Vascular

To evaluate efficacy and safety of percutaneous-endovascular aneurysm repair (p-EVAR) where large-bore access puncture holes were closed with a suture mediated closure device (SMCD) in all eligible patients.

A single-center cohort of prospectively collected data in an Internal Quality Control Registry (IQCR). An “All Comers” cohort of 368 patients with 736 access groins was assessed. All abdominal aortic aneurysm (AAA) patients eligible for p-EVAR after CTA evaluation were included. Patients with stenosis and occlusions requiring vascular Interventions during EVAR were excluded. The groins were stratified into two groups: low-profile (12Fr – 16Fr) and high-profile introducers (18Fr - 20Fr). PerClose ProGlide (Abbott Cardiovascular, IL, USA) and later the newer version PerClose ProStyle (Abbott Cardiovascular, IL, USA) SMCD devices were assessed. Primary endpoints were: Primary ProGlide technical success and Primary assisted percutaneous and non-invasive technical success. Secondary cutdown was an exclusions criterion. Safety endpoints were Freedom from early peri-operative and late 30-day groin access complications requiring vascular surgical intervention.

Primary technical success was achieved in 66.4 % (473/712) groins. Primary assisted percutaneous and non-invasive technical success was achieved in 32.2 % (229/712) groins. Continuous hemorrhage in 1.4 % (10/712) groins required a cutdown. 98.6 % (712/736) of the groins were successfully closed percutaneously. Median age was 76 years (IQR 71, 80). 78.8 % were male. 92 % (330/368) of the p-EVAR were elective. Median AAA diameter was 57mm (IQR 53, 63). Few groins required surgical intervention. No statically significant differences were found between the PerClose ProGlide and the ProStyle (p < .05).

Percutaneous closure is efficient and safe. Low-profile introducers and EVAR components (12Fr – 16Fr) had slightly better primary technical and assisted technical success. 83.5 % of the patient groins were treated with low-profile introducers reflecting the drive in the vascular field toward lower-profile devices. No statistical difference between groups was observed for primary technical success and complication rate.

It has been shown that fluoroquinolones (FQs) use may be associated with an increased risk of aortic aneurysm (AA) and/or aortic dissection (AD).

The aim of this meta-analysis was to systematically review and summarize the epidemiological evidence on the risk of aortic AA and/or AD following FQs use.

Systematic review and meta-analysis.

We performed a meta-analysis using data from PubMed, Embase, and the Cochrane Library, with research conducted up to March 15, 2025. Cohort studies examining the association between FQs use and AA or AD were included. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A combined HR with 95% CI was calculated using either a random-effects or fixed-effects model, and robustness was assessed using sensitivity analysis. This meta-analysis was registered with PROSPERO (CRD 420251012072).

11 studies were included, with 81,976,958 participants. The risk of AA/AD among FQs users was found to be elevated (HR = 1.20, 95% CI: 1.06–1.35). Similar results were found for AA (HR = 1.47, 95% CI: 1.24–1.73) and AD (HR = 1.12, 95% CI: 1.04–1.22). In subgroup analysis, the gender subgroup analysis revealed a higher risk of AA/AD for males (HR = 1.16, 95% CI: 1.06–1.27) compared to females (HR = 1.09, 95% CI: 1.00–1.20). Regionally, the risk was higher in America (HR = 1.47, 95% CI: 1.12–1.93) than Europe (HR = 1.08, 95% CI: 0.98–1.19) and Asia (HR = 0.80, 95% CI: 0.61–1.05). Risk associated with FQs use within 90 days (HR = 1.20, 95% CI: 1.13–1.26) was significantly higher, while no significant increase was observed for ≥365 days (HR = 1.00, 95% CI: 0.90–1.12). The presence of hypertension (HR = 1.24, 95% CI: 1.14–1.36) was associated with a significantly higher risk of AA/AD.

This meta-analysis demonstrates that the use of FQs is associated with a significant risk of AA/AD. Clinicians should be aware of this risk in patients prescribed FQs, and further research is needed to elucidate the role of FQs in the development of AA/AD.

Pelvic congestion syndrome (PCS), often underdiagnosed, is a cause of chronic pelvic pain in women and is frequently associated with pelvic varicose veins. Endovascular embolization is an established treatment, traditionally performed via femoral or jugular access. However, these approaches may carry higher risks of complications. This study aimed to evaluate the safety, feasibility, and clinical outcomes of using basilic vein percutaneous access for pelvic vein embolization in patients with PCS.

A retrospective cohort study was conducted on 292 women of reproductive age with symptomatic PCS who underwent pelvic varicose vein embolization using percutaneous access via the distal third of the right basilic vein. The study spanned from 2018 to 2023 and was carried out at two hospitals in Bogotá, Colombia. Inclusion criteria comprised chronic pelvic postcoital pain and Doppler-confirmed pelvic varicosities with reflux diameters >6 mm. Data collected included demographics, CEAP and Symptoms-Varices-Pathophysiology classifications, intraoperative details (access approach, duration, coil usage, complications), and postoperative outcomes (symptom resolution, complications, reintervention, ICU/hospital stay, and mortality). Follow-up evaluations were conducted at 15 days, 3 months, and 6 months post-procedure. Descriptive statistics were used for analysis. A detailed description of the surgical technique used for basilic vein access and embolization was included.

All 292 procedures were successfully performed using basilic vein access with no access-related complications such as bleeding, thrombosis, or hematoma. The average surgical duration was 41.1 min (SD = 4.1), and a mean of 2.6 coils (SD = 0.7) was used per case. The left gonadal vein was embolized in all patients, with additional embolization of the right gonadal (68.8%) and hypogastric veins (6.8%) when indicated. Only one patient (0.3%) experienced a coil migration resulting in pulmonary embolism, requiring reintervention and a short ICU stay. No mortalities were reported. Symptom resolution was achieved in 278 patients (95.2%), indicating high procedural effectiveness.

Basilic vein access is a feasible and safe alternative for pelvic vein embolization in patients with PCS. This approach demonstrated excellent technical success, a low complication rate, and high symptom resolution, with the added benefits of shorter procedure time and reduced coil usage compared to traditional access routes. These findings suggest potential procedural and resource efficiency advantages. However, due to the study’s retrospective nature and lack of comparative controls, prospective studies are necessary to further assess the long-term efficacy and cost-effectiveness of basilic access in comparison to femoral and jugular approaches. Establishing standardized guidelines for vascular access in PCS treatment could enhance outcomes and procedural safety.

Iliac limb branch occlusion after endovascular aneurysm repair (EVAR) creates risk for limb or pelvic ischemia. This study aims to explore the hemodynamic factors associated with eventual iliac branch occlusion after EVAR for abdominal aortic aneurysm.

Six patients with different causes of iliac branch occlusion were selected between January 2013 and December 2023, and computed tomography angiography (CTA) images were acquired at the time of preoperative and postoperative occlusion of EVAR. Specific CTA images were applied for modeling and computational fluid dynamics (CFD) analysis was implemented.

Pressure, velocity, wall shear stress (WSS), time-averaged wall shear stress (TAWSS), oscillatory Shear Index (OSI), and relative residence time (RRT) were calculated. Velocity, WSS, and TAWSS were elevated at the stenosis, and pressure, OSI, and RRT were decreased at the stenosis. Streamlines were reduced at stenotic sites. Iliac branch locations that eventually occluded had more disturbed flow compared to non-occluded sites. Both pressure and flow velocity gradient variations are greater on the occluded side than on the non-occluded side.

Computational fluid hemodynamic analysis identified consistent flow disturbances associated with eventual iliac limb occlusion following EVAR. These findings suggest that CFD-based hemodynamic assessment may help stratify patients at risk of iliac branch occlusion before clinical manifestation.

Accurately predicting treatment responses in varicose vein sclerotherapy is crucial for improving patient quality of life and optimizing overall healthcare costs.

Our study aims to accurately predict treatment responses in telangiectasia and reticular vein treatment in lower extremity sclerotherapy, by taking advantage of machine learning’s (ML) ability to navigate complex data sets and provide personalized predictions.

ML algorithms were used to predict outcomes in 99 patients with varicose veins. The data set, which included patient characteristics such as age, gender, dosage, and photographs, was analyzed using six ML methods. Response to treatment was divided into three groups as “poor,” “moderate,” and “good” as a result of clinical visual evaluation.

Individuals with no prior treatment exhibited a notably higher rate of “Good” responses than those who had received prior treatment. (p < .001) The group receiving a 2% polidocanol dosage showed a higher rate of “Good” responses than the group receiving a 1% polidocanol dosage. (p = .008) XGBoost outperformed other ML algorithms, particularly excelling in predicting “Poor” responses.

ML-based predictive models for assessing sclerotherapy outcomes in varicose veins, uncovering significant efficacy determinants such as dosage and prior treatment history. While pioneering ML in sclerotherapy prediction, our study acknowledges limitations and proposes future research directions, including additional variable incorporation and real-time predictive tool development.

The management of Common Femoral Artery (CFA) stenocclusive disease presents unique challenges, with debates persisting regarding the optimal treatment strategy between Open Common Femoral Endarterectomy (CFE) and Endovascular Therapy (EVT). This study aimed to compare the efficacy of CFE versus EVT, as well as simple versus advanced EVT (aEVT), using a Bayesian hierarchical framework.

A systematic review was conducted according to PRISMA guidelines by querying PubMed, ScienceDirect, Scopus, and the Cochrane Library for articles published through June 2024. The study included randomized controlled trials and retrospective observational studies with a minimum of 40 patients per cohort. Data were synthesized using a Bayesian random-intercept logistic model to estimate pooled Odds Ratios (OR) for primary patency, freedom from reintervention, and limb salvage.

The analysis included 10 comparative studies encompassing 1452 patients. Open CFE demonstrated superior outcomes compared to EVT, with a significantly reduced odds of patency loss (OR 0.480; 95% CrI: 0.367–0.626) and lower reintervention rates (OR 0.534; 95% CrI: 0.391–0.718). Limb salvage rates also favored CFE (OR 0.548; 95% CrI: 0.402–0.737). In subgroup analyses, advanced EVT (involving atherectomy) improved primary patency compared to simple EVT (OR 0.520; 95% CrI: 0.306–0.883) but did not statistically significantly reduce the need for reintervention (OR 0.910; 95% CrI: 0.427–1.894).

Open CFE remains the gold standard for CFA stenocclusive disease, offering superior long-term durability and limb salvage compared to endovascular interventions. While advanced endovascular techniques improve patency rates compared to simple balloon angioplasty, they fail to significantly reduce reintervention rates, likely due to the biomechanical stress of the femoral region. EVT should be considered a pragmatic option reserved primarily for high-surgical-risk patients.

Primary ruptured abdominal aortic aneurysm (rAAA) survival has been described in a few case reports; however, to our knowledge, there is no existing literature regarding rAAA survival secondary to isolated type II endoleak (T2EL). We aim to report a rare case of non-operative management for a T2EL-associated rAAA.

An 89-year-old man with a history of endovascular aneurysm repair (EVAR) and persistent T2EL presented with acute abdominal pain and hypotension. Computed topography angiography (CTA) confirmed rAAA with retroperitoneal haematoma. Given his advanced age, comorbidities, and initial preference against surgery, non-operative management was chosen.

After resuscitation, the patient remained stable and was discharged 5 days later. A 4-week follow-up CTA showed haematoma resolution, despite mild enlargement of the aneurysm sac. He underwent elective embolization 2- and 4-month post-rupture. One year later, he represented with acute limb ischaemia. At the time, the treated aneurysm remained stable without endoleak.

This case study sheds light on the possible different natural history between post-EVAR rAAA and primary rAAA, highlighting the possibility of non-operative management in select hemodynamically stable patients with rAAA after EVAR. While rare, rupture can occur from T2EL, underscoring the need for close surveillance among at risk population.

Few have studied the effect of concomitant femoropopliteal (FEM-POP) bypass surgery on the outcome of femorofemoral (FEM-FEM) bypass in patients with peripheral arterial disease (PAD). This study was aimed to analyze the risk relationship of concomitant FEM-POP bypass on the patency of FEM-FEM bypass.

From March 2009 to April 2020, a total of 27 patients who underwent FEM-FEM bypass surgery using polytetrafluoroethylene grafts were retrospectively analyzed according to concomitant FEM-POP bypass surgery. The mean follow-up duration was 38.20 ± 34.56 months.

The overall primary patency of the FEM-FEM bypass grafts in all 27 patients was 83.7, 78.5, and 72.0 at one, two, and 3 years, respectively. The overall limb salvage rate was 100, 94.1, and 86.9 at one, two, 3 years, respectively. Among them, ten patients underwent FEM-FEM bypass only (group 1). The other 17 patients needed a concomitant FEM-POP bypass and these patients were classified into three groups (group 2, ipsilateral FEM-POP, n = 5; group 3, crossover FEM-POP, n = 6; and group 4, bilateral FEM-POP, n = 6) The comparison of the primary patency of group 1 with the concomitant FEM-POP groups (sum of groups 2, 3, and 4, that is, group 5, n = 17) revealed a statistically significant improved patency for FEM-FEM bypasses not requiring concomitant infra-inguinal bypass (p = .036). Among the concomitant FEM-POP groups, group 2 had the lowest primary patency of the FEM-FEM bypass significantly (p = 0.07). The limb salvage rate of group 4 was significantly low.

A concomitant FEM-POP bypass influenced the outcome of FEM-FEM bypass surgery. In conclusion, compromised infra-inguinal runoff at either extremity requiring concomitant FEM-POP bypass significantly worsens long-term FEM-FEM bypass patency. In addition, a concomitant bilateral FEM-POP bypass is a risk factor affecting the limb salvage rate in FEM-FEM bypass.

Arterial hypertension (HTN) is considered a seminal risk factor for aortic dissection (AD). The purpose of this study is to evaluate whether pre-existing blood pressure (BP) control lessens the extent of dissection and has a favorable impact on outcome of patients with acute AD.

Consecutive acute AD patients who had at least two BPs recorded within the 12 months preceding the AD were retrospectively analyzed. The two most recent BPs were averaged and defined per published guidelines as normal (BP≤ 130/80), Stage I HTN (BP >130/80 and <139/89), or Stage 2 or greater HTN (BP > 140/90). The number of hypertensive medications (MEDs) was also used as a surrogate marker of HTN severity. Patients with known genetic causes of AD were excluded.

89 subjects (55% men, 45% women; mean age, 64±14 years) with acute AD (58% Stanford type A and 42% Stanford type B) were included. Two most recent BPs were recorded a mean of 5±3 and 3±2.7 months before the AD, respectively. Twenty-nine (33%) subjects had normal BP, including nine subjects with no history of HTN and on no MEDs. Sixty (67%) subjects had elevated BP, including 21 (35%) with Stage I HTN and 39 (65%) with Stage 2 HTN. Compared to subjects with normal BP, subjects with Stage 1 and Stage 2 HTN were younger (70±13 years vs 62±1 year, p = 0.01), but there were no differences in other demographics, risk factors, comorbidities, or history of drug use. There were no group differences in the distal extent of the dissections, complications requiring thoracic endograft repair, mean length of hospital stay, final discharge status, or 30-day mortality. Compared to the number of MEDs before AD, all three groups had a higher mean number of MEDs to achieve normal BP at discharge that persisted at a mean follow-up of 18±15 months.

These data show that approximately one-third of patients with acute AD had well controlled or no antecedent history of HTN. The degree of pre-existing HTN control had no bearing on the type or extent of AD, length of stay, or early outcome. Regardless of the state of HTN control before AD, the consistent and sustained increase in the severity of HTN after AD suggests that the dissection process has a profound and lasting effect on BP regulation. Further studies are indicated to elucidate the pathologic mechanisms involved in AD.

Carotid artery geometry has been suggested as a risk factor for atherosclerotic carotid disease. Although normal aging and disease development can both lead to geometric changes in the arteries, the exact nature of this phenomenon remains elusive. The aim of our study was to investigate carotid artery geometric changes in a longitudinal study.

We conducted a retrospective study of 114 subjects who underwent carotid contrast-enhanced magnetic resonance angiography at our clinic at baseline (2005 to 2007) and after 10 years. The right (Rev#2–1) carotid arteries were segmented using semi-automated methods to obtain various measurements of carotid artery geometry. For each patient, these parameters were assessed at both time points, including bifurcation angle, internal carotid artery angle, vessel diameter, and circumference.

The median age for the total patient population (n = 114) at baseline was 59.06 ± 10.40 years. Mean time interval between baseline magnetic resonance angiography and magnetic resonance angiography after 10 years of these patients was 129.18 ± 7.77 months. For the whole group, there was a significant increase in the bifurcation angle (p < 0.05) over a 10-year period. A significant increase was also noted in the diameter and circumference of the common carotid artery (p < 0.05). However, the other vessel diameters and circumferences (bulb carotid, internal carotid) as well as the internal carotid angle did not significantly change (p ≥ 0.05).

The diameter and circumference of the common carotid artery and bifurcation angle significantly increased over a decade of life.