Objective: Endovascular aneurysm repair (EVAR) constitutes the cornerstone of contemporary abdominal aortic aneurysm (AAA) treatment, owing to superior short-term outcomes in comparison with open surgical repair (OSR). However, this difference is offset by unfavorable long-term outcomes. EVAR may detrimentally affect aortic compliance, with significant subsequent consequences. We sought to elucidate the natural history of this phenomenon. Methods: We conducted a nonrandomized, prospective study of 140 consecutive patients undergoing elective EVAR or OSR for abdominal aortic aneurysm. Aortic stiffness was measured preoperatively (T0), within 1 week of the operation (T1), 4 to 6 weeks (T2), and at 1 year (T3), using a validated noninvasive device (Vicorder) to measure carotid-femoral pulse wave velocity (cfPWV) and brachial-femoral pulse wave velocity (bfPWV), as well as central pulse pressure. Repeated measures analysis of variance was applied to the hemodynamic measurements to quantify changes along time. Results: Of 140 patients, 130 (93%) underwent EVAR. EVAR resulted in a significant increase in carotid-femoral pulse wave velocity (T0, 9.9 +/- 1.3 m/s; T1, 11.0 +/- 1.6 m/s; T2, 12.2 +/- 3.8 m/s; and T3, 12.5 +/- 2.6 m/s; P < .05 for the comparison with T0), bfPWV (T0, 34.6 +/- 12 mm Hg; T1, 40.4 +/- 12.4 mm Hg; T2, 44.2 +/- 14.6 mm Hg; and T3, 44.3 +/- 12.6 mm Hg; P < .05 for the comparison with T0), and central pulse pressure (T0, 59 +/- 12 mm Hg; T1, 61 +/- 12 mm Hg; T2, 63 +/- 13; and T3, 64 +/- 12 mm Hg mm Hg; P < .05 for the comparison of T2 and T3 with T0). There were no significant differences across all timepoints for those having OSR. Conclusions: In this study, the first to use bfPWV in this context, EVAR, but not OSR, significantly decreased aortic compliance, not only immediately post intervention, but steadily over 1 year.

Biomimetic stents are peripheral infrainguinal self expanding stents that mimic the anatomy of the vasculature and artery movement. They are indicated for use in infrainguinal arteries. This research aimed to synthesise all current evidence on the use of biomimetic stents as adjuncts for endovascular treatment of infrainguinal peripheral arterial disease (PAD), helping to guide clinical decision making.

ObjectivesOur aim was to examine the feasibility and implementation of a complex intervention to improve the care of patients with peripheral arterial disease (the LEGS intervention) from the perspective of patients, general practitioners and secondary care clinicians.DesignA qualitative study involving semistructured individual interviews with patients and providers to gain an understanding of the feasibility of the LEGS intervention as well the barriers and facilitators to implementation in secondary and primary care.SettingPrimary and secondary care settings across two National Health Service Trusts.ParticipantsTwenty-five semistructured telephone interviews were conducted with (1) patients who had received the intervention (n=11), (2) secondary care clinicians responsible for delivering the intervention (n=8) and (3) general practitioners (n=6).AnalysisData were initially analysed using inductive descriptive thematic analysis. The consolidated framework for implementation research was then used as a matrix to explore patterns in the data and to map connections between the three participant groups. Lastly, interpretive analysis allowed for refining, and a final coding frame was developed.ResultsFour overarching themes were identified: (1) the potential to make a difference, (2) a solution to address the gap in no man’s land, (3), prioritising and making it happen and (4) personalised information and supportive conversations for taking on the advice. The impetus for prioritising and delivering the intervention was further driven by its flexibility and adaptability to be tailored to the individual and to the environment.ConclusionsThe LEGS intervention can be tailored for use at early and late stages of peripheral arterial disease, provides an opportunity to meet patient needs and can be used to promote shared working across the primary–secondary care interface.

Introduction Peripheral arterial disease (PAD) is a key risk factor for cardiovascular disease, foot ulceration and lower limb amputation in people with diabetes. Early diagnosis of PAD can enable optimisation of therapies to manage these risks. Its diagnosis is fundamental, though challenging in the context of diabetes. Although a variety of diagnostic bedside tests are available, there is no agreement as to which is the most accurate in routine clinical practice. The aim of this study is to determine the diagnostic performance of a variety of tests (audible waveform assessment, visual waveform assessment, ankle brachial pressure index (ABPI), exercise ABPI and toe brachial pressure index (TBPI)) for the diagnosis of PAD in people with diabetes as determined by a reference test (CT angiography (CTA) or magnetic resonance angiography (MRA)). In selected centres, we also aim to evaluate the performance of a new point-of-care duplex ultrasound scan (PAD-scan). Methods and analysis A prospective multicentre diagnostic accuracy study (ClinicalTrials.gov Identifier NCT05009602). We aim to recruit 730 people with diabetes from 18 centres across the UK, covering primary and secondary healthcare. Consenting participants will undergo the tests under investigation. Reference tests (CTA or MRA) will be performed within 6 weeks of the index tests. Imaging will be reported by blinded consultant radiologists at a core imaging lab, using a validated scoring system, which will also be used to categorise PAD severity. The presence of one or more arterial lesions of ≥50% stenosis, or tandem lesions with a combined value of ≥50%, will be used as the threshold for the diagnosis of PAD. The primary outcome measure of diagnostic performance will be test sensitivity. Ethics and dissemination The study has received approval from the National Research Ethics Service (NRES) (REC reference 21/PR/1221). Results will be disseminated through research presentations and papers. Trial registration number NCT05009602.

BACKGROUND AND OBJECTIVES:Endovascular repair (EVAR) is a common treatment for abdominal aortic aneurysm (AAA). However, its long-term effects on renal function remain unclear. We aimed to assess long-term renal dysfunction after EVAR using a contemporary estimate of GFR and to compare long-term renal outcomes in patients after EVAR with open aneurysm repair (OAR) and in patients without an AAA.DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS:We performed a nested case-matched analysis of 726 patients (using a prospectively maintained database for repairs that took place between January 2000 and May 2010 in a tertiary center): 121 patients undergoing OAR (with data at baseline and 5 years postrepair) were case matched (age, sex, smoking, diabetes, baseline eGFR) to patients undergoing suprarenal and infrarenal fixation EVAR (242 in each group) and to 121 patients undergoing carotid endarterectomy (CEA) without AAA. Changes in eGFR were compared (1 and 5 years).RESULTS:The OAR patients lost an average of 7.4 ml/min per 1.73 m2 at 5 years (95% confidence interval [95% CI], 4.8 to 10.6), compared with 8.2 ml/min per 1.73 m2 (95% CI, 6.5 to 10.8; P<0.001) for infrarenal-fixation EVAR, 16.9 ml/min per 1.73 m2 (95% CI, 13.0 to 21.9, P<0.001) for suprarenal-fixation EVAR, and 5.4 ml/min per 1.73 m2 (95% CI, 1.7 to 7.5; P<0.001) for CEA. The decrease in eGFR was steeper during the first postoperative year, with each group losing -2.2 ml/min per 1.73 m2 (infrarenal-fixation EVAR), -10.7 ml/min per 1.73 m2 (suprarenal-fixation EVAR), and -4.6 ml/min per 1.73 m2 (OAR), compared with -1.9 ml/min per 1.73 m2 for CEA.CONCLUSIONS:Elective EVAR is associated with a significant decline in eGFR after 5 years, which is steeper in the first postoperative year and more pronounced compared with a similar population with atherosclerotic disease.