Introduction:Visceral artery injuries during nephrectomy, such as superior mesenteric artery (SMA) and coeliac artery (CA) injuries, are rare but potentially lethal complications. This systematic review was performed with a focus on visceral artery injuries during nephrectomy in order to describe how to prevent and manage SMA or CA injuries. Method:A systematic literature review was performed in Medline and the Cochrane Library from inception to December 2025 to identify published case reports and case series of SMA or CA injuries during nephrectomy. MeSH terms used were: "mesenteric artery, superior" "coeliac artery", "intra-operative complications", and "iatrogenic disease". Outcomes of interest were initial operative indication, cause and type of injury, anatomic risk factors, timing of diagnosis, type of vascular repair, and patient outcome. Quality of the studies was assessed according to the CARE guidelines. Results:After duplicate removal, screening, and full text eligibility assessment, 16 publications of varying quality reporting 20 cases of SMA and or CA injury during nephrectomy were included. All injuries occurred during left nephrectomy. Injury involved the SMA in 16 cases (80%) and both the SMA and CA in four cases (20%). The dominant mechanism was anatomic misperception: the SMA or CA was mistaken for the left renal artery, facilitated by bulky lymphadenopathy, large tumour size (median 12 cm), and post-inflammatory adhesions. SMA and CA injury was recognised intra-operatively in 16 cases (80%), while delayed diagnosis (ranging 12 - 48 hours) occurred in four cases (20%) and was associated with worse outcomes. Revascularisation was performed in 18 cases (90%), mostly by primary end to end anastomosis of the injured artery. Three patients died (15%). Conclusion:Visceral artery injuries during nephrectomy carry a substantial mortality risk, especially when the diagnosis is delayed. Careful pre-operative computed tomography angiography analysis, prompt injury identification, and immediate vascular surgical support are central elements of prevention and management.

Non-technical skills (NTS) are cognitive, social, and personal abilities that, when combined with technical skills (TS), contribute to surgical competence through safe and efficient task performance. The objective of this study was to develop and implement a simulation-based training model that integrates both NTS and TS in complex cataract surgery. A comparative study was performed. Ophthalmology residents with experience in cataract surgery ranging from novice to beginner level were enrolled. During the first step, the participants were engaged in a “training simulation” on the Eyesi® Surgical simulator (CAT-D module: Advanced courses: white cataract). During the second step, an “evaluative simulation” was conducted using the Eyesi® simulator on the same complex case. After each simulation, participants were rated using HUFOES score (HUman Factors in intraoperative Ophthalmic Emergencies Scoring System) for NTS and Eyesi® performance score for TS. The primary outcome was the comparison of NTS (HUFOES score) between training and evaluative simulations. A p-value under 0.05 was considered significant. A total of 14 ophthalmology residents were included with a median age of 27 (interquartile range [IQR] 25–28). They had undergone a median of 30 cataract surgeries prior to the study (IQR 10–60). The mean global HUFOES score significantly improved between the simulations (from 42.0 ± 6.7 after the training simulation to 75.2 ± 6.3 after the evaluative simulation; p < 0.001). A positive correlation was identified between the different items of the HUFOES score following each simulation (p < 0.001). In multivariate analysis, the HUFOES score after the evaluative simulation was significantly associated with the HUFOES score after the training simulation (β = 0.49; p = 0.019) and with participant age (β = +1.89 per year; p = 0.008). A surgical simulation-based training program with debriefing led to a significant improvement in NTS for residents with a mean experience in cataract surgery ranging from novice to beginner level. NTS training could be implemented in a simulated environment and incorporated into the ophthalmology residents’ training curriculum for cataract surgery learning.

Stent thrombosis remains a critical and fatal complication of angioplasty with stenting, particularly in tandem lesion patients, where the incidence can exceed 20%. A better understanding of the thrombogenicity of clinically used stents could reduce the occurrence of stent thrombosis.We have developed a macrofluidic model mimicking the geometry of the human carotid artery, which is perfectly suited to evaluate the intrinsic thrombogenicity of carotid stents. Real-time video microscopy and scanning electron microscopy were combined to assess the thrombogenicity of three clinically used carotid stents: the laser-cut Protégé RX stent, the braided Casper stent, and Wallstent.The Casper and the Wallstent led to higher rates of platelet adhesion and thrombus formation than the Protégé RX. The thrombi were essentially localized at the intersections of the metal wires in the braided stents, whereas in the laser-cut stent, only more evenly distributed platelet adhesion was observed. Hot spots of thrombosis were identified at the crossings of the stent struts, especially around the external wires of these crossings, which are in contact with the vessel wall. Thrombus formation was effectively prevented in the presence of aspirin or the αIIbβ3 blocker abciximab. Computational fluid dynamics indicated that the wire crossings of braided stents generate a prothrombotic shear environment, with flow recirculation and stagnation regions leading to thrombus formation, as demonstrated by a macroscale in silico simulation.Design plays a major role in thrombus formation on stent wires, with braided stents being more thrombogenic than laser-cut stents.

Intravenous leiomyomatosis is characterized by the growth of leiomyomatous tissue within the venous walls. It is rare but can have devastating consequences when extending into cardiac chambers.A 45-year woman presented with abdominal pain and thrombosis of left ovarian vein extending to the renal vein. Intravenous leiomyomatosis was suspected on imaging, due to the association with uterine myomas. Left nephrectomy with complete hysterectomy, right salpingectomy and left adnexectomy were performed. Follow-up at one-year was uneventful. Even rare, vascular surgeons should include intravenous leiomyomatosis in their differential diagnosis of venous thrombosis in a reproductive or premenopausal woman regardless of symptoms.

Noninvasive plaque characterization remains limited in peripheral arterial obstructive disease (PAOD), whereas ex vivo micro-computed tomography (micro-CT) enables quasihistological assessment. This study evaluates whether plaque-related structural information—defined as compositional and morphological plaque features learned from micro-CT segmentation—can be transferred to clinical computed tomography (CT) using a super-resolution (SR) framework. Popliteal artery segments from six patients with peripheral arterial obstructive disease were analyzed using micro-CT and histology. Annotated micro-CT images were used to train convolutional neural networks for plaque segmentation. Low-resolution clinical CT images were upsampled using a Laplacian pyramid SR approach, and segmentation models were applied without retraining. Performance was assessed using Dice scores on held-out micro-CT test data, and segmentation outputs on SR-CT images were qualitatively evaluated. Segmentation of calcified plaque components on micro-CT test images yielded Dice scores ranging from 0.58 to 0.67, indicating low-to-intermediate agreement. When applied to SR-CT images, segmentation revealed nonrandom identification of calcified structures in selected image sequences, with marked heterogeneity across slices. SR enables exploratory assessment of plaque information transfer but does not overcome the fundamental resolution gap. These findings define the current limits of CT-based plaque characterization and provide a framework for evaluating future imaging technologies. Clinical Relevance: Accurate plaque characterization remains a major unmet need in peripheral arterial disease, where treatment planning is largely guided by lesion length and stenosis severity rather than plaque composition. This study proposes using micro-computed tomography (micro-CT) as a histology-informed reference to evaluate how much plaque-related information can be transferred to clinical CT. By explicitly defining current limitations, our findings caution against premature clinical application while informing future developments in advanced CT technologies, multimodal imaging, and artificial intelligence.

The transition toward competency-based medical education requires scalable, objective surgical skill assessment. While sensor-based approaches remain burdensome, video-based deep learning models often lack the interpretability required for formative feedback. We introduce a fully automated, markerless framework for assessing vascular open surgery suturing skills providing meaningful interpretation. Our pipeline leverages 3D hand tracking coupled to an LSTM-attention network for precise temporal segmentation. By merging explicit kinematic metrics with latent deep features, we develop a voting ensemble classifier categorizing surgeons into three skill levels. We further evaluated the impact of ground-truth reliability by comparing models trained on single-assessor versus multi-assessor consensus labels. The framework achieved 96.4

Introduction:Popliteal artery entrapment syndrome (PAES) is a rare but underdiagnosed vascular disorder in young, active individuals, frequently athletes. Although surgery is considered the gold standard, data on functional outcomes, return to sport, and long term quality of life remain scarce. This study aimed to evaluate the functional outcomes of the surgical management of PAES using validated patient reported measures. Method:Pre- and post-operative functional assessments were performed using the VascuQOL (Quality of Life)-25 questionnaire, complemented by sport specific questions. Imaging (dynamic duplex ultrasound, computed tomography angiography, magnetic resonance imaging when indicated) guided diagnosis was according to the Whelan classification. Primary outcomes were changes in VascuQOL scores; secondary outcomes included arterial patency, return to physical activity, and correlations with PAES type. Results:Fourteen patients (18 limbs) were analysed (mean age, 30.3 ± 13.6 years; ten men and four women). Most patients presented with exertional claudication; imaging identified predominantly type VI (functional) and type V PAES. VascuQOL-25 scores demonstrated statistically significant improvements in activity, symptoms, pain, and social domains, with overall total score increasing from 4.3 ± 1.2 to 5.2 ± 1.5 (p = 0.002). At a mean follow up of 70.4 months, one and five year primary patency rates were 94.4%. Nevertheless, only six of 13 previously active patients returned to pre-symptomatic athletic levels. Conclusion:Surgical treatment of PAES yields excellent long term patency and significant quality of life gains. However, return to pre-symptomatic athletic performance was limited, highlighting the importance of realistic counselling, tailored rehabilitation, and multidisciplinary management strategies to optimise recovery.

OBJECTIVE:The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with vascular graft or endograft infection (VGEI), in succession to the 2020 version, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS:The guidelines are based on scientific evidence complemented with expert opinion. By summarising and evaluating the best available evidence, recommendations for the evaluation and management of patients with VGEI have been formulated. The recommendations are graded according to the ESVS grading system, where the strength (class) of each recommendation is graded from I to III, and the level of evidence from A to C. RESULTS:Eighty-one recommendations have been issued across the following main topics: definitions, diagnosis, multidisciplinary team management, antimicrobial therapy, management of intracavity or extracavity VGEI, and follow up. A chapter addresses the concept of shared decision making, with supporting information for patients. A final chapter addresses unresolved issues. CONCLUSION:These ESVS clinical practice guidelines provide comprehensive, up to date advice to clinicians and patients on the management of VGEI.

PURPOSE:To assess the validity of the HelpMeSee Manual Small Incision Cataract Surgery (MSICS) module as a virtual reality training tool for technical skills and stress management in ophthalmology. METHODS:This prospective study enrolled 47 volunteer surgeons from five groups: four groups of eye surgeons with increasing experience (novice, junior, senior and expert) and a fifth group of experts from other specialties. Participants completed two standardized MSICS training runs on the HelpMeSee simulator. Performance scores, penalties and completion time were recorded. Ergonomics were assessed via the Rapid Upper Limb Assessment (RULA) score, and stress was evaluated subjectively and objectively using the State-Trait Anxiety Inventory-Y (STAI-Y) and the Analgesia Nociception Index (ANI) score. Data from the two runs were analysed and compared across groups. RESULTS:Overall scores increased significantly from novice residents (32.4 ± 10.7 out of 72) to the expert ophthalmic surgeons (50.1 ± 9.41) (p < 0.001). Non-ophthalmic experts had a lower mean score (16.8 ± 18.0). Total penalties, particularly in the second run, decreased with experience among eye surgeons, while experts from other specialties incurred the highest penalties. Time analysis did not differ between groups, as for RULA or STAI-Y scores. The mean ANI score decreased with experience, suggesting higher stress levels in more experienced participants. CONCLUSIONS:The HelpMeSee MSICS module effectively differentiates surgical experience levels, confirming its validity as a tool for technical skills training. The ANI score demonstrated modified behaviour in expert surgeons, suggesting the simulator's potential for assessing non-technical skills. These findings support the use of this virtual reality simulator for objective, skills-based surgical education.

BACKGROUND:Abdominal aortic aneurysms (AAA) open surgical repair (OSR) is still considered as a valuable option. There are no strong arguments to choose one vascular graft material and design rather than another one to perform the revascularization. The goal of the study was to evaluate the 5-year performance of the expanded polytetrafluoroethylene (ePTFE) GORE-TEX® vascular graft for AAA OSR. METHODS:We performed a retrospective, multicenter, single-arm study of patients treated with ePTFE GORE-TEX® vascular grafts for aorto-iliac aneurysms. Patients were enrolled from three different medical centers in France. Protocol enrollment was from 2022-2023, with procedure data collected between September 2013 and January 2017. Primary endpoints included survival and primary patency at 5-years and secondary outcomes included secondary patency, infection and reinterventions rates. RESULTS:Sixty-five patients were included. Fifty-seven percent of the patients were males and mean age was 66±7.1 years. Mean AAA diameter was 54±14 mm. Thirty-day mortality was 1.5%. Lost of follow-up rate was 1.5%. One and five-year survival rates were respectively 93.8% and 81.3%. One and five-year primary patency rates were respectively 98.5% and 96.7%. Five-year reintervention rate was 12.3%. No infection was reported. CONCLUSIONS:Our study, conducted on patients with at least a 5-year follow-up, demonstrated good results in terms of safety and durability of the use of an ePTFE graft for AAA OSR. This contemporary study contributes in the reappraisal of OSR for the management of AAA.