Vascular Surgery

PMEG vs off-the-shelf multibranched devices show comparable midterm outcomes in complex and thoracoabdominal EVAR

In 18 studies including 994 patients, PMEG and off-the-shelf multibranched devices had similar 1- and 2-year mortality and reintervention rates. Technical success was slightly higher with off-the-shelf devices, but spinal cord ischemia occurred more often than with PMEGs. Thirty-day mortality was low and comparable between groups, supporting both approaches as acceptable for complex and thoracoabdominal aneurysms. Substantial differences in aneurysm extent, presentation, and follow-up limit firm comparative conclusions, so device choice should be individualized. 1

Revascularization improves healing likelihood but not speed in WIfI 3–4 CLTI

Among 1,158 high-risk WIfI 3–4 wound episodes, only 47.6% healed over a median 29-month follow-up. Median wound healing time was about eight months and did not differ meaningfully by revascularization strategy. Successful revascularization independently increased the likelihood of wound healing, while WIfI stage 4 predicted decreased healing. Wound-free period after healing was roughly 1.5 years and similar across treatment strategies, but wound-care-only patients had worse limb salvage and amputation-free survival. 2

Metformin and sulfonylureas are linked to slower AAA growth and fewer AAA events

This meta-analysis of 13 studies with 150,630 participants found metformin use associated with slower AAA growth and fewer AAA-related events. Sulfonylureas were also associated with reduced AAA growth and fewer AAA-related events. DPP-4 inhibitors showed no statistically significant effect on AAA growth, and metformin did not significantly affect postoperative mortality. Most included data were observational with moderate risk of bias, so findings support hypothesis generation rather than practice-changing drug initiation solely for AAA. 3

Dual pathway inhibition after LER improves limb outcomes and is cost-effective vs DAPT

In a propensity-matched cohort after lower extremity revascularization, dual pathway inhibition improved MALE-free survival compared with dual antiplatelet therapy. MACE-free survival was similar between strategies, suggesting the main benefit was limb-related. Modeled over five years, DPI produced more QALYs but higher total costs than DAPT. The incremental cost-effectiveness ratio of DPI was well below the U.S. willingness-to-pay threshold, supporting DPI as a cost-effective post-LER regimen. 4