Vascular Surgery

Arm vein matches GSV, cryovein underperforms in diabetic CLTI bypass

Among 17,701 diabetic CLTI patients undergoing infrainguinal bypass, 87% received GSV, 3.5% arm vein, and 9.6% cryovein conduits. Perioperative mortality and early thrombosis were similar between arm vein and GSV, supporting arm vein as an acceptable alternative conduit. Cryovein had higher perioperative graft occlusion and major amputation rates than GSV, despite similar mortality. Five-year amputation-free survival and MALE-free survival were comparable for arm vein versus GSV, but significantly worse with cryovein. 1

Fragmented care increases interventions, complications, and costs in uncomplicated type B dissection

In 5476 medically managed uncomplicated type B dissections, 55.6% received care across multiple unaffiliated health systems. Mortality was similar with and without fragmented care, but fragmented care led to more CT imaging and aortic interventions. Fragmented care independently increased odds of TEVAR and postprocedural renal failure, paraplegia, and stroke. Total costs were 31% higher with fragmented care, driven by more imaging, interventions, and complications without survival benefit. 2

LEAF: a national framework for 10-year EVAR device surveillance

A multidisciplinary group and endograft manufacturers created the Long-term EVAR Assessment and Follow-up (LEAF) surveillance program. LEAF integrates VQI registry data, a large national health system registry, Medicare claims linkages, and targeted follow-up. The framework aims to capture real-world 10-year outcomes and device-specific performance for abdominal EVAR implants. This guideline details methods for data linkage, governance, and stakeholder reporting to support long-horizon device surveillance. 3

Semaglutide lowers major limb events in diabetes and obesity

This meta-analysis pooled 19 randomized trials with 51,557 participants with type 2 diabetes and/or overweight or obesity. Semaglutide reduced major limb events—revascularizations, amputations, and PAD progression—versus controls, with an odds ratio of 0.70. Benefits were consistent across diabetes and obesity subgroups, oral and injectable formulations, and regardless of background SGLT2 inhibitor use. Meta-regression showed no effect modification by age, BMI, HbA1c, follow-up duration, or SGLT2 inhibitor therapy. 4