Vascular Surgery

End-to-end proximal aortic anastomosis reduces ABF thrombosis after index hospitalization

A VQI-derived risk score for loss of aortobifemoral bypass patency used 4971 patients with derivation (N=3364) and validation (N=1607) cohorts. Independent predictors of post-discharge ABF thrombosis included operative site infection (HR 1.84), revision for patency (HR 7.14), ischemic tissue loss (HR 2.29), and femoral outflow <8 mm (HR 1.59). End-to-end proximal aortic anastomosis was protective (HR 0.568) and was the sole modifiable variable highlighted by the score. Apply the score to patients after index hospitalization to identify high-risk limbs and consider end-to-end anastomosis when not contraindicated. 1

EHR-derived model accurately predicts 30-day periprocedural ischemic stroke

An EHR-derived logistic model from 255,850 derivation procedures predicted 30-day ischemic stroke with AUC 0.87 and external validation AUC 0.86 (418 events in 189,095 procedures). Key predictors included prior stroke/TIA (aOR 6.66), inpatient/emergency setting (aOR 4.25), vascular neurosurgery (aOR 6.70), and open cardiovascular procedures (aOR 4.14). Prespecified risk strata (<1%, 1–5%, >5%) separated observed event rates in external cohorts. A locked web calculator is available for perioperative counseling and targeting prevention in higher-risk procedures. 2

Most CLTI patients have adequate GSV on mapping; GSV grade predicts patency

In 349 CLTI patients undergoing duplex vein mapping, 67% had adequate GSV to the knee (GSV-K A/B) and 46% to midcalf (GSV-MC A/B). Of limbs receiving GSV bypass, preoperative GSV-K A/B correlated with superior primary patency (P < .001). GSV-K grade D/E and spliced conduits independently predicted loss of primary patency (HR 3.8 and HR 2.1, respectively). Use standardized GSV-K/MC grading to plan conduit choice and counsel patients about expected patency and 1-year MALE risk (23%). 3