Vascular Surgery

Post-EVAR sac regression predicts better survival and fewer endoleaks

This meta-analysis pooled 27 studies with 36,822 EVAR patients to evaluate outcomes by aneurysm sac behavior. Sac regression was associated with improved overall survival (HR 0.70; 95% CI 0.61-0.80). Regression also correlated with lower endoleak risk overall and in F/BEVAR subgroups (RR 0.55 in both). Patients with sac regression had superior reintervention-free survival (HR 0.37; 95% CI 0.27-0.53) and fewer reinterventions and ruptures overall. Benefits persisted when comparing regressing with stable sacs, underscoring sac behavior as a key surveillance biomarker. 1

Cold-stored saphenous allografts offer limb salvage with heavy complication burden

This multicenter retrospective study evaluated 200 infrainguinal bypasses with cold-stored saphenous vein allografts across four centers. Most cases involved CLTI, infrageniculate targets, and redo revascularization, reflecting a salvage population. Graft-related complications occurred in 54%, including 46.5% occlusions and smaller proportions of rupture, aneurysmal change, pseudoaneurysm, and infection. Primary patency was 59.5% at 1 year and 36.5% at 5 years; secondary patency was 64.1% and 44.5%, respectively. Freedom from major amputation remained 61.5% at 5 years, but 44% required major reinterventions. Multiple-segment grafts independently increased complications and reduced primary patency, arguing for limiting segmentation when feasible. 2

Retrograde tibial access in claudicants strongly predicts tibial intervention

Using VQI data, investigators analyzed 107,822 elective IC PVIs, of which 3.9% used any tibial access. Use of tibial access increased over time and was more common in ambulatory and office-based settings than hospitals. Compared with femoral-only access, tibial access cases had more femoropopliteal and below-knee interventions and more multivessel treatment. On multivariable analysis, tibial access independently predicted tibial intervention (OR 4.65; 95% CI 4.28-5.05). Among tibial interventions, atherectomy and stenting were more frequent when tibial access was used. These patterns suggest that choosing tibial access may predispose to more aggressive infrapopliteal treatment in claudicants. 3