OBJECTIVE:Stent graft induced aortic intimo-intimal intussusception (SAoII) during thoracic endovascular aortic repair (TEVAR) of type B aortic dissection (TBAD) is a rare complication. This study aimed to report reliable imaging features of SAoII to avoid such a potentially catastrophic event. This retrospective, multicentre observational analysis was registered as a Chinese Clinical Trial (ChiCTR2300073780). METHODS:Patients undergoing TEVAR for TBAD in three centres were reviewed from January 2014 to December 2022. SAoII was defined as intra-procedural partial or circumferential disruption of the aortic intima because of TEVAR, excluding those created by natural disease progression. The imaging features and management of SAoII were summarised. RESULTS:1 643 patients undergoing TEVAR for TBAD were reviewed. Among them, SAoII was observed in 20 patients (mean age, 44.5 ± 11.8 years; 16 men). TEVAR was performed in the acute phase (8 of 20), subacute phase (11 of 20), or chronic phase (1 of 20). Imaging features including displacement of the intima, wire, or delivery system were observed in eight (40%), floating endograft in 17 (85%), intussusception of the intima layer in 13 (65%), true lumen occlusions and visceral artery loss in three (15%), and a single lumen without intimal septa in three (15%) patients. SAoII was observed in 60% (12 of 20) after deployment of the stent graft, in 20% (4 of 20) after introduction of a stent graft delivery system, and in 20% (4 of 20) after the introduction of a super stiff wire. All patients who developed SAoII were endovascularly managed by an additional stent graft; no aortic related death was observed among these patients with SAoII during the median follow up of 51.5 months. CONCLUSION:SAoII is a rare but potentially fatal iatrogenic complication during or after TEVAR; endovascular interventions could be effective to manage this acute complication. Timely and accurate identification of decisive imaging features are key to successful treatment.

OBJECTIVES:To demonstrate the outcome of thoracic endovascular aortic repair (TEVAR) for patients with type B aortic dissection (TBAD) accompanying retrograde intramural haematoma (RTIMH) in zone 0-2. METHODS:Patients were registered in a retrospective multicentre study and divided into 2 groups: presence of RTIMH involving zone 0-2 (group 1) and RTIMH confined to zones 1 and 2 not involving zone 0 (group 2). The primary end-point was any adverse aortic event (AAE), including the development of full dissection in the ascending aorta, aorta-related mortality, reintervention, and procedure-related complications. RESULTS:A total of 155 patients were enrolled, with 68 (43.9%) in group 1 and 87 (56.1%) in group 2. The AAEs occurred in 14 (9.0%) patients, with 8 in group 1 and 6 in group 2, and no significant differences were found between the 2 groups (P = .294). Patients in group 1 were younger (50.1 ± 6.5 vs 55.6 ± 9.2, P = .04) and more often had a primary entry at the inner curvature of the arch (57.4% vs 25.3%, P < .001). In group 1, freedom from reintervention was significantly lower than in group 2 with 79.1% in group 1 and 93.3% in group 2 (P = .02). CONCLUSIONS:In selected cases, TEVAR is an effective alternative treatment modality to open repair for TBAD with RTIMH extending to zone 0. However, the rate of reintervention is higher in those with RTIMH propagation into the proximal ascending aorta, suggesting closer follow-up. CLINICAL REGISTRATION NUMBER:This retrospective multicenter analysis registered as a Chinese Clinical Trial (ChiCTR2300071443).

Autoimmune disease-related critical limb ischemia (AD-CLI) represents a significant portion of no-option critical limb ischemia (NO-CLI). Despite the demonstrated safety and efficacy of cell transplantation for NO-CLI, most studies focused on thromboangiitis obliterans (TAO). There remains a scarcity of reports on cell transplantation for AD-CLI induced by systemic lupus erythematosus (SLE), hypereosinophilic syndrome (HES), and so on. From May 2011 to May 2024, 22 patients with 36 ischemic limbs were enrolled. The primary outcome was amputation, whereas secondary outcomes included toe-brachial index (TBI), Wong-Baker Faces Pain Rating Scale (WBFPS), transcutaneous oxygen pressure (TcPO2), and so on. Among them, 8 had SLE, 11 had HES, and 3 had eosinophilic granulomatous polyangiitis (EGPA). During the follow-up, one EGPA patient died, two patients underwent major amputation, and five underwent minor amputation. The 2-year major and total amputation-free survival rates were 86.4% and 72.7%, respectively. Critical limb ischemia (CLI) relief was observed in 14 patients, with a 1-year cumulative CLI-free survival rate of 61.0%. Significant improvements were noted in postoperative TBI and WBFPS. Autologous cell transplantation showed satisfactory safety and efficacy outcomes for non-TAO AD-CLI patients. Validation of the conclusions awaits more evidence based on the long-term outcomes of a larger number of patients.

Vascular tissue-resident macrophages (VRMs) maintain immune balance in blood vessels, but their role in abdominal aortic aneurysm (AAA) development remains unclear. Here we demonstrated that a specific group of VRMs located in the adventitia marked by expression of Lyve1, protected against AAA by secreting the extracellular matrix protein Sparcl1 (Sc1). Deletion of Sc1 in VRMs promoted dysfunctional lymphangiogenesis and led to the formation of tertiary lymphoid structures (TLSs), thereby accelerating AAA progression. Mechanistically, the calcium-binding domain of Sc1 acted as a trap for the growth factor FGF2, inhibiting FGF2-mediated dysfunctional lymphangiogenesis and expression of genes associated with TLS formation. A therapeutic peptide derived from Sc1 (Spa17) mitigated AAA progression in several AAA models. Our findings reveal that VRM-derived Sc1 has a protective role in AAA and identify a potential therapeutic approach.

BACKGROUND:Bacterial communities and their metabolites are increasingly recognized as key contributors to cardiovascular disease, yet their role and mechanistic involvement in abdominal aortic aneurysm (AAA) pathogenesis remain insufficiently defined. METHODS:Dental plaques from patients with AAA and matched healthy controls were subjected to metagenomic sequencing, and corresponding plasma samples underwent untargeted metabolomic profiling. In vivo, mice were topically exposed in the oral cavity to Fusobacterium nucleatum (Fn) followed by AngII (angiotensin II) infusion to evaluate its impact on AAA progression. A homologous recombination-based ilvE deletion strategy was used to confirm the role of Fn in isoleucine biosynthesis. Molecular assays were performed to assess ferroptosis-related signatures and histone acetylation in smooth muscle cells, while chromatin immunoprecipitation-quantitative polymerase chain reaction verified the specific acetylation target. In addition, dietary restriction of isoleucine was introduced in the AAA murine model to explore therapeutic relevance. RESULTS:Patients with AAA showed a marked enrichment of Fn in dental plaque, and topical application of Fn aggravated AngII-induced AAA in mice. Elevated plasma isoleucine concentrations were observed in both human AAA and experimental models. Genetic deletion of ilvE in Fn diminished bacterial isoleucine release and mitigated AAA development in mice. Mechanistic analyses revealed that Fn-derived isoleucine promoted ferroptosis in smooth muscle cells through H3K9ac (histone H3 lysine 9 acetylation)-dependent transcriptional activation of ACSL4 (acyl-CoA [coenzyme A] synthetase long-chain family member 4), a core regulator of ferroptosis. Dietary isoleucine restriction in the AngII-induced model reduced H3K9ac, suppressed ferroptosis, and alleviated aneurysmal progression. CONCLUSIONS:Fn-derived isoleucine drives ferroptosis in smooth muscle cells via H3K9ac-mediated activation of ACSL4, delineating a microbiota-metabolite-epigenetic axis in AAA pathogenesis and nominating dental plaque Fn abundance and circulating isoleucine as exploratory biomarker candidates requiring larger, independent validation.

OBJECTIVES:Isolated internal iliac artery aneurysm (IIIAA) is a rare condition, accounting for approximately 0.3% to 0.5% of all intra-abdominal aneurysms. This study aimed to evaluate the outcomes of endovascular treatment for IIIAA using a relatively large cohort. METHODS:A retrospective analysis was conducted on 45 patients diagnosed with IIIAA who were admitted to our hospital between April 2014 and April 2024. Patient demographics, intervention outcomes, and follow-up results were collected and analyzed. RESULTS:A total of 45 patients (only 2 female) with 49 IIIAAs were included, with a mean age of 70.4±9.2 years. The cohort exhibited a high prevalence of cardiovascular and cerebrovascular risk factors, and 31.1% had a history of malignancy. Thirty patients (66.7%) were diagnosed with an incidental IIIAA, while the remaining patients presented with symptoms such as abdominal or lumbar pain, dysuria, or aneurysm rupture. Stent-graft placement alone was performed in 3 patients, coil embolization alone in 5 patients, and the remaining 37 patients underwent a combined approach. The rate of complete distal branch embolization was 69.0% (29/42), and technical success was achieved in 44 patients. The mean follow-up duration was 23.8±21.5 months. During follow-up, 5 patients died from cancer or heart failure. Buttock claudication was observed in 7 patients, with only 1 case remaining unresolved after conservative treatment. Sac dilation was noted in 4 patients who had incomplete distal branch embolization; of these, 3 required re-intervention. The 12-month and 24-month re-intervention-free survival rates were 95.5% and 88.2%, respectively. CONCLUSION:Endovascular treatment, particularly the combination of stent-graft implantation and coil embolization, is both safe and effective for IIIAA, with a mid-term re-intervention-free survival rate of 85.25% and an acceptable risk of pelvic ischemia. Complete embolization of the outflow branches is technically challenging in some cases, and the efficacy of sac embolization as an alternative remains debatable.Clinical ImpactIsolated internal iliac artery aneurysm (IIIAA) is an exceedingly rare condition. This retrospective study identified and included 45 patients with IIIAA who were treated at our institution to evaluate the safety and therapeutic efficacy of endovascular treatment. The majority of patients underwent stent-graft implantation to seal the internal iliac artery ostium, along with coil embolization of the distal branches. The 2-year reintervention-free survival rate for all patients was 85.25%, demonstrating the favorable efficacy of endovascular treatment. However, postoperative sac dilation was observed in 4 patients who did not receive complete distal branch embolization, emphasizing the need for rigorous follow-up in this subset of patients.

Diabetic foot ulceration (DFU) imposes major global health burdens due to high morbidity and recurrence rates. Current therapies (debridement and offloading) show limited efficacy, highlighting the need to uncover molecular mechanisms of diabetic wound repair. Multi-omics analyses of DFU and healthy skin identify fibroblast-derived COL16A1 as a wound healing mediator. In vitro, COL16A1 overexpression or knockdown in fibroblasts is employed to assess its regulatory effects on cellular function and collagen secretory capacity. In vivo, localized adenoviral delivery of COL16A1 is administered to evaluate its therapeutic impact on wound closure in diabetic mice. DNA pull-down plus LC-MS/MS, ChIP-qPCR, and luciferase reporter assays are systematically implemented to delineate the upstream regulatory mechanism of COL16A1 expression. Transcriptomic profiling of skin specimens identifies fibroblast-derived COL16A1 as a key regulatory gene in DFU repair. Subsequent in vitro and in vivo experiments demonstrate COL16A1 enhances fibroblast activation and restores normal repair processes in diabetic wounds. Notably, Brahma-related gene 1 (BRG1) is identified as the key transcription factor governing COL16A1 expression. BRG1 directly binds to the COL16A1 promoter, upregulating its transcription and thereby accelerating diabetic wound healing. BRG1-COL16A1 axis is a critical regulatory pathway and proposes novel therapeutic targets for chronic diabetic wounds.

OBJECTIVE:The factors influencing patency loss after iliocaval and iliofemoral venous stenting remain incompletely understood. We therefore conducted a systematic review and meta-analysis to synthesize the available evidence. METHODS:PubMed, Embase, and Cochrane Library were searched to December 2025. Studies reporting associations between potential risk factors and stent outcomes were included. Data were synthesized narratively, and random-effects meta-analyses with Hartung-Knapp adjustment were performed when comparable multivariable-adjusted estimates were available. RESULTS:A total of 49 studies were included, predominantly involving retrospective cohorts. The meta-analysis suggested that post-thrombotic disease, stent extension across or below the inguinal ligament, and hyperlipidemia were associated with an increased risk of patency loss, whereas increasing age showed a modest inverse association with patency loss. The narrative evidence suggested that greater anatomical disease extent was associated with poorer stent patency, whereas the evidence regarding impaired venous inflow was heterogeneous and varied according to the disease phenotype, anatomical segment, and inflow definition. Pooled analyses did not identify statistically significant associations of sex, stent length, or number of stents with patency loss. Evidence regarding anticoagulation discontinuation and adjunctive antiplatelet therapy was insufficient and inconsistent. CONCLUSIONS:Patency loss after iliocaval and iliofemoral venous stenting appears to be associated with the disease phenotype, higher anatomical disease burden, and stent landing strategy. Venous inflow impairment may also be associated with poorer stent patency, although the evidence was heterogeneous. The predominantly retrospective evidence precludes causal inference. Prospective studies with standardized definitions and robust adjustment are needed to improve risk stratification and optimize post-stenting management.

PURPOSE:The case series aim to explore the feasibility and effectiveness of using fenestrated/branched physician-modified endovascular grafts (PMEGs) to treat aortic pathologies involving the aberrant subclavian artery (ASA). TECHNIQUE:We presented 3 cases with multiple anomalies and complications related to the ASA. Two patients had aberrant right subclavian arteries (ARSA) and developed aortic dissection spontaneously or iatrogenically after endovascular intervention for myocardial infarction. The third patient had an aberrant left subclavian artery (ALSA) together with a Kommerell's diverticulum (KD) arising from a right-sided aortic arch and developed an aortic dissection. In all 3 cases, an Ankura thoracic endograft (Lifetech, Shenzhen, China) was back-table modified by adding an inner branch and a fenestration for bilateral subclavian arteries, respectively. All procedures were successfully conducted, and all patients underwent 6-month follow-up courses, which were uneventful. CONCLUSION:Our case series demonstrate a feasible and less invasive therapeutic approach, which produces promising results in treating the aortic pathologies involving the ASA. Further studies and long-term follow-up are required to refine this technical approach and to validate its durability. CLINICAL IMPACT:The case series illustrate a total endovascular approach to treat aortic arch pathologies involving the ASA, which is one of the most frequent aortic arch anomalies. The use of PMEGs allows meticulous subclavian artery reconstruction without significant trauma brought by traditional open or hybrid approach. Our cases suggest that using PMEGs for total endovascular management of patients with ASA is feasible and effective, and it may help streamline the treatment of complex aortic pathologies.

BACKGROUND AND PURPOSE:Infiltration of macrophages and neutrophils plays a crucial role in the occurrence of aortic dissection (AD), while the mechanism elucidating their infiltration remains unknown. The present study aimed to delineate the underlying mechanism and provide a potential therapeutic strategy to attenuate AD progression. EXPERIMENTAL APPROACH:A model of AD was established in male mice using β-aminopropionitrile and angiotensin II. Proteomic analysis, histological evaluation, flow cytometry, western blot, multiple fluorescence staining and adhesion assays were used to evaluate fibrin and inflammatory cells during AD progression. Fibrinogen-lowering drugs and fibrinogen γ-chain knockout (Fgg+/-) mice were also used to evaluate the fibrin-integrin αMβ2 interaction. KEY RESULTS:Fibrin deposition was confirmed by proteomic analysis and histological staining, accompanied by infiltration of macrophages and neutrophils detected by flow cytometry during the progression of AD. After confirming that macrophages and neutrophils infiltrated at the sites where fibrin was deposited by immunofluorescence, an association between fibrin and the integrin αMβ2 was disclosed using protein-protein interaction analysis and immunofluorescence. The pivotal role of interactions between fibrin and integrin αMβ2 in AD progression was confirmed by cell adhesion in vitro, down-regulation of fibrin using batroxobin and Fgg+/- mice in vivo. The relevance of fibrin and integrin αMβ2 was also found in patients with AD. CONCLUSION AND IMPLICATIONS:Fibrin plays a crucial role in triggering AD through recruiting macrophages and neutrophils via integrin αMβ2. Regulation of fibrin deposition or inhibition of the interaction between fibrin and integrin αMβ2 provide a potential therapy against AD.

Stanford type B aortic dissections often exhibit helical morphology. However, the influences of structural helicity on periprocedural and mid-to long-term adverse events after thoracic endovascular aortic repair (TEVAR) remain unclear. In this article, a total of 197 patients who underwent TEVAR between October 2019 and December 2020 were studied. Among them, 93 patients were excluded, and 104 patients were analyzed. The maximum helical angles and the maximum twists were measured using an efficient morphological method based on computed tomography angiography images. The whole dissecting aorta was divided into five zones. The visceral aortic zone exhibited the most pronounced structural helicity compared with other zones. Patients with the maximum helical angle larger or smaller than 200° were categorized into two groups, i.e., the groups of strong helicity and weak helicity. The patients in the strong helicity group exhibited a greater likelihood of experiencing adverse events after TEVAR.

Introduction:Coil migration is an extremely infrequent finding after aneurysm coil embolisation. This case report presents a rare complication of a ruptured tuberculous aortic pseudoaneurysm that was managed by an endoscopic technique. Report:A patient presented with a ruptured tuberculous aortic arch pseudoaneurysm after receiving an emergency endovascular repair and aneurysm embolisation. After eight months, the patient returned with the sensation of a foreign body in the larynx. Computed tomography angiography (CTA) showed coil migration from the aneurysmal sac to the bronchus, trachea, and larynx, with bronchoscopy confirming the finding. Most coils within the respiratory system were disintegrated by Q switched neodymium-yttrium aluminium garnet laser and hook scissors and then removed. The patient's symptoms were relieved and follow up CTA showed no more migrated coils. Discussion:This case highlights that coil embolisation should be employed with extreme caution, or even avoided in mycotic aortic aneurysms, particularly when ruptured, given the potential consequences. A rigorous and consistent follow up protocol is essential to monitor the aneurysm for changes and to detect any complications related to the coils, particularly in the presence of a pre-existing "channel". Endoscopic techniques could be used as treatment methods for coil migration.

Background: The efficacy of excimer laser ablation (ELA) in de novo atherosclerotic lesions of lower extremity artery disease (LEAD) is unknown. Objectives: This real-world study aimed to evaluate the safety and efficacy of ELA combined with drug-coated balloon (DCB) versus DCB alone in LEAD patients. Methods: In this prospective, multicenter, real-world trial (ChiCTR2100051263), patients with de novo atherosclerotic lesions of LEAD were enrolled and allocated to either ELA + DCB or DCB-alone group in a 1:1 ratio. The primary endpoint was 12-month primary patency, with secondary endpoints including technical success, clinically driven target lesion reintervention (CD-TLR), and changes in ankle-brachial index (ABI). Results: A total of 136 patients were enrolled in the study. At baseline, patients in the ELA + DCB group presented significantly higher Rutherford classification (3.7 ± 0.9 vs. 4.2 ± 1.0, p = 0.007) and longer mean lesion lengths (7.4 ± 2.5 cm vs. 8.4 ± 1.9 cm, p = 0.012). The ELA + DCB group demonstrated significantly superior 12-month primary patency (87.5% vs. 71.2%, p = 0.03) and technical success rates (92.7% vs. 79.4%, p = 0.046) compared to the DCB-alone group. Kaplan-Meier analysis further confirmed sustained patency benefit with ELA + DCB (p = 0.015). Conclusion: In this real-world trial, ELA appears to be a promising therapy for LEAD in terms of safety and efficacy. However, these findings need to be corroborated by larger, randomized studies. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial URL: https://www.chictr.org.cn/. Unique identifier: ChiCTR2100051263 ### Funding Statement This study was supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project (grant no. 2023ZD0504300), the Postdoctoral Fellowship Program and China Postdoctoral Science Foundation (grant no. BX20250267), Youth Fund of Fudan University Affiliated Zhongshan Hospital (grant no. ZSZP202413), Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University, and the National Natural Science Foundation of China (grant no. 82270507). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study design was approved by the Ethics Committee for the Protection of Human Subjects at Zhongshan Hospital, Fudan University, Shanghai, China. All included patients were informed about the nature of the study and gave their written informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets analyzed during this study are available from the corresponding author on reasonable request.

Thromboangiitis obliterans (TAO) is often diagnosed late and characterized by high amputation rates. TAO-specific early diagnostic and disease-staging biomarkers are urgently needed. A staged mass spectrometry (MS)-based discovery-verification-validation workflow was utilized in this study. Ten healthy controls (HCs) and 20 TAOs were included for data-independent acquisition (DIA)-MS quantitative proteomic analysis for the discovery cohort. The DIA-MS analysis acquired 842 identified proteins and 470 quantifiable proteins. Twenty-three candidate biomarkers were further quantified using targeted proteomics based on parallel monitoring reaction (PRM) analysis in the verification stage. A 9-protein and a 7-protein serum biomarker panels were built by machine learning to accurately distinguish TAOs from HCs and active TAOs (A-TAOs) from inactive TAOs. A combined prognostic panel consisting of serum proteins and clinical indicators was established, allowing for risk stratification of A-TAOs. During the validation stage, an independent prospective validation cohort was recruited to validate the proteomic panels based on the enzyme-linked immunosorbent assay analysis, demonstrating the stability and robustness of the predictive models. This study presented the serum proteomic landscape of a TAO cohort and provided novel insights into further biological research. Meanwhile, serum protein signatures have a great potential to improve the early diagnosis and risk stratification in TAOs.

This study explores diabetic foot (DF), a severe complication in diabetes, by combining deep learning (DL) and machine learning (ML) to develop a multi-model prediction tool. Early identification of high-risk DF patients can reduce disability and mortality. The research also aims to create an integrated application to assist clinicians in precise, efficient risk assessment for early intervention. In this multicenter retrospective study, 6,180 elderly diabetic patients (aged 60-85) were enrolled from 11 community hospitals in Shanghai in 2024. Lasso regression was used to identify 16 key DF risk factors, including age, MMSE score, lower limb discomfort, ABI, and hematocrit. Fourteen ML models (RF, XGBoost, CART, MLP, etc.) and three DL models (DNN, CNN, Transformer) were trained, with hyperparameters optimized via cross-validation and grid search. An application was developed integrating these models, offering both single and batch prediction options with visualization tools for clinical use.Experimental results showed the Logistic regression ensemble model achieved robust performance, with AUC values of 0.943 (validation set, 95% CI: 0.935-0.951) and 0.938 (test set, 95% CI: 0.929-0.947), along with high accuracy, precision, recall, and F1 scores. SHAP analysis revealed key predictive features including ABI results, lower limb discomfort, and MMSE score. The developed app integrates multiple models, compares their predictions for different clinical scenarios, and enhances prediction transparency and reliability.The multi-model approach demonstrates strong predictive performance for DF risk, offering clinicians an intuitive and accurate assessment tool tailored to individual patients. By combining multiple models, we enhance result stability and clinical applicability compared to single-model approaches. Future work will focus on algorithm optimization, expanded datasets, and real-time monitoring integration to enable more precise, dynamic risk evaluation for improved DF prevention and early intervention.

Lipid metabolism-related inflammatory indices (LMIIs) have been recognized as potential biomarkers for the risks of atherosclerosis and major adverse cardiovascular events. This study aims to explore the associations of LMIIs, including neutrophil to high-density lipoprotein cholesterol ratio (NHR), monocyte to high-density lipoprotein cholesterol ratio (MHR), platelet to high-density lipoprotein cholesterol ratio (PHR), and lymphocyte to high-density lipoprotein cholesterol ratio (LHR), with the risk of incident peripheral artery disease (PAD) in elderly T2DM patients. A total of 2837 participants aged ≥ 60 years with T2DM from the Jinshan Cohort (China) and 13,542 participants from the UK Biobank (UK) were included in the primary analyses. According to the type of outcome variables, logistic regression models and Cox proportional-hazards models were used to estimate the risks of incident PAD associated with LMIIs. The methods of generalized propensity score (GPS), E-value and negative control exposure (NCE) were applied to control the potential confounding. Additionally, stratified analyses were performed across various populations to examine potential heterogeneity in the effects of LMIIs on PAD risk. Mediation effects of liver and kidney function-related indicators on associations between LMIIs and incident PAD were also explored. The results from traditional regression models suggested positive associations of incident PAD with all four LMIIs. In the Jinshan Cohort, the odds ratios (ORs) and 95

BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a pivotal intervention for managing esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis. AIM To evaluate the efficacy of digital subtraction angiography image overlay technology (DIT) in guiding the TIPS procedure. METHODS We conducted a retrospective analysis of patients who underwent TIPS at our hospital, comparing outcomes between an ultrasound-guided group and a DIT-guided group. Our analysis focused on the duration of the portosystemic shunt puncture, the number of punctures needed, the total surgical time, and various clinical indicators related to the surgery. RESULTS The study included 52 patients with esophagogastric varices due to chronic hepatic schistosomiasis. Results demonstrated that the DIT-guided group experienced significantly shorter puncture times (P < 0.001) and surgical durations (P = 0.022) compared to the ultrasound-guided group. Additionally, postoperative assessments showed significant reductions in aspartate aminotransferase, B-type natriuretic peptide, and portal vein pressure in both groups. Notably, the DIT-guided group also showed significant reductions in total bilirubin (P = 0.001) and alanine aminotransferase (P = 0.023). CONCLUSION The use of DIT for guiding TIPS procedures highlights its potential to enhance procedural efficiency and reduce surgical times in the treatment of esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.