BACKGROUND:Autologous great saphenous vein remains the reference conduit for infrainguinal bypass, but is unavailable or unsuitable in a substantial proportion of patients. In complex redo reconstructions, infrageniculate targets, or infected fields, alternative options (arm veins or endovascular reconstructions) may also be limited. Cold-stored venous allografts (CSVAs) represent a biological salvage conduit in such settings, although concerns persist regarding durability. This study evaluated the midterm outcomes of infrainguinal bypass using CSVA in routine practice. METHODS:This retrospective multicenter study included consecutive patients undergoing infrainguinal bypass with cold-stored great saphenous vein allografts (+4°C) between January 2018 and February 2024 across four French centers. Indications included chronic limb-threatening ischemia, disabling claudication, acute-on-chronic ischemia, and vascular prosthesis infection. The primary end point was graft-related complications (aneurysmal degeneration, graft infection, rupture, occlusion). Secondary end points included primary and secondary patency, major adverse limb events (MALEs), limb salvage, reinterventions, and survival. Kaplan-Meier methods and multivariable regression analyses were performed. RESULTS:Two hundred lower limbs (195 patients; mean age 70 ± 11 years; 159 men [79.5%]) were included. Indications were chronic limb-threatening ischemia in 131 (65.5%), acute-on-chronic ischemia in 26 (13.0%), disabling claudication in 24 (12.0%), and vascular prosthesis infection in 28 (13.7%). Infrageniculate targets were used in 150 (75.0%) and redo revascularization was performed in 131 (65.5%). The mean follow-up was 24 months. Graft-related complications occurred in 108 (54.0%), including bypass occlusion in 93 (46.5%), rupture in 15 (7.5%), aneurysmal degeneration in 11 (5.5%), pseudoaneurysm in 5 (2.5%), and graft infection in 8 (4.0%). Major reinterventions were required in 88 (44.0%), and major adverse limb events occurred in 104 (52.0%). Primary patency was 59.5% (95% confidence interval [CI], 51.5-66.5) at 1 year and 36.5% (95% CI, 27.5-45.5) at 5 years; secondary patency was 64.1% (95% CI, 56.2-71.0) at 1 year and 44.5% (95% CI, 35.0-53.6) at 5 years. Freedom from major amputation was 75.0% at 1 year and 61.5% at 5 years. Multiple segment grafts (120 [60.0%]) were independently associated with increased graft-related complications (adjusted odds ratio, 2.27; 95% CI, 1.44-3.69) and reduced primary patency (adjusted HR 1.35; 95% CI, 1.02-1.77). CONCLUSIONS:In patients lacking suitable autologous conduit and durable endovascular options, CSVAs provide meaningful limb salvage, but are associated with limited patency and substantial reintervention burden. Their use should remain restricted to carefully selected salvage scenarios with structured surveillance.

BACKGROUND:Drug-coated balloon (DCB) technology is demonstrating increasing potential in lower limb revascularization; 1-year results demonstrate acceptable levels of safety and efficacy and quality of life improvements. This follow-up study assessed whether these advantages persisted over 2 years with the Luminor DCB. METHODS:The LUMIFOLLOW registry enrolled 542 patients with 580 lesions across 15 centers. It included both de novo and restenotic lesions and calcified and/or long occlusions. Primary endpoints were medical safety (freedom from periprocedural death, index limb amputation, and/or all-cause mortality) and efficacy (primary patency defined as freedom from target lesion revascularization (f-TLR) and/or restenosis). Secondary endpoints included device, procedural and clinical success, major adverse events, and functional assessments. RESULTS:The mean age was 71.2 years, with 67.2% men; 23.8% were Rutherford classification (RC) 2, 43.2% were RC 3, 16.8% RC were 4, and 16.2% were RC 5; 57.5% of lesions were in the superficial femoral artery (SFA), 42.5% extended to the popliteal artery, with 24.2% restenosis and 44.3% total occlusions. Mean lesion length was 140.55 ± 99.42 mm. Provisional stenting was required in 43.1%. Acute clinical success was 93.5%. By 2 years, 351 of 542 (64%) patients remained in the study group, 48 patients had died. Estimated primary patency was 73.9% (95% CI: 69.3-77.9%); f-TLR was 92.0% (95% CI: 88.7-94.4%). Subgroup analyses showed no differences between f-TLR and primary patency rates between disease severity (TASC classification), de-novo versus in stent restenosis, and lesion location. Improvements in quality of life (QOL) were 63.1% improved mobility, 60.2% reduced pain, and 40.2% enhanced usual activities. Walking Impairment Questionnaire scores demonstrated sustained improvements (61.2 ± 30.0, P < 0.001). CONCLUSION:Luminor DCBs are safe and effective for femoropopliteal interventions, with equity in results in severe arterial disease, restenosis, SFA, and popliteal territories Significant improvement in QOL, walking ability, high primary patency, and low complication rates underscore the benefits of Luminor DCBs in real-world settings.

INTRODUCTION:While the benefits of carotid surgery for symptomatic carotid artery disease are well-established, the management of asymptomatic carotid lesions remains controversial, with wide variation in clinical practice. Recent studies suggest that plaque characteristics, such as thrombus versus calcium content, may predict cerebral events more accurately than the degree of stenosis alone. This study investigates the feasibility of segmenting carotid lesions on computed-tomography (CT) angiography using artificial intelligence (AI), and evaluates differences in plaque composition between symptomatic and asymptomatic patients. METHODS:Carotid plaques were analyzed using 2 segmentation approaches: physician-controlled manual segmentation and fully automated segmentation with the AI-based software PRAEVAorta2 (Nurea). Thrombus content, calcium burden, and residual lumen were analyzed and compared between the 2 techniques. The AI-based software was pre-trained on 19 CT angiograms. Sensitivity, specificity, Dice similarity coefficient (DSC), and volumetric similarity were calculated to evaluate the performance of both methods. A total of 156 patients who underwent carotid artery surgery between February 2019 and February 2022 were included in the analysis, comprising 81 symptomatic and 75 asymptomatic lesions. RESULTS:The DSC between fully automatic segmentation and physician-controlled manual segmentation was strong for lumen (0.83), calcification (0.68) and plaque (0.60) assessments but weaker for thrombus (0.33). Volume similarity, intra- and inter-observer reliability were high, with correlation coefficients of 0.98 for intra-observer, 1.00 for inter-observer analyses and 0.86 for fully automatic vs physician-controlled manual segmentation. Symptomatic carotid lesions exhibited significantly larger thrombus-to-total volume ratios (p<0.0001), higher raw thrombus volumes (p<0.0001), and greater total lesion volumes (p=0.003) than asymptomatic lesions. Conversely, asymptomatic lesions demonstrated higher calcification-to-total volume ratios (p=0.002). CONCLUSION:This study demonstrates the potential of PRAEVAorta2 to automate carotid lesion analysis, offering promise for identifying high-risk asymptomatic plaques and therefore aid surgical decision-making. Symptomatic carotid lesions displayed higher thrombus volume, lower calcium content, and larger plaque volumes than asymptomatic lesions.Clinical ImpactThis study introduces an AI-based tool, PRAEVAorta2, capable of automatically segmenting and quantifying carotid plaque components on CT angiography. By distinguishing between thrombus and calcification, the tool provides a more nuanced assessment of plaque vulnerability beyond stenosis grading. Clinically, this innovation could enhance risk stratification in asymptomatic carotid stenosis, supporting more individualized decisions for surgery. The demonstrated correlation between thrombus burden and symptoms highlights the potential to identify high-risk plaques before neurological events occur. This advancement may bridge the gap between imaging and clinical decision-making, promoting proactive and targeted management of carotid artery disease.

BackgroundChronic limb-threatening ischemia (CLTI) is the end-stage of peripheral arterial disease (PAD) posing a high risk for limb loss and mortality. This study aims to evaluate and list possible predictors of major adverse limb events (MALEs) in CLTI patients with tissue loss.MethodsThis retrospective study included all Rutherford-Becker stage 5 or 6 patients who required foot debridement and revascularization in our department from January 2016 to December 2018. The limbs were classified according to the TASC II, GLASS and WiFI grading systems. The primary composite outcome was MALEs at 2 years. The secondary outcomes included all-cause mortality, primary patency, freedom from reintervention, and major amputation. Kaplan-Meier estimates were used to determine the event rates, and Cox proportional hazards model with the index MALE as a time-dependent covariate was used to search for MALEs predictors.ResultsOf 241 included patients, 19 underwent open surgeries (7.9 %) 207 had endovascular interventions (85.9 %) and 15 required a hybrid approach (6.2 %). On univariate analysis, patients who experienced MALEs (n = 111) more often required hemodialysis (25 vs 15; p = .02), presented with more complex lesions (TASC D on femoropopliteal (p = .05) or below the knee (BTK) arteries (p = .006) with increasing infra-inguinal GLASS Stage (p < .0001)), a history of index limb open (p = .009) or endovascular (p = .049) revascularization, an occluded tibial artery (p = .002 for the posterior tibial and p = .052 for the anterior tibial), or a “desert foot” (p = .02). The CRP level was also higher at admission (p = .001). Technical success of BTK revascularization significantly reduced MALEs (p < .0001) along with the number of patent BTK vessels (p = .0007). Independent predictors of MALEs included hemodialysis (HR = 2.00; 95%CI: 1.14 to 3.39), pulsatile arterial pressure (HR = 1.01; 95%CI: 1.00 to 1.03) and the infra-inguinal GLASS Stage (HR = 2.50; 95%CI: 1.17 to 5.82). We could not correlate our results with the WiFI scores for amputation risk and revascularization benefit.ConclusionFor patients with CLTI at the stage of trophic disorders, with or without a history of index limb revascularization, the GLASS successfully predicted MALEs. Hemodialysis and high pulsatile arterial pressure increased the risk of MALEs. The WiFI score did not demonstrate its interest in this subgroup of patients.

Background: Vascular surgical training is evolving towards simulation-based methods to enhance skill development, ensure patient safety, and adapt to changing regulations. This study aims to investigate the utilization of simulation training among vascular surgeons in France, amidst ongoing shifts in teaching approaches and educational reforms. Methods: A national survey assessed the experiences and perceptions of vascular surgery professionals regarding simulation training. Participation was open to self-reported health professionals specialized (or specializing) in vascular surgery, including interns or fellows. Participants were recruited through various channels, and data were collected via a questionnaire covering participant characteristics, simulation experiences, and perceptions. Results: Seventy-six participants, predominantly male (74%) took part in the survey. While 58% reported access to simulation laboratories, only 17% had organized simulation sessions 1e3 times a year, and 5% had sessions more than 10 times annually. High fidelity simulators were available in 57% of institutions, while low fidelity simulators were available in 50%. Regarding funding, 20% received financial assistance for training, predominantly from industry (18%). One-third of the participants experienced 9 or more sessions (34%), lasting between 1 and 2 hours (34%), 30% expressed satisfaction with access to simulation, while 33% were dissatisfied with communication of simulation training opportunities. Conclusions: Despite recognizing the benefits of simulation training, its integration into vascular surgery education in France remains incomplete. Challenges such as limited access and communication barriers hinder widespread adoption. Collaborative efforts are needed to ensure uniformity and enhance the effectiveness of simulation training in vascular surgery education.

BACKGROUND:Endovascular interventions using drug-coated balloons (DCBs) have shown promise in improving outcomes for femoropopliteal (FP) revascularizations. Luminor, a nanotechnology-based paclitaxel coated balloon, has demonstrated efficacy and safety in Effpac (Effectiveness of Paclitaxel-coated Luminor Balloon Catheter Versus Uncoated Balloon Catheter in the Arteria Femoralis Superficialis). The LUMIFOLLOW (European All-comers' Multicentric Prospective REGISTRY on LUMINOR Drug Eluting Balloon in the Superficial Femoral Artery and Popliteal Artery With 5 Years Follow-up) registry, a large-scale, prospective, multicenter study, aims to assess the real-world performance of Luminor in FP lesions. METHODS:LUMIFOLLOW enrolled 542 patients with 580 lesions across 15 French centers. It included both de novo and restenotic lesions, with calcified and/or long occlusions. Primary end points were medical safety (defined as freedom from peri-procedural death, index limb amputation, and/or all-cause mortality) and efficacy (primary patency defined as freedom from target lesion revascularization and/or binary restenosis); secondary end points included acute device success, procedural and clinical success, major adverse events, and functional assessments. RESULTS:The mean patient age was 71.2 years, with 67.2% male patients. Prevalent comorbidities included diabetes (n = 231/542 [42.6%]), hypertension (n = 391/542 [72.1%]), hyperlipidemia (n = 305/542 [56.3%]), and current smoking (n = 147/540 [27.2%]); 23.8% were classified as Rutherford category 2 (n = 129/542), 43.2% as Rutherford category 3 (n = 234/542), 16.8% as Rutherford category 4 (n = 91/542), and 16.2% as Rutherford category 5 (n = 88/542). Lesions were located in the superficial femoral artery (n = 329/572 [57.5%]) and could extend to the popliteal artery (n = 243/572 [42.5%]), with 43.6% classified as Trans-Atlantic Inter-Society Consensus II C or D; 24.2% were restenosis (n = 139/575) with a 44.3% rate of total occlusions (n = 255/576). The mean lesion length was 140.55 ± 99.42 mm. Provisional stenting was required in 43.1% of patients (n = 249/580), with a mean stent length shorter than the initial lesion length at 87.21 ± 42.30 mm. The acute procedural success rate was 99.4% (n = 536/539), with two in-hospital deaths and one thrombosis of target lesion. Acute clinical success was achieved in 93.5% (n = 504/539). The 12-month composite safety end point was 82.7% (5.7% all-cause mortality, 0.7% index limb major amputation) and the estimated primary patency was 87.4% (95% confidence interval [CI], 84.1%-90.1%), with freedom from target lesion revascularization at 96.2% (95% CI, 93.9%-97.6%) and from target vessel revascularization at 94.9% (95% CI, 92.5%-96.6%). The EQ-5D-5L questionnaire indicated significant improvements in quality of life at 12 months, with 67.4% improved mobility, 63.5% reduced pain and discomfort, and 47.8% enhanced usual activities. Walking Impairment Questionnaire scores increased significantly in walking distance, speed, and stair-climbing ability (from 31.4 ± 24.7 to 62.5 ± 31.0; P < .001). CONCLUSIONS:The LUMIFOLLOW registry demonstrates that Luminor DCBs are effective and safe for FP interventions. The significant improvement in quality of life and walking ability, along with high primary patency and low complication rates, underscore the benefits of Luminor DCBs in real-world settings. However, the high rate of provisional stenting underscores the need for these devices to be used alongside other endovascular techniques in challenging lesions.

In the case of infection or persistent endoleaks, despite the adjunct endovascular procedure, a complete or partial explantation is necessary to cure the aortic aneurysmal disease initially treated by endovascular aneurysm repair. Our video gathers several cases involving different aortic stentgrafts, with or without suprarenal fixation, and fenestrated endovascular aneurysm repair. We explain the choice of the aortic approach, the technique of extraction, and the cross-clamping strategy. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIxZWY4MWE0ZjkwOGU5NDExZmU2YzFlMjI5NDJmOWE5ZiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzE2MzA2NzAwfQ.E0iR6KfTyXsqqlZ0vIA-XQcv4nugpe0CRPfMZrrRnFVGsnP1gc8CTNpmTwyql0JLtL3Db6OlvyqrpEui5DAE9peIKswmljsH0lSYp1bkSd-8TtEAo3sYnxepITCNLVn38CNxxTccoJgIvDPeYBSs-l3Y5OImlc1lD7XOumeI_lFKaEvaj0HnoHER03EFmpFdyA7hIzibhRNRvqZJPnIxThtpY3sE5MKWhyFwgr98CgcqQLf64N-TZXF7NsvCjAz_d1IfmmDFnwYAM2j3ztsFbFo3XWGwGXxoCZKEkj0ZG22-Kg4meNYvefY0uRKEN3M5uVVv_hMaaSLcaelTrKMOdQ Download .mp4 (74.14 MB) Help with .mp4 files Video 1XXX.

Introduction: Endoleaks represent one of the main complications after endovascular aortic repair (EVAR) and can lead to increased re-intervention rates and secondary rupture. Serial lifelong surveillance is required and traditionally involves cross-sectional imaging with manual axial measurements. Artificial intelligence (AI)-based imaging analysis has been developed and may provide a more precise and faster assessment. This study aims to evaluate the ability of an AI-based software to assess post-EVAR morphological changes over time, detect endoleaks, and associate them with EVAR-related adverse events.Methods: Patients who underwent EVAR at a tertiary hospital from January 2017 to March 2020 with at least 2 follow-up computed tomography angiography (CTA) were analyzed using PRAEVAorta 2 (Nurea). The software was compared to the ground truth provided by human experts using Sensitivity (Se), Specificity (Sp), Negative Predictive Value (NPV), and Positive Predictive Value (PPV). Endovascular aortic repair-related adverse events were defined as aneurysm-related death, rupture, endoleak, limb occlusion, and EVAR-related re-interventions.Results: Fifty-six patients were included with a median imaging follow-up of 27 months (interquartile range [IQR]: 20-40). There were no significant differences overtime in the evolution of maximum aneurysm diameters (55.62 mm [IQR: 52.33-59.25] vs 54.34 mm [IQR: 46.13-59.47]; p=0.2162) or volumes (130.4 cm3 [IQR: 113.8-171.7] vs 125.4 cm3 [IQR: 96.3-169.1]; p=0.1131) despite a -13.47% decrease in the volume of thrombus (p=0.0216). PRAEVAorta achieved a Se of 89.47% (95% confidence interval [CI]: 80.58 to 94.57), a Sp of 91.25% (95% CI: 83.02 to 95.70), a PPV of 90.67% (95% CI: 81.97 to 95.41), and an NPV of 90.12% (95% CI: 81.70 to 94.91) in detecting endoleaks. Endovascular aortic repair-related adverse events were associated with global volume modifications with an area under the curve (AUC) of 0.7806 vs 0.7277 for maximum diameter. The same trend was observed for endoleaks (AUC of 0.7086 vs 0.6711).Conclusions: The AI-based software PRAEVAorta enabled a detailed anatomic characterization of aortic remodeling post-EVAR and showed its potential interest for automatic detection of endoleaks during follow-up. The association of aortic aneurysmal volume with EVAR-related adverse events and endoleaks was more robust compared with maximum diameter.Clinical Impact The integration of PRAEVAorta AI software into clinical practice promises a transformative shift in post-EVAR surveillance. By offering precise and rapid detection of endoleaks and comprehensive anatomic assessments, clinicians can expect enhanced diagnostic accuracy and streamlined patient management. This innovation reduces reliance on manual measurements, potentially reducing interpretation errors and shortening evaluation times. Ultimately, PRAEVAorta's capabilities hold the potential to optimize patient care, leading to more timely interventions and improved outcomes in endovascular aortic repair.

The incidence of campylobacteriosis has substantially increased over the past decade, notably in France. Secondary localizations complicating invasive infections are poorly described. We aimed to describe vascular infection or endocarditis caused by Campylobacter spp. We included 57 patients from a nationwide 5-year retrospective study on Campylobacter spp. bacteremia conducted in France; 44 patients had vascular infections, 12 had endocarditis, and 1 had both conditions. Campylobacter fetus was the most frequently involved species (83%). Antibiotic treatment involved a β-lactam monotherapy (54%) or was combined with a fluoroquinolone or an aminoglycoside (44%). The mortality rate was 25%. Relapse occurred in 8% of cases and was associated with delayed initiation of an efficient antimicrobial therapy after the first symptoms, diabetes, and coexistence of an osteoarticular location. Cardiovascular Campylobacter spp. infections are associated with a high mortality rate. Systematically searching for those localizations in cases of C. fetus bacteremia may be warranted.

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our "modern" postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.

ANZ Journal of SurgeryVolume 91, Issue 9 p. E603-E605 IMAGES FOR SURGEONS Pseudoaneurysm of the medial plantar artery following low-energy closed calcaneal fracture Michael Symes BAppSc (Physio), MBBS, FRACS, MPH, FAOrthA, Michael Symes BAppSc (Physio), MBBS, FRACS, MPH, FAOrthA orcid.org/0000-0002-4613-2653 St George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia The Orthopaedic Research Institute, St George Hospital, Sydney, New South Wales, Australia Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Supervision, Writing - original draftSearch for more papers by this authorBrian Le BMed, MD, Brian Le BMed, MD orcid.org/0000-0002-8870-2618 Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorMichael Le BMedSc, MD, Michael Le BMedSc, MD Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorBrahman Sivakumar MBBS, BSc (Med), MS, FRACS, FAOrthA, PFET, Brahman Sivakumar MBBS, BSc (Med), MS, FRACS, FAOrthA, PFET Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorDaniel Cohen BSc, MSc, MBBS, FRACS, FAOrthA, Daniel Cohen BSc, MSc, MBBS, FRACS, FAOrthA Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorClaire Webster MBChB, MRCS, Claire Webster MBChB, MRCS Department of Vascular Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorLubomyr Lemech MBBS (Hons), FRACS (Vascular), DDU (Vascular), Lubomyr Lemech MBBS (Hons), FRACS (Vascular), DDU (Vascular) Department of Vascular Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Supervision, Writing - review & editingSearch for more papers by this author Michael Symes BAppSc (Physio), MBBS, FRACS, MPH, FAOrthA, Michael Symes BAppSc (Physio), MBBS, FRACS, MPH, FAOrthA orcid.org/0000-0002-4613-2653 St George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia The Orthopaedic Research Institute, St George Hospital, Sydney, New South Wales, Australia Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Supervision, Writing - original draftSearch for more papers by this authorBrian Le BMed, MD, Brian Le BMed, MD orcid.org/0000-0002-8870-2618 Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorMichael Le BMedSc, MD, Michael Le BMedSc, MD Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorBrahman Sivakumar MBBS, BSc (Med), MS, FRACS, FAOrthA, PFET, Brahman Sivakumar MBBS, BSc (Med), MS, FRACS, FAOrthA, PFET Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorDaniel Cohen BSc, MSc, MBBS, FRACS, FAOrthA, Daniel Cohen BSc, MSc, MBBS, FRACS, FAOrthA Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - review & editingSearch for more papers by this authorClaire Webster MBChB, MRCS, Claire Webster MBChB, MRCS Department of Vascular Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Writing - original draftSearch for more papers by this authorLubomyr Lemech MBBS (Hons), FRACS (Vascular), DDU (Vascular), Lubomyr Lemech MBBS (Hons), FRACS (Vascular), DDU (Vascular) Department of Vascular Surgery, St George Hospital, Sydney, New South Wales, Australia Contribution: Supervision, Writing - review & editingSearch for more papers by this author First published: 17 February 2021 https://doi.org/10.1111/ans.16592Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume91, Issue9September 2021Pages E603-E605 RelatedInformation

BACKGROUND Pelvic trauma has emerged as one of the most severe injuries to be sustained by the victim of a blast insult. The incidence and mortality due to blast-related pelvic trauma is not known, and no data exist to assess the relative risk of clinical or radiological indicators of mortality. METHODS The UK Joint Theater Trauma Registry was interrogated to identify those sustaining blast-mediated pelvic fractures during the conflicts in Iraq and Afghanistan, from 2003 to 2014, with subsequent computed tomography image analysis. Casualties that sustained more severe injuries remote to the pelvis were excluded. RESULTS One hundred fifty-nine casualties with a 36% overall mortality rate were identified. Pelvic vascular injury, unstable pelvic fracture patterns, traumatic amputation, and perineal injury were higher in the dismounted fatality group (p < 0.05). All fatalities sustained a pelvic vascular injury. Pelvic vascular injury had the highest relative risk of death for any individual injury and an associated mortality of 56%. Dismounted casualties that sustained unstable pelvic fracture patterns, traumatic amputation, and perineal injury were at three times greater risk (relative risk, 3.00; 95% confidence interval, 1.27–7.09) to have sustained a pelvic vascular injury than those that did not sustain these associated injuries. Opening of the pubic symphysis and at least one sacroiliac joint was significantly associated with pelvic vascular injury (p < 0.001), and the lateral displacement of the sacroiliac joints was identified as a fair predictor of pelvic vascular injury (area under the receiver operating characteristic curve, 0.73). CONCLUSION Dismounted blast casualties with pelvic fracture are at significant risk of a noncompressible pelvic vascular injury. Initial management of these patients should focus upon controlling noncompressible pelvic bleeding. Clinical and radiological predictors of vascular injury and mortality suggest that mitigation strategies aiming to attenuate lateral displacement of the pelvis following blast are likely to result in fewer fatalities and a reduced injury burden. LEVEL OF EVIDENCE Prognostic, level III.

Sylvain Sebert, Estelle Lowry , Nicole Aumüller, Mercedes G Bermúdez, Lise G Bjerregaard, Susanne R de Rooij, Maneka De Silva, Hanan El Marroun, Nadine Hummel, Teija Juola, Giacomo Mason, Daniela Much, Elena Oliveros, Stavros Poupakis, Nina Rautio, Phillipp Schwarzfischer, Evangelia Tzala, Olaf Uhl, Cornelieke van de Beek, Florianne Vehmeijer, Juan Verdejo-Román, Niko Wasenius, Claire Webster, Leena Ala-Mursula, Karl-Heinz Herzig, Sirkka Keinänen-Kiukaanniemi, Jouko Miettunen, Jennifer L Baker, Cristina Campoy, Gabriella Conti, Johan G Eriksson, Sandra Hummel, Vincent Jaddoe, Berthold Koletzko, Alex Lewin, Maria Rodriguez-Palermo, Tessa Roseboom, Ricardo Rueda, Jayne Evans, Janine F Felix, Inga Prokopenko, Thorkild IA Sørensen and Marjo-Riitta Järvelin*

Sylvain Sebert, Estelle Lowry , Nicole Aumüller, Mercedes G Bermúdez, Lise G Bjerregaard, Susanne R de Rooij, Maneka De Silva, Hanan El Marroun, Nadine Hummel, Teija Juola, Giacomo Mason, Daniela Much, Elena Oliveros, Stavros Poupakis, Nina Rautio, Phillipp Schwarzfischer, Evangelia Tzala, Olaf Uhl, Cornelieke van de Beek, Florianne Vehmeijer, Juan Verdejo-Román, Niko Wasenius, Claire Webster, Leena Ala-Mursula, Karl-Heinz Herzig, Sirkka Keinänen-Kiukaanniemi, Jouko Miettunen, Jennifer L Baker, Cristina Campoy, Gabriella Conti, Johan G Eriksson, Sandra Hummel, Vincent Jaddoe, Berthold Koletzko, Alex Lewin, Maria Rodriguez-Palermo, Tessa Roseboom, Ricardo Rueda, Jayne Evans, Janine F Felix, Inga Prokopenko, Thorkild IA Sørensen and Marjo-Riitta Järvelin*

Over 80% of wounded Service Members sustain at least one extremity injury. The ‘deck-slap’ foot, a product of the vehicle’s floor rising rapidly when attacked by a mine to injure the limb, has been a signature injury in recent conflicts. Given the frequency and severity of these combat-related extremity injuries, they require the greatest utilisation of resources for treatment, and have caused the greatest number of disabled soldiers during recent conflicts. Most research efforts focus on occupants seated with both tibia-to-femur and tibia-to-foot angles set at 90°; it is unknown whether results obtained from these tests are applicable when alternative seated postures are adopted. To investigate this, lower limbs from anthropometric testing devices (ATDs) and post mortem human subjects (PMHSs) were loaded in three different seated postures using an under-body blast injury simulator. Using metrics that are commonly used for assessing injury, such as the axial force and the revised tibia index, the lower limb of ATDs were found to be insensitive to posture variations while the injuries sustained by the PMHS lower limbs differed in type and severity between postures. This suggests that the mechanism of injury depends on the posture and that this cannot be captured by the current injury criteria. Therefore, great care should be taken when interpreting and extrapolating results, especially in vehicle qualification tests, when postures other than the 90°–90° are of interest.