Vascular Surgery

MISACE before F/BEVAR linked to lower SCI and shorter hospital stay

In this single-center retrospective series, MISACE was incorporated into a multidisciplinary spinal protection strategy before F/BEVAR from 2018 onward. Among 42 MISACE and 50 historical non-MISACE patients, in-hospital SCI after F/BEVAR was lower with MISACE (9.5% vs 30%; P = .016). MISACE patients had shorter median postprocedural length of stay (7 vs 11 days; P = .022) without higher in-hospital mortality or lower technical success. On univariate analysis MISACE was associated with reduced SCI odds, but multivariable modeling identified prior aortic surgery as the only independent protective factor. MISACE, typically targeting three segmental arteries in a single session about 2–3 months pre-F/BEVAR, was technically feasible in almost all patients. 1

180-day CLTI progression after claudication revascularization shows major inequities

This VQI–Medicare cohort included 10,012 patients undergoing index lower-extremity revascularization for claudication between 2016 and 2019. An intersectional variable combining race, ethnicity, and sex was used to evaluate 180-day CLTI, amputation, and mortality after revascularization. Black and Hispanic patients more often had diabetes, dialysis, and smoking, and were less likely than White men to receive preoperative statins. The highest 180-day CLTI progression rates were observed in specific minoritized groups, with particularly unfavorable outcomes among Black women. Findings support intensified surveillance, optimization of risk-reduction therapy, and equity-focused pathways after claudication interventions, especially for high-risk intersectional groups. 2

Clopidogrel poor response markedly increases ischemic events after noncoronary endovascular procedures

This meta-analysis synthesized nine studies assessing CYP2C19 genotyping or platelet-function testing to define clopidogrel responsiveness for noncoronary endovascular interventions. Poor clopidogrel response was frequent, averaging 43% by genotyping and 23% by platelet-function testing, despite routine postprocedural clopidogrel use. Ischemic complications occurred in 35.1% of poor responders versus 14.0% of normal responders across studies. Poor responders had higher ischemic event odds by genotyping (OR 2.8; 95% CI 2.1–3.8) and platelet testing (OR 6.3; 95% CI 2.0–20.0). Hyper-responsiveness was not clearly linked to more major bleeding, but estimates were imprecise and limited to neuroendovascular cohorts. 3

ACC statement updates PAD diagnosis and treatment in adults with diabetes

This ACC scientific statement reviews evidence for PAD screening, diagnosis, and management specifically in adults with diabetes. It emphasizes that PAD in diabetes is often asymptomatic or atypical, leading to delayed diagnosis and frequent presentation with CLTI. The document highlights disproportionately high amputation rates and underuse of guideline-directed medical therapies in this population. Consensus recommendations stress proactive case finding, ankle-brachial index–based diagnosis, intensive risk-factor modification, and selective revascularization to prevent cardiovascular and limb events. The statement also prioritizes research on optimal screening strategies, EHR-supported identification, and standardized cardiovascular and limb outcome endpoints. 4