ObjectivesPostoperative hypotension is one of the common and serious complications following carotid endarterectomy (CEA). Early identification of high-risk patients is significance for improving perioperative management. This study aims to develop and validate a nomogram model for predicting post-CEA hypotension.MethodsThis single-center retrospective study included 527 patients with carotid artery stenosis who underwent CEA. They were randomly divided into a training cohort (n = 369) and an internal validation cohort (n = 158) at a ratio of 7:3. The demographic characteristics, clinical data and perioperative data of patients were collected in the hospital medical record system. The least absolute shrinkage and selection operator (LASSO) regression was used for predictor selection, and a postoperative hypotension risk prediction model was developed based on multivariable logistic regression, which was then visualized as a nomogram. The discrimination, calibration, and clinical utility of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).ResultsPostoperative hypotension occurred in 88 of 527 patients (17%). Eight predictors were included in the nomogram model, including plaque length above the carotid bifurcation, diabetes mellitus, hypertension, symptomatic stenosis, contralateral carotid stenosis, homocysteine, operation duration, and surgical treatment. The model achieved good discrimination in the training and internal validation cohorts, with AUCs of 0.864 (95% CI, 0.814–0.914) and 0.868 (95% CI, 0.792–0.944), respectively, and showed good calibration and clinical utility.ConclusionThis study developed and validated a nomogram model for predicting post-CEA hypotension, which can provide a reference for patient risk assessment and individualized perioperative management.

Objective: The Wound, Ischemia, and foot infection (WIfI) classification is widely used for risk stratification in patients with chronic limb-threatening ischemia (CLTI). However, its prognostic performance in patients with chronic kidney disease (CKD) undergoing infrapopliteal endovascular revascularization remains unclear. This study aimed to evaluate the prognostic value of WIfI staging in this high-risk population. Methods: This subgroup analysis was derived from the PRIME-WIFI study, a prospective, multicenter, real-world registry. Patients with infrapopliteal CLTI (Rutherford categories 4–6) and coexisting CKD who underwent endovascular revascularization were included. WIfI stage was assessed at baseline for each limb. The primary outcome was 12-month freedom from major adverse events (F-MAE), defined as a composite of major amputation, all-cause mortality, and re-intervention. Secondary outcomes included amputation-free survival (AFS), all-cause mortality, major amputation, and target-limb re-intervention. Time-to-event analyses were performed using Kaplan–Meier methods and Cox proportional hazards models, with Firth’s penalized Cox regression applied for endpoints with limited events. Results: A total of 147 patients (156 limbs) with CKD were included. A borderline association was observed between WIfI stage and F-MAE when WIfI was modeled as an ordinal variable (hazard ratio [HR] per stage increase, 1.36; 95% confidence interval [CI], 0.99–1.86; p = 0.055). WIfI stage was independently associated with worse AFS (HR per stage increase, 1.65; 95% CI, 1.15–2.36; p = 0.006) and increased all-cause mortality (HR per stage increase, 1.55; 95% CI, 1.06–2.28; p = 0.024). In contrast, WIfI stage was not significantly associated with limb-specific outcomes, including major amputation or re-intervention. Conclusions: In patients with infrapopliteal CLTI and coexisting CKD undergoing endovascular revascularization, the WIfI classification retained prognostic value for systemic outcomes, particularly AFS and all-cause mortality, whereas its association with F-MAE was borderline. By contrast, its association with limb-specific events may be less apparent in this cohort. These findings suggest that the prognostic performance of the WIfI classification for limb-related outcomes may be attenuated in the setting of CKD; however, this observation remains exploratory and requires confirmation in larger, prospective studies.

Background: Carotid artery stenosis represents a significant risk factor for ischemic stroke; yet stenosis severity alone imperfectly predicts risk. This research aimed to assess how plaque vulnerability features, visualized through high-resolution 3D black-blood magnetic resonance imaging (MRI), correlate with recent ischemic stroke event. Methods: A total of 215 patients with carotid artery stenosis who underwent high-resolution MRI of the neck vessels at our hospital from June 2022 to June 2024 were included in this retrospective cohort analysis. Patients were stratified into Acute Ischemic Stroke (AIS, n = 124) and non-AIS (n = 62) groups based on stroke occurrence within three months prior to MRI. Plaque characteristics were assessed, including components (e.g., intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC)), vulnerability classification (modified American Heart Association criteria), Plaque Reporting and Data System (Plaque-RADS) score, and stenosis degree. Results: A total of 287 carotid arteries (196 AIS, 91 non-AIS) were analyzed. Vulnerable plaque components (IPH, LRNC, thin/ruptured fibrous cap, thrombus, active inflammation) were markedly more frequent in the AIS group (all P < 0.05). Vulnerable plaques (modified AHA types IV-V & VI) were observed more often in the AIS group (60.20% vs. 31.87%, P < 0.001), as were high-risk Plaque-RADS scores (Score 4: 34.69% vs. 9.89%, P < 0.001). Stenosis was also more severe in the AIS group (P = 0.003). A combined model (Plaque-RADS, IPH, LRNC) showed high predictive value (AUC = 0.937). Conclusion: High-resolution 3D black-blood MRI identifies vulnerable plaque features strongly associated with recent ischemic stroke, providing enhanced risk stratification beyond stenosis assessment.

Objective Contrast-induced acute kidney injury (CI-AKI) is a serious complication following endovascular procedures, yet its risk profile in patients with peripheral vascular disease (PVD) remains poorly defined. This study aimed to identify independent risk factors for CI-AKI in PVD patients undergoing diagnostic or therapeutic endovascular interventions, with the goal of discovering strategies to reduce the incidence of CI-AKI. Methods A retrospective cohort study was conducted on 782 consecutive PVD patients who underwent endovascular procedures in the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, between January 2018 and December 2024. Baseline demographic data, comorbidities, and laboratory parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of CI-AKI. Results Postprocedural CI-AKI occurred in 54 patients (6.9%). Multivariate logistic regression analysis revealed that: Remote ischemic preconditioning (RIPC) (OR = 0.090, 95%CI: 0.011–0.715, P = 0.023) and hemoglobin level (OR = 0.965, 95%CI: 0.949–0.981, P < 0.001) were protective factorsagainst CI-AKI; Carotid artery stenting (OR = 3.338, 95%CI: 1.712–6.505, P < 0.001), history of diuretic use(OR = 2.726, 95%CI: 1.170–6.349, P = 0.020), and uric acid level (OR = 1.005, 95%CI: 1.003–1.008, P < 0.001) were independent risk factors for CI-AKI. Conclusion Remote ischemic preconditioning exerts a significant and potent protective effect against CI-AKI in PVD patients undergoing endovascular interventions. Carotid artery intervention, diuretic use, and hyperuricemia are major risk factors. These findings provide a simple, low-cost, and non-invasive preventive strategy for perioperative renal protection in high-risk populations, warranting further validation in large-scale prospective studies. Level of Evidence: Level III, Retrospective cohort study.

BackgroundPopliteal artery entrapment syndrome (PAES) is a rare anatomical anomaly that may rarely lead to secondary popliteal artery aneurysm (PAA). We present a case in which chronic extrinsic compression culminated in a giant PAA, highlighting the diagnostic workflow and surgical strategy.Case presentationA 50-year-old man presented with a 2-year history of exercise-induced pain and numbness in the right lower limb. On examination, popliteal and distal pulses were absent. Duplex ultrasound showed a 4.1 cm saccular popliteal artery aneurysm (PAA) containing a 15 mm mural thrombus; CT angiography revealed moderate-to-severe stenosis of the proximal popliteal artery. Intra-operatively, the popliteal artery was found compressed and occluded by the medial head of the gastrocnemius, confirming popliteal artery entrapment syndrome; after partial myotomy to release the vessel, only the eccentric aneurysmal sac wall was excised while the macroscopically normal-appearing arterial wall was preserved, and the artery was reconstructed with an autologous small-saphenous-vein patch angioplasty.DiscussionPAES-induced PAA is uncommon; failure to recognise the underlying entrapment risks could lead to incorrect endovascular treatment. Open decompression combined with venous bypass remains the gold standard when the artery is structurally damaged.ConclusionClinicians encountering an isolated PAA in a relatively young patient should actively exclude PAES. Timely surgical decompression and revascularisation can prevent thrombo-embolic complications and limb loss.

OBJECTIVE:Femoropopliteal in stent re-stenosis (ISR) remains a significant challenge following endovascular peripheral artery occlusive disease procedures, with Tosaka III lesions representing the most complex form of complete occlusive re-stenosis. Limited prospective, observational study data have focused on endovascular treatment of femoropopliteal Tosaka III ISR. METHODS:The FP-RESTORE study was a prospective, observational study involving 13 Chinese hospitals from April 2021. It enrolled 322 consecutive patients (353 limbs) with femoropopliteal Tosaka III ISR undergoing endovascular intervention. Primary endpoints were clinically driven target lesion revascularisation (CD-TLR) and major adverse limb events (MALE) at 24 months. Competing risk regression analysis was performed to identify independent predictors of adverse outcomes. RESULTS:Of the enrolled patients, the mean age was 71.6 ± 9.1 years, with 54.67% presenting Rutherford grade > 3. Average occlusive lesion length was 22.0 ± 10.5 cm, with suspected thrombotic components presenting in 46.74% of lesions. Technical success rates were 96.88%. Ankle brachial index (ABI) improved statistically significantly from 0.33 ± 0.2 to 0.77 ± 0.22 post-operatively; ABI improved by more than 0.2 after the procedure and this was observed in 85.8% of patients. The follow up rate was 86.0% with a median follow up duration of 24.5 months. At 24 months, the CD-TLR rate was 21.4% (95% confidence interval [CI] 16.82 - 25.93%) and MALE rate was 27.2% (95% CI 22.26 - 32.21%). The all cause mortality rate was 14.3%. Independent predictors of CD-TLR and MALE included multiple previous procedures and popliteal artery (P2 and P3) involvement. CONCLUSION:Endovascular treatment for femoropopliteal Tosaka III ISR achieved acceptable immediate and 24 month outcomes. Multiple previous procedures and popliteal artery involvement were key predictors of adverse events, suggesting valuable guidance for risk stratification and treatment modification in this challenging patient population.

Background The Wound, Ischemia, and Foot Infection (WIfI) classification system was proposed to improve risk stratification and prognostic prediction in chronic limb-threatening ischemia patients. Objectives The aim of this prospective, multicenter observational study was to evaluate the prognostic value of the WIfI classification in patients with infrapopliteal arterial occlusive disease undergoing endovascular therapy. Methods Patients from 10 Chinese centers were enrolled. The primary outcome was 12-month freedom from major adverse events (MAE), which was a composite of major amputation, all-cause death, and clinically driven target limb reintervention. Secondary outcomes included amputation-free survival and the composite components of the primary outcome. Results This study involved 944 patients (975 limbs). Cox regression analysis identified WIfI stage as an independent predictor of MAE (HR: 1.23; 95% CI: 1.06-1.43; P = 0.007). Additionally, WIfI stage was independently associated with combined major amputation or all-cause death (HR: 1.41; 95% CI: 1.18-1.69; P < 0.001) and with all-cause death alone (HR: 1.38; 95% CI: 1.12-1.70; P = 0.002). WIfI stage 4 carried a consistently higher risk for these 3 endpoints compared with stages 1 to 3. Although WIfI stage was independently linked to major amputation, pairwise comparisons did not show significant differences among stages. No independent association was observed between WIfI stage and clinically driven target lesion reintervention. Conclusions Although the WIfI classification system shows predictive ability for MAE, amputation-free survival, major amputation, and all-cause death, the prognostic differences are driven primarily by stage 4.

This study aimed to compare directional atherectomy (DA) and plain old balloon angioplasty (POBA) for vessel preparation before drug-coated balloon (DCB) therapy in moderately to severely calcified peripheral artery disease. This study is a sub-analysis of the Evolusion study. Inverse probability weighting was applied to balance the two groups. The primary endpoints were freedom from major adverse events (f-MAE), freedom from all-cause mortality (f-ACM), and major adverse limb events (MALE). Secondary endpoints included Rutherford classification improvement rate, bailout stent implantation rate, and bailout stent length. A total of 337 patients were included (254 in POBA group, 83 in DA group). POBA had higher bailout stent implantation rate (28.7

BACKGROUND:In 2024, several researchers introduced the concept of "woundosome" in an editorial, highlighting the need to prioritize perfusion and microcirculation function within patient wound areas. Building upon this foundation, we systematically compared this concept with the previously established angiosome theory. METHODS:A comprehensive search was performed across the Cochrane Central Register of Controlled Trials, Embase, and PubMed. Twenty-five relevant studies met the inclusion criteria, including four investigations using wound blush (WB). We implemented a Bayesian network meta-analysis to evaluate angiosome-related studies and reviewed the literature on WB. Within the framework of the network meta-analysis, therapeutic efficacy was compared among direct revascularization (DR), indirect revascularization (IR), and indirect revascularization with collateral vessels (IRc). Primary outcome measures encompassed wound healing rate (WHR), amputation-free survival (AFS), and limb salvage rate (LSR). RESULTS:The network meta-analysis revealed that DR was significantly better than IR in WHR outcomes at 3, 6, and 12 months, as well as in the overall analysis. In addition, IRc demonstrated a significant advantage over IR in both the 12-month and overall analyses. The surface under the cumulative ranking curves (SUCRA) values for WHR indicated that DR achieved the highest ranking at 3, 6, and 12 months after surgery. IRc SUCRA values at 6 months, 12 months, and in the overall analysis were comparable to those of DR. In terms of AFS, DR showed significantly better results than IR at 6 months, 12 months, and in the overall analysis. LSR analysis indicated that both DR and IRc were significantly superior to IR at 12 months and in the overall analysis. The SUCRA curves for AFS and LSR revealed that DR and IRc had similar SUCRA values and higher compared with IR. In the second part of the study, we reviewed research related to WB. Our findings indicated that WHR, LSR, and AFS were significantly higher in the WB+ group compared with the WB- group. The benefit of LSR in WB+ patients persisted for over 3 years, whereas there was no significant difference in DR/IR between the two groups. Notably, the proportion of DR patients in the WB+ group was higher than that in the WB- group, suggesting that DR may increase the likelihood of WB+. CONCLUSIONS:For endovascular treatment of critical limb-threatening ischemia disease, DR and IRc exhibit comparable efficacy across all three end points and are both superior to IR. WB reflects a focus on wound microcirculation and appears to better inform intraoperative decision-making and predict favorable clinical outcomes.

BackgroundPrevious studies have suggested site-specific differences in lesion distribution and risk factor profiles in peripheral artery disease (PAD). However, these associations have not been systematically evaluated within a broader framework incorporating disease extent, clinical severity, and systemic vascular involvement.MethodsWe conducted a retrospective cohort study of 3548 patients with lower extremity PAD. Lesion distribution was classified as aortoiliac (AI), femoropopliteal (FP), or infrapopliteal (IP) in patients with single-site disease, while disease extent was defined as single-site versus multisite involvement (>= 2 segments). Ordinal logistic regression was used to assess associations with lesion distribution and multivariable logistic regression to evaluate disease extent, clinical severity, and vascular comorbidities. Stratified and sensitivity analyses were performed.ResultsDistinct patterns of association were observed across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. Age and diabetes were strongly associated with distal lesions, whereas smoking was associated with proximal disease. Lipid-related variables showed heterogeneous associations that varied across individual lipid measures and were modified by diabetes status and age. In contrast, disease extent was more strongly associated with smoking and hypertension, but not diabetes. Disease extent, as reflected by multisite involvement, was independently associated with increased disease severity and a higher prevalence of cerebrovascular disease (CeVD), indicating a greater systemic atherosclerotic burden.ConclusionsCardiovascular risk factors exhibit differential associations across multiple dimensions of PAD, including lesion distribution, disease extent, and clinical severity. These findings highlight the multidimensional and heterogeneous nature of PAD and support more individualized, site-specific approaches to risk assessment and management. In particular, these findings suggest the potential value of tailoring risk factor control according to lesion characteristics, such as emphasizing smoking cessation in proximal disease and optimizing glycemic control in distal disease.

BACKGROUND:To evaluate drug-coated balloon (DCB) effectiveness for femoropopliteal disease in diabetic versus nondiabetic patients, using propensity score matching. METHODS:This multicenter registry analyzed 1,779 patients completing 1-year follow-up from 2,356 enrolled patients undergoing DCB treatment. Propensity matching, based on diabetes status, created 597 matched pairs balanced across 23 demographic and lesion characteristics. Primary endpoints included freedom from clinically driven target lesion revascularization and major adverse events at 12 months. Amputation-free survival and freedom from amputation outcomes were specifically analyzed in the chronic limb-threatening ischemia (CLTI) subgroup. RESULTS:Freedom from clinically driven target lesion revascularization rates were equivalent between diabetic and nondiabetic patients (93.63% vs. 93.84%, P = 0.912), confirming consistent DCB efficacy. Technical success exceeded 98% in both cohorts. Overall survival was 91.68% in diabetic patients versus 95.74% in nondiabetic patients (P = 0.009). In the CLTI subgroup (n = 431; diabetic patients n = 220, nondiabetic patients n = 211), amputation-free survival demonstrated significant risk stratification between diabetic and nondiabetic patients (81.39% vs. 90.19%, P = 0.022, hazard ratio 1.895, 95% confidence interval 1.117-3.214), while freedom from amputation remained excellent without significant difference between diabetic and nondiabetic patients (99.02% vs. 97.92%, P = 0.397, hazard ratio 0.488, 95% confidence interval 0.098-2.418). CONCLUSION:DCB angioplasty demonstrates comparable technical success and freedom from target lesion revascularization in diabetic and nondiabetic patients. However, diabetic patients exhibited significantly lower overall survival and, in the CLTI subgroup, reduced amputation-free survival, despite similar freedom from amputation rates.

Background Peripheral artery disease (PAD) caused by atherosclerotic stenosis or occlusion of the arteries of the lower extremities is a major global health concern. Despite advances in endovascular therapies, treating complex lesions such as heavily calcified segments and chronic total occlusions remains challenging, which limits procedural success and long-term patency. The novel 355-nm cold laser atherectomy (CLA) system offers a photochemical, low-thermal approach to plaque ablation, with potential advantages in safety and efficacy. Objectives The aim of this study was to evaluate the safety and efficacy of a 355-nm CLA system for treating lower limb atherosclerotic stenosis and occlusion in a prospective, multicenter, randomized controlled trial. Methods This trial enrolled 110 patients with symptomatic lower extremity PAD (Rutherford classes 2-5) and ≥70% stenosis or occlusion. Patients were randomly assigned to the CLA and excimer laser atherectomy (ELA) groups. The primary endpoint was improvement in vessel diameter stenosis (DS%) prior to any adjunctive therapy. Secondary endpoints included primary patency, target lesion revascularization (TLR), Rutherford classification improvement, and ankle-brachial index values at 30 days and 6 months postoperatively, as well as a device-oriented composite endpoint. Results A total of 109 patients (CLA, n = 58; ELA, n = 51) were included in the analysis. Baseline demographics and comorbidities were well balanced between the groups. Postprocedural DS% improved significantly in both groups, with no significant intergroup differences (CLA, 59.92% ± 15.02%; ELA, 57.52% ± 17.22%; P = 0.438). The mean improvement in DS% (CLA, 34.28%; ELA, 34.35%) met the noninferiority threshold. At 30 days, the primary patency rates were 85.1% (CLA) and 87.8% (ELA), with TLR rates of 0.0% and 1.9%, respectively. At 6 months, patency decreased to 71.7% (CLA) and 61.5% (ELA), and TLR occurred in 6.5% and 10.2% of patients, respectively (P = 0.698). Ankle-brachial index values and Rutherford classification improved similarly in the 2 groups. Subgroup analyses revealed that for TASC (Trans-Atlantic Inter-Society Consensus) C/D and long lesions (≥10 cm), CLA had lower TLR rates at 6 months (P < 0.05), suggesting potential advantages for complex lesions. Conclusions The 355-nm CLA system showed similar safety and efficacy to the excimer laser, with a trend toward reducing TLR in complex PAD lesions. These findings highlight its potential as a next-generation endovascular tool that could refine revascularization strategies and improve patient outcomes in clinical practice. (DCB for Dialysis Access Stent Graft Restenosis; NCT03360279)

BackgroundDiabetic foot ulcers represent a significant clinical challenge requiring comprehensive knowledge of classification systems and surgical intervention strategies. The BOPPPS (Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, Summary) teaching model has gained increasing attention in medical education, yet its effectiveness in vascular surgery residency training remains underexplored.ObjectiveThis study aimed to evaluate the effectiveness of the BOPPPS teaching model in standardized training for vascular surgery residents regarding diabetic foot Wagner classification and surgical intervention strategies.MethodsThis retrospective cohort study included 196 vascular surgery residents who underwent standardized training at the Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University from January 2023 to December 2024. Based on their training rotation schedule, residents were allocated to either an experimental group (n = 98) receiving BOPPPS-based instruction or a control group (n = 98) receiving traditional teaching methods. Primary outcomes included theoretical examination scores, clinical skill assessment (Mini-CEX and DOPS), self-directed learning readiness (SDLRS), critical thinking disposition (CTDI-CV), and teaching satisfaction.ResultsThe experimental group demonstrated significantly higher theoretical examination scores (82.47 ± 8.63 vs. 74.85 ± 9.21, p < 0.001) and Mini-CEX scores (7.84 ± 1.12 vs. 6.93 ± 1.28, p < 0.001) compared to the control group. DOPS scores for wound debridement (8.12 ± 0.95 vs. 7.23 ± 1.18, p < 0.001), vascular assessment (7.96 ± 1.08 vs. 7.14 ± 1.25, p < 0.001), and amputation level determination (7.78 ± 1.15 vs. 6.89 ± 1.32, p < 0.001) were significantly improved in the BOPPPS group. Self-directed learning readiness scores increased significantly in the experimental group (168.52 ± 18.74 vs. 153.28 ± 21.36, p < 0.001), and critical thinking disposition scores were notably higher (292.84 ± 28.65 vs. 271.35 ± 31.42, p < 0.001). Teaching satisfaction rates reached 94.9% in the experimental group versus 78.6% in the control group (p < 0.001).ConclusionThe BOPPPS teaching model significantly enhances the effectiveness of standardized training for vascular surgery residents in diabetic foot management, improving theoretical knowledge, clinical competence, self-directed learning ability, and critical thinking disposition.

OBJECTIVE:The objective of this study was to investigate the relationship between preoperative below-the-knee (BTK) runoff and major adverse limb event (MALE)-free survival, as well as clinically-driven target lesion revascularization (CD-TLR) and all-cause mortality, in patients with femoropopliteal occlusive disease (FPOD) treated with drug-coated balloons (DCB). METHODS:A large-scale, multicenter, prospective study was initiated in January 2021. Endpoint outcomes were obtained prior to December 31, 2024. The exposure of interest was BTK runoff, with the primary endpoint being MALE-free survival, and secondary endpoints being CD-TLR and all-cause mortality. Multivariate Cox regression was employed to control for confounding variables, and stratified analyses were conducted. RESULTS:A total of 1757 participants (36.1% male) with a mean (SD) age of 71.2 (9.5) years were enrolled in the study. The median follow-up duration was 1.5 years. In the fully adjusted model, 1 runoff, 2 runoff and 3 runoff were associated with significantly lower incidences of MALE or death compared with 0 runoff (1 runoff: hazard ratio [HR]=0.75, 95% confidence interval [CI]: 0.56, 1.00, p=0.054; 2 runoff: HR = 0.63, 95% CI: 0.46, 0.87, p=0.006; 3 runoff: HR=0.49, 95% CI: 0.34, 0.72, p<0.001). In addition, 3 runoff demonstrated a lower incidence of CD-TLR (HR=0.56, 95% CI: 0.35, 0.90, p=0.017) and all-cause mortality (HR=0.47, 95% CI: 0.25, 0.89, p=0.021) compared with 0 runoff. There was a significant trend toward reduction in the incidence of all 3 endpoints with increasing numbers of BTK runoff vessels (p for trend <0.05). The relationship between BTK runoff and the endpoints was consistent across all subgroups, with no significant interaction observed. CONCLUSIONS:In patients with FPOD treated with DCB, a higher number of BTK runoff vessels was significantly associated with fewer MALE or death, fewer CD-TLR, and fewer deaths. This association was independent of traditional cardiovascular risk factors and represents an important stratification factor for patient outcomes (The PROMISING Study, NCT04826705).Clinical ImpactThis large, prospective multicenter study demonstrates that preoperative below-the-knee (BTK) runoff remains a strong and independent prognostic factor in patients undergoing femoropopliteal drug-coated balloon (DCB) therapy. Despite the antiproliferative benefits of DCBs, distal hemodynamics continue to influence procedural durability and long-term limb outcomes. Our findings show a graded reduction in MALE, CD-TLR, and mortality with increasing runoff vessels, independent of lesion complexity, stent implantation, and concomitant outflow intervention. These results reinforce the importance of systematic preprocedural runoff assessment and support incorporating BTK runoff into risk stratification, patient counseling, and surveillance planning in contemporary endovascular practice.

This study aims to evaluate the 12-month clinical outcomes of drug-coated balloon (DCB) treatment for infrapopliteal chronic limb-threatening ischemia (CLTI) in a real-world setting, and to provide evidence to inform clinical decision-making. Based on the PRIME-WIFI multicenter prospective registry, 538 patients (553 limbs) from 10 centers were consecutively enrolled between December 2020 and June 2023. All patients underwent infrapopliteal DCB angioplasty and were included in the 12-month outcome analysis. The primary endpoint was the freedom from major adverse events (MAE), including major amputation, all-cause mortality, and clinically driven target limb reintervention (CD-TLR). Secondary endpoints included amputation-free survival (AFS), sustained clinical improvement, and quality of life. The Kaplan–Meier method was used to estimate event rates, and Cox regression was applied to identify independent predictors of 12-month MAE. The 12-month MAE-free rate was 75.5

PURPOSE:To compare the 2-year outcomes of drug-eluting stents (DES) versus drug-coated balloons (DCB) plus bare-metal stents (BMS) in patients with femoropopliteal artery disease. MATERIALS AND METHODS:Data were analyzed from The Impact of Tibial Runoff on Clinical Outcome of Endovascular Therapy in Femoropopliteal Lesions (TALENT) study, a multicenter, prospective study. Inverse probability of treatment weighting was applied to balance baseline characteristics. The primary outcomes were freedom of all-cause mortality, freedom of major adverse events, clinically driven target lesion revascularization (CD-TLR), and major adverse limb events (MALEs), and the secondary outcomes were the improvement in Rutherford classification and changes in quality of life assessed by the 25-item Vascular Quality of Life questionnaire. RESULTS:A total of 429 patients were included (81 in DES group; 348 in DCB plus BMS group). During a median (Q1-Q3) follow-up of 20.2 months (11.6-27.1 months), no significant differences were observed between the 2 groups in 2-year freedom of all-cause mortality (91.4% vs 85.1%; P = .096), freedom of major adverse events (79.6% vs 73.9%; P = .330), CD-TLR (9.6% vs 12.6%; P = .737), and MALEs (10.1% vs 12.3%; P = .612). Both treatment modalities significantly improved in VascuQol score and Rutherford classification, with improvement rates of 76.1% and 71.3% at 24 months, respectively. An interaction effect (P = .014 and .005, respectively) was observed for patients with intermittent claudication (R2-R3), suggesting that DES may be associated with lower risks of CD-TLR and MALEs. CONCLUSIONS:Over the 2-year follow-up, DES and DCB plus BMS demonstrated favorable and comparable overall effectiveness in real-world patients with complex femoropopliteal lesions.

This retrospective multicenter cohort study from the PROMISING registry compared directional atherectomy (DA) and plain old balloon angioplasty (POBA) as vessel preparation before drug-coated balloon (DCB) therapy for femoropopliteal occlusive disease. After propensity score matching, 147 DA-treated and 480 POBA-treated patients were analyzed with well-balanced baseline characteristics. DA markedly reduced the need for stent implantation (8.8% vs. 20.4%) and shortened total stent length, while allowing subsequent use of larger-diameter DCBs. Major peri-operative complications were rare in both groups, but minor complications were more frequent after DA. Postoperative ankle-brachial index and Rutherford classification improved significantly in both groups, without intergroup differences. During 24-month follow-up, Kaplan-Meier analysis showed no significant differences between DA and POBA in all-cause mortality, clinically driven target lesion revascularization, amputation-free survival, or major adverse limb events. Subgroup analyses revealed that patients with chronic total occlusion (CTO) derived greater benefit from DA, with a significant interaction (P for interaction = 0.002), whereas outcomes were consistent across other subgroups. Overall, DA before DCB therapy effectively reduces stent use and enhances vessel preparation without compromising long-term efficacy or safety, supporting its selective application in complex femoropopliteal lesions, particularly those with CTO.

OBJECTIVE:Real-world evidence comparing dual-pathway inhibition (DPI) with dual antiplatelet therapy (DAPT) after endovascular revascularization for acute or nonacute limb ischemia is limited. This study aims to compare the 24-month effectiveness and safety outcomes of DPI versus DAPT in this setting. METHODS:This prospective, multicenter observational study from the RESOLVE registry used propensity score matching (PSM) to analyze patients receiving DPI or DAPT after endovascular revascularization. The primary endpoint was 24-month major adverse events (MAE) including recurrent acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, or cardiovascular death. Secondary endpoints included major adverse limb events (MALE), major adverse cardiovascular events (MACE), and all-cause death. RESULTS:After PSM, 109 matched pairs were analyzed. The DPI group had significantly lower 24-month MAE incidence than the DAPT group (11.47% vs 28.45%; HR = 2.83; P < .01), as well as lower MALE (16.83% vs 28.40%; HR = 1.83; P = .04) and all-cause death (2.94% vs 11.65%; HR = 4.28; P = .02). MACE showed a trend toward lower incidence with DPI (2.00% vs 7.77%; HR = 4.22; P = .07). No major bleeding events were observed in either group. Modified SVS run-off score >10 and chronic limb-threatening ischemia predicted greater DPI benefit (P for interaction=.020 and .031). CONCLUSIONS:In this PSM analysis, DPI was associated with significantly lower 24-month rates of MAE, MALE, and all-cause death compared with DAPT. No major bleeding events were observed in either group. These findings suggest a potentially favorable efficacy profile for DPI but warrant confirmation in further randomized controlled trials.

Isolated superior mesenteric artery dissection (ISMAD) is a rare vascular surgical disease. Its symptoms have no obvious specificity, and it is easy to be misdiagnosed or missed. This paper reports a patient with peritoneal metastasis who was eventually diagnosed with ISMAD presenting with abdominal pain, highlighting the diagnostic challenge and the importance of considering vascular emergencies in oncology patients.

INTRODUCTION:Chronic venous disease (CVD) is a widespread disease characterized by various clinical manifestations. This manuscript is Part II of a systematic literature review and meta-analysis assessing the effects of micronized purified flavonoid fraction (MPFF) on lower limb symptoms and signs in patients with CVD at all stages of the disease. Part I examined symptoms and Part II presented herein focused on signs. EVIDENCE ACQUISITION:A systematic literature review was conducted in November 2023 to identify studies investigating the efficacy of MPFF oral treatment (1000 mg daily for at least 1 month) on venous symptoms and signs in patients with CVD at all stages (C0s-C6). Databases searched included Medline, Embase, and Cochrane. Eligible studies included randomized controlled trials (RCTs) and non-RCTs (non-randomized comparative, single-arm, and observational studies) evaluating venous signs: edema, redness, ulcer healing and disease severity assessed by venous clinical severity score (VCSS). A single-group random-effects meta-analysis was used to estimate the mean change in sign intensity and the proportion of sign improvement or complete resolution from baseline to the final assessment. EVIDENCE SYNTHESIS:Out of 387 identified articles, 56 studies were included in the analysis, among which 33 reported CVD signs in 24,617 MPFF-treated patients. Included participants were mainly females (84.1%) with a mean age (±SD) of 48.6 (±8.8) years, and overweight with a mean BMI of 26.3 (±4.5) kg/m2. Significant reductions were observed in mean [95% confidence interval] ankle and calf circumferences (-7.6 mm [-9.1 to -6.2] and -8.0 mm [-11.2 to -4.8], respectively, P<0.001). Venous ulcers were healed in 48.9% [30.3% to 67.8%] or regressed in 73.4% [63.3% to 82.3%] of the patients (P<0.001). Significant improvements were also shown in redness and VCSS score (P<0.001). Twelve studies had a high risk of bias, while sensitivity analyses did not change the study results. Heterogeneity level was frequently high among studies. CONCLUSIONS:This comprehensive meta-analysis provides additional evidence supporting the effectiveness of MPFF in improving clinical signs of CVD across all stages of the disease.