Vascular Surgery

Direct infrapopliteal revascularization and wound blush improve CLTI wound and limb outcomes

This Bayesian network meta-analysis of 25 infrapopliteal endovascular studies in CLTI compared direct revascularization (DR), indirect (IR), and indirect with collaterals (IRc). DR produced significantly higher wound healing rates than IR at 3, 6, and 12 months and in overall analysis, with highest WHR SUCRA rankings. IRc outperformed IR for 12‑month and overall wound healing and limb salvage, with SUCRA profiles comparable to DR for amputation-free survival and limb salvage. Wound blush positivity was associated with higher wound healing, limb salvage, and amputation-free survival than wound blush–negative status. 1

Deep vein arterialization improves outcomes and is cost-effective in no-option CLTI

This pooled analysis compared no-option Rutherford 5–6 CLTI patients treated with transcatheter arterialization of the deep veins (TADV) versus propensity-matched standard of care from a registry. At 1 year, TADV improved limb salvage (74.6% vs 57.8%), survival (86.4% vs 71.1%), and amputation-free survival (64.9% vs 39.1%) versus standard care. Lifetime modeling showed TADV added 1.15 QALYs and 2.33 life-years at an incremental cost of $24,738, yielding $21,600 per QALY gained. TADV remained highly cost-effective across extensive scenario and sensitivity analyses, including reimbursement-related assumptions. 2

One-month type II endoleak predicts sac expansion and reintervention after EVAR

This two-center cohort included 292 degenerative fusiform AAA patients with 1‑month post-EVAR imaging and no type I/III endoleak. Type II endoleak (T2EL) at 1 month occurred in 22.3% and was associated with higher sac expansion (32.3% vs 7.0%) and more endoleak-related reinterventions (18.5% vs 4.0%). On multivariable analysis, early T2EL independently predicted sac expansion (hazard ratio 4.75) and endoleak-related reintervention (hazard ratio 3.08), but not all-cause mortality. These results indicate that early T2EL is prognostically important and should prompt closer surveillance and a lower threshold for intervention. 3

Women have more major adverse events after F/BEVAR despite similar aortic outcomes

This two-center retrospective cohort of 423 patients undergoing fenestrated or branched EVAR examined sex-related midterm outcomes. Women (17.3% of patients) more often had extensive type II/III thoracoabdominal aneurysms and were more frequently treated with branched devices. Freedom from aorta-related mortality and aortic reintervention at 12 and 36 months was similar between sexes after adjustment. Major adverse events were significantly more frequent in women (9.5% vs 2.6%), including higher myocardial infarction, dialysis-requiring renal failure, and spinal cord ischemia rates. 4