搜索结果：Journal of vascular surgery

In patients with chronic limb threatening ischemia (CLTI), the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial demonstrated a significant benefit of infrainguinal bypass with single segment great saphenous vein (GSV). Given the rise of venous ablation and the lack of consistent vein mapping, prevalence of adequate GSV is poorly defined in current patients with CLTI. Our goal was to assess the availability of adequate GSV in a contemporary CLTI population. We conducted a single center review of unique CLTI patients (2016-2025) who had vein mapping before an open or endovascular intervention was performed. Patients with a history of prior open infrainguinal revascularizations were excluded. Duplex ultrasound reports were evaluated for GSV diameter. Vein diameter was assessed for a minimum of 2.5 mm and 3 mm throughout the thigh alone and the entire leg (thigh and calf). Ipsilateral and contralateral measurements were recorded. Patient and anatomical details were compared and stratified by available GSV. We identified 223 patients. The patients had a mean age of 68.6 years; 64.1% were male, 50.2% were of Black race and 17.9% were of Hispanic ethnicity. The majority (69.1%) had diabetes mellitus and 35% were currently smoking. Of these patients, 16.6% had a history of deep vein thrombosis, 18.4% had chronic venous insufficiency, and 0.9% had a prior GSV ablation; 29.1% had a prior ipsilateral infrainguinal endovascular intervention. With respect to duplex based measurements, thigh GSV ≥ 2.5 mm alone was seen in 69.5% and 74% of the ipsilateral and either leg, respectively. Entire leg GSV ≥ 2.5 mm was observed in 42.9% and 46.6% of ipsilateral and either leg. Thigh GSV ≥ 3 mm alone was seen in 58.7% and 64.6% of ipsilateral and either leg. Entire leg GSV ≥ 3 mm was observed in 23.8% and 27.4% of ipsilateral and either leg. Overall, 102 patients (45.7%) underwent femoropopliteal intervention, including 46 endovascular (20.6%) and 56 bypass (25.1%) procedures. Among patients having femoropopliteal intervention, 153 (68.6%) had a thigh GSV diameter ≥2.5 mm and 133 (59.8%) had a diameter ≥3.0 mm. Male gender (OR 2.32, 95% CI 1.28 - 4.24, P = .006) and diabetes mellitus (OR 2.17, 95% CI 1.15 - 4.1, P=.02) were associated with >2.5 mm vein diameter on multivariable analysis. The majority of patients with CLTI had adequate thigh GSV with a high percentage having adequate GSV throughout the entire leg. These findings suggest that a significant number of patients fit for revascularization could be candidates for a single segment GSV bypass.

To perform a systematic review and meta-analysis evaluating the prognostic utility of the Global Limb Anatomical Staging System (GLASS) classification in patients with chronic limb-threatening ischemia (CLTI), and to determine which intervention, endovascular or open bypass, is associated with superior outcomes for GLASS III patients. We conducted a systematic review and meta-analysis using PubMed, Scopus, and Cochrane Central from inception through October 2025. Outcomes compared across GLASS stages included immediate technical success (ITS) of endovascular procedures, overall survival (OS), amputation-free survival (AFS), limb salvage (LS), freedom from major adverse limb events (FF-MALE), and limb-based patency (LBP). For patients with GLASS III disease, we directly compared endovascular versus surgical bypass revascularization for OS, FF-MALE, and LS. We included 17 studies in the meta-analysis, comprising 5,290 patients and 5,492 limbs: 945 (17.2%) GLASS I, 1,431 (26.1%) GLASS II, 3,116 (56.7%) GLASS III. Compared with GLASS I, GLASS II presented a significantly higher hazard for LBP failure (HR 1.53; 95% CI 1.06 - 2.20; p = 0.032) and major amputation (endovascular only) (HR 1.45; 95% CI 1.13 - 1.86). When comparing GLASS III to GLASS I, GLASS III had significantly higher hazard for mortality (HR 1.28; 95% CI 1.06 - 1.56; p = 0.021) and MALE (HR 1.36; 95% CI 1.02 - 1.83; p = 0.042), LBP failure (HR 2.23; 95% CI 1.56 - 3.19, p = 0.003). GLASS I presented a significantly higher ITS rate compared to GLASS II (RR 1.03; 95% CI 1.01 - 1.05; p = 0.016) and GLASS III (RR 1.24; 95% CI 1.09 - 1.41; p = 0.005). GLASS II also showed a significantly higher ITS rate compared to GLASS III (RR 1.20; 95% CI 1.04 - 1.38; p = 0.017). No other comparisons across GLASS stages were statistically significant. Among GLASS III patients, we found an increased hazard of MALE in the endovascular group compared to open bypass surgery (HR 1.88; 95% CI 1.35 - 2.61; p = 0.015). No significant differences were identified between endovascular and surgical bypass revascularization for other outcomes. This meta-analysis demonstrates that increasing GLASS anatomical severity is associated with progressively lower ITS following endovascular intervention and increased hazard of LBP failure across all revascularization strategies in patients with CLTI. GLASS I patients, with low complexity anatomies, had a lower mortality and MALE hazard compared with those with high-complexity disease (GLASS III). Among GLASS III patients, endovascular therapy is associated with an increased hazard for MALE compared to bypass surgery.

This study aims to evaluate the demographic characteristics, anatomical distribution, diagnostic and treatment patterns, postoperative complications, recurrence rates, and recurrence-associated factors in patients diagnosed with tenosynovial giant cell tumors (TGCTs). A total of 246 patients diagnosed with TGCT and treated between January 2010 and March 2021, were retrospectively analyzed. Pre- and postoperative data of the patients were recorded. Histopathological diagnosis was reviewed, and tumors were classified as localized TGCT and diffuse-type TGCT. Recurrence was defined as the reappearance of a lesion at the same location following an initially complete surgical excision. Survival time was defined as the time elapsed since surgery. Recurrence-free survival was calculated from the date of the surgical procedure to the date of recurrence or the last follow-up. Of a total of 246 patients included in the study, 87 were male and 159 were female with a mean age of 44.3 ± 16.3 (range, 18 to 75) years. The lesions were most commonly located in the hand (62.6%), predominantly at the phalangeal level (89.6%). Foot involvement was mainly at the ankle region (40.8%), while the knee was the third most frequently affected site (15%), with 64.8% of knee lesions being intra-articular. Multiple lesions were observed in 3.3% of patients. Small joints were involved in 63% of cases. Excisional biopsy was the most common diagnostic approach (63.8%), followed by Tru-Cut biopsy (23.2%) and incisional biopsy (8.5%), while macroscopically complete marginal resection was performed in 4.5% of cases. Postoperative complications occurred in 15.4% of patients, including infection, sensory deficits, hematoma, motion restriction, and vascular complications. The median follow-up was 43 months, and recurrence occurred in 15.4% of patients, of whom 76.3% required reoperation. Our study results suggest that TGCT is associated with a notable recurrence rate and postoperative morbidity. Accurate diagnosis, complete surgical excision, and long-term follow-up are essential for optimal management. Recurrence may be associated with factors such as pain at presentation, presence of multiple lesions, delayed treatment, and postoperative infection. Adequate surgical excision with sufficient margins is of utmost importance in reducing the risk of recurrence.

The Society for Vascular Surgery recommends surgery be reserved for claudicants with severe lifestyle limiting symptoms despite optimal medical therapy (OMT) and supervised exercise therapy - the sum of these known as guideline-directed care (GDC). However, most claudicants do not receive the full spectrum of GDC prior to open surgery or endovascular intervention. We investigate the impact of complete versus partial versus non-adherence to pre-operative GDC in claudicants and assess its impact on two-year major adverse limb events (MALE). A retrospective analysis was performed on claudicants with open surgery or endovascular intervention at a tertiary care institution between 2016-2023. GDC was measured prior to surgery and defined as: 1) severe lifestyle limitation documentation, 2) OMT adherence (composite of single antiplatelet agent, lipid-lowering therapy, smoking cessation), and 3) exercise therapy completion. Partial adherence was defined by meeting one or two of these components, and non-adherence was defined by meeting none of the components. The primary outcome was two-year MALE, defined as a composite of major amputation or major open/endovascular reintervention of the target limb. Statistical analysis included one-way analysis of variance, Pearson &#x3c7;2 tests, Kaplan-Meier, and univariable and multivariable Cox regression modeling. Of the 258 claudicants receiving open surgery or endovascular intervention, 13.9% demonstrated non-adherence to GDC, 73.3% demonstrated partial adherence and 12.8% demonstrated complete adherence. MALE was seen in 23.3% of claudicants at two years, primarily due to re-interventions. On Kaplan-Meier analysis, claudicants with non-adherence to GDC demonstrated a two-year MALE-free survival of 66.6%, partial-adherence with 76.7%, and complete with 87.9% (p < 0.01). On multivariable Cox regression modeling, patients with complete guideline adherence demonstrated a decreased risk of MALE (hazard ratio [HR]: 0.24 [0.09, 0.69]) when compared to non-adherence, whereas partial adherence did not (0.99 [0.56, 1.74]. Complete adherence to pre-operative GDC is protective against MALE in claudicants undergoing intervention out to two years post-intervention whereas partial adherence may not offer a similar benefit. Future studies must prioritize improving adherence rates prior to surgery in claudicants to ensuring long-term risk mitigation and preventing complications.

Device sales representatives (DSRs) play a key role in providing vascular surgeons with device-specific education, operational guidance, and troubleshooting support. However, industry relationships may introduce bias, raising ethical concerns. This study aimed to evaluate the clinical benefit of DSR presence in the operating room (OR) during standard, infrarenal endovascular aortic repair (EVAR). A retrospective, case-control study was conducted to assess the association between DSR presence and surgical outcomes in elective, infrarenal EVAR cases at an experienced endovascular institution. Preoperative (age, gender, ASA classification, and past medical history), perioperative (device company, OR and fluoroscopy time, and use of additional endografts or stents) and postoperative (length of hospital stay post-operation, endoleaks at six weeks and six months, and mortality at six months) variables were collected for cases between June 1st, 2019 to December 31st, 2022. Fisher's exact test, chi-squared test and student's t-test were used to compare DSR-present and control groups. Ninety standard infrarenal EVARs were included with a DSR present in 64 (71.1%) cases. Cook and Gore devices were used in roughly equal proportions with a single case using a Medtronic device. DSR presence was not associated with a statistically significant change in operative duration (p&#x2009;=&#x2009;0.53) or fluoroscopy time (p&#x2009;=&#x2009;0.95), or in rates of endograft usage (p&#x2009;=&#x2009;0.35) or adjunctive stent use (p&#x2009;=&#x2009;1.00). Length of hospital stay (p&#x2009;=&#x2009;0.46), short- (p&#x2009;=&#x2009;0.63) and long-term (p&#x2009;=&#x2009;1.00) endoleaks, and mortality rates (p&#x2009;=&#x2009;1.00) were similar between groups. In this study of standard, infrarenal EVAR procedures at a high volume endovascular centre, DSR presence was not associated with statistically significant differences in case efficiency, device utilization or clinical outcomes. These findings suggest that routine DSR involvement in such procedures may not provide a clear clinical advantage. In light of important ethical considerations, the study calls for a more selective use of DSR support and for larger, multicentre studies to better understand their role in EVAR cases.

The Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Registry represents the largest and most comprehensive prospectively maintained non-claims-based dataset of endoluminal repairs in North America. As part of the SVS-VQI benchmarking initiative, we sought to define national reference standards for patient selection, perioperative outcomes, and process-of-care metrics. All EVAR procedures from 2011 to 2024 were included and stratified by indication as elective, symptomatic (intact, non-ruptured), or ruptured. The primary endpoint was in-hospital mortality; secondary endpoints included in-hospital complications, adherence to SVS guideline-endorsed elective diameter treatment thresholds (men &#x2265;5.5 cm; women &#x2265;5.0 cm), discharge prescription of guideline-directed medical therapy, and one-year follow-up compliance. Risk-adjusted observed-to-expected (O:E) mortality ratios were derived from mixed-effects logistic regression models incorporating patient- and procedure-level covariates. Temporal trends were analyzed using linear and logistic regression across four periods: 2011-13, 2014-17, 2018-21, and 2022-24. Among 90,370 EVARs performed across >400 centers, 76,350 (85%) were elective, 8,349 (9%) symptomatic-intact, and 5,671 (6%) ruptured. Mean patient age was 73.5&#xb1;8.8 years, and 17,531 (19%) were women. Adoption of percutaneous femoral access increased markedly after 2014, exceeding 80% of all cases across the study period (overall rate 81.1% [95%CI, 80.8-81.4]) and reaching a contemporary benchmark of 89.4% (95%CI, 89.1-89.8) in 2022-24. In-hospital mortality was 0.5% (95%CI, 0.42-0.52) for elective, 2.2% (1.91-2.56) for symptomatic-intact, and 21.5% (20.4-22.6) for ruptured repairs. Over time, mortality declined from 0.6% in 2011-13 to 0.4% in 2022-24 (p=.02) for elective cases, from 2.3% to 1.8% (p=.14) for symptomatic-intact, and from 24.0% to 20.6% (p=.09) for ruptures. Composite in-hospital complication rates decreased significantly across all indications (p<.001). Among elective repairs, adherence to diameter-based guidelines improved modestly, with male non-compliance decreasing from 46% to 40% and female non-compliance declining from 23% to 21%. In 2024, 87% of patients were discharged on an antiplatelet agent, 83% on a statin, and 74% on both. By 2022, one-year clinical follow-up reached 79%, while imaging surveillance was reported in 51%. EVAR outcomes within the SVS-VQI demonstrate persistently low in-hospital mortality and improving perioperative morbidity over time. Despite these gains, opportunities remain to improve adherence to societally endorsed diameter treatment thresholds, optimal medical therapy, and post-EVAR imaging surveillance. These findings establish contemporary national benchmarks for EVAR performance and provide reference standards for center-level comparison and quality improvement within the SVS-VQI.

The triglyceride-glucose (TyG) index has emerged as a powerful and accessible marker of insulin resistance and a predictor of adverse events in patients undergoing percutaneous coronary intervention (PCI). Yet, its prognostic relevance in large, demographically diverse populations remains unestablished. This study sought to evaluate the association between the TyG index and clinical outcomes in a broad cohort of patients undergoing PCI at a high-volume tertiary care center in the United States. We included consecutive patients undergoing PCI from 2012 to 2022. Quartiles of the TyG index, calculated as Ln(fasting triglycerides&#x200a;&#xd7;&#x200a;fasting glucose/2), were derived and patients were stratified accordingly. The incidence of major adverse cardiovascular events (MACE), consisting of all-cause mortality, myocardial infarction (MI), or stroke, was assessed at 1 year. Multivariable Cox regression analyses were performed using the lowest TyG quartile as the reference. A total of 21&#x200a;124 patients were enrolled. Those with higher TyG index values were more likely to be female and to have cardiovascular risk factors or comorbidities. They also exhibited a greater extent of coronary artery disease (CAD) and more complex PCI features, while showing a lower prevalence of moderate-to-severe coronary calcifications. At 1 year, MACE incidence increased progressively across quartiles, with the highest risk observed in the fourth quartile compared with the first. After multivariable adjustment, this association remained significant and was primarily driven by spontaneous MI. In this large PCI cohort, the TyG index correlated with adverse cardiovascular outcomes, supporting its potential role in clinical practice.

Chronic limb threatening ischemia (CLTI) in older adults is associated with severe morbidity and high mortality. The rising prevalence is largely driven by the aging population and confronts healthcare systems with challenges like increasing demand for chronic care, staff shortage and rising healthcare costs. To improve post-operative outcomes and reduce the burden on healthcare systems, multimodal prehabilitation has gained interest and has the potential to improve post operative outcomes. However, evidence of the effect in older adults with CLTI remains scarce. The aim of this study is to determine whether a multimodal multicomponent prehabilitation program (MMPP) reduces length of stay and improves clinical, patient-reported and economic outcomes of older adults with CLTI. We developed a multicenter randomized controlled trial, with embedded cost-effectiveness analyses.. CLTI-patients aged 65 years or older, planned for revascularization, and their primary informal caregiver (IC) will be eligible. A total of 300 patients will be randomized to receive either standard preoperative care or a 2-week MMPP. All patients receive a general health screening. The MMPP includes physiotherapy and, if indicated, referral to a geriatrician, dietician or smoking-cessation coach, ferric carboxymaltose infusion or pre-arranged homecare. The primary outcome is length of stay. Exploratory secondary outcomes include minor complications, quality of life of patient and IC and health related quality of life. Descriptive secondary outcomes include 30-day and 6-month mortality, major complications, readmissions, burden on the IC, cost-effectiveness; and experiences and preferences regarding shared decision making. To the best of our knowledge, this is the first randomized controlled trial to evaluate the effect of an MMPP within older CLTI-patients. Findings will inform healthcare professionals whether an MMPP should be implemented in routine vascular surgical practice to reduce length of stay and improve clinical and patient-centered outcomes. The study is registered at the International Clinical Trials Registry Platform (NL-OMON58069).

Endovenous therapies are the current standard of care for the management of pelvic venous disorders (PeVD) secondary to pelvic venous insufficiency. We previously reported superior short-term results after iliac vein stenting (ST) compared to ovarian vein embolization (OVE). The purpose of this investigation is to determine the long-term durability and clinical effectiveness of endovenous therapies for PeVDs and identify the time period where maximal pain reduction is observed. A retrospective review of prospectively collected data at the Center for Vascular Medicine from October 2016 to October 2022 was performed. Women with a PeVD secondary to an iliac vein stenosis and/or ovarian vein reflux were included. Assessments and interventions consisted of an evaluation for other causes of PeVD by a Gynecologist, CEAP, pre, 1, 3, 6, 12, 24 and 36 month post-operative visual analog pain scores (VAS), trans-abdominal duplex ultrasound stent surveillance, stent type, diameter and length. Patients were separated into three treatment groups: Pelvic pain alone, leg pain alone or pelvic and leg pain and analyzed according to treatment type. Patients treated with venoplasty or venoplasty and OVE were excluded. Differences between groups were analyzed utilizing analysis of variance. 521 women with a PeVD were evaluated and treated with either OVE alone, OVE and ST or ST alone: Pelvic Pain (n=33), Leg Pain (n=208) and Pelvic + Leg (Mixed) (n=280). The average age of the cohort was 52&#xb1;13.4. Pelvic and mixed pain patients were younger compared to leg patients (p&#x2264;0.001). No racial differences by symptom presentation were observed. Patients with pelvic and leg symptoms had a higher prevalence of endometriosis and ovarian cysts (p&#x2264;0.001). The average pre-intervention ST, OVE and OVE+ST VAS scores by presentation were the following: Pelvic (ST+OVE: 3.07&#xb1;3.71, OVE: 5.27&#xb1;3.2), Leg (ST: 6.18&#xb1;3.07), Mixed (ST: 7.47&#xb1;2.28, OVE+ST: 6.67&#xb1;2.56). Significant improvements in pain scores were observed in all treatment groups. Regardless of symptom presentation, patients who received OVE+ST demonstrated significant pain reduction at one month with no further decrement in pain that was sustained up to 36 months (p&#x2264;0.001). ST and OVE alone patients demonstrated pain reduction up to 3 months with no further pain decrement that was sustained up to 36 months (p&#x2264;0.001). Women with PeVD often present with concomitant pelvic and lower extremity venous symptoms. Regardless of symptomatology or treatment modality, patients report improved and sustained symptom relief up to 36 months. Patients receiving OVE + ST demonstrated maximal pain reduction at one month with sustained relief up to 36 months whereas OVE or ST patients alone required 3 months for maximal and sustained pain reduction. These data suggest that combined therapies provide faster pain relief in patients with ovarian vein reflux and iliac vein stenoses. If a staged approach with OVE followed by stenting is employed, ST should be considered at 3 months as no further improvement at six months was observed.

Background and Objectives: The aim of this study was to use a modified lateral lumbar approach developed by the authors for single-level lumbar decompression and interbody fusion using intervertebral implants. Materials and Methods: A total of 38 patients with single-level L1-L5 degenerative disc disease who underwent lumbar interbody fusion were included in this study. The procedure was performed using the modified lateral lumbar surgical approach. Clinical outcomes included the assessment of functional status using the Karnofsky Performance Scale and Oswestry Disability Index (ODI), quality of life using the EuroQol Visual Analogue Scale (EQ-VAS), and pain intensity using Visual Analogue Scale (VAS). Preoperative and postoperative radiographic parameters assessed on magnetic resonance imaging (MRI) were compared. Results: Significant improvement in functional status, quality of life, and pain reduction was observed in all patients. Radiographic outcomes also improved significantly. Mean disc height increased from 8.2 mm preoperatively to 12.2 mm postoperatively (p < 0.05). The cross-sectional area of the spinal canal increased significantly following surgery. Furthermore, a reduction in disc herniation width and enlargement of the intervertebral foramina were observed. No neurovascular complications occurred, and endplate injury with cage subsidence was noted in 5% of patients. Conclusions: Lateral lumbar discectomy and interbody fusion increase spinal canal area, enlarge the neuroforamina, and restore intervertebral disc height. Most patients experienced substantial functional improvement and pain reduction. No neurological or vascular complications were observed, which may be due to the modified approach. The confirmation of this hypothesis requires further research and a longer follow-up period.

Endovenous thermal ablation is recommended as the primary method of managing symptomatic truncal venous reflux. One of the important alternatives to the thermal energy-based methods is mechano-chemical ablation; however, its performance and outcomes can significantly differ in relation to the applied technology and sclerosing agent formula. The aim of the study was to prove the safety and efficacy of the non-rotational mechano-chemical ablation with polidocanol foam performed by Flebogrif catheter. In the paper 12 month follow up results are presented. The POLFLEB study was a prospective, multicenter clinical trial assessing the safety, efficacy, and feasibility of Flebogrif catheter (Balton, Poland) in a population of patients with incompetent Great Saphenous Vein (GSV) (ClinicalTrials.govNCT04558957). 200 patients were enrolled and treated (GSV diameter range 4 -10 mm). In all cases, during non rotational mechano-chemical ablation, 3% polidocanol foam was used, and the patients underwent the clinical and ultrasound-based 12 month follow-up. The primary efficacy endpoint was the GSV anatomical occlusion rate 3 months after the procedure. The primary safety study endpoint was the occurrence of serious adverse events up to 30 days after the procedure. According to the study protocol, the additional foam sclerotherapy treatment was allowed 3 months after the initial truncal ablation. The mean length of the treated GSV segment was 43.30 &#xb1; 10.30 cm (min. 20 cm, max. 70 cm), and the mean foam volume used during the procedure was 8.69 &#xb1; 2.23 mL (in 87.5% of the treated cases, the foam volume did not exceed 10 ml in total and in 96% of the patients the foam volume not exceeding 12 ml was used). Successful vein obliteration was achieved in all patients, which was confirmed intraoperatively and within 7 days of postoperative ultrasound control. Three months after the treatment, 95.8% of the treated Saphenous veins remained without reflux, including 8.9% with partial vein occlusion and no reflux. No serious adverse events were reported within 30 days after the procedure. In the 12 month follow up the whole vein reopening was found in 4.4% and in 90.6% of the patients no Saphenous vein reflux was noticed. Mechano-chemical ablation by Flebogrif catheter represents the safe and clinically effective option for non-thermal saphenous vein ablation. The efficacy of the method should be confirmed in the long-term follow-up studies.

Recurrence after open superficial venous surgery occurs in 20-60% of patients at 5 years, yet no validated composite preoperative scoring system exists to quantify individual risk. We aimed to develop and internally validate a predictive model and a derived clinical risk score - the Varicose Vein Recurrence (VVR) Score - for 5-year recurrence after open surgery of the superficial venous system. This retrospective single-centre cohort study included consecutive patients undergoing saphenofemoral or saphenopopliteal junction ligation with or without trunk stripping and concomitant phlebectomies between January 2006 and December 2025. The primary outcome was duplex-confirmed recurrent reflux with clinically visible recurrent varices at 5 years; reintervention (open, endovenous, or foam) within 5 years served as a prespecified harder secondary endpoint. The primary analysis was conducted on extremities with complete 5-year outcome ascertainment. We used multivariable logistic regression with cluster-robust standard errors (patient-level clustering) for model development and cluster bootstrap resampling (500 replications) for internal validation. A simplified integer-based score was derived from shrinkage-adjusted coefficients. Prespecified sensitivity analyses included procedure-stratified subgroup models (three mutually exclusive primary subgroups - high ligation + stripping, high ligation alone, phlebectomy alone - plus an overlapping SPJ-procedure subgroup), continuous calendar-year analyses with time &#xd7; predictor interactions, treatment choice as a model covariate, IPCW, and Cox regression. Reporting followed the TRIPOD guidelines (Type 1b). Among 12,480 eligible extremities (9,210 patients), 10,142 (81.3%) had complete 5-year ascertainment and constituted the primary cohort. The 5-year recurrence rate was 25.1% (2,546/10,142); 74.1% of recurrent extremities underwent reintervention (5-year reintervention rate 18.6%). Six preoperative predictors were retained: anterior saphenous vein (ASV; formerly anterior accessory saphenous vein, AASV) reflux (OR 2.33, 95% CI 2.03-2.67), incompetent perforators (OR 2.04, 1.77-2.35), BMI &#x2265;30 kg/m2 (OR 1.82, 1.60-2.07), deep venous reflux or obstruction (OR 1.72, 1.44-2.06), CEAP C4-C6 (OR 1.62, 1.42-1.86), and great saphenous vein (GSV) diameter &#x2265;7 mm (OR 1.41, 1.23-1.62). The optimism-corrected C-statistic was 0.744 (95% CI 0.726-0.762), with calibration slope 0.97 (0.924-1.016) and intercept -0.02 (-0.06 to 0.02). Model performance was preserved for the harder reintervention endpoint (C-statistic 0.73) and across operative subgroups (apparent C-statistics 0.70-0.74). The derived VVR Score (0-13 points) stratified patients into low (12.8%), moderate (25.2%), high (41.7%), and very high (66.8%) 5-year recurrence-risk categories. Continuous calendar-year analysis showed no significant time &#xd7; predictor interactions (smallest p = 0.21). Sensitivity analyses including IPCW on all 12,480 extremities, Cox regression, GEE, and treatment-choice-adjusted models produced consistent results. The VVR Score provides an internally validated tool for estimating 5-year recurrence risk after open superficial venous surgery using six preoperative clinical and duplex parameters. Performance was preserved across operative subgroups and for the harder reintervention endpoint. Because the score is derived in an open-surgical population, external validation in geographically diverse open-surgical cohorts and re-derivation/recalibration before use in endothermal, non-thermal, or foam-sclerotherapy populations are essential before broader clinical adoption.

Endovascular aneurysm repair (EVAR) is used to treat patients with abdominal aortic aneurysm (AAA) who have suitable anatomy, while complex AAAs often require fenestrated and branched stent grafts, necessitating further refinement of the technique. To evaluate the safety and efficacy of fenestrated/branched EVAR (F/B-EVAR) assisted by three-dimensional (3D) printing for treating complex AAA. Retrospective cohort study. This multicenter retrospective cohort study collected baseline data and clinical outcomes from patients treated with F/B-EVAR between January 2012 and June 2025. The population was divided into the 3D simulation group and the conventional measurement group. The 3D simulation group underwent a simulation to assess fenestration and branch positioning strategies. Study endpoints included procedural success rate, incidence of periprocedural complications and major adverse events, as well as procedural duration and radiation dose. The mean age of patients was 70.2&#x2009;&#xb1;&#x2009;8.8&#x2009;years, with 68.9% being male. Compared to the conventional measurement group, the 3D simulation group had a significantly higher procedural success rate (98.8% vs 91.6%, p&#x2009;<&#x2009;0.001), shorter procedural duration ((115.2&#x2009;&#xb1;&#x2009;35.0) min vs (138.7&#x2009;&#xb1;&#x2009;43.7) min, p&#x2009;<&#x2009;0.001), and lower radiation dose ((107.2&#x2009;&#xb1;&#x2009;43.9) mGy vs (144.5&#x2009;&#xb1;&#x2009;56.3) mGy, p&#x2009;<&#x2009;0.001). Furthermore, although no significant differences were observed in the incidence of all-cause mortality and major cardiovascular adverse events during the 30-day follow-up between the two groups, the incidence of life-threatening major bleeding, major vascular complications, and acute kidney injury stage &#x2a7e;3 was significantly lower in the 3D simulation group. F/B-EVAR guided by 3D simulation may allow for accurate planning of fenestration and branch positioning, potentially improving procedural success rate and suggesting a potential to enhance the quality of outcomes.

The study aims to evaluate the incidence of thirty-day thrombosis following iliac vein stent placement, stratified by age, and to analyze long-term follow-up outcomes. A retrospective analysis was conducted of 4,312 procedures performed in 2,642 patients with symptomatic chronic venous insufficiency (CEAP clinical classes 3-6) from 2012 to 2024. Patients underwent iliac vein assessment using intravascular ultrasound (IVUS) and received stent placement. Follow-up included iliac vein duplex ultrasound assessments at 3 to 7 days postoperatively, with additional evaluations at 3 to 6 months during the first year. For subsequent years, follow-up occurred at 6 to 12-month intervals. Intraoperative heparin was not administered, and postoperative management included daily clopidogrel (Plavix). Stents were assessed for partial and complete thrombosis. The mean age of the study population was 73 years (range, 30-108), with 39.30% male and 60.70% female patients. Age distribution by decade, based on the number of nonthrombotic iliac vein lesions (NIVLs) treated, was as follows: patients in their 30s (43), 40s (151), 50s (498), 60s (926), 70s (1,116), 80s (1,035), and >90 years (543). Thirty-day thrombosis rates by age group were: 30s (0%), 40s (0.01324%), 50s (0.0200%), 60s (0.0118%), 70s (0.0179%), 80s (0.0116%), and >90s (0.0074%). Thirty-day thrombosis rates by CEAP clinical class were: CEAP 3 (0.01395%), CEAP 4 (0.0121%), CEAP 5 (0.0172%), and CEAP 6 (0.0166%). Among patients with thrombosis within 30 days of stent placement, 76.3% experienced partial stent thrombosis and 27.7% experienced complete stent thrombosis. The mean age of patients with complete thrombosis was 71.4 &#xb1; 17 years, compared with 71.8 &#xb1; 12 years for those with partial thrombosis. Of patients with complete thrombosis, 71.43% were female. Of the 14 patients with complete thrombosis within 30 days, 10 cases occurred between 2012 and 2021, three in 2022, and one in 2023. Binary logistic regression revealed no significant association between thirty-day thrombosis and age (p = 0.719), CEAP clinical class (p = 0.938), or laterality (p = 0.326). Iliac vein stenting for symptomatic nonthrombotic iliac vein lesions (NIVL) is a safe and effective procedure with a low incidence of early thrombosis. Age, laterality, and CEAP clinical class were not significantly associated with 30-day thrombosis outcomes. This study supports the use of iliac vein stenting in patients across a broad spectrum of CVI severity, demonstrating its effectiveness in an outpatient-based laboratory (OBL) setting.

To compare the haemostatic efficacy and safety of suturing, Ligaclips, and Hem-o-Lok clips in laparoscopic nephrectomy. A descriptive study. Place and Duration of the Study: Department of Urology, Institute of Kidney Disease, Peshawar, Pakistan, from January 2020 to December 2024. This study included 200 patients (aged 15-60 years) undergoing laparoscopic nephrectomy for non-functioning kidneys. The exclusion criteria were bleeding disorders, incomplete records, unrelated open conversions, and bilateral cases. Patients were grouped by ligation method: suturing (n = 53), Ligaclips (n = 74), and Hem-o-Lok clips (n = 73). Outcomes included ligature slippage, blood loss, transfusion, conversion, complications, adjacent injury, and length of hospital stay. Data were analysed using ANOVA/Kruskal-Wallis tests, chi-square/Fisher's exact tests, and multivariable regression analysis. Baseline demographic and clinical characteristics were similar across groups (p >0.05). Haemoglobin reduction was lowest with Hem-o-Lok clips (0.70 &#xb1; 0.30 g/dL), higher with Ligaclips (1.00 &#xb1; 0.20 g/dL), and highest with suturing (1.20 &#xb1; 0.30 g/dL; p <0.001). Hospital stay was longer with suturing (median 4.0 [4-5] days) compared with Hem-o-Lok (4.0 [3-4] days) and Ligaclips (4.0 [3-5] days; p = 0.03). Conversion to open surgery occurred only in the Ligaclips group (9.6%), with none in the Hem-o-Lok or suturing groups (p <0.001). Regression analysis showed diabetes as the only independent predictor of complications, with higher odds of ligature slippage (OR = 6.71 [1.02-50.68]; p = 0.046) and injury to adjacent structures (OR = 8.38 [2.29-33.47]; p = 0.002). Hem-o-Lok clips provide relatively reliable ligation during laparoscopic nephrectomy in terms of haemoglobin reduction, hospital stay, and conversions to open surgery. Laparoscopic nephrectomy, Hem-o-Lok clips, Ligaclips, Suturing, Vascular ligation, Surgical complications.

Depression affects 20% to 37% of patients with peripheral artery disease, frequently requiring serotonergic antidepressants while receiving antiplatelet therapy concomitantly after vascular intervention. Because platelets depend entirely on the serotonin transporter for serotonin uptake, serotonergic agents may alter platelet function in this setting. Hence, we aimed to determine whether serotonergic antidepressant exposure is associated with longitudinal instability in adenosine diphosphate (ADP)-mediated platelet inhibition. In this retrospective cohort study of prospectively enrolled patients with PAD undergoing lower extremity revascularization (December 2020-December 2025) at a single US tertiary care center, serial thromboelastography with platelet mapping (TEG-PM) data (December 2020-December 2025) were used to construct consecutive-visit pairs. The primary outcome was visit-to-visit variability in ADP-mediated platelet inhibition, defined as log-transformed absolute change between consecutive measurements, capturing larger visit-to-visit change regardless of direction. Serotonergic antidepressant exposure (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or trazodone) was evaluated both as active exposure at the current assessment within each consecutive measurement pair and as a 4-level transition variable: stable non-exposure ((0&#x2192;0), reference), initiation(0&#x2192;1, exposure onset between two sequential assessments), discontinuation (1&#x2192;0), and stable exposure (1&#x2192;1). Associations were estimated using adjusted linear mixed-effects model. Prespecified exploratory analyses were performed in the chronic limb threatening ischemia (CLTI) subgroup. Among 514 enrolled cases, 330 contributing 896 consecutive-visit pairs were included; 307 patients contributed 838 consecutive-visit pairs in the complete case adjusted analysis. Active serotonergic exposure was not independently associated with greater longitudinal variability in platelet inhibition (&#x3b2;=0.135; 95% CI, -0.901 to 0.360; p=0.240). However, serotonergic initiation was associated with increased variability compared with stable non-exposure (&#x3b2;=0.571, 95% CI, 0.144 to 0.998; p=0.009), persisting after adjustment for psychiatric diagnosis burden. Discontinuation showed a borderline association (&#x3b2;=0.405, p=.05); stable exposure was not associated with greater variability (&#x3b2;=0.105, p=.40). Ticagrelor use was independently associated with lower variability in primary adjusted models (&#x3b2;= -0.521, 95% CI, -0.901 to -0.141; p=0.008). In exploratory chronic climb-threatening ischemia (CLTI) analyses, initiation was associated with a 19.7 percentage point mean upward shift in ADP-mediated platelet inhibition (95% CI, 3.9-35.6, p=0.015) and higher odds of entering a high-inhibition range previously linked to bleeding risk (OR 7.61, 95% CI 1.32-43.96, p=0.023). Serotonergic antidepressant initiation, rather than stable ongoing therapy, was associated with increased instability in ADP-mediated platelet inhibition after lower extremity revascularization. These findings identify the peri-initiation window with implications for medication reconciliation in vascular surgery patients and raise the hypothesis that background P2Y12 regimen consistency may modulate the magnitude of serotonergic medication-induced platelet instability.

The purpose of this systematic review was to review imaging and diagnostic modalities for their roles in (1) diagnosing upper and lower extremity lymphedema, (2) detecting subclinical disease through prospective surveillance, (3) providing anatomical assessment of the lymphatic system, and (4) guiding surgical treatment planning. A systematic review was conducted following the PRISMA 2020 guidelines. The search included PubMed, Embase, CENTRAL, Web of Science, and Scopus from January 2010 to April 2026. Four reviewers screened 2,847 articles using Covidence software. The inclusion criteria were studies that reported original data on one or more imaging modalities and presented diagnostic accuracy, reliability, staging parameters, or impact on surgical planning RESULTS: A total of 28 studies were included, comprising 4 RCTs, 12 prospective diagnostic studies, 6 cohort studies, 1 observational study, and 5 systematic reviews or meta-analyses. In upper extremity studies, predominantly composed of breast cancer related lymphedema (BCRL), bioimpedance spectroscopy (BIS) demonstrated sensitivity up to 100% and specificity of 98% for early detection, with the PREVENT trial showing 59% relative risk reduction in chronic BCRL through BIS triggered surveillance. ICG lymphography achieved 100% diagnostic accuracy versus 62% for lymphoscintigraphy in early disease, and UHFUS at 70 MHz achieved 94.9% sensitivity for vessel detection. In the lower extremity, MRL at 3.0 T achieved 100% sensitivity for lymph vessel abnormalities versus 79% for lymphoscintigraphy (&#x3ba; = 0.93 for delayed drainage). Ultrasound achieved 95.5% sensitivity and 92.9% specificity for vessel detection. Two validated ICG based classifications, SCaT and Shinaoka, enabled lower extremity specific severity staging. This systematic review identified important differences in the evidence supporting imaging and diagnostic modalities across the four clinical domains evaluated. For diagnosis and subclinical detection, BIS-triggered prospective surveillance for upper extremity lymphedema is supported by RCT evidence demonstrating significant reduction in chronic BCRL progression. However, comparable trial data for the lower extremity remains absent. For anatomical assessment, region-specific ICG classification systems (SCaT and Shinaoka) address the unique drainage patterns of the lower extremity, while MRL provides comprehensive deep and superficial system visualization across both regions. For surgical planning, the combined use of NIRF-L and MRL offers complementary information to guide microsurgical interventions.

Residual venous obstruction and in-stent restenosis (ISR) are common and challenging complications that may occur after interventional procedures performed for acute deep vein thrombosis (DVT) or chronic ilio-femoral venous obstruction. A novel fully integrated thrombectomy system (Recana Thrombectomy Device, RTD) was designed to treat (ISR) and native vessel obstructions. The system includes a debulking catheter, collection baskets, and a family of sheaths (Figure 1). This report describes its use in animal models of native and stented veins to assess safety compared to currently available thrombectomy devices. The RTD was studied in comparison to 2 currently marketed thrombectomy devices, the Argon CLEANER 15&#x2122; (CLEANER) and the Inari ClotTriever&#xae; (ClotTriever). Devices were studied in a porcine iliac vein model used in a manner consistent with Good Laboratory Practice for Nonclinical Laboratory Studies. 26 iliac veins in 13 animals were studied to evaluate performance in normal veins (9 animals, 18 iliac veins) and in 4 animals with 8 iliac veins pre-treated with iliac stents implanted 21 days prior to device treatment. Twelve normal iliac veins were treated with the RTD, 4 normal veins were treated with CLEANER and 2 with the ClotTriever. Five pre-stented iliac veins were treated with the RTD, and 3 pre-stented veins were treated with the CLEANER. Procedures were completed under fluoroscopic and IVUS guidance. For each model, both iliac veins were treated with 10 passes of the test or control thrombectomy device through the length of the common and external iliac veins. Survival and sacrifice periods were completed at varied timepoints to evaluate peak histological injury potential, vein wall healing and vein patency. Necropsy was performed at 5 &#xb1; 2 days or 30 &#xb1; 2 days after catheter intervention for gross evaluation of the iliac veins and other related tissues. Histology was performed on representative sections of treated iliac veins to evaluate wall damage, thrombosis, or other effects of intervention. All animals survived to their designated endpoints with no unexpected mortality. One common femoral vein access complication led to unilateral perivenous hematoma and thrombosis. Another animal showed post-intervention venous constriction with eventual vessel occlusion. All other iliac veins (n=24) remained patent without significant stenosis at necropsy. No clinically relevant lacerations, perforations, or hemorrhagic events were observed with either the Test or Control devices. Histology revealed intimal disruption and inflammation with all devices, more pronounced with the RTD compared to CLEANER but similar to those seen after use of the ClotTriever. Mild perivenous bruising occurred in some Test device cases, without evidence of transmural bleeding. In an in-vivo model of stented and native iliac veins, a novel venous tissue debulking system was able to engage intraluminal material without serious injury. Vein wall trauma was comparable to a commonly used mechanical thrombectomy device, with no transmural lacerations or device-related hemorrhage. These findings support continued development toward initial clinical trials in patients with venous obstruction.

Our understanding of plaque morphology and its relationship with procedural complexity and immediate technical failure (ITF) in percutaneous vascular intervention (PVI) is poorly understood, particularly in tibial disease due to significant limitations of CTA, DSA and DUS imaging. Ultrashort echo time (UTE) MRI is a non-contrast 3T MRI technique that can identify and differentiate plaque morphology and characteristics. The aim of this study was to create a UTE MRI-defined staging system to support clinicians evaluate endovascular procedural complexity. Patients scheduled for PVI underwent pre-operative UTE MRI. Lesions were graded based on MRI-defined anatomical characteristics and plaque morphology on a four-scale staging system, where stage A was least severe and stage D most severe. The primary outcome was the association of UTE Stage with ITF and was evaluated using logistic regression. Secondary outcomes included associations between UTE Stage and number of wire/catheter escalations required during the procedure, and UTE Stage and number of treatment devices used. TASC scoring was also evaluated and investigated for any influence on ITF. 47 patients with 90 arterial lesions were included. Stage D and stage C UTE MRI- defined disease strongly influenced ITF (Odds ratio 114.3, 95% CF 10.4-1257.5, p<0.001 and OR 21.0 95% CF 2.33-189.3, p=0.007 respectively). Logistic regression identified Stage D disease was 99 times more likely to require catheters/wire escalations for crossing (OR 0.01, p=0.004, 95% CF 0.00-0.24). UTE MRI stage did not influence number of treatment devices used (Chi 2.53, p=0.47). Logistic regression showed that TASC score had no influence on ITF (Chi 2.13, p=0.55). UTE-MRI defined staging is strongly associated with ITF, crossing time and need for crossing device escalation whereas TASC staging had no influence on ITF. This study supports the notion that an understanding of plaque morphology and plaque characteristics is pivotal to procedural planning.