30-Second Takeaway
- Complex branched and fenestrated endovascular repairs are durable but carry substantial late mortality and reintervention needs.
- Urgency, arch and aortic extent, and spinal cord risk should heavily influence complex TEVAR and TAAA strategies.
- Adjuncts such as botulinum toxin, regenerative biologics, and advanced carotid imaging expand limb and brain preservation options.
- PAD remains underrecognized, highly comorbid, and inequitably distributed, demanding targeted screening and referral pathways.
- Registries and EHR analyses reveal large outcome gaps and limited SDOH data, underscoring the need for better equity metrics.
Week ending December 13, 2025
Complex aortic repair, limb salvage, and PAD: evolving tools, risks, and disparities
Five-year mortality patterns after physician-modified fenestrated/branched EVAR
This single-center study followed 232 high-risk patients undergoing fenestrated physician-modified endografts for complex thoracoabdominal and juxtarenal pathology from 2010-2016. Most procedures were elective, but symptomatic and ruptured cases comprised one-quarter and accounted for most early deaths. Mean survival was roughly 5 years, and over half of patients died during follow-up, predominantly after 30 days and discharge. The complexity of four-vessel repairs and extensive proximal coverage underscores the need for lifelong imaging and cardiovascular risk management.
Ten-year experience with off-the-shelf T-Branch for CAAA/TAAA
Among 130 complex and thoracoabdominal aneurysm repairs with an off-the-shelf T-Branch, technical success was 91%, including many cases outside IFU. Spinal cord ischemia occurred in 8%, with paraplegia in 2%, and was associated with ruptured aneurysms and postoperative mesenteric events. Thirty-day mortality was 9%, higher with urgent presentation, iliac conduits, and postoperative cardiac morbidity. At about 3 years, survival reached 64%, with good target artery stability but frequent reinterventions, especially after urgent TAAA and Crawford I-III extent.
Laser LSA fenestration during TEVAR for acute type B dissection
The prospective multicenter LLTEVAR trial enrolled 100 patients undergoing TEVAR with in situ laser fenestration of the left subclavian for acute complicated or high-risk type B dissection. Technical success of LSA fenestration was 98%, demonstrating high procedural feasibility across five centers. Thirty-day freedom from major adverse events was 86%, indicating a nontrivial early complication rate despite technical success. Complicated TBAD and type II/III aortic arch anatomy quadrupled the odds of 30-day major adverse events, emphasizing careful patient and arch selection.
Botulinum toxin for refractory digital ischemia and ulcers
This systematic review and individual participant data meta-analysis included 119 patients with acute ischemia, ulcers, or gangrene from systemic sclerosis and related vasculopathies. Botulinum toxin injections achieved very high complete response rates for ischemia, ulcers, and gangrene, each around 90%. Adverse events were infrequent and generally mild, mainly transient muscle weakness and injection site pain. No strong independent predictors of complete response were identified, although autoimmune etiologies and younger age appeared to respond faster.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.