INTRODUCTION:Accurate identification of vortices is critical for predicting the rupture risk of abdominal aortic aneurysms (AAA). However, existing vortex identification methods perform poorly in noisy 4D Flow MRI data. This study aims to develop a robust vortex identification framework to address these limitations. METHODS:A new vortex identification method based on Liutex method is proposed that integrates relative pressure information and divergence-based noise estimation to enhance the accuracy and robustness of vortex identification in noisy environments. The performance of the proposed method was validated against conventional techniques (vorticity, Q-criterion, Δ-criterion) and original Liutex using 4D Flow MRI data from 10 AAA patients, with the Fβ score as the evaluation metric. RESULTS:Qualitative visualization and quantitative analysis demonstrated the superior performance of the Noise-Pressure Constrained Liutex (NPC-Liutex) method. It achieved clearer delineation of vortical structures across diverse hemodynamic patterns, with significantly higher Fβ scores (average improvement: 0.058), lower spatial entropy (average improvement: 65.8%) and lower false identification rates (average reduced false identification: 78.6%) compared to existing methods. CONCLUSION:The NPC-Liutex method enables reliable extraction of vortical structures, accurate quantification of vortex intensity, and robust tracking of their dynamic evolution in AAA. By addressing noise sensitivity and shear contamination, this approach offers a clinically viable tool for enhancing hemodynamic risk assessment in AAA using 4D Flow MRI.

Physical exercise is known to enhance vascular function by regulating PPARs, ERs, and RXR signaling pathways. It improves cardiopulmonary capacity through optimized lipid metabolism, immune regulation, and blood pressure reduction. Additionally, exercise reduces postoperative complications by maintaining energy expenditure and skeletal muscle function, which may ultimately improve patients’ quality of life (QoL). However, the safety and efficacy of exercise therapy post-endovascular aortic aneurysm repair (EVAR) remain uncertain. Due to the potential impact of exercise training on abdominal pressure, supervised exercise by medical professionals is crucial for ensuring patient safety. Although exercise offers notable benefits, patient adherence tends to be low. Therefore, leveraging smartphones as pervasive monitoring tools may provide timely feedback on patients’ exercise status and influence their behavior. This trial aims to assess whether a smartphone-monitored physical exercise management program, including physical exercise interventions under medical supervision for 3 months, affects the short-term QoL of individuals post-EVAR. A total of 176 participants with abdominal aortic aneurysms will be recruited from the Department of Vascular Surgery at West China Hospital of Sichuan University. All participants will receive standard medical care according to current guidelines. The experimental group will be monitored via smartphones using WeChat for exercise tracking by medical staff, while the control group will not have real-time monitoring or feedback from mobile health tools. The trial will last 3 months, with assessments at baseline and 3 months. Primary outcomes include QoL assessments at 1 and 3 months post-surgery. Secondary outcomes include exercise capacity, frailty status, muscle strength, resting heart rate, and lung function at 1 and 3 months post-surgery. Additionally, adverse events in the first month post-surgery will be measured, including all-cause mortality, unplanned reoperations, readmissions, endoleaks, major adverse cardiovascular and cerebrovascular events, renal impairment, and pulmonary infections. Exercise-related adverse events, such as falls, injuries, and fractures, will also be assessed. The study utilizes smartphones to monitor physical exercise during and after activities. It provides personalized feedback and implements strategies to enhance motivation through engaging activities. The results of this study will provide crucial insights and evidence on the impact of early exercise in patients post-EVAR, guiding the scientific prescription of exercise programs for these patients. Providing exercise instructors and dynamically tailoring exercises to individual cases is crucial for reinforcing patient adherence to smartphone-based tracking and exercise programs. chictr.org.cn ChiCTR2400083901. Registered on May 7, 2024.

Objective: To investigate the impact of asymptomatic high-risk status for ischemic stroke on patients with abdominal aortic aneurysm undergoing endovascular aortic repair (EVAR). Methods: Eligible patients with abdominal aortic aneurysm who underwent EVAR between January 2011 and December 2021 were enrolled in this retrospective cohort study. Propensity score matching (PSM) was used to balance baseline characteristics between the cerebrovascular high-risk group and the standard control group. The impact of cerebrovascular high-risk status on short- and long-term outcomes was assessed using Cox proportional hazards regression and generalized linear models, with results presented as hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs). Results: A total of 1080 patients were included (299 high-risk, 781 standard). During the 13-year follow-up period, ischemic stroke occurred in 45 patients (15.1%) in the high-risk group (HR, 7.01; 95% CI, 4.11-11.94; p < 0.001). The high-risk group also had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), which occurred in 129 patients (43.1%) (HR, 1.78; 95% CI, 1.43-2.24; p < 0.001). These findings remained consistent across inverse probability of treatment weighting (IPTW) and propensity score matching combined with multivariable generalized linear model (PSM+MVA-GLM) analyses. Conclusions: Although no significant increase in perioperative cerebrovascular adverse events was observed in asymptomatic patients with a preoperative cerebrovascular high-risk status, their worse long-term prognosis appears to be associated with this risk status. This association highlights the need for rigorous cardiovascular and cerebrovascular risk management in this vulnerable population after surgery.

BACKGROUND:Major adverse cardiovascular and cerebrovascular events (MACCE) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) are serious outcomes. The primary aim of this study was to evaluate the incidence of MACCE after EVAR and to investigate the relevant predictive factors for MACCE. MATERIALS AND METHODS:This single-center retrospective cohort study included patients who were diagnosed with infrarenal AAAs and who underwent EVAR from February 2012 to February 2022. The cumulative incidence of MACCE after EVAR in this study was assessed via a competing-risk model. RESULTS:This study included 1090 patients with AAAs who underwent EVAR. Multivariate analyses revealed that the maximum diameter of the AAA may be an independent predictor of MACCE after EVAR (hazard ratio per 10-mm increase = 1.219; 95% confidence interval [CI] = 1.072-1.397; P = .002). During a median follow-up of 42 months, 323 patients experienced at least 1 MACCE, whereas 767 patients did not experience MACCE. The cumulative risks of MACCE excluding noncardiovascular/noncerebrovascular mortality at 12, 36, and 60 months after EVAR were 5.4%, 9.1%, and 19.0%, respectively. CONCLUSION:The cumulative incidence of MACCE after EVAR for AAAs is relatively high, and the maximum diameter of the AAAs is a predictor of MACCE.Clinical ImpactMajor adverse cardiovascular and cerebrovascular events remain an important long-term concern after EVAR. In this large retrospective cohort, approximately one in five patients experienced MACCE within 5 years, after accounting for competing noncardiovascular/noncerebrovascular mortality. Importantly, larger maximum AAA diameter was independently associated with a higher risk of subsequent MACCE. These findings suggest that aneurysm diameter may provide additional information for cardiovascular risk stratification beyond its established role in determining aneurysm-related treatment. Patients with larger AAAs may therefore warrant closer cardiovascular surveillance and more intensive management of modifiable risk factors after EVAR.

Endovascular aortic aneurysm repair (EVAR) has become the first-line treatment for abdominal aortic aneurysms (AAA); however, its long-term durability is affected by Type II endoleak. This narrative review describes the evolution of sac filling techniques and concepts developed to address this complication. In selected cases of diagnosed Type II endoleaks, early therapeutic sac filling, while clinically indicated, is frequently constrained by difficult access, variable success rates, and recurrence. Consequently, prophylactic sac filling during primary EVAR has been adopted as an alternative approach, with reported high technical success and reduced endoleak incidence. The subsequent Nellix Endovascular Aneurysm Sealing (EVAS) system, although early results showed technical feasibility, was associated with graft migration, endobag separation, and reintervention at long-term follow-up, leading to its withdrawal from the market. Currently, devices based on shape memory polymer (SMP) provide early observations of decreased endoleaks and sac regression. This review outlines the transition from reactive management to preventive strategies, and, more recently, to patient-specific, material-based approaches, while showcasing emerging strategies that may influence long-term EVAR outcomes. However, these novel approaches remain under investigation, and larger controlled studies with extended follow-up are required to establish their clinical utility.

Background:The flow-induced displacement force (DF) exerted on the stent-graft (SG) by the pulsatile blood flow has been considered a potential cause of sealing failure and endoleaks following endovascular aneurysm repair (EVAR). However, its clinical adoption remains limited by time-consuming computational simulations. This study aimed to validate whether rapid morphology-derived DF parameters, quantified from preoperative imaging, can predict stent-graft-related endoleaks (SGELs). Methods:In this retrospective case-control study, we analyzed data from 217 patients who underwent EVAR between July 2011 and May 2020. Sixty-nine patients were diagnosed with SGEL while controls (n=148) were matched. DF parameters were derived from preoperative computed tomography angiography (CTA) images using a simplified momentum-based theory. The predictive performance of models integrating DF with oversizing ratio (OSR) was evaluated using area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results:Among 217 patients (mean age 72±8 years; 85% male), 69 (32%) developed SGEL over a median follow-up of 24 months. Higher DF values were independently associated with SGEL [adjusted odds ratio (OR) =2.1; 95% confidence interval (CI): 1.4-3.2; P<0.001]. A model combining DF and OSR achieved superior discrimination (AUC =0.85; 95% CI: 0.80-0.90) compared to traditional anatomical risk factors alone (AUC =0.72; 95% CI: 0.65-0.79; P<0.01), with significant reclassification improvement (NRI =0.613, IDI =0.114; both P<0.001). Conclusions:Morphology-derived DF parameters, combined with OSR, provide a rapid and reproducible method to predict SGEL after EVAR. This approach may enhance preoperative risk stratification without requiring computationally intensive simulations. Further validation in prospective cohorts is needed to confirm its utility across diverse clinical settings.

OBJECTIVES:To systematically assess the robustness of meta-analyses based on randomised controlled trials (RCTs) in vascular surgery using the Fragility Index (FI). DESIGN:Cross-sectional study. SETTING:Meta-analyses published in English from January 2019 to April 2025, identified from EMBASE, PubMed and Web of Science. PARTICIPANTS:67 articles, with 291 meta-analyses involving RCTs evaluating vascular surgical interventions, covering venous, aortic, peripheral arterial, vascular access and other relevant fields. MAIN OUTCOME MEASURES:FI, defined as the minimum number of event changes required to alter the statistical significance of meta-analysis results, and its association with sample size and total number of events, analysed using frequency distribution histograms and restricted cubic spline models. RESULTS:The median FI was 7, with considerable variation across different fields. Aortic meta-analyses demonstrated higher robustness compared with venous and vascular access meta-analyses. FI showed a non-linear relationship with sample size and total number of events, indicating robustness improved only up to specific thresholds, beyond which robustness declined or plateaued. CONCLUSION:Overall robustness of meta-analyses in vascular surgery was moderate, with notable variability among research areas. FI provides valuable insight into the stability of synthesised evidence, suggesting the need for improved methodological quality and advocating broader adoption of FI in meta-analytical research.

Objectives: Guidelines widely recommend endovascular therapy (ET) for infrainguinal peripheral artery diseases (PAD) despite the lack of adequately powered data. This meta-analysis aimed to directly compare the clinical safety and efficacy of ET versus vein bypass (VBP) in patients with infrainguinal PAD from available randomized controlled trials (RCTs). Methods: We conducted a systematic literature search of MEDLINE, Embase, and the Cochrane databases from inception until 21 July 2023 for RCTs comparing ET and VBP. Treatment effects were expressed as odds ratios (OR) with 95% confidence intervals (CIs), pooled using the Mantel–Haenszel method. Study quality was assessed via the Cochrane Risk of Bias tool. Results: From 2210 identified studies, four low-risk-of-bias RCTs were included. Pooled analysis demonstrated that ET was associated with significantly higher risks of reintervention (OR = 4.69, 3.69–6.04), major reintervention (OR = 2.80, 1.96–4.00), and any reintervention (OR = 1.92, 1.44–2.56) compared to VBP. ET also showed a lower rate of index procedure technical success (OR = 0.13, 0.07–0.25) and site infection (OR = 0.05, 0.01–0.25). However, no significant differences were observed between the two strategies regarding 30-day mortality (OR = 0.66, 0.34–1.29), all-cause mortality (HR = 1.05, 0.90–1.22), index limb amputation (OR = 1.29, 0.90–1.86), MACE (OR = 1.20, 0.94–1.54), or bleeding events (OR = 0.86, 0.30–2.50). Conclusions: This analysis of RCT data still supports VBP, which retained certain advantages over ET for patients with infrainguinal peripheral artery disease in terms of both efficacy and safety. In cases where a suitable vein is available, vein bypass should be considered as the primary treatment option.

Currently, the blood force on the vessel wall (BFVW) is generally obtained using computational fluid dynamics (CFD), which is hampered by professional CFD knowledge to perform the correct simulation. This study aims to propose a new method to quickly calculate BFVW in TBAD-susceptible areas and to find the association between BFVW and the occurrence of TBAD. Using the momentum theorem, a fast, accurate, and clinician-friendly non-numerical simulation method was proposed and validated against CFD in 30 high-risk TBAD patients and 30 healthy controls. It is found out that aortic geometric morphology of one specific patient experienced almost no change before and after the onset of TBAD. The post-onset imaging data of acute TBAD patients is adequate as pre-onset models. The linear regression analysis showed good agreement in BFVW calculated by the two methods (R > 0.98). The magnitude of BFVW in the TBAD groups was significantly greater than in healthy controls (23.22 N ± 5.64 N vs 15.37 N ± 3.08 N, P < 0.01). The BFVW orientation in the healthy control group was primarily vertical, whereas the angle between the BFVW and the vertical direction was greater in the TBAD group (P < 0.01). The proposed method can quickly and accurately calculate patient-specific BFVW. It can therefore help clinicians identify potential TBAD populations early on and provide further evidence for optimizing blood pressure management to prevent TBAD.

Background:Isolated superior mesenteric artery dissection (ISMAD) is a rare arterial disease, and its exact cause is still not well understood. This study aimed to investigate the potential role of anatomical factors in the development of ISMAD. Methods:This case-control study included patients diagnosed with ISMAD via computed tomography angiography from two major medical centers in China. An equal number of age-sex and body mass index matched patients without aortic and superior mesenteric artery disease were selected as controls. Several anatomical parameters were compared between the ISMAD group and the control group. Significant parameters were identified through univariate and multivariate analyses, and models were evaluated using receiver operating characteristic (ROC) curve analysis. A p-value < 0.05 was considered statistically significant. Results:A total of 60 patients with isolated superior mesenteric artery dissection and 60 age-sex (52.6 ± 6.1 vs. 52.2 ± 13.5, p = 0.82) and body mass index (24.3 ± 2.5 vs. 24.0 ± 4.0, p = 0.72) matched normal controls from two major hospitals in China were included in the study. Compared with normal controls, the multivariate analysis revealed that curvature (OR 1.239, 95% CI 1.122-1.369, p < 0.001) and tortuosity (OR 0.002, 95% CI, 0.000-0.083, p = 0.001) were independent predictors of ISMAD occurrence. Conclusion:Patients with ISMAD exhibited higher levels of curvature and lower levels of tortuosity compared to normal control group.

INTRODUCTION:The optimal choice of either percutaneous or cutdown access for endovascular abdominal aortic repair (EVAR) remains uncertain due to insufficient evidence, particularly regarding patient-centered outcomes (PCOs). This study aimed at comparing both clinician-reported outcomes (ClinROs) and PCOs of percutaneous versus cutdown access in patients after EVAR. METHODS:The study was a single-blind, single-center, non-inferiority, randomized controlled trial. After eligibility screening, patients diagnosed with abdominal aortic diseases were randomly assigned to either the intervention group receiving percutaneous EVAR or the control group receiving cutdown EVAR. Primary ClinRO was access-related complications, and primary PCO was time return to normal life/work. RESULTS:Overall, 120 patients (containing 240 accesses) were allocated to either intervention group ( n = 62) or control group ( n = 58). Percutaneous EVAR (10/124, 8.1%) was non-inferior and not superior to cutdown EVAR (17/116, 14.7%) regarding access-related complications ( P = 0.110; OR: 0.521, 95% CI: 0.225-1.157). As for PCOs, the recovery time back to normal life or work was superior in percutaneous EVAR compared to cutdown EVAR (16 vs. 28 days, P = 0.025; median difference: 7 days, 95% CI: 0-13 days). Moreover, percutaneous access did better in other PCOs, including a reduction in the duration of access-related pain (4 vs. 8 days, P = 0.001), decreased use of analgesics for access-related pain (0/61, 0% vs. 6/55, 10.9%; P = 0.026), and improved quality of life scores at 2 weeks following EVAR (0.876 vs. 0.782; P = 0.022). Prespecified subgroup analyses demonstrated percutaneous access significantly reduced the incidence of access-related complications compared to cutdown access in patients with thick subcutaneous tissue (1/42, 2.4% vs. 7/32, 21.9%; P = 0.026). CONCLUSION:In patients without massive common femoral artery calcification, percutaneous access may accelerate postoperative recovery and enhance patient experience and quality of life following EVAR, but did not provide obvious advantages regarding access-related complications.

It is an important cause of death in old age to rupture an abdominal aortic aneurysm. The pathogenesis of AAA has not been fully elucidated, and m6A RNA methylation regulators have never been implicated in AAA development. This study aimed to explore the expression profile, potential functions and regulated mechanism of m6A RNA methylation in the abdominal aortic aneurysm mice model. A successful AAA mouse model was established using Ang II. M6A- methylated RNA Immunoprecipitation (MeRIP) sequencing and RNA sequencing were performed to identify the m6A sites in the abdominal aorta walls samples. The expression of m6A methylation regulators was analyzed in the datasets and MeRIP-qPCR was performed to verify the results of MeRIP-sequencing. Bioinformatics analysis was used to evaluate the m6A patterns and indicate the potential signaling pathway. There were 2039 differentially methylated m6A peaks involving 1865 mRNAs in the AAA group relative to the control, of which 1610 peaks in 1466 mRNAs were hypermethylated, and 429 peaks in 410 mRNAs were hypomethylated. The hypermethylated mRNAs in AAA group were primarily enriched in transcription regulation and intercellular signaling, especially the Wnt signaling-associated processes. Hypomethylated m6A sites were mainly enriched in G protein-coupled receptor activity and ion channel activity. MeRIP-qPCR suggested that the sequencing data were reliable and accurate. The mRNA expression of 24 m6A regulators showed no obvious difference between AAA and the control group, but the m6A methylation levels of three components of methyltransferases complex and one 'readers' were significantly increased. Our study suggested an original viewpoint that the m6A modification might be regulated by several unidentified regulation modes or genes in the Ang II-induced AAA mice model, and be closely relevant to the combined effect of m6A methylation modification in the Wnt pathway, G protein-coupled receptor, and ion channel-associated genes, which were worthy of further investigation.

Atherosclerosis (AS), a complex and long-term disease, is a major contributor to cardiovascular complications and a leading cause of death across the globe. Lipid droplets (LDs) are closely involved in the initiation and development of AS plaques. Therefore, visualization and quantification of the complexity of LDs may assist in understanding the biology of atherosclerotic plaques and assessing lesion stability. In this study, we report lipophilic fluorescent sensors based on a BODIPY scaffold (P1 & P2). These probes exhibited fluorescence responsiveness in oil/water systems and lipid droplet mimics (LDMs), with detection limits as low as 50 μg mL-1. In a cellular milieu, the probes effectively tracked LD accumulation induced by oxidized low-density lipoprotein (ox-LDL) as well as lipid suppression caused by treatment with rosiglitazone. Ex vivo imaging of atherosclerotic plaques in ApoE-/- mice and human tissues further demonstrated that these probes could distinguish pathological characteristics across various vascular regions. Collectively, these results highlight the first application of LD sensors in sensing the distinct lipidic lesions in biopsied atherosclerotic plaques from patients, suggesting an organ-specific pathogenesis.

BackgroundLower extremity peripheral arterial disease (LEPAD) significantly affects quality of life and is associated with severe cardiovascular risks. Studies on its long-term incidence trends are limited.ObjectiveThis study aims to analyze global trends in LEPAD incidence from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database and to forecast future trends between 2022 and 2030, providing insights for healthcare planning and resource allocation.MethodsData were extracted from the GBD 2021 database by genders, age groups, continents, and sociodemographic index (SDI) levels. Using Joinpoint regression analysis, annual percentage changes (APC) and average annual percentage changes (AAPC) were calculated to assess age-standardized incidence rates (ASIR) historical trends. Autoregressive integrated moving average (ARIMA) model was applied to predict ASIR between 2022 and 2030.ResultsThe global ASIR of LEPAD showed a slight decrease from 1990 to 2021, though regional differences were notable. In 2021, the highest ASIR was in the Americas, while Africa had the lowest. Gender and age disparities were significant, and females and older populations were at higher risk. ARIMA predictions indicate a stable ASIR trend from 2025 onward.ConclusionThis study provides a comprehensive analysis of LEPAD incidence trends and a forecast through 2030. While global incidence may stabilize, the rising burden in lower-income countries calls for prioritizing early intervention and health education in high-risk regions. These findings emphasize the importance of targeted resource allocation and strategic prevention efforts.

Introduction The best lifestyle for small abdominal aortic aneurysms (sAAA) is essential for its conservative management. Physical exercise can improve the cardiopulmonary function of the patients, but it remains unclear which specific type of exercise is most beneficial for individuals with sAAA. The current study was designed to investigate the effect of physician-guided enhanced physical exercise programme on the aorto-cardiac haemodynamic environment, aneurysm sac wall, cardiac function and growth rate of sAAA by multimodality MRI.Methods and analysis AAA MOVE study is a prospective, parallel, equivalence, randomised controlled trial. Eligible individuals will be recruited if they are diagnosed with sAAA (focal dilation of abdominal aorta with maximum diameter <5 cm), without contraindication for MRI scanning, or severe heart failure, or uncontrolled arrhythmia. Participants will be randomly allocated to intervention group (physician-guided enhanced physical exercise programme: mainly aerobic training) and control group (standard clinical care) separately in a 1:1 ratio. The primary outcome is 12-month growth rate of sAAA. The first set of secondary outcomes involve multimodality MRI parameters covering flow haemodynamics, aortic wall inflammation and cardiac function. The other secondary outcome (safety end point) is a composite of exercise-related injury, aneurysm rupture and aneurysm intervention. Follow-up will be conducted at 6 and 12 months after intervention.Ethics and dissemination This study was approved by the Ethics Committee on Biomedical Research of West China Hospital (approval number: 2023-783) on 16 June 2023. Main findings from the trial will be disseminated through presentations at conferences, peer-reviewed publications and directly pushed to smartphone of participants.Trial registration number ChiCTR2300073334.

Phlegmasia cerulea dolens (PCD) is a rare yet severe complication of deep vein thrombosis (DVT), characterized by a high amputation rate and mortality. Early diagnosis and treatment are crucial in managing this condition. PCD predominantly affects the lower extremities rather than the upper extremities. We herein present a rare upper extremity PCD case accompanied with supra vena cava and pulmonary embolism in a cervical cancer patient, who presented to our institution with severe pain, edema and irreversible venous gangrene of right upper limb with no response to anticoagulation therapy. Emergency fasciotomy and amputation were performed due to the progressed venous gangrene, however, the patient developed severe infection and coagulation disorders, gastrointestinal bleeding and disseminated intravascular coagulation after the surgery. Despite medical interventions, her family chose to withdraw treatment and the patient died in ICU at the fourth day following emergency surgery.

BACKGROUND:Current evidence regarding gender difference in retroperitoneal liposarcoma (RLPS) is scarce, so we sought to investigate whether gender may affect prognosis after primary resection of RLPS.METHODS:We used the Surveillance, Epidemiology, and End Results (SEER) database to identify RLPS patients from January 1973 to December 2015. Multivariate cox proportional hazard analysis was adopted to generate adjusted hazard ratio (AHR) and 95% confidence intervals (CIs) of survival outcomes.RESULTS:In total, 2108 RLPS patients, including 971 women and 1137 men, were identified, with a median follow-up of 45.0 (17.0-92.0) months. The 5-year and 10-year overall survival rates were 50.5% and 31.5% for men and 60.4% and 42.5% for women. The 5-year and 10-year disease-specific survival rates for men and women were 71.5%, 57.3% and 76.3%, 62.1%, respectively. We found men were associated with an increased risk of all-cause mortality (AHR 1.3, 95% CI 1.0-1.6, P = .017) but not disease-specific mortality (AHR 1.2, 95% CI .9-1.6, P = .246). The subgroup analyses revealed that men were associated with an increased risk of all-cause mortality in patients with low-grade tumors (AHR 1.8, 95% CI 1.3-2.5) or patients who received non-radical resection (AHR 1.6, 95% CI 1.2-2.1). In the subgroup of low-grade tumors, men were also associated with an increased risk of disease-specific mortality (AHR 2.0, 95% CI 1.2-3.3).CONCLUSION:Men may have worse survival after primary resection of RLPS compared with women, especially in patients with low-grade tumors or patients who received non-radical resection. Gender-based disparities may deserve more attention in patients with RLPS.