30-Second Takeaway
- For high-risk hypertensive major abdominal surgery, targeting intraoperative MAP ≥80 mmHg reduced postoperative organ dysfunction and AKI.
- In CLTI with single-toe amputation, bypass produced faster one-year wound healing than endovascular therapy.
Latest - Week ending July 4, 2026
Grand Rounds: Selected vascular and perioperative evidence briefs
Higher intraoperative MAP target (≥80 mmHg) reduced organ dysfunction and AKI
HISTAP randomized 630 high-risk hypertensive adults undergoing elective major abdominal surgery to intraoperative MAP targets of ≥80 versus ≥65 mmHg. Targeting MAP ≥80 mmHg reduced the composite primary outcome (48.9% vs 38.1%, RR 0.78; P=0.006) and lowered acute kidney injury (23.5% vs 33.7%; P=0.005). Mean intraoperative MAPs were 88±9 mmHg versus 77±7 mmHg, with benefits concentrated in centers using continuous hemodynamic monitoring and protocolized fluids. Applicability is to older hypertensive patients having major abdominal surgery with intensive monitoring; results may not generalize to low-risk patients or settings without protocolized hemodynamics.
Bypass associated with faster wound healing after single-toe amputation in CLTI
This multicenter retrospective cohort of 412 CLTI patients compared wound healing after infrainguinal revascularization with toe amputation between bypass and endovascular therapy. In single-toe amputations, bypass achieved higher 1-year wound-healing (84.4% vs 72.7%) with no significant difference in limb salvage. In multiple-toe cases bypass trended toward better healing and limb salvage, and multivariate analysis identified bypass as an independent predictor. Consider tissue-loss extent (number of toes) when selecting revascularization strategy, recognizing observational design and potential selection confounding.
Complete revascularization linked to lower 3-year MACE in AMI with multivessel disease, including high bleeding risk
In a nationwide registry of 13,460 AMI patients with multivessel disease, 32.7% met high bleeding risk criteria. Complete revascularization was associated with lower 3-year major adverse cardiac and cerebrovascular events in HBR patients (40.0% vs 28.1%, adjusted HR 0.65) and non-HBR patients. Bleeding rates were similar between complete and incomplete revascularization in both HBR and non-HBR groups. This is observational registry data; causality remains uncertain and patient selection for complete revascularization may confound results.
References
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Additional Reads
Optional additional studies from this edition.