Vascular Surgery

Sex disparities persist in perioperative pharmacologic GDMT for infrainguinal PAD

In a Vascular Quality Initiative cohort of 257,129 infrainguinal PAD interventions, 38% were female and preoperative GDMT was 62% overall. Postoperative combined statin and antiplatelet use rose from 68% in 2013 to 81% in 2023. After multivariable adjustment, females had lower odds of preoperative GDMT (OR 0.88) and postoperative GDMT (OR 0.84). Preoperative GDMT use plateaued despite postoperative improvements, indicating missed opportunities before intervention. 1

Bypass after failed endovascular therapy shows similar 4‑year outcomes when distal targets preserved

In a prospective diabetic limb preservation cohort (94 bypasses), distal bypass targets were unchanged in all OAFE cases. Four‑year limb salvage was similar: iOPEN 89% versus OAFE 91% (p=0.92). No significant differences were seen in freedom from MALE, MALE-or-death, or amputation‑free survival between groups. Authors conclude an endovascular‑first approach is reasonable if distal targets remain suitable for subsequent bypass. 2

Thrombectomy in active cancer: good reperfusion but worse 90‑day outcomes

This narrative review finds reperfusion rates after thrombectomy in active cancer are high and symptomatic ICH rates broadly comparable to non‑cancer cohorts. Registries report lower 90‑day functional independence and higher 90‑day mortality in patients with active cancer. Worse medium‑term outcomes likely reflect cancer‑related systemic factors and baseline status rather than procedure harm. Authors propose a clinical‑ethical framework for selection, consent, and aftercare, emphasizing individualized decisions. 3