Added Diagnostic Value of Intravascular Ultrasound Over Venography in "High Risk for Dialysis Circuit Vascular Access Failure" ESRD Patients.

Objectives: As a two-dimensional modality, venography has limitations in its capacity to measure lumen caliber and to assess stenotic disease accurately. This has implications in the management of end-stage renal-disease (ESRD) patients "no-option" candidates access for arteriovenous fistula (AVF) or graft (AVG) creation secondary to high risk of vascular access failure. The incremental diagnostic and clinical impact of intravascular ultrasound (IVUS) was quantified in this tunneled dialysis catheter dependent ESRD cohort.

Iliofemoral endarterectomy and stenting improves mid-term patency for advanced aortoiliac disease with concomitant common femoral disease.

ObjectiveCombined iliofemoral endarterectomy and iliac stenting (IFE + S) is a proven surgical approach for TransAtlantic Inter-society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD). Iliac stenting alone (ISA) may be an attractive, minimally invasive option in select cases; however, untreated moderate-to-severe common femoral disease may threaten iliac stent patency and limit symptom improvement. This study evaluates the mid-term patency rates after IFE + S versus ISA for TASC C and D AIOD as well as the rate of interval femoral endarterectomies in those who underwent ISA.

High-risk carotid plaque features may be more accurate predictors of ipsilateral ischemic stroke risk than the degree of carotid artery stenosis.

Introduction: The optimal management of patients with asymptomatic carotid stenosis (AsxCS) is enduringly controversial. The current stratification of AsxCS patients based on the degree of stenosis alone does not always reflect ipsilateral ischemic stroke risk. We hypothesized that the presence of ≥1 "high-risk" carotid plaque feature may more accurately identify AsxCS patients at high risk for a future ipsilateral ischemic cerebrovascular event.

Circulating Trimethylamine N-Oxide and Growth Rate of Abdominal Aortic Aneurysms and Surgical Risk.

Importance: Plasma levels of the gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) are associated with prevalent abdominal aortic aneurysms (AAA) in humans and fostering of AAA progression in animal models; therapeutic targeting of TMAO production blocks AAA progression and rupture in multiple mouse models. A blood biomarker that identifies individuals at risk for incident AAA development, accelerated AAA expansion, or recommendation for surgical AAA repair could be an asset for risk stratification.

Objective: To determine whether TMAO is associated with risk for AAA development, rapid AAA expansion, and risk for recommended surgical intervention.

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.

Reintervention Rates for Restenting Versus Angioplasty Alone in Mesenteric Artery In-Stent Restenosis.

Background: Mesenteric artery in-stent restenosis (MAISR) is a common complication of endovascular interventions for mesenteric ischemia and the major cause of treatment failure. The objective of this study was to characterize the spectrum of endovascular interventions performed for MAISR at a large academic center and to compare 1-year clinical outcomes between the major treatment groups, angioplasty, and stenting to identify predictors of early reintervention.

Methods: Consecutive patients undergoing endovascular intervention for MAISR from 2008 to 2021 in the Cleveland Clinic Health System were identified.

Advanced imaging and management of superior vena cava syndrome.

Superior vena cava (SVC) syndrome results from stenosis and/or occlusion of the central venous system leading to symptomatology associated with head and neck as well as upper-extremity venous congestion. With the rise in central venous catheter use and increasing cases of malignancy, the incidence of SVC syndrome has steadily increased in recent years. This narrative review explores the clinical presentation of SVC syndrome, alongside its evolving etiologies within modern clinical practice and its pathophysiology.

A Contemporary Paradigm for Value-Based Medicine in Vascular Care: Challenges and Opportunities.

Value-Based Medicine shifts vascular care from volume-driven to outcome-focused systems, prioritizing quality relative to cost. This review explores challenges, including misaligned incentives and cost variability, alongside opportunities like predictive analytics, patient-centered care, and interdisciplinary collaboration. Strategies to integrate evidence-based thresholds, shared decision-making, and advanced technologies are discussed to enhance care quality and reduce unnecessary interventions.

The Role of Open Abdominal Aortic Aneurysm Repair in the Era of Fenestrated Endovascular Repair.

Background: Advances in endovascular aneurysm repair have been made with new commercially available devices for treatment of more complex aortic pathology. Despite that, adhering to instructions for use (IFUs) excludes multiple patients necessitating the need for open surgical repair (OSR). This study aims to review the need for OSR for abdominal aortic aneurysm (AAA) in a quaternary academic setting with a large volume of patients treated both with open and commercially available devices.

The future in the management of patients with asymptomatic carotid artery stenosis.

Introduction: The optimal management of patients with asymptomatic (AsxCS) and symptomatic carotid stenosis (SxCS) is still debatable. The present article will discuss emerging technological advances for the diagnosis and management of patients with AsxCS.

Evidence Acquisition: PubMed/MedLine was searched until December 31, 2024 for studies in English discussing emerging technological advances in the diagnosis and management of patients with AsxCS.

Cross-sectional imaging for presurgical planning of dialysis circuit vascular access creation in the end stage renal disease patient population.

This systematic review explores the role of cross-sectional imaging modalities-computed tomography angiography (CTA) and magnetic resonance angiography (MRA)-in the preoperative planning of dialysis vascular access for patients with end-stage renal disease (ESRD). A systematic search was conducted using PubMed and Cochrane databases, yielding 45 studies meeting inclusion criteria. These modalities are particularly valuable in cases of complex vascular anatomy, central venous stenosis, and prior surgical interventions.

Venous Insufficiency: Endovascular and Surgical Treatment.

Purpose Of Review: Venous insufficiency (VI) is a is a common and debilitating disease that can present with a wide range of manifestations ranging from telangiectasias to venous ulceration. The chapter explores various endovascular and open-surgical modalities used for VI, their technique, patient selection, outcomes, complications, and comparison with other modalities.

Recent Findings: The use of non-thermal and non-tumescent ablation techniques are found to have a better quality of life scores; however, the primary closure rates are inferior to thermal ablation techniques.

Surgical technique and outcomes associated with the use of femoral vein in venous reconstruction for superior vena cava syndrome.

Objective: Superior vena cava syndrome (SVC) is a debilitating disease, and surgical reconstruction has been described with some of the best results using spiral great saphenous vein (SGSV) grafts. SGSV grafts can be difficult to construct, and a long segment of saphenous vein is needed. Femoral vein has been an excellent conduit for infected aortic and peripheral reconstructions in our hands, and we sought to review outcomes using this conduit for SVC reconstruction.

Translumbar and Transhepatic Tunneled Dialysis Catheter Placements in the End Stage Renal Disease Population.

For end-stage renal disease (ESRD) patients requiring hemodialysis, reliable vascular access is crucial, especially when conventional supradiaphragmatic options are exhausted. This study reviews the technical aspects, clinical outcomes, and complications of translumbar and transhepatic tunneled dialysis catheter (TDC) placements. These alternative infradiaphragmatic approaches provide essential hemodialysis access for patients with central venous occlusions.

An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR).

Background: Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics.

Concomitant Carotid and Coronary Artery Disease Management: A Review of the Literature.

This review examines current evidence regarding management of patients with both coronary and carotid artery disease. It highlights the elevated stroke risk after surgery for this cohort and scrutinizes approaches to minimize this risk. Various revascularization methods are outlined, including carotid endarterectomy (CEA), carotid artery stenting (CAS), and staged versus simultaneous surgical approaches.

Multicenter CT Image-Based Anatomic Assessment of Patients with Aortoiliac Aneurysm Undergoing Endovascular Repair with Iliac Branch Devices.

Background: The Global Iliac Branch Study (NCT05607277) is an international, multicenter, retrospective cohort study of anatomic predictors of adverse iliac events (AIEs) in aortoiliac aneurysms treated with iliac branch devices (IBDs).

Methods: Patients with pre-IBD and post-IBD computed tomography imaging were included. We measured arterial diameters, stenosis, calcification, bifurcation angles, and tortuosity indices using a standardized, validated protocol.

No difference in midterm outcomes and complication rate between retroperitoneal and transperitoneal open aortic aneurysm repair in females.

ObjectivesAbdominal Aortic Aneurysms (AAA) in females are less prevalent, have higher expansion rates and experience rupture at smaller diameters than in males. Studies have compared outcomes of the retroperitoneal (RP) and transperitoneal (TP) approach in open aortic aneurysm repair (OAR) with conflicting results. No study to date has compared the two approaches solely in females.

DETOUR2 trial outcomes demonstrate clinical utility of percutaneous transmural bypass for the treatment of long segment, complex femoropopliteal disease.

Objective: Percutaneous transmural arterial bypass (PTAB) using the DETOUR system aims to create a percutaneous, endovascular femoropopliteal bypass for the treatment of long segment, complex superficial femoral and proximal popliteal artery disease. The goal of the DETOUR2 study is to investigate the safety and effectiveness of the therapy in comparison with pre-established performance goals.

Methods: The DETOUR2 investigational device exemption study is a prospective, single-arm, multicenter, international trial of symptomatic peripheral arterial disease patients (Rutherford classes 3-5) undergoing the DETOUR procedure for long segment (>20 cm) superficial femoral artery disease.

Natural history of superior mesenteric artery in-stent restenosis.

Objective: Superior mesenteric artery (SMA) stenting is the preferred approach for patients with symptomatic SMA-associated chronic mesenteric ischemia (CMI). The durability of this modality is impacted by in-stent restenosis (ISR). Duplex ultrasound (DUS) and computed tomographic angiography (CTA)-measured ISR may be weakly correlated and not uniformly associated with recurrence of presenting symptoms.