A Contemporary Paradigm for Value-Based Medicine in Peripheral Artery Disease.

Objective: Peripheral artery disease (PAD) imposes significant clinical and economic burdens. Current fee-for-service models incentivize volume rather than outcomes, highlighting the need for value-based medicine (VBM) approaches. This review evaluates contemporary strategies for integrating VBM into PAD management, focusing on enhancing patient outcomes, optimizing resource use, and reducing healthcare expenditures.

Three-Year Recurrence in People With Diabetic Foot Ulcers and Chronic Limb Threatening Ischemia Is Comparable to Cancer.

This study aimed to compare the 3-year recurrence rates of diabetic foot ulcers (DFU) and the rate of endovascular reintervention for chronic limb-threatening ischaemia (CLTI) to recurrence rates of advanced-stage cancers. We systematically collected original data reporting 3-year DFU recurrence from studies published through 2024 and calculated a pooled mean. These findings were compared to recurrence rates for advanced breast, prostate, colorectal, and lung cancers using contemporary sources from the National Cancer Institute and American Cancer Society.

Wound care-first strategies provide superior amputation-free survival in patients with chronic limb-threatening ischemia Wound, Ischemia, and foot Infection clinical stages 1 and 2.

Objective: The optimal timing of revascularization in patients with mild-to-moderate chronic limb-threatening ischemia (CLTI) remains unclear. We aimed to evaluate long-term outcomes associated with conservative-first vs early revascularization strategies in patients with Wound, Ischemia, and foot Infection (WIfI) stage 1-2 CLTI.

Methods: A 10-year, retrospective two-center analysis of patients with WIfI stage 1-2 CLTI was conducted.

Contemporary outcomes in no-option chronic limb-threatening ischemia.

The incidence of chronic limb-threatening ischemia, the most severe form of peripheral artery disease, is increasing. A considerable portion are deemed "no-option" patients and have high rates of limb loss and death, with even worse outcomes in underrepresented populations. This study aimed to delineate real-world, contemporary outcomes in an observational study of no-option chronic limb-threatening ischemia patients.

Bypass Versus Endovascular Therapy for Elective Infrapopliteal Interventions in Chronic Limb-threatening Ischemia: Propensity Score-matched Analyses of Vascular Quality Initiative Registry.

Objective: We used multi-institutional data from the Vascular Quality Initiative (VQI) to compare outcomes following revascularization in infrapopliteal chronic limb-threatening ischemia (CLTI).

Background: The choice between bypass and endovascular therapy (ET) in patients with CLTI is controversial, particularly when the distal target is within the infrapopliteal region.

Methods: We used VQI data (2018-2023) to compare bypass with single-segment great saphenous vein (SSGSV) versus ET and bypass with an alternative conduit (AC) versus ET in patients presenting with CLTI who underwent first-time elective infrapopliteal-only or femorotibial revascularizations.

Forecasting the Global Burden of Peripheral Artery Disease from 2021 to 2050: A Population-Based Study.

Vascular disease is the leading cause of death worldwide. Predicting the burden of vascular disease and identifying modifiable key risk factors are critical for developing effective prevention strategies. This study aimed to project the global and regional burden of peripheral artery disease (PAD) from 2021 to 2050, with a specific focus on the impact of modifiable key risk factors and the potential benefits of their management.

Textbook outcomes after revascularization for chronic limb-threatening ischemia remain rare.

Objective: Suggested performance outcome metrics and traditional surgical benchmarks may be inadequate proxies for evaluating the quality of revascularization in chronic limb-threatening ischemia (CLTI). Textbook outcomes (TOs) following revascularization in CLTI are poorly described and limited to cohorts studying open bypass only. We aim to propose a TO in CLTI to provide a more comprehensive evaluation of modern CLTI outcomes.

Robotic First Rib Resection With Adjuvant Endovascular Therapy for Chronic Paget-Schroetter Syndrome.

Background: Patients with acute Paget-Schroetter syndrome (PSS) are treated with endovascular therapy and first rib resection (FRR); however the care of patients with chronic PSS is less well understood. This report describes an emerging approach of robotic-FRR, with adjuvant endovascular therapy, for chronic PSS.

Methods: A single-center, retrospective analysis was conducted of patients undergoing robotic-FRR for chronic PSS between 2017 and 2020.

Diagnostic Test Accuracy of Pedal Acceleration Time to Identify Peripheral Artery Disease.

Objective: Pedal acceleration time (PAT) is a novel method of using diagnostic ultrasound to evaluate the haemodynamic characteristics of pedal arteries and has potential as an adjunctive vascular testing method. The primary objective of this study was to assess the diagnostic accuracy of PAT in identifying peripheral artery disease (PAD) in a population with clinically suspected PAD.

Methods: This was a multicentre cross sectional study to estimate the diagnostic test accuracy.

Improving Depression Detection and Measuring Its Impact upon Short-Term Survival in Chronic Limb-Threatening Ischemia.

Background: Depression is underdiagnosed in chronic limb-threatening ischemia (CLTI) patients, and its impact on outcomes is unclear. This study aims to evaluate a CLTI-specific questionnaire designed to detect depression and anxiety, as well as to quantify its impact on early outcomes.

Methods: A serial cross-sectional study was conducted over the following 2 4-month periods: block I, which retrospectively examined depression prevalence based on medical records, and block II, which prospectively assessed depression using a CLTI-specific questionnaire.

Validation of the WIfI classification in the Vascular Quality Initiative database.

Objective: The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification was introduced in 2014 and has been validated in multiple institutional series as a useful tool to assess the severity of chronic limb-threatening ischemia (CLTI) and predict the risk of major amputation after lower extremity revascularization (LER). The Vascular Quality Initiative (VQI) Peripheral Vascular Interventions (PVI) database captures data on wounds, ischemia, and infection, which are key components of the WIfI score, but does not provide the complete WIfI stage. The aim of this study is to validate the WIfI classification in the VQI PVI database and analyze the different combinations of components.

Progression of the contralateral limb in chronic limb-threatening ischemia.

Objective: For patients initially presenting with unilateral chronic limb-threatening ischemia (CLTI), the progression and natural history of the contralateral limb (CL) remain underexplored, and current guidelines provide insufficient guidance for monitoring progression and managing contralateral disease. This study aims to evaluate the prevalence, risk factors, and outcomes associated with the development of contralateral CLTI (CL-CLTI) in patients initially diagnosed with unilateral CLTI.

Methods: This was a single-center, retrospective cohort study including patients with unilateral CLTI.

Advanced Wound, Ischemia, and Foot Infection stage is associated with poor outcomes in the BEST-CLI trial.

Objective: Wound, Ischemia, and foot Infection (WIfI) staging was established to provide objective classification in patients with chronic limb-threatening ischemia (CLTI) and to predict 1-year major amputation risk. Our goal was to validate WIfI staging using data from the Best Endovascular vs Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

Methods: Data from the BEST-CLI Trial, a prospective randomized trial comparing surgical revascularization (OPEN) and endovascular revascularization (ENDO), were used to assess the association of WIfI stage on long-term outcomes in an intention-to-treat analysis.

Use of arterial transposition for vascular reconstruction within contaminated or infected abdominal fields.

Intra-abdominal arterial reconstructions in the setting of reoperative, contaminated, or frankly infected fields can be a challenging undertaking for even the most experienced vascular surgeons. Open surgical arterial transpositions have been less commonly performed than other methods of reconstruction in the current era of vascular surgery despite many historical reports of successful outcomes. Autologous artery transpositions represent a viable option in the case of an infected or a contaminated operative field.

Appropriate care in chronic limb threatening ischemia: A review of current evidence and outcomes.

Chronic limb threatening ischemia (CLTI) poses a significant treatment challenge for vascular surgeons, interventionalists, podiatrists, and associated medical specialists. The evidence for what constitutes appropriate care is rapidly evolving and new treatment options are in constant development. This review examines the current guidelines for CLTI care, as well as reported outcomes for multiple care strategies in this patient population, including revascularization and medical optimization.

Multilevel thrombotic or embolic burden and its role in sex-related outcomes in acute limb ischemia.

Objective: The impact of sex upon outcomes in acute limb ischemia (ALI) remains disputed. We aim to quantify the effect of sex upon amputation-free survival (AFS) after a percutaneous-first approach for ALI.

Methods: This was a two-center retrospective review of ALI managed via a percutaneous-first approach.

A Review of WIfI Clinical Staging to Predict Outcomes in Patients With Threatened Limbs.

The Society for Vascular Surgery Wound, Ischemia, and foot Infection's (WIfI's) threatened limb classification system serves to comprehensively assess the severity of disease in patients with chronic limb-threatening ischemia by identifying and grading the main factors that place the threatened limb at greatest risk: wound severity, ischemic burden, and presence of infection. Each of these 3 factors is graded and the limb placed into a clinical stage, with increasing stage associated with severity of limb threat and predicted risk of major limb amputation at 1 year. Globally, there is a growing body of evidence reported from multiple institutions that has assessed amputation rates and wound-healing outcomes following revascularization in patients with WIfI clinical staging.

Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association.

Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country.