Vascular

While general anesthesia has been the dominant anesthesia used in endovascular aneurysm repair (EVAR), locoregional anesthesia is suggested as a viable alternative for eligible patients. However, the majority of previous findings came from infrarenal EVAR while the choice of anesthesia for complex EVAR remains less established. This study aimed to retrospectively compare the 30-day outcomes of patients who underwent non-emergency complex EVAR under locoregional or general anesthesia.

Patients who had EVAR for complex abdominal aortic aneurysm (AAA) were selected from ACS-NSQIP targeted database between 2012 and 2022. Complex AAA included juxtarenal, suprarenal, or pararenal proximal extent, Type IV thoracoabdominal aneurysm, and/or aneurysms treated with Zenith Fenestrated endograft. Exclusion criteria included age under 18 years, ruptured AAA, acute intraoperative conversion to open, and emergency. A 1:2 propensity-score matching was used to balance demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, and concomitant procedures between the locoregional and general anesthesia groups. Thirty-day outcomes were examined.

There were 284 (9.63%) and 2664 (90.37%) patients who underwent EVAR for complex AAA under locoregional and general anesthesia, respectively. All patients under locoregional anesthesia were matched to 549 patients under general anesthesia. Patients under locoregional and general anesthesia had comparable risks of mortality and surgical complications. However, patients under locoregional anesthesia had a shorter hospital length of stay (LOS; 2.37 ± 3.25 vs 3.35 ± 4.81 days, p < .01).

Both locoregional and general anesthesia are effective options for eligible patients undergoing complex EVAR. However, patients under general anesthesia had a longer hospital LOS by about 1 day, which was likely due to increased case complexity that may necessitate prolonged recovery and closer monitoring for complications. To further optimize anesthesia protocols for these procedures, future prospective studies may be necessary.

To describe the endovascular treatment of symptomatic pararenal abdominal aortic aneurysm (PAAA) with severe infrarenal angulation using a combination of Prolene Encircling Reducing Ties (PERT), through-and-through wire, and a physician-modified 4-fenestrated endograft (PMEG).

A 73-year-old male presented with symptomatic PAAA with a 105-degree infrarenal angulation. A right common femoral artery (CFA) to right axillary artery through-and-through wire (0.035 soft hydrophilic wire) was placed, and a modified Valiant Captivia stent graft was advanced through the right CFA. The modified stent graft was deployed until the superior mesenteric artery (SMA) fenestration was opened. The SMA fenestration was then adjusted to the correct position, then the free-flow bare stent was opened. Sequential deployment of the modified stent graft was performed. After successful cannulation of three visceral arteries (SMA and renal arteries) from axillary approach, a 7 Fr sheath was advanced into the SMA, and the modified stent graft was fully deployed. Following removal of the delivery system, the stent graft was fully opened by compliance balloon inflation, which ruptured the 6-0 Prolene ties. The SMA and both renal arteries were then stented and flared. A modified bifurcated Endurant stent graft (without free-flow bare stent) was deployed approximately 1 cm below the lowest renal fenestration, and the iliac limbs were deployed to complete the procedure. 6-month follow-up computed tomography angiography (CTA) demonstrated complete exclusion of the aneurysm without endoleak.

A combination of PERT, through-and-through wire, and PMEG for the treatment of symptomatic PAAA with severe infrarenal angulation demonstrated acceptable early results.

The accumulation of adipose tissue, such as increased epicardial adipose tissue volume (EATV) and visceral fat area (VFA), is associated with the development of cardiovascular (CV) disease. However, little information is available regarding the relationship between EATV and CV death in patients who undergo open surgical repair (OSR) for abdominal aortic aneurysms (AAAs). The aim of this study was to evaluate the association between adipose tissue and CV death and to identify factors related to CV death after AAA repair.

Between June 2005 and December 2019, a total of 739 patients underwent OSR for AAA with or without iliac artery aneurysm and isolated iliac artery aneurysm at our institution. AAA with a diameter of 50 mm or more and iliac artery aneurysm with 35 mm or greater were considered to be a surgical indication. Patients with ruptured AAAs and infected AAAs were excluded. Four hundred ninety-two patients with preoperative optimal computed tomography (CT) scans were included in this study. The EATV, VFA, and subcutaneous fat area (SFA) were retrospectively quantified from preoperative noncontrast CT images. The EATV index was defined as the EATV divided by the body surface area, and the VFA index and SFA index were defined as each number divided by height squared. The correlations among the EATV, VFA, and SFA indices were analyzed, and the cut-off values of the parameters for predicting CV death after OSR for AAA patients were determined via receiver operating characteristic curves. Regression analysis was used to assess predictors of CV death during the follow-up period. Cox hazard regression analysis was performed.

The median age was 71 years, and 12% of the patients were female. The median body mass index was 23.1 kg/m². The prevalence of comorbidities was 31% for coronary artery disease, 9% for stroke, 15% for diabetes, and 41% for chronic kidney disease. The median follow-up period for overall patients was 62.5 months (interquartile range: 33.7–99.6). The EATV index was positively correlated with the VFA (R = 0.615, p < .001) and SFA (R = 0.421, p < .001) indices. The cut-off value of the EATV index was 73.8 cm³/m² (area under the curve (AUC); 0.566). Multivariate analysis revealed that age ≥75 years and an EATV index ≥73.8 cm³/m² were significantly associated with CV death after AAA repair.

This study demonstrated that the EATV index was associated with CV death in patients who underwent OSR for AAA, suggesting its potential utility as a novel risk stratification tool for personalized postoperative management.

Disseminated cancer may complicate decision-making processes for major surgical interventions, including endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). However, the postoperative outcomes of EVAR in patients with disseminated cancer have not been well-established. This study aimed to explore the impact of preoperative disseminated cancer on 30-day outcomes of non-ruptured EVAR.

Patients who underwent infrarenal EVAR were identified in ACS-NSQIP targeted database from 2012 to 2022. Exclusion criteria included age <18 years, ruptured aneurysm, acute intraoperative conversion to open repair, and emergency cases. A 1:3 propensity-score matching was used to match demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, anesthesia, and concomitant procedures between patients with and without preoperative disseminated cancer. Thirty-day postoperative EVAR outcomes were examined.

There were 154 (0.80%) patients with disseminated cancer who underwent non-ruptured EVAR. Meanwhile, 19,109 patients without disseminated cancer went under EVAR, where 462 of them were matched to all patients with disseminated cancer. After propensity-score matching, patients with and without disseminated cancer had comparable mortality rates (5.19% vs 4.76%, p = 0.83). However, patients with disseminated cancer had higher lower extremity ischemia (2.60% vs 0.43%, p = 0.04), unplanned reoperation (9.74% vs 3.90%, p = 0.01), and 30-day readmission (19.48% vs 10.61%, p = 0.01).

Disseminated cancer is significantly more prevalent among patients undergoing EVAR than the general population (0.05%), likely due to shared pathophysiology between AAA development and the incidence and progression of cancer. While EVAR is relatively safe in terms of short-term outcomes in patients with disseminated cancer, the long-term prognosis for these patients needs further investigation.

The global adoption of endovascular aortic techniques has progressed rapidly, yet the extent of Latin America’s participation in this revolution requires comprehensive evaluation. This review examines the region’s current capabilities, innovations, and barriers in aortic endovascular therapy.

We conducted a systematic analysis of published experiences and institutional reports from across Latin America, focusing on three key areas: ascending/arch aortic interventions, thoracoabdominal repairs, and endoleak management strategies.

The region has demonstrated significant progress in adopting complex endovascular therapies despite resource limitations. Several centers have successfully implemented advanced techniques, including total percutaneous arch repairs, hybrid debranching procedures, and customized endograft solutions. Experience with thoracoabdominal pathologies shows promising outcomes with fenestrated and branched endografts, while innovative approaches to endoleak management have been developed, particularly for challenging type II and III cases. However, variability in outcomes persists due to disparities in technology access, training opportunities, and follow-up protocols. The available evidence, while growing, remains largely limited to single-center experiences with modest sample sizes.

Latin America has made measurable strides in aortic endovascular therapy, demonstrating both technical capability and innovative adaptations to local challenges. The establishment of a Latin American Aortic Registry (LATAR) would address critical gaps in data standardization, facilitate outcome benchmarking, and promote equitable technology dissemination. Such structured collaboration is essential for the region to fully participate in the global advancement of aortic care.

To analyze the association between blood groups (ABO and Rh) and long-term outcomes following abdominal aortic aneurysm (AAA) repair.

Retrospective cohort study including all patients submitted to elective AAA surgery between 2009 and 2019. Outcomes were mortality and major adverse cardiac events (MACE).

Of the 333 patients included in this study, 49.5% had blood type A, followed by 39.3% with type O, 8.1% with type B and 3.1% with type AB. Regarding Rh factor, 82.4% were Rh⁺ and 17.6% were Rh^-. The distribution of the blood phenotypes was similar between AAA patients and the Portuguese population. The median follow-up time was 75.4 months (interquartile range 65.8–81.6). Patient survival rates at 1 and 5 years were 89.3% (95% Confidence Interval 86.0–92.7) and 61.9% (56.2–68.2), respectively. MACE-free survival at 1 and 5 years was 85.7% (81.9–89.5) and 57.6% (51.9–64.0), respectively. Survival and MACE-free survival rates were similar across blood group types. Age, maximum aortic diameter, peripheral arterial disease and chronic obstructive pulmonary disease were independent predictors of mortality. Maximum aortic diameter, estimated glomerular filtration rate, cerebrovascular disease and type of surgery were independent predictors of MACE.

We found no association between the blood types and the prevalence of AAA or adverse outcomes following AAA repair.

To assess dedicated venous stents’ feasibility and early outcomes as a post-EVAR graft limb kinking treatment.

We report two clinical cases of severe graft limb kinking detected 1 year after EVAR.

Both patients were successfully treated with dedicated venous stents and experienced no further aortic-related events during follow-up. Graft limb kinking is a common EVAR complication, particularly in anatomically complex cases involving iliac tortuosity. Current literature emphasises the evaluation of graft-related complications but lacks recommendations for preemptive stenting or standardised management.

Our findings highlight the potential of venous stents’ adaptability to challenging anatomy vessels. Venous stents’ flexibility and high radial force may reduce early occlusion rates. Further research is needed to compare the outcomes of dedicated venous stents with bare-metal stents and to optimise prevention and treatment strategies for post-EVAR graft limb kinking.

Thoracic aortic aneurysm (TAA) involving the aortic arch poses a significant risk of cerebrovascular accidents and presents technical challenges for repair. This report presents a hybrid approach combining carotid-subclavian bypass (CSbp) and physician-modified endografts (PMEGs) for a patient with extensive aortic arch involvement.

A 77-year-old asymptomatic man with a large TAA extending into the aortic arch underwent a hybrid procedure. The intervention included a CSbp and the deployment of a double-fenestrated PMEG, prepared using a Valiant Captivia stent-graft platform, with additional branches to accommodate supra-aortic vessels.

The patient’s intraoperative and postoperative course was uneventful, with no neurological or vascular complications. Follow-up CTA at 1 year showed a patent carotid-subclavian bypass, well-positioned stent grafts, and no evidence of endoleak or graft migration.

The combination of carotid-subclavian bypass and PMEGs offers a feasible and effective treatment for complex TAA involving the aortic arch, particularly in high-risk patients unsuitable for open repair or total endovascular approaches.

Combined aneurysmal and occlusive disease presents a challenging clinical problem often treated with a hybrid combined open and endovascular approach. Gluteal compartment syndrome is a rare but serious complication following vascular surgical intervention.

We present the case of a 77-year-old man who underwent hybrid repair of an iliac aneurysm and chronic limb-threatening ischemia with associated rest pain. Following an uneventful repair, in the early postoperative period, he developed severe left buttock pain with an isolated lactic acidosis and elevated creatine kinase. He was expeditiously diagnosed with left gluteal compartment syndrome and underwent operative exploration with fasciotomy and subsequent delayed primary closure.

Gluteal compartment syndrome is a rare complication of hybrid iliac artery repair; however, early recognition and treatment may avoid the potential long-term morbidity. The patient in this case presentation recovered uneventfully and was shown to have complete aneurysmal exclusion with resolution of his occlusive symptoms.

To report on the surgical treatment of complex renal artery aneurysms (RAAs) using kidney autotransplantation in two patients at a single institution.

We retrospectively reviewed two cases of patients with RAA treated with renal autotransplantation at a single center over a period of 15 years.

Case 1: A 50-year-old male presented to the outpatient clinic with left flank and lumbar pain. A CT scan revealed a 25 mm aneurysm at the left renal pelvis and bilateral renal fibromuscular dysplasia. A laparoscopic left nephrectomy was performed, followed by bench aneurysm resection, saphenous vein bypass reconstruction, and kidney autotransplantation into the right iliac fossa. At 11 years follow-up, his renal function remains normal, with adequate patency and function of the transplanted kidney. Case 2: A 51-year-old male reported a 6-month history of nonspecific abdominal pain. A CT scan revealed nephrolithiasis and multiple renal artery aneurysms, the largest measuring 50.2 mm in his right kidney. He underwent laparoscopic right nephrectomy and renal autotransplantation in the right iliac fossa. At 3 years follow-up, the patient remains asymptomatic with normal renal function.

Ex vivo autotransplantation is an acceptable option for addressing complex RAAs beyond the bifurcation of the main renal artery.

Venous malformations (VMs) are the most common type of vascular malformation. Recurrence after treatment remains a significant challenge in clinical management.

A multi-center retrospective cohort study was conducted on consecutive patients who received surgical or endovascular VM treatment from 2005 to 2020. The study aimed to compare treatment efficacy between surgical and non-surgical endovascular approaches. Post-treatment size, symptoms, and recurrence were evaluated more than 1 year after treatment.

Ninety-eight patients with 288 VM treatment cases were included. The mean follow-up duration was 60.7 ± 42.4 months. Both surgical and non-surgical treatments showed size improvement and symptom improvement in more than 90% and 75% of the cohort, respectively. Regarding recurrence, patients who underwent total resection (26.5%; p < .001) and primary closure (44.6%; p = .04) had significantly lower recurrence rates among the whole cohort.

Where feasible, total resection is the ideal treatment modality. Sclerotherapy has a higher long-term recurrence rate but is a less invasive procedure that can be performed repeatedly.

The purpose of this study was to evaluate the impacts of obesity on patients undergoing aortobifemoral bypass for aortoiliac occlusive disease (AIOD). AIOD is an atherosclerotic disease of the suprainguinal arteries, and treatment approaches are often guided by the TASC II classification. The obesity paradox, a phenomenon where higher-than-normal BMI individuals exhibit better outcomes in various medical conditions, has yet to be fully understood in the context of AIOD.

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried for AIOD cases between January 1, 2011 and December 31, 2016. All patients included in the AIOD targeted files were eligible for inclusion unless their BMI was missing. Patient demographics and surgical characteristics were analyzed across BMI, categorized as underweight (<18.5), normal (18.5–24.9), overweight (25.0–29.9), obese (30–34.9), and very obese (≥35). Multivariable logistic and linear regression models, adjusting for demographics, comorbidities, and AIOD symptoms, were used to estimate the association between BMI and patient outcomes.

Overall, 4885 patients met inclusion criteria, of which 274 (6%) patients were underweight, 1720 (35%) were normal weight, 1649 (32%) were overweight, 843 (16%) were obese, and 399 (8%) were very obese. Among all groups, neither age nor symptoms were significantly different. The functional status of the patients across all groups was also similar. Compared to normal-weight patients, obese and very obese patients were significantly more likely to be diabetic (34% and 50% vs 16%) and have hypertension (82% and 84% vs 5%), p < .0001. Both obese (OR 2.11, 95% CI 1.47, 3.04) and very obese patients (OR 2.94, 95% CI 1.95, 4.45) had significantly higher incidences of infection. Very obese patients also had a higher incidence of pneumonia (OR 2.03, 95% CI 1.11, 3.74) and prolonged ventilator requirement (OR 3.09, 95% CI 1.86, 5.14) compared to normal-weight patients. No differences were seen in mortality (p = .92) or length of stay (p = .20).

An elevated body mass index (BMI) is associated with a higher vulnerability to infection, pneumonia, and an extended need for ventilation after open aortobifemoral bypass surgery. However, there was no association between BMI and 30-day mortality or duration of hospitalization in patients who had AOBF bypass.

Unibody Endoprosthesis (UBE) is a newer treatment modality for abdominal aortic pathology (AAP) and has increasingly been utilized for aortoiliac occlusive disease (AIOD). We report outcomes of patients undergoing UBE for AAP and AIOD.

Patients (2016–2021) undergoing UBE were identified retrospectively at an academic institution. AAP included aneurysm/pseudoaneurysm/PAU. Chi-square and Kaplan-Meier analysis were used to evaluate outcomes by group.

90 patients undergoing UBE were included with 39 patients undergoing AAP (43%) and AIOD treatment in 51 (57%). AAP patients were older (72.9 vs 62.5 years; p = .01), with a lower prevalence of female patients treated than AIOD (36% vs 57%; p = .04), diabetes (23% vs 45%; p = .03) and current smokers (46% vs 69%; p = .03). There were significant differences in arterial diameters with AAP patients exhibiting larger minimum aortic diameter (19 mm vs 15 mm; p < .0001), iliac (12.5 mm vs 9.8 mm; p < .0001), femoral (9 mm vs 6.9 mm; p < .0001), SFA (6.8 mm vs 5.2 mm; p < .0001) and profunda femoris (6 mm vs 4.9 mm; p = .002). Shorter surgery duration was seen with AAP than AIOD patients (135 min vs 194 min; p = .001). There were six major amputations in the overall cohort with two BKA and four AKA. There were no significant differences in unadjusted 30-day outcomes or mid-term outcomes between groups at a mean follow-up period of 20 months. Reinterventions over the follow-up period occurred in 9 limbs (5%) in the overall cohort with no significant associations between demographic or anatomic variables identified. Subgroup analysis of the whole cohort by sex revealed that female patients exhibited smaller minimum aortic diameter (14.9 mm vs 18.6 mm; p < .0001), common iliac (9.3 mm vs 12.5 mm; p < .0001), femoral (6.9 mm vs 8.7; p < .0001), SFA (5.2 mm vs 6.6 mm; p < .0001) and profunda femoris (4.9 mm vs 5.9 mm; p = .0006). Logistic regression analysis revealed an independent association between minimum aortic diameter (OR 1.61; 95% CI 1.0–2.4) and surgery length (OR 1.02; 95% CI 1–1.03) and overall mortality. Kaplan-Meier estimated survival at 36 months was 94% for AIOD and 84% for AAP (p = .23). At 36 months, primary patency was 78% for AIOD versus 100% for AAP (p = .002), primary-assisted patency was 94% for AIOD versus 100% for AAP (p = .12) and secondary patency for AIOD was 82% versus 100% for AAP (p = .008).

UBE can be safely and effectively used for treating aortic aneurysmal pathology as well as aortoiliac occlusive disease in selected patients. Despite the differing pathologies, outcomes are similar with a low reintervention rate and excellent mid-term patency of the intervention. Interestingly, an independent association between mortality and small minimum aortic diameter was seen, further reinforcing AIOD as a marker for overall mortality when compared with aneurysm patients.

Prosthetic infection is a feared complication following vascular surgery and is associated with significant morbidity. Recently, biologic wound care adjuncts have been used more given their advantageous effects on wound healing. The goal of this study is to evaluate the outcomes of patients who underwent placement of biologic wound care products over prosthetics with the goal of observing reduced deep dehiscence involving the prosthetic or prosthetic infections.

From June 1, 2023 to June 26, 2024, 13 patients met criteria for inclusion. Ten of the 13 (77%) involved placement of a prosthetic in a revision field as the primary indication; two of the 13 (15%) involved high-risk prosthetics in either obese fields or in fields with little soft tissue coverage over a prosthetic implant (1/13, 8%). Overall, there was one graft infection (8%) and there were no deep dehiscence occurrences which involved the underlying prosthetic. The graft infection occurred after a failed surgical thrombectomy, which involved a surgical cutdown at a new surgical site over a femoral-tibial prosthetic bypass in a patient had previously demonstrated a fully healed wound with no indication of wound infection. No other patients suffered a deep dehiscence of their wound involving the prosthetic or graft infection.

This study demonstrates the feasibility of prophylactic use of biologic products with the hope of preventing deep space infection involving underlying prosthetics. More studies are needed to evaluate this technique; however, these early results are promising.

Traditionally, acute mesenteric ischemia studies are performed by utilizing an open superior mesenteric artery (SMA) occlusion, which is an invasive technique with potentially devastating effects. A new endovascular technique for SMA occlusion using a catheter-balloon system was designed and compared to the open SMA occlusion to test its efficacy and animal safety.

All animals underwent open instrumentation of the superior mesenteric vein (SMV) for blood flow monitoring. The animals were grouped into an open SMA occlusion technique group and an endovascular SMA occlusion group. The open SMA occlusion technique group involved exposure of the SMA via left medial visceral rotation with vascular clamping. In the endovascular group, an endovascular balloon was placed in the SMA and inflated to produce occlusion.

Complete cessation of flow to the SMV was observed in the endovascular group, compared to the residual SMV flow in the open occlusion group. Following a 30-min post-occlusion period, the MAP in the endovascular group increased, compared to a decline of MAP in the open occlusion group.

This study indicates the endovascular technique provides a more potent SMA occlusion, with insignificant consequences on the overall health of the animal, in contrast to the open vascular clamping.

Chronic venous insufficiency (CVI) is a prevalent condition with significant socioeconomic implications. Endovenous radiofrequency ablation (RFA) is a minimally invasive treatment option that has gained widespread acceptance due to its high efficacy and low complication rates. This study aimed to investigate the effectiveness of a novel venous access technique using a subcutaneous side branch of the greater saphenous vein (GSV) and compare it to the conventional direct GSV access technique.

A total of 211 patients (288 legs) with CVI were randomly assigned to either the conventional access group (group 1, 145 legs) or the subcutaneous side branch group (group 2, 143 legs). Patients were assessed for demographic characteristics, venous access success rates, complications, and clinical outcomes. The primary outcomes were venous access success and procedural time, while secondary outcomes included complication rates such as vasospasm, ecchymosis, and thrombophlebitis.

The mean access time was significantly lower in group 2 (30.8 ± 9.9 seconds) compared to group 1 (46.7 ± 14.9 s) (p < 0.001). Additionally, group 2 required fewer cannulation attempts (1.28 ± 0.5) than group 1 (2.2 ± 0.9) (p < 0.001). Vasospasm occurred less frequently in group 2 (3.1%) than in group 1 (5.2%) (p = 0.005), and group 2 had significantly lower rates of ecchymosis (p = 0.033), thrombophlebitis (p = 0.026), and paresthesia (p = 0.045). No significant differences were observed between the groups regarding thermal skin injury (p = 0.142) or GSV occlusion rates at 3 months.

This study demonstrates that accessing the GSV via a subcutaneous side branch is a feasible and advantageous technique, leading to faster cannulation and reduced complication rates compared to the conventional approach. Further research is warranted to assess this novel technique’s long-term outcomes and potential benefits in diverse clinical settings.

Chronic venous disease (CVD) commonly presents as varicose veins, affecting a significant proportion of the population. Current treatments vary from invasive surgeries to advanced minimally invasive techniques, but many involve high costs and risk of complications. This study aimed to introduce and evaluate a novel, cost-effective technique combining high ligation of the great saphenous vein (GSV) with foam sclerotherapy, designed to minimize invasiveness, reduce complications, and improve patient outcomes.

The procedure began with ultrasound-guided mapping and marking of the GSV and perforating veins. Under local anesthesia, two small micro-incisions were created on the medial side of the leg. A double ligation was performed at the saphenofemoral junction using a 2-0 PDS suture, ensuring complete vein closure. Subsequently, the angiocatheters were inserted into the GSV above the perforators or in the mid-section of the vein if no perforators were present. Foam sclerotherapy was administered using a mixture of sodium tetradecyl sulfate, normal saline, and air. Compression bandaging was applied from the lower leg upward postoperatively. 18 patients were treated with this technique and followed up at 2 weeks, 3 months, and 6 months to assess clinical outcomes, complications, and recurrence.

The novel technique demonstrated satisfied clinical outcomes with no reported complications, such as ecchymosis, hematoma, or discomfort, at the 2-week follow-up. No deep vein thrombosis (DVT) or recurrence cases were observed at the 3- and 6-month follow-ups. Our method reduced postoperative discomfort, bruising, and recovery time compared to traditional high ligation with stripping. Patients reported high satisfaction due to the minimally invasive nature and improved cosmetic results. Compared to thermal ablation methods, the technique was similarly effective but offered notable advantages in cost-effectiveness and accessibility, as it eliminated the need for expensive equipment or anesthesia. Future studies with larger sample sizes and extended follow-up periods are needed to validate these findings further, explore long-term recurrence rates, and refine patient selection criteria. This approach represents a promising, practical alternative for varicose vein treatment in diverse clinical settings.

To assess the risk factors for varicose veins in patients under the age of 40 and the long-term results of surgery.

This multicenter case-control study comprised patients who received great saphenous vein stripping and ambulatory phlebectomy between January 2014 and December 2015 and were followed for at least 5 years. Patients under the age of 40 were assigned to Group 1. Patients in Group 2 were selected in a 3:1 ratio by matching their CEAP classification to those in Group 1. We studied their demographics, risk factors, and follow-up findings.

There were 42 patients (mean age 35) in Group 1 and 126 patients (mean age 57) in Group 2. Group 2 patients had a higher prevalence of hypertension (16% vs 2%, p = .022). The proportions of C2, C3, C4, C5, and C6 were 52%, 10%, 24%, 10%, and 5%, respectively. For risk factors, only family history was more prevalent in Group 1 (odds ratio 4.9, 95% confidence interval 2.3–10.4). The course of the disease was shorter in Group 1 (p = .003). During a mean follow-up of 79 months, there were no difference in the recurrences of varicose vein, Venous Clinical Severity Score, or Aberdeen Varicose Vein Questionnaire scores (p > .05), which indicated similar 5-year surgery efficacy between the two groups.

Family history was more prevalent and the course of the disease was shorter among young patients with varicose veins. The 5-year prognosis of surgery was satisfactory despite the age of receiving the treatment.

The diagnosis of deep vein thrombosis (DVT) is usually made by a sonographer using a thorough Doppler ultrasound. The current study examined whether emergency resident physicians could accurately diagnose DVT using a point-of-care, three-point compression protocol.

The patient population consisted of patients with suspected DVT who presented to the emergency department between 2021 and 2022. All patients underwent a three-point compression ultrasound exam by the emergency resident. Each patient then had a comprehensive whole-leg ultrasonography exam performed by a supervisor emergency specialist. The results of the ultrasound exams by the emergency resident physicians and comprehensive exams were then analyzed and compared.

The average age of the patients was 60,96 ± 16,67. There was a statistically significant difference between three-point compression and whole-leg ultrasound examination data. The negative predictive value of the resident physician was determined as 94%. The coefficient of the compression variable in the Ridge regression analysis for diagnosing DVT in the whole-leg ultrasound examination was obtained as −0.3754.

We think that compression ultrasonography may be sufficient in patient management compared to whole-leg ultrasonography in emergency management. However, we think that three-point compression ultrasonography applied by the emergency resident is quite successful in diagnosing and excluding DVT in the emergency department.

To evaluate the efficacy and safety of the AcoStream device (Acotec Scientific, Beijing, China) when used in combination with other endovascular therapies in patients with deep vein thrombosis (DVT) in a lower extremity.

This single-center retrospective study included 126 consecutive patients who were treated for DVT at our institution between December 2022 and August 2024. Mechanical aspiration of thrombus using the AcoStream device was performed under local anesthesia in all cases. Residual thrombus of >30% after aspiration mechanical thrombectomy was treated by catheter-directed thrombolysis. Percutaneous balloon dilatation and stent implantation were performed in the event of residual iliac vein stenosis of >50%. We analyzed related indices during aspiration mechanical thrombectomy and evaluated the early outcome during follow-up.

Technical success (>70% resolution of thrombus) was achieved in 110 patients (87.3%). Seventy-six patients (60.3%) also underwent catheter-directed thrombolysis (mean duration 4.47 ± 2.69 days and mean urokinase dose 33.19 ± 9.58 *10,000 IU per day), and 71 (56.3%) also underwent balloon dilatation and stent implantation. The mean decrease in hemoglobin after aspiration mechanical thrombectomy was 15.20 ± 10.21 g/L. There were no major complications. The median follow-up duration was 7.87 ± 3.56 months. The primary patency rate was 92.9% (117/126). Thrombus recurred in five patients (in-stent thrombosis, n = 4; re-thrombosis, n = 1) and was treated successfully by catheter-directed thrombolysis. Post-thrombotic syndrome occurred in 7.1% of patients, including one with a venous ulcer.

The findings of this study indicate that use of the AcoStream device combined with other endovascular therapies is a feasible and effective treatment for DVT with a high technical success rate and satisfactory short-term results.

Photoplethysmography provides information about global venous function and is also used to assess the time required to refill the veins within the dermis or the venous refill time. This descriptive cross-sectional study aims to investigate the relationship between pain, quality of life, and venous refill time in patients with chronic venous insufficiency.

The study was conducted on a sample of 72 patients diagnosed with chronic venous insufficiency. Data were collected using the Descriptive Characteristics Form, the Short-Form McGill Pain Questionnaire, and the Venous Insufficiency Epidemiological and Economic Study: The Quality of Life/Symptoms Scale (VEINES-QOL/Sym), and venous refill time was obtained by using photoplethysmography.

The mean age of the patients included in the study was 41.24 ± 13.58 years, and 54.2% were female. A positive correlation was found between photoplethysmography and VEINES-QOL/Sym, whereas a negative correlation was found with the McGill Pain Questionnaire (p < .001). The results showed that photoplethysmography significantly predicted VEINES-QOL/Sym and McGill Pain Questionnaire with a statistically significant correlation (p < .001).

The results of this study indicate that venous refill time has a significant impact on both pain and quality of life. The findings underscore the need to mitigate the negative impact of CVI on quality of life in patients diagnosed with CVI. In this regard, it is of great importance to identify the factors that negatively affect the quality of life of patients with CVI and to provide counseling services for these factors.

We suspect that the May-Thurner syndrome (MTS) is the main etiology of secondary varicose veins of the lower extremities (VVLE). However, there is no definitive agreement on the priority and necessity of relieving iliac vein compression when treating patients with VVLE and MTS.

In this study, according to the results of anterograde venography of lower extremity, 99 patients were divided into two groups, namely, simple VVLE (n = 66) and VVLE-MTS groups (n = 33). The patients in the former group only received sclerotherapy, while the patients in later group received the combination treatments of intravascular balloon dilatation, stent placement of iliac vein, and sclerotherapy. After surgery, we applied VVCS score, postoperative recanalization rate, and improvement in clinical symptom to assess therapeutic effects.

VCSS score: At 1 week, 1 month, 3 months, and 6 months after operation, there were significant differences between group A and group B (p < 0.01), the difference of VCSS: compared with preoperation, there was statistical difference between group A and group B at 1 week after operation (p < 0.01), there was no statistical difference 6 months after operation (p = 0.052); Postoperative recanalization: cumulative trunk recanalization events 6 months after surgery There was no statistical difference between (p = 0.192) and branch recanalization events (p = 0.207). When the two events were combined to increase the positive rate, no statistical difference was found. However, after stratifying patients, mild (CEAP2-3) and moderate (CEAP4) patients were obtained. There was no statistical difference in the incidence of recanalization events between the two groups, but there was a statistical difference between severe (CEAP5-6) groups (p = 0.025).

It was great of importance and necessity of solving iliac vein compression prior to treating VVLE when handling patients with VVLE and MTS, especially for the cases with high CEAP score.

Malignant carotid body tumors (CBTs) represent a rare clinical entity, with existing studies limited by small sample sizes and fragmented data. This systematic review aims to: (1) Pool epidemiological estimates of malignant CBTs; (2) Characterize clinicopathological profiles; (3) Evaluate treatment modalities and survival outcomes; (4) Identify risk factors for malignant transformation.

A comprehensive search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted through January 1, 2024 for literatures with malignant CBTs. The incidence, clinicopathological features, management and survival of patients with malignant CBTs were pooled analyzed and described. Benign and malignant CBTs were compared to identify any relevant risk factors of malignant transformation for CBTs. Two independent reviewers performed study selection, data extraction, and quality assessment. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.

A total of 99 reports and 447 patients with malignant CBTs were identified. The pooled results indicated that the incidence of malignant CBTs was 5% (4% ‒ 6%) with a mean age of 44.11 years. In addition, female patients with malignant CBTs accounted for 61% and 14.58% experienced bilateral lesions. 74.63% malignant CBTs were defined as Shamblin III with a mean maximal diameter of 5.19 cm. We found that compared to patients with benign CBTs, patients with malignant CBTs experienced significantly higher proportion of Shamblin III (OR 4.65; 95% CI 1.80–12.06) and preoperative symptoms (hoarseness/dysphonia) (OR 7.96; 95% CI 1.79–35.5) respectively. It was observed that patients with malignant CBTs experienced more vascular and neurologic complications including vascular reconstruction or repair (OR 19.22; 95% CI 6.23–59.3), overall neurological complication (OR 3.81; 95% CI 1.28–11.36) and permanent nerve deficits (OR 3.95; 95% CI 1.26–12.41) respectively.

This meta-analysis established that malignant CBTs were more likely to be Shamblin III with larger size and common in middle-aged female. The majority of patients with malignant CBTs experienced preoperative systems. Preoperative hoarseness/dysphonia was associated with malignancy. Malignant CBTs increased vascular and neurologic complications. Postoperative radiotherapy was mainly used for malignant CBTs. Cohort studies with enough sample size and long follow-up are required to clear the risk factors, treatment and survival of malignant CBTs.

Carotid artery stenting is a minimally invasive procedure often chosen to treat carotid artery stenosis. In-stent restenosis is a well-known complication of this procedure. Statins, primarily recognized for their role in lowering LDL cholesterol, have been demonstrated to reduce in-stent restenosis following coronary artery stenting. This effect is often attributed to their pleiotropic properties rather than solely their impact on LDL cholesterol. Given that neointimal hyperplasia is the mechanism underlying in-stent restenosis in both coronary and carotid artery stenting, this study aims to investigate the effects of statins on in-stent restenosis in patients undergoing carotid artery stenting, as well as to identify factors that contribute to restenosis.

The study included 51 patients who underwent carotid artery stenting. Data collected included the patients’ age, gender, presence of hypertension, diabetes mellitus, hyperlipidemia, smoking history, post-procedure smoking, statin use, plaque morphologies, and Doppler and NASCET stenosis rates. Follow-ups were performed at 3rd and 6th months post-procedure. Maximum LDL cholesterol levels and HbA1c levels were measured at the 6-month follow-up. Intima-media thickness within the stent lumen was assessed, and restenosis was evaluated based on spectral Doppler findings.

In our study, according to the measurements obtained from the in-stent segment, restenosis was detected in 5 patients (9.8%) overall. After the procedure, 37 patients (72.5%) were on statins, while 14 (27.5%) were not. Restenosis occurred in 4 patients (28.6%) in the non-statin group and 1 patient (2.7%) in the statin group, with a statistically significant difference (p = .017). All patients in the non-statin group had maximum LDL cholesterol levels ≥100 mg/dl during the follow-up. In the statin group, 67.6% of patients had maximum LDL cholesterol levels ≥100 mg/dl, while 32.4% of patients had <100 mg/dl. The difference was found statistically significant (p = .022). All 5 patients who developed restenosis had left-sided stents, and the difference between the groups was found to be close to statistical significance (p = .051). No significant differences were found between groups concerning other factors influencing restenosis and neointimal hyperplasia (p > .05).

Our study is the first in the literature to demonstrate that statin use is effective in preventing the development of restenosis in patients who underwent carotid artery stenting. This effect appears to occur independently of LDL cholesterol levels and is attributed to the pleiotropic effects of statins. Based on the data obtained, we believe that statin use after the procedure may reduce restenosis rates, regardless of LDL cholesterol levels.

Atherosclerosis in carotid arteries can lead to carotid stenosis, where carotid endarterectomy (CEA) is the first-line intervention. Malignancy has a two-way relationship with atherosclerosis, where they share common molecular pathways in their pathophysiology. However, the postoperative outcomes of CEA in patients with disseminated cancer remain unclear. This study aimed to examine the 30-day outcomes of CEA in patients with disseminated cancer.

Patients with and without disseminated cancer who underwent CEA were identified in the ACS-NSQIP targeted database from 2011 to 2022. Patients with age <18 years were excluded. A 1:5 propensity-score matching was used to address preoperative differences between the cohorts. Thirty postoperative outcomes were examined.

There were 148 (0.37%) patients with disseminated cancer who went under CEA. Meanwhile, 40,028 patients without disseminated cancer underwent CEA, where 740 of them were matched to those with disseminated cancer. After 1:5 propensity-score matching, disseminated cancer patients had higher risks of 30-day mortality (4.73% vs 1.62%, p = .03), and deep vein thrombosis (3.38% vs 0.68%, p = .01), while stroke, transient ischemic attacks, and other 30-day outcomes were comparable between the groups.

Patients with disseminated cancer had higher thromboembolism and mortality after CEA. Given the prevalence of cancer-related thrombosis and its associated increased mortality risk, effective prophylaxis and treatment for venous thromboembolism, such as low molecular weight heparin administration, should be essential in patients with disseminated cancer. These findings can also be valuable for preoperative risk stratification and in determining the surgical candidacy of patients with disseminated cancer in CEA. CEA for asymptomatic patients with disseminated cancer may require further justification given their elevated perioperative risk.

Arteriovenous fistula (AVF) is the preferred method for vascular access. However, fistulas can fail and may develop stenosis. Therefore, maintaining the patency of the access is vital. Balloon angioplasty has been accepted as the first-line treatment for central venous stenosis. However, the reintervention rate with plain balloon angioplasty (PBA) is high. Drug-coated balloons (DCB) have emerged as a promising therapy for effectively prolonging the patency of treated vessels and reducing the reintervention rate. This study aims to determine the 12-month patency of arteriovenous fistulas following paclitaxel-coated balloon (PCB) angioplasty for central and peripheral venous stenosis.

This single-center retrospective analysis included patients with end-stage renal disease who underwent hemodialysis via native arteriovenous fistulas. The information was collected from medical records and compiled into a de-identified database provided by the institution. All patients were included regardless of sex or age, provided they had an angiography demonstrating central or peripheral venous stenosis and were treated with PCB. Patients were followed up every 3 months for 12 months at the vascular center. The primary objective was to ensure the vascular access was functioning effectively for hemodialysis and to monitor for any complications.

A total of 137 patients with AVF dysfunction were treated with PCB; among them, 111 (81%) had central venous stenosis and 26 (19%) had peripheral venous stenosis. There was no significant difference in patency rates at 12-month follow-up between central (79%) and peripheral (85%) accesses. Factors associated with non-patency at 12-month follow-up were exhausted access (HR = 0.21, 95% IC 0.09–0.47, p < .001) and stenosis length greater than 20 mm (HR = 0.33, 95% IC 0.15–0.72, p = .005).

The high patency rate at 12 months for dysfunctional AVFs indicated that treatment with PCB is highly effective in both central and peripheral vein stenosis.

This study aims to investigate the association of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) with peripheral artery disease (PAD) and long-term mortality.

Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004 were analyzed, with mortality follow-up tracked via the National Death Index until December 31, 2019. Logistic regression was used to examine the relationship between MHR and PAD, while Cox proportional hazards regression assessed the association of MHR with mortality in individuals with PAD.

A total of 6319 participants were included, among whom 550 were identified as having PAD. In weighted multivariate logistic regression analysis, participants in the third (odds ratio [OR]: 1.031, 95% confidence interval [CI]: 1.009–1.053, p = 0.007) and fourth (OR: 1.034, 95% CI: 1.011–1.057, p = 0.006) quartiles of MHR demonstrated significantly higher risks of PAD compared to those in the first quartile. Among PAD individuals, during a median follow-up period of 136 (71, 197) months, 422 deaths occurred. Higher MHR was associated with an increased risk of long-term mortality in females (hazard ratio [HR]: 1.695, 95% CI: 1.222–2.350, p = 0.002) but not in males (HR: 0.761, 95% CI: 0.554–1.044 p = 0.090).

Elevated MHR is independently associated with PAD among U.S. population. The association between MHR and long-term prognosis of PAD exhibits gender differences, with a significant relationship observed between elevated MHR and long-term mortality risk in females, but not in males.

The great saphenous vein (GSV) is the preferred conduit for infrainguinal arterial bypass procedures, due to its long-term patency and resistance to infection. However, traditional harvesting methods, including open vein harvesting (OVH) with continuous or skip incisions, pose significant risks of wound complications, with reported rates as high as 40%. To address these issues, minimally invasive techniques such as endoscopic vein harvesting (EVH) have emerged, promising reduced complications while maintaining graft integrity. This comprehensive review synthesises the current literature on various saphenous harvesting techniques, evaluating their impact on graft patency and postoperative complications.

A systematic electronic literature search was conducted using PubMed and Embase, focussing on articles published between 2013 and 2023. The search utilised keywords related to infrainguinal bypass, saphenous vein harvesting, and associated complications. Nine relevant studies were selected for analysis, assessing outcomes related to different harvesting techniques.

The reviewed studies present mixed results regarding wound complications and graft patency. Wartman et al. found comparable 30-day wound complication rates between EVH and OVH (29% vs 27%), with no significant differences in long-term patency rates. In contrast, Eid et al. reported significantly higher wound infections in the OVH group (20.4% vs 0% in EVH), but OVH demonstrated superior primary patency at 30 months (69.4% vs 43.2% for EVH). Santo et al. supported this, noting better primary patency rates for OVH (71% at one year) compared to EVH (58%). Teixeira et al. found no significant differences in surgical site infections across techniques but highlighted inferior one-year primary patency rates for EVH. Additionally, Mirza et al. corroborated OVH’s superior primary patency (62.8% vs 47%). Conversely, Kronick et al. indicated lower wound complications in the EVH group (2% vs 28% for OVH). The systematic review by Jauhari et al. revealed a pooled hazard ratio indicating inferior patency for EVH.

The findings indicate that while EVH offers advantages in terms of reduced wound complications, concerns regarding long-term graft patency persist. The data suggest that OVH may provide better primary patency, although both techniques have their unique benefits and drawbacks. Surgical choice should consider patient-specific factors such as comorbidities and anatomical variations. A thorough understanding of these harvesting techniques is essential for improving patient outcomes in infrainguinal bypass surgery. Future research is needed to identify optimal harvesting strategies and enhance the efficacy of vein harvesting techniques, balancing complication rates with graft performance to inform clinical practice.

To compare outcomes between patients who underwent preoperative non-invasive testing and those who did not prior to all-level lower extremity amputation (LEA).

A retrospective analysis of patients undergoing LEA between April 1st 2019 and June 30th 2023 at an acute care facility was performed and relevant demographic and perioperative data collected. The primary endpoint was the association of preoperative non-invasive testing on MALE and MACE.

188 patients who underwent all-level LEA were included and stratified into two groups: those who had preoperative non-invasive testing (52.7%; n = 99; p < .01) and those who did not (Groups A and B, respectively). Group A demonstrated higher minority representation (p = .04), pre-existing vascular disease (p < .01), hypertension (p < .01), and renal and cardiac comorbidities (both p < .01).

Chi-squared analysis between groups demonstrated no significant difference in all-level LEA for outcomes of postoperative revascularization (p = .63), re-amputation (major or all-level; p = .98 and p = .78, respectively), nor any differences in wound complications (p = .79) or mortality (p = .37). In sub-analyses for major and minor amputations, there remained no significant differences in major re-amputation (p = .69 and p = .27, respectively), 30-day wound complications (p = .44 and p = .65, respectively), or MACE (p = .50 and p = .93, respectively) between groups.

Authors note infrequent use of non-invasive testing prior to LEA, and similar MALE and MACE outcomes between groups with potential benefit in medically vulnerable cohorts. With a lack of established guidelines on preoperative workup prior to LEA, additional prospective studies with matched cohorts and similar endpoints may promote algorithms to optimize perioperative outcomes.

Chronic lower extremity arterial occlusive disease (LEAO) presents significant diagnostic and management challenges, often requiring effective perioperative pain management to enhance patient outcomes. This study evaluated the efficacy of ultrasound-guided popliteal sciatic nerve block (PSNB) compared to traditional analgesia in managing early perioperative pain and improving microcirculation in patients with severe LEAO.

This retrospective, exploratory study involved 92 patients with Fontaine classification III and IV LEAO, treated from January 2021 to December 2022. Patients were divided into two groups: those receiving traditional analgesia with fentanyl patches and those undergoing PSNB. Clinical outcomes assessed included early perioperative pain intensity using the Visual Analogue Scale (VAS), Toe-Brachial Index (TBI), foot temperature (FT), and feet transcutaneous oxygen pressure (FTpO2). Data on tramadol usage and results from lower limb ultrasound post-analgesia were also collected.

PSNB was associated with significantly lower VAS scores and higher TBI, foot temperature, and transcutaneous oxygen pressure compared to traditional analgesia, indicating enhanced pain management and microcirculation. Furthermore, PSNB patients showed a significantly reduced consumption of tramadol and improved collateral circulation in the lower limbs as evaluated on the fifth day post-analgesia.

PSNB provides superior pain control and enhances microcirculatory outcomes in the early perioperative period for patients with severe LEAO, presenting a promising alternative to traditional analgesic methods. These findings suggest that PSNB has the potential to improve early perioperative management in LEAO, although further research is needed to confirm these results across broader populations.

The aim of this study was to evaluate the one-year results of the Eluvia drug-eluting vascular stent (Boston Scientific, Marlborough, MA, USA) for the treatment of femoropopliteal occlusive disease (FPOD).

From January 2021 to November 2023, this multicenter study prospectively enrolled patients with peripheral artery disease involving the femoropopliteal artery. The primary outcome measures were the rate of freedom from clinically driven target limb revascularization (f-CD-TLR), rate of freedom from major adverse events (f-MAE), rate of freedom from symptom recurrence (f-SR) and rate of freedom from all-cause death (f-ACD). The secondary outcome measures were the Rutherford grade and Vascular Quality of Life (VascuQoL) scale scores.

In total, 159 patients were enrolled in this study. The mean follow-up time was 370 days, and the follow-up rate was 83.0%. The patients’ mean age was 72 years, and 82.4% were male. A total of 159 patients received 199 stent deployments. The mean lesion length was 194.4 ± 118.9 mm, and 76.7% had total occlusions. The technical success rate for endovascular treatment was 100%, and five complications occurred during the perioperative period. At one, three, six, and 12 months, the f-CD-TLR rate was 99.3%, 97.9%, 96.4%, and 92.8%, respectively; the f-MAE rate was 98.0%, 96.7%, 93.1%, and 91.3%, respectively; the f-SR rate was 94.6%, 85.5%, 80.3%, and 73.4%, respectively; and the f-ACD rate was 98.0%, 98.0%, 95.9% and 94.1%, respectively. There was a substantial increase in the Rutherford grade and average VascuQoL scores at the one-, three-, six-, and 12-month follow-ups (p < .001).

The Eluvia stent had a favorable effect on FPOD throughout 12 months of follow-up. Further studies with larger sample sizes and longer-term follow-up are required to confirm the real-world performance of the Eluvia stent.

Aortoiliac disease is a severe manifestation of peripheral artery disease (PAD) that reduces blood flow to the lower limbs, leading to significant morbidity and mortality. Patients with AID frequently present lesions in other arterial territories, particularly in the superficial femoral artery (SFA), which may lead to more challenging and higher risk outcomes in patients. This study aims to evaluate the prognostic value for major adverse cardiovascular events (MACE) of SFA disease in patients undergoing aortoiliac revascularization.

This prospective cohort study included all consecutive patients who underwent elective aortoiliac revascularization between January 2013 and September 2022 at both a central and a district hospital, representing two healthcare facilities within the Portuguese Health System. Only patients with aortoiliac Transatlantic Inter-Society Consensus (TASC) II type D lesions were included, excluding those with aortoiliac aneurysmal disease. Moreover, patients with severe multivessel disease in other arterial areas, apart from the aortoiliac artery and SFA, were excluded. Patient demographics, clinical characteristics, and procedural details were collected. Outcomes were assessed in the first 30 days post-procedure and during long-term follow-up. Statistical analyses included Kaplan–Meier survival curves and multivariate Cox regression.

A total of 133 patients were included, with a mean age of 62.3 ± 9.23 years; 94.0% were male, and a median follow-up of 61 [IQR: 55.0–67.0] months. SFA disease was present in 60.9% of patients and was associated with hypertension (p = .025), coronary artery disease (p = .005), congestive heart failure (p = .020), and age (p = .008). Patients with SFA disease had a lower 30-day ankle-brachial index (ABI) (p < .001), smaller post-surgery ABI variation (p = .003), longer hospital stays (p = .005), and higher rates of major adverse limb event (MALE) (p = .007). Survival analysis demonstrated increased long-term MALE, MACE, and all-cause mortality in patients with SFA disease. Multivariable analysis confirmed SFA disease as a significant predictor of all-cause mortality (HR = 2.046 [1.042–4.443] p = .048) and suggested a trend towards increased risk of MACE (HR = 1.542, [0.866–3.101], p = .075).

This study identifies SFA disease as a critical prognostic marker for adverse cardiovascular outcomes in patients undergoing aortoiliac revascularization. Further research with larger sample sizes and longer follow-up periods is warranted to validate these findings and improve patient management strategies.

While concomitant vascular injury is associated with an increased risk of amputation following lower extremity trauma, risk factors for amputation after attempted revascularization are lesser known. In centers where dedicated vascular traumatic expertise is not available, a lack of guidance regarding high-risk vascular trauma may limit efforts to appropriately triage and transfer patients to a higher level of care. We identified factors associated with in-hospital amputation after revascularization for isolated lower extremity trauma.

The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) is a multicenter, prospectively maintained database containing deidentified traumatic admissions data for over 900 trauma centers in the United States. From 2017 to 2021, ACS TQIP was queried for adult patients undergoing arterial revascularization following isolated lower extremity trauma. Injury-related variables were derived from structured data fields, Injury Severity Scores, and Abbreviated Injury Scores. The primary endpoint was post-revascularization in-hospital lower extremity amputation. Univariate and multivariate logistic regression of demographic data, medical history, and injury-related variables were performed to identify factors associated with post-revascularization amputation.

Of 5669 patients undergoing revascularization, 10.2% underwent amputation a median 8.31 days after their surgical procedure. Most revascularizations were done via open surgical approach (81.9%), followed by endovascular (13.8%) and hybrid (4.3%) methods. Amputated patients were older (39.5 vs 35.6 years, p < 0.001, Table 1) and more likely to have a preoperative history of peripheral arterial disease (1.4% vs 0.6%, p = 0.017). On multivariate logistic regression, blunt mechanism (OR 4.80, p < 0.001, Table 2), popliteal arterial injury (OR 2.11, p < 0.001), and concurrent bony injury (OR 2.03, p < 0.001) were independently associated with amputation.

In the multicenter American College of Surgeons Trauma Quality Improvement Program, the overall rate of post-revascularization amputation in patients with isolated lower extremity trauma was 10.20%. Amputation risk was higher in patients with advanced age and comorbidity, suggesting that triage for revascularization already incorporates an evaluation of patient frailty. In multivariate analysis, blunt mechanism of injury, popliteal artery injury, and bony injury were independently associated with amputation. Each additional hour between admission and revascularization was associated with greater amputation risk, highlighting the importance of efforts to expediently and appropriately triage patients at with high-risk injuries to optimize limb salvage outcomes.

Lower extremity amputations (LEA) are serious complications of the infected diabetic foot. Subsequent amputations are underreported and the occurrence of an ipsilateral second re-amputation (third amputation) is unknown.

This is a retrospective study of a continuous series of patients admitted for LEA due to diabetic foot complications, with a minimum of 2 years of follow-up after the first re-amputation. A total of 111 patients comprising 149 index amputation; 97 and 52 cases in the minor and major type groups, respectively. The primary outcomes were the observed frequencies of first and second re-amputations with comparative analysis based on amputation type. Logistic regression analysis was used to look for independent risk factors.

Out of 149 index LEA cases, 111 cases (74.5%) had no re-amputation. First re-amputation frequencies were 25.5%, 35%, and 7.7% for the whole sample, minor, and major groups, respectively. Second re-amputation frequencies were 34.2%, 31.6%, and 2.6% for the whole sample, minor, and major groups, respectively. Infection re-occurrence was the cause in 89.5% and 100% of cases for first and second re-amputation. Out of the 13 second re-amputation cases in the minor group, 30.7% were minor and 69.3% were major amputations. The mean time for the first re-amputation was 5.4 ± 9.4 months and that for the second re-amputation was 9.5 ± 7.1 months (p = .04). For the first re-amputation, independent risk factors were smoking (p = .04) and creatinine level (p = .02) outcome. For the second re-amputation outcome, male sex was the only independent variable (p = .03).

This study demonstrated that a second re-amputation, mostly major, was needed in more than one-third among first re-amputation cases. Second re-amputation could be a relevant major endpoint outcome in this frail population.