30-Second Takeaway
- Fenestrated/branched EVAR yields good long-term survival for complex aortic aneurysms but demands intensive reintervention surveillance.
- Preoperative antifibrinolytics cut transfusion use after major open vascular surgery without an evident short-term safety signal.
- Updated randomized data support paclitaxel-coated femoropopliteal devices as mortality-neutral with mid-term patency and TLR advantages.
- GLP-1–based therapies appear limb- and cardio-protective in PAD, beyond glucose control alone.
- Economics and next-generation graft designs will strongly influence future access to complex vascular procedures.
Week ending April 25, 2026
Complex aortic repair, perioperative hemostasis, device safety, and graft innovation in vascular surgery
Long-term outcomes in 916 fenestrated/branched EVARs at a high-volume aortic center
This 916-patient series reports outcomes of custom-made and off-the-shelf fenestrated/branched EVAR for juxtarenal and thoracoabdominal aneurysms, including urgent cases. Technical success was 93.6%, with urgent presentation and TAAA II independently associated with lower success. Thirty-day mortality was 7.4% overall (4.4% elective) and was independently linked to aortic rupture at presentation. Spinal cord ischemia occurred in 16% (Grade 3 non-recovery 2.9%), associated with rupture and off-the-shelf devices. Five-year survival was 82.6%, aorta-related mortality freedom was 89.2% at 4 years, yet only 40% remained free from aortic reintervention at 5 years.
Preoperative antifibrinolytics reduce transfusion after major elective vascular surgery
This multicenter cohort included 674 elective open abdominal and lower extremity revascularization procedures, with 31.6% receiving preoperative tranexamic or aminocaproic acid. By postoperative day five, treated patients were less likely to receive transfusion and required fewer blood products when transfused. Adjusted analysis showed preoperative antifibrinolytics were associated with fewer transfused units (aIRR 0.57, 95% CI 0.34–0.98). Safety endpoints included seizures, venous thromboembolism, arterial thrombosis, and bleeding complications, with no concerning signal described in the abstract.
Paclitaxel-coated PAD devices show neutral mortality and amputation risk up to 5 years
This meta-analysis pooled 15 randomized trials with 5,859 PAD patients comparing paclitaxel-coated versus noncoated devices with at least 24 months follow-up. All-cause mortality did not differ at 1, 2, or 5 years, arguing against a late paclitaxel mortality signal. Amputation risk was also similar at all timepoints, mitigating prior limb-safety concerns. Paclitaxel devices reduced target lesion revascularization at 1 and 2 years and improved 2-year primary patency, with attenuated TLR benefit by 5 years.
GLP-1–based therapies associated with fewer MALE and MACE in PAD
This systematic review examined six real-world studies including over 240,000 adults with PAD treated with GLP-1–based therapies or comparators. GLP-1 treatment was associated with lower major adverse limb events (HR 0.59, 95% CI 0.39–0.90), despite substantial heterogeneity. Major adverse cardiovascular events were reduced (HR 0.67, 95% CI 0.53–0.85), with particularly consistent benefit among diabetic patients. Stroke declined (HR 0.75, 95% CI 0.63–0.89), and myocardial infarction and all-cause mortality were also reduced with more variable effect sizes.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.