Vascular Surgery

Real-world low-dose rivaroxaban after PVI: large amputation benefit but more bleeding and poor adherence

In 88,792 MarketScan patients undergoing lower extremity PVI, only 1.5% were prescribed low-dose rivaroxaban within 30 days. Among rivaroxaban users, just 43% were adherent over 1 year, indicating major implementation and persistence problems. Adherent low-dose rivaroxaban users had about 70% lower 1-year major amputation risk after PVI (HR 0.30; 95% CI 0.10–0.91). Rivaroxaban use increased bleeding complications compared with no rivaroxaban (HR 1.85; 95% CI 1.24–2.76). 1

Carotid free-floating thrombus: current data challenge anticoagulation-alone strategies

This systematic review included 11 mostly low-quality observational studies with 179 patients with carotid free-floating thrombus. Antithrombotic medication alone was used in 67% of cases, with smaller groups receiving endovascular therapy or carotid endarterectomy. Short-term stroke/death rates were highest with antithrombotics alone (6.7%), versus endovascular therapy (5.0%) and CEA (2.6%). All reported long-term death/stroke events occurred in patients managed with antithrombotic medication alone. 2

Aortic and iliac calcification on CT strongly predicts aortic events and MALEs in DANCAVAS

This prospective DANCAVAS cohort included 13,065 mainly male participants (mean age 67) with thoracoabdominal CT quantification of aortic and iliac calcification. Over about 8 years, 42 aortic dissections or ruptures and 311 major adverse limb events occurred. Highest-level abdominal aortic calcification markedly increased aortic event risk after adjustment (SHR 7.61; 95% CI 1.44–40.22). Severe calcification in all aortic segments and iliac arteries strongly predicted MALEs, with iliac SHR 13.52 (95% CI 4.32–42.24). 3

Targeted AAA screening in high-risk 70-year-old women smokers is efficient and preserves detection

This Swedish program invited all 70-year-old women but especially encouraged attendance among those with ≥20 years of smoking. Targeted screening halved attendance versus prior general screening (43% vs 74%) yet enriched smokers (71% vs 44%). Among attenders, AAA prevalence doubled with the targeted strategy (0.8% vs 0.4%), and subaneurysm prevalence also increased (1.1% vs 0.6%). Considering all invited women, AAA detection rates were similar for targeted versus general strategies (0.3% vs 0.2%). 4