution of research trends, key contributors, and emerging themes in the treatment of aortic diseases over the past three decades.

Bibliometric data from Scopus and Web of Science databases were analyzed for peer-reviewed articles published between 1994 and 2024. A systematic approach adhering to the PRISMA 2020 framework identified 2985 articles. Descriptive and advanced bibliometric techniques, including citation, co-authorship, and keyword co-occurrence analyses, were employed using tools such as VOSviewer and Biblioshiny.

The annual scientific output demonstrated consistent growth, with significant contributions from the United States, United Kingdom, and Germany. Leading institutions, including Harvard Medical School and Beth Israel Deaconess Medical Center, played pivotal roles in advancing research. Keywords revealed a dual focus on minimally invasive techniques, such as EVAR and TEVAR, and patient-centered outcomes like quality of life and survival. Collaboration networks and citation analyses highlighted influential authors and foundational studies shaping the field.

The study underscores the importance of global collaboration and technological innovation in advancing aortic disease treatment. While disparities in research representation persist, emerging trends in hybrid approaches, multidisciplinary methods, and outcome-based studies offer promising directions for future research. These findings provide a comprehensive resource for clinicians, researchers, and policymakers seeking to address challenges and improve patient care in this critical field.

To investigate the differences in aneurysmal sac regression after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in patients with and without dyslipidemia.

This was a retrospective analysis of 3453 patients from an international prospective registry (Europe, United States of America, Brazil, Australia, and New Zealand) of patients treated with the GORE® EXCLUDER® endograft. All scheduled EVARs for infrarenal AAAs between 2014 and 2016 with complete 6-year follow-up imaging data were included. Logistic regression analysis was performed to assess changes in aneurysm diameter based on dyslipidemia after adjusting for sex, age, body mass index, tobacco use, hypertension, coronary artery disease, aneurysm diameter, aneurysm neck length, and aneurysm neck angle. The secondary outcomes included all-cause mortality, stroke/transient ischemic attack (TIA), paraplegia/paraparesis/spinal cord ischemia, reintervention, endoleaks, and aortic rupture. A control group of patients without dyslipidemia with similar age and comorbidities was selected using propensity scores and matched using a 1:1 scheme.

Of the 3453 patients, 85.3% in the non-dyslipidemia group and 85.5% in the dyslipidemia group were men. The mean age was 73.5 ± 8.8 years for the non-dyslipidemia group and 73.4 ± 8.2 years for the dyslipidemia group (p < .001). The mean body mass index was 26.7 ± 4.9 kg/m² for the non-dyslipidemia group, whereas it was 28.0 ± 5.2 kg/m² for the dyslipidemia group (p < .001). Overall, 2269 patients (64.0%) were identified as having dyslipidemia. After propensity score matching (PSM), the dyslipidemia group had higher rates of hypertension (p < .001), TIA (p = .006), carotid disease (p = .002), coronary artery bypass grafting (p = .005), congestive cardiac failure (p = .018), and peripheral artery disease (p < .001). The indications for device placement were similar between the groups. After PSM, the non-dyslipidemia group was more likely to be treated off-label (p = .030) and to have an aneurysm neck length of <15 mm (p = .035). There was no significant difference in the sac size changes within 1 year (p = .7) or 6 years (p = .14) between the groups. After PSM, all-cause mortality was 6.7% in individuals with dyslipidemia and 10.6% in those without (p = .018). However, there were no significant differences in aortic-related mortality between the overall (p = .571) and the matched (p = .662) populations. The rates of reintervention, stroke/transient ischemic attack, and spinal cord ischemia were not significantly different. Among patients with dyslipidemia, larger aneurysm size at 1 year (p = .037) and increased age at 6 years (p < .001) were associated with sac expansion.

In this comprehensive real-world study of patients who underwent EVAR with the GORE® EXCLUDER endoprosthesis found that dyslipidemia did not increase endoleak rates or worsen imaging outcomes over 6 years. Overall, these findings suggest that dyslipidemia does not negatively impact EVAR outcomes and may indicate improved long-term care.

Non-syndromic hereditary aortic diseases are caused by mutations in genes encoding for connective tissue components, involving structural integrity of aortic tissue. Amongst them, MYH11 gene mutation is a known causative factor for aortic diseases, especially in young patients.

We report the case of a 37 years-old male which came to our attention for an acute DeBakey type I aortic dissection. In three different operations he was submitted to a total aortic substitution with a Bentall operation, a Frozen Elephant Trunk and a Thoracoabdominal Aortic open repair. During the last two operations particular technical tips, which are reported in this work, have been adopted to optimize surgical strategy.

Innominate artery (IA) injury resulting from right subclavian vein (RSV) puncture is a relatively rare and life-threatening iatrogenic vascular injury.

In a 72-year-old female patient, in whom iatrogenic IA injury occurred during the RSV puncture, a 6-Fr sheath had entered into ascending aorta through IA. Due to the concern about the difficulty in hemostasis after removing the sheath, the patient was immediately transferred to our hospital. In emergency situations, when there were no covered stents of appropriate sizes available, we ultimately opted to physician-modified endograft (PMEG) for endovascular repair. A 16 × 124 mm Medtronic iliac branch (Endurant, Medtronic Vascular, Santa Rosa, CA, USA) was released on a sterile operating table, trimmed to 16 × 37 mm, and then reassembled into the delivery sheath.

The right subclavian artery (RSA) was exposed in the right supraclavicular fossa and punctured. After established the guidewire pathway from the RSA puncture site to the ascending aorta, the PMEG was delivered to IA and precisely deployed. Subsequently, the 6-Fr sheath was removed, and final angiography confirmed patent blood flow in IA, right common carotid artery, and RSA, with no bleeding. The patient recovered well and discharged.

In emergencies, PMEG can be tailored to fit the anatomical structure of IA, providing a viable and effective alternative for managing complex iatrogenic IA injury.

Pediatric arterial aneurysms are very uncommon. Those without an underlying identifiable etiology such as infection or autoimmune disease are even rarer. In young children, options for repair are limited. We report the case of a pediatric common iliac artery aneurysm that was surgically repaired.

A 27-month-old male presenting for an evaluation of persistent hypertension underwent an abdominal CT scan and was incidentally found to have a large right common iliac artery aneurysm along with a thrombosed, proximal right internal iliac artery aneurysm. Given the size, the aneurysm was repaired with a bypass constructed from cryopreserved femoral artery allograft.

The procedure was uncomplicated, with continued patency of the graft determined via ultrasound at 7 months.

A pediatric iliac artery aneurysm was successfully repaired with a cadaveric femoral artery graft in the setting of limited conduit options.

Ruptured abdominal aortic aneurysm (RAAA) is a life-threatening vascular emergency with high mortality rate despite advances in surgical and endovascular techniques. This study evaluates the impact of internal iliac artery interventions on short-term (30-day) and long-term (up to 6564 days) mortality and intestinal ischemia in patients undergoing endovascular aneurysm repair (EVAR) for RAAA.

A retrospective analysis of 4274 patients who underwent emergent EVAR for RAAA between 2004 and 2022 was conducted using the Vascular Quality Initiative (VQI) database. Patients were stratified into four groups based on the type of internal iliac intervention: no intervention, revascularization of at least one internal iliac artery, occlusion of both internal iliac arteries, and occlusion of one internal iliac artery. Mortality and intestinal ischemic outcomes were compared using chi-square tests, and logistic regression models were used to identify significant predictors.

No statistically significant differences in short-term (p = .5638) or long-term mortality (p = .5776) were observed between groups. Group 3 (occlusion of both internal iliac arteries) had the highest rates of intestinal ischemia (11.36%) and 30-day mortality (31.11%), though these differences were not statistically significant. Intestinal ischemia increased the odds of long-term mortality by 2.82 times (p < .001). Advanced age and preoperative creatinine levels were strong predictors of mortality: each additional year of age increased the odds of death by 7% (p < .0001), and the presence of COPD raised the odds of long-term mortality by 51% (p < .001). Prolonged procedure time and blood loss were also associated with higher risks of both long-term mortality and intestinal ischemia.

The type of internal iliac intervention did not significantly affect short-term or long-term mortality, but mitigating intraoperative factors such as prolonged procedure time and excessive blood loss is critical for improving short-term survival and reducing the risk of intestinal ischemia. Managing chronic conditions like COPD and optimizing renal function are essential to improving long-term outcomes, especially in high-risk patients with advanced age and systemic disease.

There is a lack of consensus on the benefit of early thoracic endovascular aortic repair (TEVAR) over medical management for uncomplicated acute type B aortic dissection (aTBAD). The aim of this study is to compare readmissions of TEVAR versus medical management as the initial treatment strategy for uncomplicated aTBAD using the Nationwide Readmissions Database (NRD).

The NRD was created under the Healthcare Cost and Utilization Project, comprising over half of the U.S. inpatient population. Patients admitted for uncomplicated aTBAD were queried from the NRD from 2016 to 2018. Risk of index admission mortality, spinal cord ischemia, stroke, and overall major complication; 90-day readmission and 90-day treatment failure, between TEVAR and medical management alone.

A total of 12,645 patients with an uncomplicated aTBAD were identified (TEVAR 12% and medical management 88%). Overall major complications during index admission were higher in the medical management group (27% vs 40%, p < .0001). On multivariate analysis TEVAR was associated with lower mortality (OR: 0.47, p < .0001), but a significantly higher rate of spinal cord ischemia (OR: 2.49, p < .0001), with no difference in stroke (OR: 0.93, p = .73). 90-day readmission rates were high but were not significantly different between treatment types (22% vs 25%, OR: 0.88, p = .14). Similarly, TEVAR was not associated with a lower rate of 90-day treatment failure (OR: 0.61, p = .22). Four TEVAR (0.3%) and 40 medical management (0.5%) patients were readmitted for treatment failure due to retrograde type A dissection.

TEVAR for uncomplicated aTBAD was not associated with a lower 90-day readmission rate. Similarly, TEVAR was not associated with a lower rate of 90-day treatment failure. These findings provide further evidence to the equipoise of treatment options and support the need for the randomized trials currently ongoing in the U.S. and Europe investigating outcomes of TEVAR versus medical management for the treatment of uncomplicated aTBAD.

The Vascular Quality Initiative (VQI) of the Society for Vascular Surgery (SVS) is a collection of 14 registries that collects data on over 1,000,000 vascular procedures performed in North America. These registries exist in order to improve the quality, safety, and cost of vascular healthcare. Centers participating in the VQI are subject to routine audits to ensure accurate and comprehensive data entry. The aim of the study is to describe a single-institution experience with the VQI audit of the thoracic endovascular aortic repair (TEVAR)/complex endovascular aneurysm repair (EVAR) registry, highlighting the benefits and lessons learned from participating in the audit.

In 2022, our institution received a VQI audit notification to review all TEVAR/complex EVAR procedures performed between January 1^st, 2021 and December 31^st, 2021. The institutional financial department obtained claims validation data for all procedures billed under corresponding CPT codes for the listed dates. This was matched against the procedures entered manually into the VQI database by institutional data managers and abstracters. Mismatches between claims validation data and VQI entries were identified and sent to a coding specialist for review and possible revision.

Between January 1, 2021 and December 31, 2021, there were 125 unique TEVAR/complex EVAR patients identified by either the claims validation data or manually entered VQI registry data. Sixteen patients were listed in the VQI registry only and one patient was identified by claims validation data only, leaving 108 patients that were identified by both the registry and claims data, for an 86% (108/125) match rate. The audit revealed that 13 patients were incorrectly billed, of which 12/13 patients were incorrectly billed as TEVAR extensions (CPT 33886) instead of new TEVAR procedures (CPT 33880). Recoding and rebilling these patients had significant financial implications to the institution.

This audit highlighted the importance of meticulous coding and manual review to maintain registry accuracy and optimize financial outcomes. Our findings underscore the necessity of ongoing education for coding and billing personnel and the value of VQI participation in identifying coding discrepancies and improving institutional practices.

Image fusion allows for reduced operative time and radiation exposure during endovascular aortic operations. There are two approaches to register a preoperative CT scan to the patient; two X-ray images (2D) or a cone beam CT (CBCT, 3D). The goal of this study was to compare accuracy of initial image fusion alignment and time for image fusion setup using 2D versus 3D registration.

We performed an analysis of patients who underwent endovascular aortic aneurysm repair at our institution. Offline, we re-registered the patient’s preoperative CT scan to the images stored from the procedure. We used an anterior–posterior image and a lateral image to register for the 2D approach and used a CBCT for the 3D registration. We then used the patient’s initial aortogram to assess accuracy between the actual aortogram and the created virtual mask for both 2D and 3D registration. We chose the inferior angle between renal artery and aorta as the fiducial marker. We measured the time to complete two registration processes. We employed the Wilcoxon matched-pairs signed-rank test to compare the two populations.

A total of 27 patients were evaluated; 11 patients underwent EVAR, 3 FEVAR, 13 PMEG. The median (Q1,Q3) distance between the aortogram and the virtual mask for 3D registration was 8 mm (4,11) and for 2D was 14 mm (9,18.75), (p < .001). 22 patients (81%) had a more accurate registration with 3D image fusion. 2D fusion on average was faster by 93 seconds (p < .001) where time to register was 105 seconds for 2D and 197 seconds for 3D registration.

In the current study, 3D registration showed improved alignment of the fusion image over the 2D registration, at the expense of a longer registration time. This should be further evaluated in larger studies. Despite this added effort, we believe that 3D registration should be considered the preferred initial approach given the importance of an accurate mask for complex procedures.

Abdominal aortic aneurysms (AAAs) are a significant vascular disease characterized by the degradation of medial elastic lamellae, neovascularization, and inflammatory responses. While surgical intervention remains the standard treatment for large or rapidly expanding AAAs, there is no universally accepted pharmacological therapy to prevent aneurysm progression. Matrix metalloproteinases (MMPs), particularly MMP-9, and inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) are implicated in AAA pathogenesis, making them potential therapeutic targets. Doxycycline, a broad-spectrum tetracycline antibiotic, has demonstrated inhibitory effects on MMP-9 and anti-inflammatory properties. However, its efficacy in slowing AAA progression remains unclear.

A systematic review was conducted following PRISMA guidelines. Electronic searches were performed in PubMed, MEDLINE, EMBASE, and ClinicalTrials.gov. Inclusion criteria encompassed randomized controlled trials (RCTs), cohort studies, in vitro studies, and systematic reviews evaluating the effects of doxycycline on AAA growth. Data extraction was performed using Covidence software, and study quality was assessed using the Cochrane Risk of Bias Tool 2.0 (RoB2) for RCTs, the QUIN tool for in vitro studies, and the SYRCLE tool for animal experiments. Statistical analysis employed a random-effects model to evaluate heterogeneity among studies.

The initial search identified 1313 references, of which 10 studies met inclusion criteria: two RCTs, two systematic reviews, three in vitro studies, one in vivo study, one methodological study, and one experimental study. The two RCTs, involving 515 patients with an average age of 71 years, reported minimal to no significant reductions in AAA growth following doxycycline administration. In contrast, in vitro and in vivo studies demonstrated inhibition of MMP-9 and inflammatory markers, supporting doxycycline’s potential therapeutic role. Meta-analysis was not performed due to high heterogeneity (I² = 75%). Risk of bias assessment indicated a low risk for RCTs, whereas in vitro and in vivo studies showed a moderate risk of bias.

While doxycycline exhibits promising biochemical effects in AAA pathophysiology, its clinical efficacy remains uncertain. Current evidence does not support its routine use in AAA management outside clinical trials. Future research should focus on targeted pharmacotherapy integrating patient-specific biomarkers to enhance therapeutic outcomes.

Simulators are used for improvement of vascular surgical skills. This study compares a cadaveric pressurized circulation model (CPCM) with electronic simulators to perform of endovascular and open procedures.

A cadaveric pressurized simulation model was developed and implemented for Endovascular Aortic Repair and peripheral arterial angioplasties. We utilized a system to infuse the body with an extracorporeal perfusion pump; and participants performed the same endovascular procedures on an electronic simulator. Addtionally, simulation for an open aortic repair was also conducted and evaluated. Data were analyzed with the statistical package SPSS version 22.

We found significant differences in median comparison between simulators; 100% agree CPCM is very similar to an actual patient, median 5 IQR (4–5) (p = 0.001), it enhances the acquisition of endovascular skills (p = 0.001), offers benefits over other simulators (p = 0.001), and simulated conditions of a real procedure (p = 0.01), likewise can replace animal models (p = 0.001). All participants agree or strongly agree it could help improve the success rate and minimize complications in real patients (p = 0.01).

The cadaveric model provides superior experience fidelity for endovascular training over an electronic simulator.

Ankle and toe brachial pressure index are recommended globally as first line non-invasive screening tests for peripheral arterial disease. However, they can be inaccurate and have limited utility in patients with incompressible arteries, lower limb wounds and/or lack of digits. This study aims to evaluate BlueDop, a novel device that purports to assess peripheral perfusion without the need for a lower limb tourniquet or patients lying flat.

Patients attending vascular and podiatry clinic at Aneurin Bevan University Health Board were recruited between May 2022 and May 2023. A BlueDop reading was recorded in addition to ankle and/or toe brachial pressure index. Satisfaction and preference of each method was recorded using an electronic proforma.

176 patients were included. BlueDop ABPI was shown to be moderately correlated with cuff-ABPI (r_s = 0.42, p = .001) and weakly correlated with TBPI (r_s = 0.22, p = .04). BlueDop had moderate accuracy in diagnosing PAD (C statistic = 0.653) and was more accurate in diagnosing severe PAD (C statistic = 0.706). Diagnostic accuracy appeared to be improved when PAD was defined according to cuff-ABPI only. Patients were more satisfied with BlueDop (mean satisfaction score (MSS) = 4.33) compared to cuff-ABPI (MSS = 2.89, mean difference = 0.544, p < .001) and TBPI (MSS = 3.82, mean difference = 0.579, p < .001) while operator satisfaction was equal.

There is moderate correlation between BlueDop and cuff-ABPI. Patients prefer BlueDop to cuff-ABPI or TBPI. BlueDop appears to be an acceptable method of non-invasive assessment of PAD, although users must appreciate there is a discrepancy between it and cuff-ABPI/TBPI.

Chronic limb-threatening ischemia (CLTI), a severe form of peripheral artery disease (PAD), results in significant morbidity and mortality. The Global Limb Anatomic Staging System (GLASS) is a new tool designed to predict outcomes in CLTI patients undergoing endovascular treatments, yet its relationship with short-term outcomes requires further investigation.

This study evaluates the correlation between GLASS staging and short-term outcomes in CLTI patients treated with endovascular procedures for infrainguinal lesions.

Prospective cohort of 160 CLTI patients who received endovascular treatment for infrainguinal lesions was analyzed. GLASS staging was assigned based on angiographic data, and short-term outcomes, including immediate technical failure (ITF), limb-based patency (LBP) at 1 year, and amputation-free survival (AFS) at 1 year, were measured.

In the cohort of patients, a significant association was found between GLASS staging and short-term outcomes. Higher GLASS stages correlated with increased ITF rates, lower 1-year LBP rates, and reduced 1-year AFS rates. Specific GLASS parameters, such as femoropopliteal and infrapopliteal scores, independently predicted short-term outcomes.

This study indicates that GLASS staging is a useful prognostic tool for assessing short-term outcomes in CLTI patients undergoing endovascular treatment for infrainguinal lesions. Utilizing GLASS staging in clinical settings may enhance treatment planning and patient prognoses.

To investigate the effect of catheter-directed thrombolysis (CDT) combined with drug-coated balloon (DCB) dilatation in the treatment of femoral-popliteal thromboangiitis obliterans (TAO).

The clinical data of 26 patients with femoral-popliteal TAO who underwent CDT combined with DCB dilatation were collected from April 2020 to November 2023. The clinical efficacy at different time points (preoperative, 24 hours postoperatively. and every 6-month intervals after the procedure) in terms of the pain score, Rutherford classification, and ankle-brachial index (ABI) was compared. The primary patency was assessed at 6 months and 1 year postoperatively. Amputation-free survival and limb salvage rate were also evaluated.

The femoral-popliteal artery occlusions were successfully recanalized in all 26 patients. No complications such as thrombosis, rupture of vessel, and distal embolism occurred during the operation. Thrombolytic-related hemorrhage occurred in one patient. The pain score and Rutherford grade were lower and ABI was higher at 24 hours, 6 months, and 1 year postoperatively (p < .05). The primary patency rate was 88.5% (23/26) at 6 months and 65.3% (17/26) at 1 year postoperatively. Amputation-free survival and limb salvage rate were both 92.3% at 1 year.

The efficacy of CDT therapy combined with DCB dilatation for femoral-popliteal thromboangiitis obliterans is acceptable at 6 months and 1 year, and the long-term effects need to be further observed.

Peripheral arterial disease (PAD) represents a significant cardiovascular burden in low- and middle-income countries (LMICs), yet its prevalence in Nepal remains unknown. As Nepal undergoes demographic transition with increasing life expectancy and cardiovascular disease burden, understanding PAD prevalence is crucial for healthcare planning. We aimed to determine PAD prevalence among Nepali adults aged ≥45 years using ankle-brachial index (ABI) screening.

This cross-sectional study was conducted at two sites in Nepal between October 2022 and March 2023. Participants aged ≥45 years without a prior PAD diagnosis were recruited through voluntary screening during routine care visits. We collected demographic data, cardiovascular risk factors, and claudication symptoms. PAD was defined as ABI <0.9, with ABI >1.4 considered non-diagnostic due to incompressible vessels.

Among 639 participants (median age 60 years, IQR 53-68; 52% male), 638 were included in the analysis. The overall PAD prevalence was 7.4% (95% CI 5.6%-9.7%), increasing to 8.7% (95% CI 6.6%-11.3%) when excluding incompressible ABIs (14.9% of participants). PAD prevalence increased with age, reaching 12.1% in those >75 years. Participants with PAD showed significantly higher rates of cardiac disease (15% vs 4%, p = .002) and claudication symptoms (26% vs 10%, p = .001) compared to those with normal ABIs. Diabetes was more prevalent in those with incompressible ABIs compared to normal ABIs (26% vs 15%, p = .02).

This first systematic assessment of PAD in Nepal reveals a prevalence comparable to other South Asian countries, with significant associations with cardiac disease and claudication symptoms. The findings highlight the need for enhanced vascular disease education in Nepal, where only 25 vascular surgeons serve 31 million people. Future research should include expanded geographic sampling and longitudinal outcomes to inform national screening policies and resource allocation.

Endovascular modality used in peripheral vascular intervention (PVI) varies widely. Long-term outcomes are poorly studied between covered stents (CS) and bare metal stents (BMS) for the SFA.

Patients (2017–2021) undergoing CS and BMS to the SFA were identified at an academic institution. Comparative statistics and Kaplan–Meier analysis were used to evaluate outcomes by group.

One hundred and nineteen patients undergoing stenting were included with 60 patients undergoing CS (50%) and BMS in 59 (50%). There were no differences in sex (p = 0.5), preoperative ABI (p = 0.2) or indication for surgery between groups (p = 0.8). CS patients had undergone more prior SFA interventions (p = 0.03) and were younger (62 vs. 66 years; p = 0.04). Regarding anatomic and operative characteristics, CS patients had more TASC C/D lesions (69 vs. 47%; p = 0.006) less severe calcification (8 vs.17%; p = 0.0006) and more often underwent angioplasty and stenting (90 vs 51%; p < 0.0001) and less often angioplasty, DCB and stenting (5 vs. 43%; p < 0.0001). CS patients had larger SFA (5.7 vs 4; p < .0001), longer lesions (119 vs. 89 mm; p = 0.0008), higher popliteal runoff score (8.3 vs. 6.4; p = 0.02), longer surgery (140 vs. 118 min; p = 0.03), less fluoroscopy time (21 vs. 26 min; p = 0.03), larger SFA stent (6.2 vs. 5.6 mm; p < 0.0001), and longer stented length (260 vs. 171 mm; p < 0.0001). There were no differences in concomitant iliac/tibial treatment between groups (p = 0.3). Regarding outcomes, there were no differences in amputation (CS 10 vs. BMS 10.2%; p = 1) but overall mortality was lower in CS patients (8 vs 22%; p = 0.04) as was acute limb ischemia (17 vs. 34%; p = 0.03). CS patients underwent fewer endovascular (p = 0.03) and open reinterventions (p = 0.005) but a shorter time to first endovascular reintervention (5.6 vs. 17.8 months; p = 0.0002) on unadjusted analysis. Kaplan-Meier estimated survival at 48 months was 83% for CS and 75% for BMS (p = 0.28). At 36 months, primary patency was 35% for CS vs. 41% for BMS (p = 0.09), primary-assisted patency was 57% for CS vs. 68% for BMS (p = 0.04) and secondary patency for CS was 61% vs. 61% for BMS (p = 0.99).

In this series, CS was associated with lower reintervention rates than BMS despite higher TASC classification, longer lesions, and higher popliteal runoff scores. CS was more often used to salvage previous SFA intervention. At 3 years, however, patency was similar between groups. These data suggest some advantages for CS over BMS in endovascular salvage of failed SFA intervention and potentially a preferred modality for more complex SFA lesions than BMS.

Lower extremity peripheral arterial disease (PAD) is associated with increased morbidity and mortality. The primary objective of the study was to identify nonspecific risk factors for 2- and 5-year all-cause mortality in endovascularly treated patients with PAD. The secondary objective was to develop a clinically applicable scoring system to estimate the probability of 2- and 5-year all-cause mortality based on our results.

We performed a retrospective study using data from patients with PAD who underwent endovascular treatment between January 2016 and December 2018. All data were collected from electronic medical records. A Cox proportional hazards regression model was used to examine the association between variables and all-cause mortality. Multivariate analyses were performed after adjusting for age, chronic limb-threatening ischaemia (CLTI), creatinine and fibrinogen in model 1, and for age, hypertension, diabetes mellitus, sex, smoking, dyslipidemia, CLTI, chronic obstructive pulmonary disease, malignancy, atrial fibrillation, heart failure with reduced ejection fraction, coronary artery disease, fibrinogen and creatinine in model 2. Variables associated with mortality with p-value <.02 in all analyses were included in the scoring system. The predictive performance of the scoring system was evaluated using the Area Under Curve (AUC) of Receiver Operating Characteristic curve.

A total of 676 patients with a mean age of 68.6 ± 9.74 years were analyzed, 66.7% of patients had CLTI. The 2-year mortality rate was 22.3%; 29.5% in patients with CLTI and 8% in patients with claudications. The 5-year mortality rate was 48.8%; 60.5% in patients with CLTI and 25.3% in patients with claudications. CLTI presence, creatinine, age and fibrinogen were included in the scoring system. Based on the cut-off values of creatinine >102.4 umol/l, fibrinogen >5.41 g/L, age ≥68 years and CLTI presence, patients were categorized into five groups. For 2-year mortality, a score of 0 points corresponded to a 5.0% risk of death, 1 point to an 11.1% risk, 2 points to a 23.0% risk, 3 points to a 41.7% risk and a score of 4 points to a 63.1% risk of death (AUC 0.73; p = .000). For 5-year mortality, a score of 0 points corresponded to a 13.5% risk of death, 1 point to a 31.3% risk, 2 points to a 57.1% risk, 3 points to a 79.5% risk and a score of 4 points to a 91.9% risk of death (AUC 0.74; p = .000).

The all-cause 2-year mortality rate in patients with PAD was 22.3%, and the 5-year mortality rate was 48.8%. The strongest associations with 2- and 5-year mortality were observed for CLTI presence, creatinine, age and fibrinogen. The scoring system based on these variables predicts 2- and 5-year all-cause mortality risk in patients with PAD, with a probability approaching 75%.

Major lower limb amputations, often performed as lifesaving procedures in patients with advanced peripheral vascular disease (PVD), are associated with high rates of postoperative complications and reoperations. Identification of risk factors associated with reoperation is crucial for targeted perioperative management. The objective of the study is to identify the factors associated with increased risk of reoperation following major amputation and to develop and evaluate a predictive model for the same.

A prospective observational study was conducted at our tertiary care centre between October 2022 and December 2023. After taking institutional ethical committee clearance, 83 patients undergoing major lower limb amputations (above or below the knee) for PVD were included in study. Demographic, clinical, and radiological variables were collected and analyzed. Reoperation was defined as any additional procedure requiring revision of the stump within 30 days, excluding minor wound interventions. Multivariable binomial logistic regression analysis was performed to identify independent risk factors associated with reoperation.

The reoperation rate following major amputation was 44.57%, the two common causes were stump necrosis (40.54%) and wound infections (29.72%). On multivariable analysis, age >60 years (OR: 8.26, p = .001) and arterial blockage above the common femoral artery (CFA) (OR: 4.32, p = .038) emerged as significant independent risk factors. The regression model demonstrated moderate predictive strength with a Nagelkerke R² value of 40.9% and good model fit (p = .724).

Advanced age and proximal arterial occlusion are significant predictors of reoperation after major amputation. The proposed model offers a practical tool for risk stratification, patient counselling, and surgical planning. Multicentre validation is needed to refine its predictive accuracy.

True aneurysms of the superior mesenteric artery (SMAA) are rare but clinically significant due to the risk of severe complications such as mesenteric ischemia and fatal hemorrhage upon rupture. While the European Society for Vascular Surgery (ESVS) recommends endovascular repair as the first-line treatment, open surgery remains a valuable option when endovascular repair is not feasible due to clinical or technical constraints.

A systematic literature review was conducted covering the period from 2010 to 2024. Twenty-five surgically treated SMAA cases were identified. Data were collected on patient characteristics, surgical indications, procedures performed, and clinical outcomes.

The majority of patients were male (80%) with a mean age of 46 years. Indications for open repair included mycotic aneurysm (48%), collagenous disease or fibrodysplasia (20%), emergency repair for hemoperitoneum (4%), and unfavorable anatomy for endovascular treatment (28%). Surgical techniques included simple aneurysmectomy (56%) and aneurysm resection with graft reconstruction (44%). No intra- or postoperative bleeding or major complications were reported. In-hospital mortality was 16%, primarily due to acute bowel ischemia (12%). Among survivors, vascular reconstructions demonstrated 100% patency at a mean follow-up of 14 months (range 1–48 months), with no need for reintervention and no deaths during follow-up.

Open surgical repair remains a viable treatment option in cases of infected SMAA, collagenous disease, or complex anatomy unsuitable for endovascular repair. It ensures satisfactory survival, favorable clinical outcomes, and durable mid-term patency without the need for reintervention.

Combined iliofemoral endarterectomy and iliac stenting (IFE + S) is a proven surgical approach for TransAtlantic Inter-society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD). Iliac stenting alone (ISA) may be an attractive, minimally invasive option in select cases; however, untreated moderate-to-severe common femoral disease may threaten iliac stent patency and limit symptom improvement. This study evaluates the mid-term patency rates after IFE + S versus ISA for TASC C and D AIOD as well as the rate of interval femoral endarterectomies in those who underwent ISA.

This is a retrospective, single-center analysis of patients from 2011 to 2018 with TASC C or D AIOD and concomitant femoral artery stenosis of >50% who underwent IFE + S or ISA. Baseline lesion and patient characteristics such as TASC classification, degree of stenosis, calcification severity, lesion length, and baseline ankle-brachial index (ABI) were collected. Primary, primary-assisted, and secondary patency rates were calculated over three years with Kaplan-Meier estimates. The rate of interval femoral endarterectomies in the ISA cohort was measured at the same time endpoint.

Of the 78 limbs identified, 64 (82.1%) underwent IFE + S and 14 (17.9%) underwent ISA. No significant differences in aortoiliac or femoral lesion characteristics existed. Iliac stent primary patency was significantly improved in the IFE + S group at three years [85.1% versus 55.6%, HR 3.96 (95% CI 1.54, 10.2, p = .004)]. Primary-assisted and secondary patency rates were not significantly different. Five (35.7%) patients in the ISA cohort required an interval femoral endarterectomy for ischemic symptoms over the three-year endpoint.

Conclusions: In select patient populations with concomitant TASC C or D AIOD and common femoral artery disease, IFE + S may provide improved mid-term primary stent patency when compared to ISA. A subset of patients who undergo ISA may require future femoral endarterectomies for ischemic symptoms.

To compare endovascular kissing stent (KS) and aortobifemoral bypass (AFB) procedures in patients with bilateral common iliac artery occlusion.

This was a single-centre retrospective study. Subjects who underwent treatment for bilateral TASC II C and D common iliac artery occlusion between August 2013 and August 2021 with at least 3 years of follow-up were included in the study. The study group was divided into kissing stent (group A) and aortobifemoral bypass (group B) groups. The subjects’ demographic data (including age, sex, body mass index (BMI), smoking history, comorbid diseases and medications), TransAtlantic Inter-Society Consensus (TASC) II classifications and Rutherford classifications were noted. Preoperative diagnostic data included ankle–brachial index (ABI) measurements and computed tomography (CT) angiography assessments of the aorta and iliac–femoral axis. Intraoperative data (including operative times and complications) and hospital stay data were recorded. Patients were evaluated at the 1^st, 3^rd, 6^th, 12^th, 24^th and 36^th months after the procedure at outpatient visits. The primary patency, primary-assisted patency and secondary patency rates were calculated.

This study included 120 cases. The mean age of the participants in the study group was 66.18 ± 4.63 years (range: 56–78). The BMI of group A was significantly greater than that of group B (23.13 ± 1.36 for group A and 21.51 ± 1.38 for group B, p = 0.001) (Table 1). The rate of TASC D classification in group B was significantly greater than that in group A (p = 0.001; p < 0.01). The operation time of group B was significantly greater than that of group A (mean of 56 min for group A and 210 min for group B, p = 0.001). Moreover, the hospital stay of group B was significantly longer than that of group A (mean of 1 day for group A and 7 days for group B, p = 0.001).

For the follow-up CT angiography measurements, a significant difference was observed between the groups at the 24^th month of follow-up (p = 0.023; p < 0.05). The rate of full patency in patients in group B was significantly greater than that in group A (p = 0.027; p < 0.05). Additionally, the rate of 0%–50% stenosis in patients in group B was significantly lower than that in patients in group A (p = 0.023; p < 0.05). Other comparisons, such as those for CT angiography measurements, were not significant (p > 0.05 for all comparisons). Eleven (n = 11, 18.3%) out of sixty subjects in group A and seven (11.7%) out of sixty subjects in group B underwent secondary interventions (p = 0.444). The calculated primary patency, primary-assisted patency and secondary patency rates at 36 months were 68.3%, 21.7% and 10% for group A and 83.3%, 11% and 6.7% for group B, respectively.

The use of KS and AFB procedures in subjects with bilateral common iliac artery occlusion has comparable long-term patency rates.

Although some publications are comparing the early clinical and anatomical results of endovenous laser ablation and endovenous cyanoacrylate embolization in great saphenous vein insufficiency, according to our knowledge, there are limited publications comparing the long-term clinical and anatomical results of these methods. I aimed to compare the long-term clinical and anatomical outcomes of these endovenous treatment methods.

A total of 248 patients over the age of 18 who underwent endovenous laser ablation or endovenous cyanoacrylate embolization for the treatment of great saphenous vein insufficiency were included in the study. Patients who have been treated with a treatment method other than these methods were not included in this study. The equal numbers of patients were included in two groups according to the applied treatment methods. The groups were not fully matched in terms of baseline characteristics in this study, and significant differences were detected in age and preoperative reflux duration values (p < .05), and therefore, the results were re-analyzed with models (ANCOVA) adjusted for age and clinical severity parameters.

Endovenous laser ablation or endovenous cyanoacrylate embolization procedures were performed in a total of 248 patients with a mean age of 51.22 ± 13.20 years. There was a statistically significant difference in mean age between the groups (p = .017). The mean preoperative CEAP score of study patients was 3.07 ± 0.57 (between 2 and 6), and the mean preoperative VCSS value was 6.85 ± 1.18. The average follow-up period of the study patients was 3.5 ± 0.50 years and at the end of the follow-up, a decrease in CEAP stage and VCSS values was observed in both groups.

The endovenous cyanoacrylate embolization offers similar long-term success rates to endovenous laser ablation, is a shorter procedure time, and offers advantages in returning to daily activities after the procedure. Both treatment methods, with effective and accessible healthcare systems, offer a variety of treatment options. The results of this study suggest that while both methods reduce the CEAP stage in the long term, endovenous cyanoacrylate embolization may provide a greater reduction. However, endovenous laser ablation may be more effective in reducing symptom severity (VCSS) and may offer an effective treatment option with lower complication rates and similar outpatient benefits and cost-effectiveness.

This study aimed to assess whether Large Language Models (LLMs), like ChatGPT-4, could simplify discharge summaries for vascular surgery patients while maintaining accuracy and completeness, ultimately improving patient comprehension and engagement in their postoperative care.

In this cross-sectional multicentric study, discharge summaries from 90 vascular surgery patients across three centers were collected. These were divided into three groups based on patient pathology: aortic pathology, peripheral artery disease, and carotid artery disease. Summaries were processed by LLMs to create patient-friendly versions with a target reading level suitable for a 6th-grade education. The readability of the original and AI-generated summaries was evaluated using the Flesch-Kincaid Grade Level and Ease Score. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Print (PEMAT-P), which evaluates the clarity, organization, and actionable nature of the text. Accuracy and completeness were rated using a 6-point Likert scale and a 3-point Likert scale, respectively. Statistical analyses, including paired-samples t-tests, ANOVA, and post-hoc tests, were performed to assess the differences between the original and AI-modified summaries.

AI-generated summaries demonstrated significant improvements in readability, with a 39.6% reduction in Flesch-Kincaid Grade Level and a 106.37% increase in Ease Score. The mean understandability score based on PEMAT-P was 77.71, while the actionability score was 52.12. Accuracy was rated highly (mean score of 5.21), and completeness had a mean score of 2.61. However, 10.8% of summaries had omissions, and 7.5% had hallucinations, with corrections made in some cases.

LLMs like ChatGPT-4 can significantly improve the readability and accessibility of discharge summaries for vascular surgery patients, enhancing their understanding and engagement in postoperative care. While the summaries were accurate and complete, the occurrence of errors suggests the need for further refinement to minimize omissions and hallucinations. These findings indicate that AI can be a valuable tool in improving communication between healthcare providers and patients. Future research should focus on reducing errors and enhancing actionability.

Arteriovenous fistula is the preferred vascular access for patients with chronic kidney disease on hemodialysis. Brachiobasilic arteriovenous fistulas are valued for their durability and long-term patency in patients with unsuitable superficial venous anatomy. The basilic vein, located deeper within the arm, offers a larger diameter. However, due to its depth, surgical interventions like superficialization or transposition are necessary to make the vein accessible for routine cannulation. This study compares the outcomes of three different surgical techniques used during the second stage of brachiobasilic arteriovenous fistula superficialization.

This retrospective study analyzed data from patients who underwent a second-stage brachiobasilic arteriovenous fistula between January 2020 and February 2023. The procedure involved elbow brachiobasilic AVF, resulting in vein dilatation and arterialization, followed by superficialization using techniques like skin-flap elevation or tunnel-transposition with veno-venous re-anastomosis or veno-arterial re-anastomosis. Follow-ups included routine clinic visits, duplex ultrasound scans, and monthly surveillance visits.

A study of 238 second-stage brachiobasilic arteriovenous fistula procedures revealed no significant differences among the three groups. The skin-flap elevation technique had shorter operative times and higher technical success rates but was associated with higher postoperative complications like hematomas, infections, and nerve injuries. The veno-venous re-anastomosis and veno-arterial re-anastomosis groups had lower complication rates, particularly nerve injuries and steal syndrome, but required longer operative times and had lower technical success rates.

Superficial tunneling techniques provide better healing and less complications as compared to skin-flap elevation.

Mycotic aneurysms of the extracranial carotid artery are a rare consequence of localised or systemic infection. Typically caused by Staphylococcal infections, sequelae include further bacterial dissemination, stroke, rupture and death. Scarcely discussed in literature, the management of this pathology is limited to case reports and general consensus.

The case of an internal carotid artery mycotic aneurysm in the setting of contralateral internal carotid artery occlusion managed with urgent endovascular repair is discussed. A systematic review was subsequently conducted according to PRISMA guidelines to further review the preferred management for this uncommon pathology.

A total of 38 articles discussing the clinical details of 48 mycotic ICA aneurysms in the adult population were reviewed. Similarly to the described case, the majority of infections were due to Staphylococcus species; however, contrary to the present case, most were managed with open repair. All cases were managed with antibiotic therapy.

Whilst most cases previously described in the literature have been managed with open bypass grafting, the present case describes an alternative treatment method with endovascular management in the emergent setting with good outcomes at 1-year post-stent placement.

Previous studies have reported that inflammatory biomarkers have prognostic value in various fields, including vascular surgery. Biomarkers such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) help identify patients at higher risk for cerebrovascular events, as well as in the treatment and follow-up of patients. There are studies investigating the usefulness of these biomarkers for carotid artery disease. However, data on whether they help predict neurological complications after carotid artery surgery are limited. This study examined the correlation between preoperative carotid arterial stenosis severity, symptomatic presentation, and PLR and NLR levels as potential biomarkers for predicting postoperative neurological complications.

We retrospectively analyzed the preoperative and postoperative demographics, physical examination, and laboratory results of patients who underwent carotid endarterectomy for carotid artery stenosis in our clinic between January 2019 and January 2023.

While our findings did not demonstrate a statistically significant correlation between NLR and PLR levels and postoperative neurological complications, elevated platelet counts were associated with such complications, underscoring the importance of antiplatelet therapy in managing carotid artery disease.

The study linked high platelet counts to postoperative complications and highlights the importance of antiplatelet therapy in managing carotid artery disease. The differences in findings highlight the complexity of stroke prediction and the need for a multifactorial approach.

Carotid arterial disease is one of the most important causes of stroke and the gold standard in its treatment is surgical endarterectomy. Different approaches have been reported regarding revascularization methods (stent/surgery) and surgical methods (with shunting/with-out shunting) in patients with contralateral carotid stenosis. In this study, revascularization methods and postoperative follow-up of patients with contralateral carotid arterial stenosis in our clinic were investigated.

Patients who underwent carotid endarterectomy in our clinic between 01.04.2019 and 30.04.2024 were retrospectively analyzed. Patients were divided into 4 groups according to contralateral carotid artery stenosis. On the contralateral side; patients with <50% stenosis constituted Group 1, patients with 50–69% stenosis constituted Group 2, patients with 70–99% stenosis constituted Group 3, and patients with total occlusion constituted Group 4. In all patients, the operation was performed with NIRS monitoring. The groups were compared in terms of postoperative neurological events and mortality.

There were 248 patients, who had undergone carotid endarterectomy during the study period. There were 143 patients in Group 1, 47 patients in Group 2, 44 patients in Group 3, and 14 patients in Group 4. Demographics, preoperative findings and cross clamping times were similar between the groups. All of the operations except 2 with regional anesthesia were performed under general anesthesia. Shunting was required in 6 patients and arteriotomy was closed with patchplasty in 17 patients. In the comparison of postoperative events, there was no statistically significant difference between the groups in the terms of early-term minor (1.4%, 2.1%, 2.3%, and 0, respectively) and major (0.007%, 0, 2.3%, and 0, respectively) neurological events. There were 5 reoperations due to bleeding (3 in Group 1 and 2 in Group 2) 3 mortalities (1 in Group 1 and 2 in Group 3). There was no neurological event and mortality and 1 restenosis in Group 1 in the follow-up period.

In carotid artery stenosis, contralateral carotid artery stenosis is not a marker for determining the revascularization method. Performing the operation with standard precautions without deviating from routine practice has similar results to the surgical approach applied in unilateral stenosis. In these patients, the operation might be performed safely with precautions such as cerebral monitoring and not lowering blood pressure during the operation.