PURPOSE:This report describes first-in-human experiences and early results of novel SureCham stent-graft system (SC) for aortic arch pathologies. DESCRIPTION:The SC system consists of a modular design comprising a pre-fenestrated main stent-graft and a designed skirt-flared bridging covered stent to enhance the structural integrity of the stent connection. The SC incorporates a preloaded catheter for precise supraaortic cannulation, along with a precurved delivery system that enables navigation and accurate alignment. Collectively, these design features facilitate efficient reconstruction of the supraaortic branches while repairing aortic arch pathologies. EVALUATION:We report 10 patients diagnosed with type B aortic dissections. Technical success, defined as accurate stent deployment, complete exclusion of pathology, patency of stent-grafts and absence of early endoleaks, was achieved in all patients. No major complications, such as death, stroke, and paraplegia, were observed. CONCLUSIONS:The novel SC system may be a safe and effective option for single-branch revascularization in endovascular repair. However, caution is warranted in extending its use to routine cases, given the limited evidence on outcomes.

OBJECTIVE:The aim of this study was to evaluate the safety and efficacy of an innovative, single stage, two target vessel revascularisation endovascular repair strategy, namely single branch and chimney stenting during thoracic endovascular aortic repair (scTEVAR), for zone 2 aortic pathologies requiring proximal sealing in zone 1. METHODS:This was a retrospective, observational cohort study of consecutive patients who underwent scTEVAR at a tertiary Chinese centre between June 2021 and December 2024. Aortic diameter, centreline distance, tortuosity, and angulation were measured for pre-operative assessment. All procedures adhered to established surgical protocols. Outcomes of interest included technical success, death, stroke, type Ia endoleak, re-intervention, and branch patency. Descriptive statistical analyses were performed using R software. RESULTS:Sixty-six patients (94% men; median age 67 years, interquartile range [IQR] 60, 72) were included. The technical success rate was 91% (60 of 66), with the remaining six patients requiring proximal cuff extension with physician modified fenestration due to intra-operative "sail effect". All additional procedures were successful. Another patient (2%) developed retrograde type A aortic dissection and received emergency surgical repair on the eighth post-operative day. There was no death, stroke, or type Ia endoleak during a median follow up of 22 months (IQR 13, 31). Freedom from re-intervention was 93.8% (95% confidence interval [CI] 88.3 - 99.9%) at both one and three year follow up. The left subclavian artery branch patency rate was 96.8% (95% CI 92.6 - 100.0%) at 1 year and 94.1% (95% CI 87.7 - 100.0%) at 3 years. All left common carotid artery stents remained patent during follow up. CONCLUSION:scTEVAR is a standardised and clinically effective single stage endovascular arch repair strategy for zone 2 aortic pathologies, which enables two target vessel revascularisations and proximal sealing zone extension to zone 1. Peri-operative and 2 year safety and efficacy profiles in anatomically suitable candidates were satisfactory. Studies with improved design on larger cohorts are required to further confirm its durability and safety profiles.

Compared with conventional synthetic grafts, decellularized tissue-engineered vascular grafts (dTEVGs) hold transformative potential for hemodialysis access owing to their capacity for host‑driven recellularization. To investigate the cellular origin of this process, we established a rat arteriovenous graft model using dTEVGs and systematically mapped the temporal dynamics of infiltrating cell phenotypes. To spatially resolve cellular origins, we developed a specifically designed strategy featuring surface-specific cytophobic barriers that selectively block cellular entry from defined compartments. Our results demonstrated that abluminal blockade reduced cellular infiltration by 96.7 % and abolished collagen deposition, whereas luminal blockade showed no significant effect, definitively establishing the perigraft compartment as the dominant cellular source for dTEVG recellularization. Crucially, perigraft‑sourced cells exhibited superior proliferative capacity, stemness, and pro‑regenerative potential, making them uniquely suited for driving functional vascular regeneration. These findings, enabled by a compartment-selective blockade model, definitively establish the perigraft compartment as the dominant cellular source for recellularization in this dTEVG and underscore the critical importance of perivascular niche engagement. This work provides a methodological framework and a theoretical rationale for considering abluminal-focused strategies in the design of next-generation dTEVGs. STATEMENT OF SIGNIFICANCE: This study definitively establishes the perigraft compartment, not the lumen, as the dominant cellular source for recellularizing decellularized tissue-engineered vascular grafts. These perigraft-derived cells exhibit superior regenerative potential, overturning the long-held circulation-centric paradigm and guiding the design of next-generation grafts for improved hemodialysis access.

OBJECTIVE:To evaluate the early-term outcomes of endovascular repair for zone 2 aortic arch pathologies using the Castor single-branched stent-graft, with adjunctive chimney technique employed when extending for proximal extension into zones 1 and 0. METHODS:A single-center retrospective study was conducted on 63 patients (mean age=57.0±13.4 years; 55 males, 87.3%) with zone 2 aortic pathologies treated between February 2023 and June 2024. Proximal landing zones determined treatment strategy: Standard zone 2 landing (n=37, Castor branch in left subclavian artery [LSA]); extended zone 1 landing (n=20, Castor branch in LSA+LCCA chimney); extended zone 0 landing (n=6, Castor branch in LCCA+innominate artery (IA) chimney+selective LSA revascularization based on vertebral artery dominance). Baseline characteristics, procedural data, and outcomes were analyzed to assess technical success, perioperative/follow-up complications, reinterventions, and branch patency. Outcomes were described separately for each landing zone cohort (zones 2, 1, and 0). RESULTS:The overall technical success was 96.8% (61/63). No mortality, stroke, paraplegia, retrograde type A aortic dissection/ (RTAAD), endoleak, or upper limb ischemia occurred within the 30-day postoperative period. During a mean follow-up of 17.4±5.5 months, the overall endoleak rate was 1.6% (1/63), comprising a single zone 2 landing type II endoleak (LSA backflow) detected at the 3-month follow-up. No graft-related type I/III endoleaks occurred. Branch occlusion occurred in 1.6% of cases (1/63), involving the Castor LSA branch in a zone 1 landing case at 10 months. All chimney stent-grafts maintained patency. Reinterventions (3.2%, 2/63) comprised: one zone 2 landing type II endoleak, and one zone 1 landing complications (LSA occlusion). All-cause mortality was 1.6% (1/63, occurring at 11 months postoperatively in a zone 1 landing patient due to non-aortic-related causes). CONCLUSIONS:The Castor single-branched stent-graft enabled effective zone 2 reconstruction. Combined with chimney technique, it facilitated treatment extension into zone 1 and exploratory applications in zone 0. The results for each strategy demonstrate high technical success, a favorable safety profile, high branch/chimney patency rates, and low-complication rates.Clinical ImpactThis study demonstrates that the Castor single-branched stent-graft is safe and effective in endovascular repair of zone 2 aortic arch pathologies. Combined with a chimney stent, its application can be successfully extended to zone 1 and exploratory zone 0 cases. This hybrid strategy provides a minimally invasive endovascular alternative for complex arch pathologies, particularly in patients at high surgical risk or ineligible for custom-made devices. This work contributes by providing the first detailed perioperative and follow-up data for this combined approach, including preliminary technical experience in highly selected zone 0 reconstructions, thereby enriching the evidence base for endovascular arch repair.

Introduction: Epidemiologic studies have shown that obesity is strongly associated with the development of peripheral vascular diseases. However, the causal relationship between obesity and peripheral vascular diseases has not been fully established. Moreover, the basal metabolic rate, a determinant of obesity, has been understudied in peripheral vascular diseases. Therefore, we aimed to assess the causal relationships between obesity-related indicators (waist‒hip ratio, body fat percentage, waist circumference, and basal metabolic rate) and major peripheral vascular diseases. Methods: We first selected GWAS data for obesity-related indicators (waist‒hip ratio, body fat percentage, waist circumference, and basal metabolic rate) and major peripheral vascular diseases (aortic dissection, abdominal aortic aneurysm, thoracic aortic aneurysm, peripheral artery disease, deep vein thrombosis, and varicose veins) from the IEU Open GWAS project and FinnGen databases. Two-sample Mendelian randomization analysis was first used to assess the causal relationships between the obesity-related indicators and major peripheral vascular diseases. Multivariate Mendelian randomization was subsequently used to adjust for total cholesterol, hypertension, and diabetes, thereby assessing the direct effects of obesity-related indicators on peripheral vascular diseases. Finally, a two-sample Mendelian randomization analysis was again used to revalidate the positive results from the multivariate Mendelian randomization analysis using validated GWAS data. Results: Body fat percentage, waist circumference, and basal metabolic rate were identified as risk factors for major PVDs. Conversely, the waist-to-hip ratio demonstrated a protective effect against varicose veins (OR = 0.79, p = 5.057e-6). Discussion: The results of our Mendelian randomization analysis revealed causal relationships between obesity-related indicators and major peripheral vascular diseases, providing valuable guidance for the individualized prevention and treatment of peripheral vascular diseases in clinical practice. Conclusion: Mendelian randomization establishes that obesity-related indicators (body fat percentage, waist circumference, basal metabolic rate) are causal risk factors for major peripheral vascular diseases. Conversely, waist‒hip ratio demonstrates a protective effect against varicose veins, highlighting distinct roles of adiposity measures in disease etiology and prevention strategies.

Objective: To evaluate early and mid-term outcomes of thoracic endovascular aortic repair (TEVAR) using the Castor single-branched aortic stent graft in a real-world multicenter Italian experience. Methods: This retrospective, nonrandomized, multicenter study included all consecutive patients treated with the Castor stent graft between January 2019 and April 2025 in eight Italian centers. The device was used in patients with thoracic aortic pathologies requiring TEVAR in proximal landing zones 1 or 2. Primary endpoints included technical success, intraoperative major adverse events (MAEs), and deployment accuracy. Secondary endpoints were aortic-related mortality, neurological complications, reinterventions, and endoleaks. Results: Fifty-one patients (mean age 68.8 ± 8 years, 75.5% male) were treated, primarily for type B aortic dissection (45.1%) and thoracic aortic aneurysm (27.5%). Proximal landing was in zone 2 in 92.1% and zone 1 in 7.8% of cases. The technical success rate was 94.1%, with three cases (5.8%) of intraoperative type Ia endoleak. No intraoperative deaths or major adverse events occurred. Two cases of minor embolic stroke (3.9%) were observed, both in zone 1 procedures involving left common carotid artery revascularization. At a median follow-up of 22.3 months (range 2–58), no additional endoleaks or neurological events were reported, with 100% branch patency rate. Conclusions: The Castor single-branched stent graft is a feasible option for TEVAR in zone 2, with high technical success and low rates of neurological complications. Accurate case selection and procedural planning are essential.

Background: Thoracic endovascular aortic repair (TEVAR) is an established minimally invasive approach for selected aortic arch pathologies; however, it is associated with risks including stroke and spinal cord ischemia. Revascularization techniques, such as in situ fenestration (ISF), play a critical role in preserving supra-aortic branch perfusion and reducing neurological complications. Methods: This prospective, single-center observational cohort study enrolled 74 consecutive patients undergoing TEVAR with ISF between October 2017 and September 2023. Data collected included demographics, lesion morphology, procedural details, and clinical outcomes. The primary endpoint was procedural technical success; secondary endpoints included 30-day complications, reintervention rate, and all-cause mortality. Results: Technical success was achieved in 100% of cases (74/74; 95% CI: 95.2-100.0%), defined as successful fenestration creation, patent bridging stent graft without kinking or embolization, absence of Type I or III endoleak on completion angiography, and restored antegrade branch flow. Physician-modified fenestration was combined with ISF-thoracic endovascular aortic repair (TEVAR) in 28.4% (21/74) of cases. At 30-day follow-up, 30-day clinical success (freedom from mortality, reintervention, and procedure-related complications) was achieved in 87.8% (65/74) of patients. No mortality was recorded at 30 days. Treatment-related complications included subclavian branch thrombosis (n = 1, 1.4%), transient ischemic attack (n = 1, 1.4%), and endoleaks (n = 7, 9.5%; including Type Ia, Type II, and Type III), with reintervention required in 6 patients (8.1%) during the follow-up period. Beyond 30 days, three late deaths were documented: one aorta-related death (aneurysm rupture at 9 months), one neurological death (ischemic stroke at 13 months), and one cardiovascular death (myocardial infarction at 60 days post-procedure), yielding a late all-cause mortality rate of 4.1% (3/74). Conclusions: ISF-TEVAR demonstrated a high procedural technical success rate and a low 30-day complication and mortality profile in this single-center prospective series of selected patients treated at an experienced center. These early and mid-term results are encouraging; however, given the single-center, non-comparative design and limited standardized follow-up, broader conclusions regarding durability and comparative effectiveness remain premature. Larger multicenter prospective studies with standardized long-term imaging follow-up are warranted.

BACKGROUND:This report describes the second-generation unibody Cratos single-branched stent-graft for left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR). METHODS:The Cratos device represents the second-generation evolution of the Castor single-branched stent-graft, featuring an outer unibody branch configuration that allows simultaneous exclusion of the primary entry tear and revascularization of the LSA. It incorporates an adjustable proximal stent segment that optimizes sealing and reduces the risk of bird-beak formation at the proximal landing zone, while a reinforced branch-main body junction enhances fatigue resistance and long-term durability. RESULTS:We reported 2 patients presented with TBAD extending to the distal aortic arch, with the primary entry tear located just distal to the LSA zone 3. Both were successfully treated with the Cratos single-branched stent-graft, achieving complete exclusion of the entry tear and preservation of LSA flow without endoleak or neurological complications during follow-up. CONCLUSIONS:The Cratos single-branched stent-graft provides a safe and effective option for one-stage endovascular repair of aortic arch pathologies requiring zone 2 landing. Long-term follow-up and larger studies are warranted to confirm these promising early outcomes.

Background:Concave supra-arch triple branched stent-graft system (CS system) offers a new option for treating aortic arch pathologies. However, the efficacy of the innovative device still lacks objective evaluations. Patient-specific CS system design and treatment strategies remain unknown. This study aims to assess the effectiveness and to inform the patient-specific CS system design by evaluating the hemodynamic effects of key parameters. Methods:Simulations were conducted via pre- and post-operative computed tomography angiography datasets from five first-in-man study cases. Parametric studies on the CS system were developed by virtually adjusting concave degree (angle α) in scenarios with patient-specific aortic diameter. Boundary conditions were obtained through three-element Windkessel model. Quantitative and qualitative hemodynamic analyses were conducted via flow rate, pressure, time-averaged wall shear stress (TAWSS)-based parameters and energy loss. Results:CS system insertion effectively maintained supra-aortic trunks (SATs) blood flow, without significantly affecting ascending aortic (AA) pressure and hemodynamic environments, regardless of postoperative normotensive (120/80 mmHg) or hypertensive (180/140 mmHg) states. Larger concave angles improved SATs perfusion by approximately 1-2%, with hemodynamic variations becoming notably more pronounced when α increased beyond 150°. Specifically, increases in SATs flow were 0.6-0.7% from 120° to 150°, compared with 1.8-2.0% from 150° to 180°, while flow to the left subclavian artery decreased by ~0.45% and ~0.75% over the same ranges. AA pressure changes remained small, with CS implantation increasing systolic pressure by only ~1.2%. Larger aortic diameters or smaller diameter differences between AA and descending aorta (DA) further reduced postoperative AA pressure by approximately 0.1-2%. Notably, patients with smaller aortic diameters exhibited substantially larger hemodynamic changes: for example, TAWSS in the thoracic aorta increased by up to ~40% when D1 =30 mm, compared with only ~10% when D1 =48 mm. Conclusions:CS system shows improved hemodynamic features in treating aortic arch aneurysm and can maintain stability under both normotensive and hypertensive postoperative blood pressure conditions. Larger concave angle can improve surgical convenience, but may also increase the risk of pressure elevation. For patients with small aortic diameters, reducing the concave degree may help to optimize the hemodynamic environment. The findings presented herein provide objective evaluation for assessing CS system outcomes and patient-specific clinical decision making.

BACKGROUND:Thoracic aortic aneurysm (TAA) is a life-threatening disease with limited therapeutic options, largely due to an incomplete understanding of its pathogenic mechanisms. Inflammation and immune dysregulation are central to TAA progression, yet the specific pathogenic cell subsets and signaling pathways remain unclear. METHODS:Single-cell RNA sequencing was performed on aortic tissues from four healthy individuals and four TAA patients. Key immune cell populations were identified through clustering, macrophage subsetting, and M1/M2 polarization scoring. Machine learning (Random Forest and Boruta) across multiple bulk RNA-seq cohorts was used to identify robust biomarkers. Cell-cell communication was analyzed using CellChat and NewCCI. Molecular docking of 2988 FDA-approved drugs was conducted to screen potential CLEC5A inhibitors, followed by cellular validation experiments. RESULTS:A total of 105,541 cells were profiled, revealing significant alterations in macrophage, dendritic cell, and NK cell proportions in TAA. CLEC5A+ macrophages emerged as the predominant pathogenic subset, exhibiting the highest M1 polarization score. Machine learning consistently identified CLEC5A and SPP1 as stable diagnostic biomarkers across four cohorts (AUC > 0.7). Cell-cell communication revealed strong CCL5-CLEC5A signaling from T/NK cells to macrophages. Molecular docking identified Dioscin as a potential CLEC5A inhibitor. Cellular experiments showed that CCL5-induced M1 polarization was CLEC5A-dependent and could be effectively blocked by Dioscin. CONCLUSIONS:CLEC5A+M1-polarized macrophages are key pathogenic cells in TAA. CLEC5A serves as a robust biomarker, and targeting the CCL5-CLEC5A axis with Dioscin represents a promising therapeutic strategy.

Background:Stress hyperglycemia ratio (SHR) is closely related to adverse clinical outcomes. However, the link between general population all-cause mortality (ACM) and cardiovascular mortality (CVM) remains undetermined. Thus, this research was designed to investigate the associations between SHR and ACM and CVM. Methods:The research data are sourced from NHANES. The correlations between SHR and death were examined via multivariate Cox proportional hazards models. These models were adjusted for clinical, socioeconomic, and demographic characteristics. Potential nonlinear relationships were estimated via restricted cubic spline (RCS) analysis. Predictive accuracy was measured by time-dependent ROC curves, and mortality risk across SHR quartiles was examined by Kaplan-Meier survival curves. Age, sex, race, BMI, level of education, smoke, and poverty-income ratio were used as subgroups to investigate potential moderators of the effect. Results:About 1847 people died from any cause and 589 from cardiovascular disease throughout the median follow-up period of 97 months. SHR was negatively associated with ACM (HR: 0.77, 95% CI: 0.68-0.88) and CVM (HR: 0.73, 95% CI: 0.60-0.90) when SHR was below the threshold values (SHR < 0.81 in ACM and SHR< 0.84 in CVM), whereas it was positively associated with ACM (HR: 1.10, 95%CI: 1.05-1.15) and CVM (HR: 1.08, 95%CI: 1.00-1.16) when it was above the threshold values. The ROC curve revealed that the SHR may serve as a predictor of ACM and CVM. Conclusions:SHR exhibits a nonlinear, threshold-dependent association with ACM and CVM, and it may serve as a predictor of ACM and CVM.

Abdominal aortic aneurysm (AAA) is a severe vascular condition with a high mortality rate upon rupture. Emerging evidence suggests that metabolic factors, particularly plasma amino acids, may influence AAA risk, though specific causal roles remain unclear. This study investigates the causal relationship between plasma amino acids and AAA using Mendelian randomization (MR) and in vivo validation. A bidirectional two-sample MR analysis was conducted using genome-wide association study (GWAS) data. Genetic variants associated with amino acid levels and AAA served as instrumental variables, with inverse variance weighting as the primary method. Sensitivity analyses, including MR-Egger, weighted median, and leave-one-out tests, were performed to assess robustness and pleiotropy. In vivo experiments in an elastase-induced AAA mouse model evaluated the therapeutic potential of proline supplementation. MR analysis identified five amino acids causally linked to AAA risk. Specifically, increased AAA risk was linked to aspartate (OR: 1.218, P = 0.027), glutamate (OR: 1.349, P < 0.001), and glycine (OR: 1.147, P = 0.040), while proline (OR: 0.856, P = 0.005) and tryptophan (OR: 0.871, P = 0.048) were associated with reduced risks. The reverse MR analysis revealed no causal effect of AAA on these amino acids. In vivo experiments further showed that proline administration significantly inhibited the development of elastase-induced AAA in mouse models. This study presents new evidence of a causal relationship between plasma amino acids and AAA risk, providing valuable insights into AAA pathogenesis. Additionally, the findings suggest that proline supplementation could be a potential therapeutic strategy for AAA, warranting further translational research.

Background:Thoracic endovascular aortic repair (TEVAR) frequently requires coverage of the left subclavian artery (LSA) to achieve an adequate proximal landing zone, which carries the risk of LSA occlusion and associated ischaemic complications. No validated real-time intraoperative tool currently exists to assess LSA hemodynamics during TEVAR. This study aimed to identify hemodynamic predictors associated with midterm LSA patency after TEVAR involving LSA management. Methods:Patients who underwent TEVAR for aortic pathologies between April 2018 and December 2020 were retrospectively enrolled. Quantitative assessment of LSA blood flow before and after TEVAR was conducted using the angiography post-processing software, iFlow. Two key hemodynamic parameters, the differential of delayed time to peak (diff.dTTP) and peak ratio (diff.Pr) in the proximal (P), middle (M), and distal (D) areas of the LSA were extracted. LSA patency was determined through follow-up computed tomography angiography (CTA). Cox regression analysis was used to identify hemodynamic predictors for LSA patency. Results:A total of 94 patients [median age, 61 years; interquartile range (IQR), 51.00-65.75 years; 83.0% male] were included, with 7 patients (7.4%) experiencing LSA occlusion during follow-up (median duration, 1,242 days; IQR, 968-1,356 days). The diff.dTTPs were identified as independent risk factors for midterm LSA occlusion [diff.dTTP.P: hazard ratio (HR) =30.0, P<0.001; diff.dTTP.M: HR =6.1, P<0.001; diff.dTTP.D: HR =5.1, P<0.001]. These hemodynamic parameters provided incremental prognostic value for midterm LSA occlusion [diff.dTTP.P: area under the curve (AUC) =0.957; diff.dTTP.M: AUC =0.921; diff.dTTP.D: AUC =0.938]. Conclusions:iFlow provides a real-time quantitative approach for evaluating LSA hemodynamics during TEVAR. The diff.dTTP values can predict midterm LSA patency and may guide LSA management strategies during TEVAR.

Background Mesotherapy, a widely utilized minimally invasive cosmetic procedure, carries potential risks of adverse reactions due to non-standardized protocols and overuse. Delayed granulomatous reactions represent a chronic complication, imposing significant physical and psychological burdens on patients. Objective This case series aims to evaluate the efficacy and safety of tofacitinib in managing non-infectious granulomatous reactions following mesotherapy. Methods This retrospective analysis included six patients diagnosed with non-infectious granulomatous reactions post-mesotherapy, treated at Peking Union Medical College Hospital between October 2021 and April 2025. All patients received oral tofacitinib. Clinical outcomes, treatment regimens, and safety profiles were assessed. Results All six patients demonstrated significant improvement in skin lesion severity, with no treatment-related adverse events observed during follow-up. Conclusion Oral tofacitinib exhibits promising clinical efficacy and a favorable safety profile for non-infectious granulomatous reactions induced by mesotherapy, positioning it as a viable therapeutic option during the inflammatory phase.

Abdominal aortic aneurysm (AAA) is a degenerative vascular disease with a high mortality rate of rupture, yet effective pharmacological interventions to delay its progression or prevent rupture remain unavailable. Vascular calcification (VC), a prominent pathological feature of AAA, exhibits a paradoxical role. Clinical and biomechanical studies confirm that VC exerts a dual effect: it accelerates AAA progression by inducing local stress concentration, while simultaneously providing mechanical stability through global load-sharing effect. This functional paradox may stem from a dynamic imbalance between anabolic and catabolic processes at the cellular and molecular levels. Specifically, microcalcification is mediated by the osteogenic transition of vascular smooth muscle cells (VSMCs), whereas the osteoclastic transformation of macrophages contributes to the ultimate matrix degradation. Furthermore, the impacts of vascular aging, sex differences, and metabolic dysregulation between VC and AAA are briefly summarized. This review systematically synthesizes multi-scale evidence to elucidate the dual role of VC in AAA progression, proposing a non-linear dynamic trajectory linking microcalcification initiation to macrocalcification maturation during aneurysm progression. Finally, it also emphasizes that future research should shift from assessing static calcification burden toward dynamically monitoring the metabolic activity of microcalcification, as well as discussing emerging therapeutic targets. This perspective offers new insights for early risk stratification and precise intervention in AAA.

Objective Our purpose is to compare the clinical outcomes of the covered endovascular reconstruction of the aortic bifurcation (CERAB) and the kissing stent technique in the treatment of aortoiliac occlusive disease (AIOD). Methods We conducted a retrospective review of consecutive patients with AIOD who underwent either CERAB or kissing stent procedures at a tertiary referral center in China between December 2015 and January 2025. Baseline characteristics, procedural details, ankle-brachial index (ABI), early complications, and patency rates were compared. Kaplan–Meier analysis assessed primary/secondary patency and freedom from reintervention. Multivariate Cox regression analysis was performed to identify the independent predictors of primary patency. Results A total of 75 AIOD patients were included, including 57 patients (76.0%) in the Kissing stent group and 18 patients (24.0%) in the CERAB group. Technical success (100% vs. 98.2%, P = 1.000) and 30-day mortality (0% vs. 3.5%, P = 1.000) did not differ significantly between the groups. Both groups showed significant ABI improvement. The 5-year primary patency was lower with CERAB (57.2% vs. 74.4%, P = 0.012), but the difference was nonsignificant after multivariate adjustment (P = 0.100). Secondary patency (88.5% vs. 89.8%, P = 0.180) and freedom from reintervention (61.4% vs. 78.9%, P = 0.170) were comparable. Multivariate analysis identified access route, femoral artery stenosis, and stent diameter as independent predictors of primary patency. Conclusions Both techniques are safe and effective. Anatomic factors and procedural details exert a greater influence on clinical outcomes than the choice of technique itself. Therefore, preprocedural planning should emphasize individualized anatomical assessment and meticulous surgical execution.

AIMS:Heart failure (HF) is a major global public health challenge, with obesity being one of its key risk factors. Although several HF risk prediction models have been developed in the general population, few are specifically tailored to individuals with obesity. This underscores the urgent need for precise biomarkers to improve individual risk stratification and enable personalized prevention strategies. We aimed to develop and validate a plasma proteomics-based protein risk score (PRS) to predict incident HF among individuals with obesity. MATERIALS AND METHODS:We analysed 9831 participants with obesity (BMI ≥ 30 kg/m2) from the UK Biobank with baseline measurements of 2911 circulating proteins and up to 16 years of follow-up. Multivariable Cox regression identified proteins associated with incident HF after comprehensive covariate adjustment. A PRS was constructed using LASSO regression and evaluated in a held-out test set. Protein trajectories before HF onset were reconstructed using LOESS modelling. To enhance clinical feasibility, a minimal protein panel was identified using LightGBM with forward feature selection. RESULTS:A total of 727 participants developed HF during follow-up. Multivariable cox analyses identified 578 proteins significantly associated with HF. LASSO regression further selected 81 proteins to build the PRS, which showed a strong association with HF risk in both training (HR 3.57; 95% CI 3.19-4.00) and test cohorts (HR 2.45; 95% CI 2.20-2.74). Adding the PRS improved prediction beyond age and sex (ΔC = 0.091) and beyond the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) model (ΔC = 0.052), with consistent gains in NRI and IDI. Proteomic deviations were detectable up to 16 years before diagnosis. A four-protein panel (GDF15, NT-proBNP, TNFRSF10B, CTHRC1) achieved robust discrimination (AUC 0.789), outperforming NT-proBNP alone (AUC 0.695) and complementing the PCP-HF model (combined AUC 0.803). DISCUSSION:Large-scale plasma proteomics substantially improves HF risk prediction in individuals with obesity and reveals long-standing molecular alterations preceding clinical onset. A simplified four-protein panel maintains robust predictive accuracy and provides a practical approach for the early detection and targeted prevention of obesity-related HF.

Repairing abnormal vessels in the complex fluidic and biological environment of blood remains challenging. Current approaches, such as non-adhesive polymeric sealants or vessel coiling, have unsatisfactory outcomes. Here, we present an injectable magnetoactive adhesive hydrogel (iMAH) for vascular repair in the challenging blood environment. Designed with biocompatible functional components, including the superparamagnetic component, a bio-inspired tissue adhesive, and quick-crosslinking agents, the catheter-deployable iMAH can be magnetically guided to a targeted site, quickly crosslink within approximately 2 s, and strongly adhere to the vessel surface in dynamic conditions with circulating and pressurized blood. Moreover, magnetic actuation enables targeted gel deployment and can drive the iMAH into a narrow and confined space, squeezing out interfacial fluid to facilitate high-strength tissue adhesion, as systematically investigated in vitro. Magnetically controlled delivery of iMAH for vascular repair has been demonstrated in a large-animal beagle dog model; branching lumbar arteries from the abdominal aorta, mimicking the opening of a ruptured artery, were successfully embolized under magnetic guidance using a 5-axis magnetic vascular robot. With these demonstrated features, magnetically controlled delivery of injectable magnetoactive adhesive hydrogel provides a promising solution for vascular repair such as sealing ruptured vessels or embolizing abnormal arteries in the challenging blood environment.