Vascular Surgery

Sac expansion after F/B-EVAR strongly predicts subsequent aortic events and death

In 1,932 patients undergoing fenestrated or branched EVAR across 10 IDE trials, median follow-up was 3.5 years with serial imaging. At 1 year, roughly one-third of sacs regressed, over two-fifths were stable, and a minority expanded or remained uncharacterized. Any sac expansion during follow-up increased hazards of aortic events, including rupture, dissection, and aortic death, and also non-aortic death. Endoleak presence increased transition to sac expansion, whereas absence of endoleak favored sac regression and lower aortic event risk. 1

Women undergoing CLTI endovascular revascularization have better survival but worse functional outcomes

Among 333,173 Medicare patients treated endovascularly for CLTI, 44% were women, who were older and more often Black and socioeconomically distressed. Women underwent CLTI endovascular revascularization at lower population rates than men despite advanced disease in this cohort. After multivariable adjustment, women had lower hazards of death or major amputation, as well as each component, compared with men. However, women were more likely to experience restriction in ambulatory function after revascularization. 2

Women with acute type A dissection face delayed diagnosis, less surgery, and worse survival

IRAD analyzed 11,586 acute aortic dissection patients from 1996-2022, with about one-third women in both type A and B cohorts. Women were older and had longer times from hospital admission to diagnosis for both type A and type B dissections. For type A dissection, surgical repair was performed less frequently in women, and medical management was used more often across both types. Women with type A dissection had higher overall and surgical in-hospital mortality and lower 4-year survival than men. 3

Mechanical thrombectomy has rapidly displaced catheter-directed thrombolysis for intermediate/high-risk PE

In the PERT Consortium Registry, 2,958 intermediate- and high-risk PE patients received advanced therapies across 48 U.S. centers between 2016 and 2024. Mechanical thrombectomy use increased by 18% per year, surpassing catheter-directed thrombolysis by 2021, while CDT and systemic lysis declined annually. Mechanical thrombectomy was preferentially used in older patients, men, those needing vasopressors or ECMO, and those with saddle embolus or clot in transit. Catheter-directed thrombolysis was more often selected for younger women and patients presenting with prominent cardiorespiratory symptoms. 4