Background: Foot ulcers and minor amputations represent notable complications of peripheral arterial disease (PAD), and this risk is further heightened by concomitant diabetes. A comprehensive assessment should account for comorbid conditions, vascular status, and prior surgical interventions to inform optimal treatment strategies. The present study evaluates the impact of PAD and revascularization on the probability of major amputation following an initial minor amputation. Methods: We conducted a retrospective cohort study of patients undergoing minor lower extremity amputation at a single tertiary referral center between 2017 and 2023. Limbs were identified using five Current Procedural Terminology codes and followed for <= 1 year after the index procedure. Data collected included demographics, comorbidities, wound characteristics, Wound, Ischemia, and foot Infection stage when available, and attempted revascularization categorized as endovascular, open, or diagnostic only. The primary exposure was PAD. Primary outcomes were major amputation at 30 days, 6 months, and 1 year, and 1-year all-cause mortality. Kaplan-Meier analysis estimated 1-year amputation-free survival with comparisons by log-rank test. Time to major amputation was evaluated using Cox proportional hazards models. Multivariable logistic regression and limb-level generalized estimating equation models accounting for within-patient clustering were performed as secondary analyses. Results: A total of 973 limbs from 861 patients who underwent minor lower extremity amputation were included (mean age, 60.2 +/- 13.3 years; 32.8% female) with PAD present in 46.0% of limbs. Progression to major amputation occurred in 11.5% of limbs during follow-up, and the 1-year all-cause mortality rates was 10.8% among limbs with known survival status. Limbs with PAD had higher crude major amputation rates compared with non-PAD limbs (16.3% vs 7.3%; P < .001). Kaplan-Meier analysis demonstrated shorter amputation-free survival among limbs with PAD (324 +/- 5 days vs 348 +/- 3 days; log-rank P < .001). In multivariable Cox analysis, PAD was independently associated with increased hazard of major amputation (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.31-3.16; P = .002), along with dialysis-dependent end-stage renal disease (HR, 2.71; 95% CI, 1.64-4.47; P< .001), thrombophilia (HR, 2.48; 95% CI, 1.21-5.07; P = .013), and Black race (HR, 1.68; 95% CI, 1.09-2.59; P = .019). Atrial fibrillation was independently associated with a lower hazard of major amputation (HR, 0.37; 95% CI, 0.16-0.89; P = .026). Revascularization was attempted in 280 limbs (61.8% endovascular, 26.8% open, 11.4% diagnostic only). Major amputation rates did not differ by revascularization strategy (P = .199). The limb-level generalized estimating equation model confirmed these findings, with PAD (P = .004), dialysis-dependent end-stage renal disease (P < .001), and thrombophilia (P = .016) remaining significant. Other covariates, including age, coronary artery disease, hypertension, smoking status, and revascularization, were not associated with major amputation. Conclusions: PAD significantly increases the risk of major amputation following a minor foot amputation. Dialysis dependence, thrombophilia, and cerebrovascular disease further contribute to this heightened risk. Notably, the specific revascularization method performed did not affect outcomes. These findings emphasize the paramount importance of assessing PAD status and comorbidity profile during patient counseling.

BACKGROUND:Residual venous obstruction and in-stent restenosis are common and challenging complications that may occur after interventional procedures performed for acute deep vein thrombosis or chronic iliofemoral venous obstruction. A novel fully integrated thrombectomy system [Recana Thrombectomy Device (RTD)] was designed to treat (in-stent restenosis) and native vessel obstructions. The system includes a debulking catheter, collection baskets, and a family of sheaths. This report describes its use in animal models of native and stented veins to assess safety compared with currently available thrombectomy devices. METHODS:The RTD was studied in comparison to two currently marketed thrombectomy devices, the Argon CLEANER 15 (CLEANER; Argon Medical Devices Inc.) and the Inari ClotTriever (ClotTriever Catheter; Inari Medical, Inc.). Devices were studied in a porcine iliac vein model used in a manner consistent with good laboratory practice for Nonclinical Laboratory Studies. A total of 26 iliac veins in 13 animals were studied to evaluate performance in normal veins (9 animals, 18 iliac veins) and in four animals with eight iliac veins pretreated with iliac stents implanted 21 days before device treatment. Twelve normal iliac veins were treated with the RTD, four normal veins were treated with CLEANER, and two with the ClotTriever. Five prestented iliac veins were treated with the RTD, and three prestented veins were treated with the CLEANER. Procedures were completed under fluoroscopic and intravascular ultrasound guidance. For each model, both iliac veins were treated with 10 passes of the test or control thrombectomy device through the length of the common and external iliac veins. Survival and sacrifice periods were completed at varied time points to evaluate peak histological injury potential, vein wall healing, and vein patency. Necropsy was performed at 5 ± 2 or 30 ± 2 days after catheter intervention for gross evaluation of the iliac veins and other related tissues. Histology was performed on representative sections of treated iliac veins to evaluate wall damage, thrombosis, or other effects of intervention. RESULTS:All animals survived to their designated end points with no unexpected mortality. One common femoral vein access complication led to unilateral perivenous hematoma and thrombosis. Another animal showed postintervention venous constriction with eventual vessel occlusion. All other iliac veins (n = 24) remained patent without significant stenosis at necropsy. No clinically relevant lacerations, perforations, or hemorrhagic events were observed with either the Test or Control devices. Histology revealed intimal disruption and inflammation with all devices, more pronounced with the RTD compared with CLEANER but similar to those seen after use of the ClotTriever. Mild perivenous bruising occurred in some Test device cases, without evidence of transmural bleeding. CONCLUSIONS:In an in vivo model of stented and native iliac veins, a novel venous tissue debulking system was able to engage intraluminal material without serious injury. Vein wall trauma was comparable to a commonly used mechanical thrombectomy device, with no transmural lacerations or device-related hemorrhage. These findings support continued development toward initial clinical trials in patients with venous obstruction. CLINICAL RELEVANCE:This experimental study utilizes a porcine model for examination of a novel venous thrombectomy device in normal and stented iliac veins. The study examines the degree of injury occurring within the vein wall in normal and stented iliac veins after treatment with the test device compared with currently marketed thrombectomy devices. The feasibility of removal of the material causing in-stent restenosis is established using the Test device. The study also provides key information on the response of the iliac vein wall in this model to intraluminal devices that impact the wall during treatment.

OBJECTIVE:Acute iliofemoral deep vein thrombosis (IFDVT) in young adults and adolescents is a cause of lower extremity pain and edema that may lead to chronic debilitating symptoms. Treatment options include pharmaco-mechanical thrombectomy, stent placement, and anticoagulation. The lack of long-term data in young patients after venous stenting leads to variability in treatment and reluctance to employ stents in this population. The purpose of this study is to review the etiology and incidence of post-thrombotic syndrome (PTS) along with the role of intervention in young patients after IFDVT. METHODS:Patients presenting with acute IFDVT were identified retrospectively through Peripheral Vascular Lab databases. IFDVT was defined as any thrombus believed to be <1 month old involving the common femoral or more proximal veins. Charts were reviewed to identify demographics, risk factors for venous thrombosis, relevant laboratory data, treatment provided for the DVT, and patient outcomes. RESULTS:Forty-nine patients under age 25 were identified with acute IFDVT and no other acute illness or trauma precipitating thrombosis. Forty patients (81%) were female. Thirty-three patients (58.1%) identified as White, 10 (28%) as Black and five (9.3%) as Hispanic. Hypercoagulable states were identified in 25 patients (51%) with Factor V deficiency (9 patients) and antiphospholipid antibodies (6 patients) being the most common. Intervention was performed in 36 patients (73.5%), which consisted of pharmaco-mechanical thrombectomy with balloon angioplasty in 22 patients and with stent placement in 14. One year after IFDVT, 19 patients (43.2%) reported no PTS symptoms, 10 (22.7%) reported mild symptoms, and 15 (34.1%) reported moderate or severe symptoms. Recurrent IFDVT occurred in 18% of patients at 1 year and 26.2% at 3 years after IFDVT. CONCLUSIONS:Acute IFDVT in young patients occurs typically in females, the majority of whom are found to have a hypercoagulable state. Most of this cohort were treated without venous stenting. However, significant PTS and recurrent IFDVT occurred frequently after the initial event, suggesting that aggressive treatment is warranted. This is an understudied patient population in whom the role of intervention and stenting is unclear, suggesting that focused study in larger cohorts is required to improve treatment recommendations.

OBJECTIVE:Venous compression at the iliac confluence is a reported risk factor for deep vein thrombosis, with venous stenting as the standard management for relieving this compression. Kibbe et al demonstrated that left common iliac vein (LCIV) compression is present in 35.3% of asymptomatic patients. However, this study included only adults with an average age of 40 years. The iliac vein confluence in patients under 21 years with no symptoms attributable to venous disease was evaluated in this study. The study goal is to determine prevalence of LCIV narrowing in patients under age 21 years, and as such, assist in determining the appropriate treatment for iliac vein compression in this patient population. METHODS:A retrospective review of patients aged 13-20 undergoing abdominal/pelvic computed tomography (CT) imaging for nonvascular indications was performed. This group was compared with patients aged 35 to 65 years undergoing CT imaging for similar reasons. Axial CT images were reviewed by two independent examiners to identify the diameter of the noncompressed left and right CIVs below the confluence and the diameter of the LCIV at the site of compression between the right common iliac artery and spine. RESULTS:A total of 122 patients aged 13 to 20 years were identified with high-quality CT imaging and no venous symptoms for image review. Mean LCIV diameter was 12.7 ± 2.5 mm, and mean right CIV diameter was 13.1 ± 2.2 mm. The diameter of the LCIV at the confluence was 4.2 ± 1.8 mm, resulting in a mean diameter stenosis of the LCIV of 69.4% ± 12.6%. In this population, 55.7% of patients were found to have ≥70% stenosis of the LCIV on CT imaging compared with 1.7% of patients aged 35 to 65 years (P < .001). There was no statistical difference in the percentage of LCIV stenosis in young patients based on body mass index, gender, race, or ethnicity. CONCLUSIONS:Severe compression of the LCIV at the iliac confluence was identified in over 50% of asymptomatic patients aged 13 to 20 years on CT imaging performed for nonvascular reasons. This suggests that narrowing of the LCIV is a normal anatomic finding in this age group. The incidence of severe compression is significantly lower in older asymptomatic persons. In young persons, the high incidence of iliac vein compression on CT imaging suggests that this finding may not be a significant risk factor for deep vein thrombosis or limb symptoms, questioning the need for routine intervention for compression correction in this patient population.

OBJECTIVES:Previous literature demonstrated an association between preoperative proteinuria and mortality after endovascular repair of juxtarenal aortic aneurysms. The aim of this study is to evaluate the association of preoperative proteinuria on 1- and 5-year survival after fenestrated/branched endovascular repair (F/BEVAR) of thoracoabdominal aortic aneurysms (TAAAs), pararenal aortic aneurysms, and juxtarenal aortic aneurysms treated with patient-specific company-manufactured devices (CMDs) or off-the-shelf devices. The impact on kidney function after F/BEVAR was also analyzed. METHODS:A retrospective analysis was performed with prospectively collected data, including patients with complex anatomy aortic aneurysms who underwent F/BEVAR at a single institution from July 2012 to February 2024. All patients were treated with a company-manufactured device or off-the-shelf devices under a physician-sponsored investigational device exemption protocol. Patients were divided into two groups based on the preoperative urinalysis performed within 30 days before the index procedure: patients with trace or no proteinuria vs patients with proteinuria (1+, 30-100 mg/dL; 2+, 100-299 mg/dL; 3+, ≥300 mg/dL). Primary outcomes were 1-year and 5-year survival. Secondary outcomes were 30-day mortality, myocardial infarction, stroke/transient ischemic attack, acute kidney injury, and spinal cord ischemia. The follow-up protocol included imaging studies (chest, abdomen and pelvis computed tomography angiography, abdominal radiography, and renal-mesenteric duplex ultrasound examination) and laboratory analysis. Time-to-event analysis was performed with Kaplan-Meier plots compared through log-rank testing. Binary logistic regression model was designed to investigate predictors associated with 5-year survival after F/BEVAR. RESULTS:A total of 454 patients underwent the F/BEVAR procedure; patients were 71.5% male and 15.4% Black, with a mean age of 72 ± 5.2 years. Sixty-seven patients (14.7%) had preoperative proteinuria of ≥30 mg/dL. Patients with and without preoperative proteinuria were similar in terms of demographics, aneurysm extension, and comorbidities, except for chronic kidney disease and cerebrovascular disease, which were more prevalent in patients with proteinuria (P < .001 and P = .011, respectively). There was no significant differences observed in 30-day mortality, acute kidney injury, spinal cord ischemia, stroke/transient ischemic attack, or myocardial infarction rates. The survival analysis demonstrated a significantly lower 1-year (77.9 ± 5.4% vs 89.4 ± 1.6%; P = .004) and 5-year survival (33.8 ± 8.8% vs 65.2 ± 3.0%; P = .002) among the patients with proteinuria when compared with individuals presenting trace or no proteinuria. Patients with preoperative proteinuria had a risk of death almost two times higher (odds ratio, 1.95; 95% confidence interval, 1.27-2.99; P = .002) and a risk of developing kidney failure requiring dialysis at 5 years more than eight times higher (odds ratio, 8.28; 95% confidence interval, 2.62-26.13; P ≤ .001). Proteinuria was a better predictor of mortality than a preoperative estimated glomerular filtration rate of <60 mL/min/1.73 m2, which was not significantly associated with this adverse event (P = .060). CONCLUSIONS:The presence of significant proteinuria preoperatively is associated with reduced 1- and 5-year survival after F/BEVAR procedure in patients undergoing repair for complex anatomy aortic aneurysms. Preoperative proteinuria can be used to aid in preoperative risk assessment of either survival or kidney function deterioration after F/BEVAR.

To investigate which preoperative factors are most impactful on the 5-year survival of patients undergoing fenestrated/branched endovascular aortic repair (F/BEVAR) and to identify modifiable elements that, if time allows, should be actively managed and adequately controlled preoperatively.

Bacterial biofilms are a significant concern in various medical contexts due to their resilience to our immune system as well as antibiotic therapy. Biofilms often require surgical removal and frequently lead to recurrent or chronic infections. Therefore, there is an urgent need for improved strategies to treat biofilm infections. Ultrasound-mediated drug delivery is a technique that combines ultrasound application, often with the administration of acoustically-active agents, to enhance drug delivery to specific target tissues or cells within the body. This method involves using ultrasound waves to assist in the transportation or activation of medications, improving their penetration, distribution, and efficacy at the desired site. The advantages of ultrasound-mediated drug delivery include targeted and localized delivery, reduced systemic side effects, and improved efficacy of the drug at lower doses. This review scrutinizes recent advances in the application of ultrasound-mediated drug delivery for treating biofilm infections, focusing on in vivo studies. We examine the strengths and limitations of this technology in the context of wound infections, device-associated infections, lung infections and abscesses, and discuss current gaps in knowledge and clinical translation considerations.

In this article, the authors report the results of a Delphi consensus study in which vascular experts from China and Taiwan experienced in venous stenting participated to produce recommendations on preferred antithrombotic therapy in patients after venous stenting.1 The Delphi process has been validated to assist in defining best practices, particularly when the evidence base is insufficient to define these practices clearly.

The aim of this study was to compare the outcomes of F/BEVAR patients treated with and without concomitant endovascular hypogastric preservation. This single-center retrospective cohort included patients with a diagnosis of Crawford types I-IV thoracoabdominal aneurysms (TAAAs), suprarenal or juxtarenal aortic aneurysms treated with either a patient-specific company-manufactured device (CMD) or an off-the-shelf device. Patients were divided into 2 groups:F/BEVAR (group-A) and F/BEVAR + iliac device (group-B). Patients in group-B had their iliac artery aneurysm treated either with an IBD (Zenith Branch Endovascular Graft ZBIS–Iliac Bifurcation–by Cook Medical), an IBE (iliac branch endograft,IBE,by Gore), or with an investigational patient-specific manufactured iliac fenestrated graft (by Cook Medical). Patients with implanted iliac devices prior to the F/BEVAR or with parallel stenting into the iliac system were excluded from the study. Primary outcomes were 30-day survival, freedom from secondary interventions (SIs), and long-term patency of the IB graft. Secondary outcomes included perioperative adverse events considering the first 30 days post-intervention and long-term survival. Four hundred ten patients treated between July/2012-February/2023 were included, 391 in group-A and 19 in group-B. Four cases in group-B had bilateral implantation of iliac grafts. The two groups were similar in terms of demographics and comorbidities. There was no difference between the groups in terms of aneurysm extent (P = .759). Mean follow-up for groups A and B were 33.6 ± 22.6 and 23.8 ± 20.1 months, respectively (P = .06). For patients in group-B, a larger volume of contrast was used (P = .007) and the duration of the procedure was longer (P = .003), as well as fluoroscopy time (P = .002) (Table I). As for the perioperative variables, there was no significant difference between the groups in terms of major cardiovascular events (P = .240), and the 30-day mortality was 2% in group-A and 0% in group-B (P > .99). There were 11 cases of spinal cord ischemia (2.8%) in group-A, but none in group-B. Considering long-term results, time-to-event analyses did not demonstrate a significant difference in freedom from SI (Log-rank P = .945) or long-term survival (Log- rank P = .545) (Fig 1) between the groups. Primary patency of the iliac grafts was 94.4% at 1 and 3 years. The incidence of Type Ib endoleak in group-A was 2.3% and 0% in group-B (P > .99). F/BEVAR for complex aortic aneurysms can be safely performed concomitantly with the endovascular treatment of common iliac artery aneurysms using iliac branched or fenestrated grafts. Despite the longer duration of the procedures, longer fluoroscopy times, and higher doses of contrast, these patients do not present significant differences in terms of short and long-term outcomes when compared to the ones that were submitted to a F/BEVAR alone.TableMain aortic device typeDevice typeF/BEVAR (n = 391)F/BEVAR + IBD/IBE (n = 19)P valueCMD356 (91.1)17 (89.4)>.99p-branch22 (5.6)1 (5.3)>.99t-branch13 (3.3)1 (5.3)>.99Intraoperative dataVariablesF/BEVAR (n = 391)F/BEVAR + IBD/IBE (n = 19)P valueEBL281.1 ± 599.3258.3 ± 279.3.755Procedure duration, minutes246.6 ± 93.8309.7 ± 77.2.003Fluoroscopy time, minutes79.4 ± 43.3114.1 ± 40.9.002Air kerma, mGy1808.52159.3.384Contrast volume, mL94.2 ± 42.6145.66 ±70.3.007Early outcomes (first 30-day period)VariablesF/BEVAR (n = 391)F/BEVAR + IBD/IBE (n = 19)P value30-day mortality8 (2)0 (0)>.99AKI (RIFLE criteria)17(4.3)1(5.2).542Spinal cord ischemia11 (2.8)0 (0)>.99MACE45 (11.5)0 (0).24030-day secondary interventions18 (4.6)0 (0)>.99Access complications50 (12.7)0 (0).146Bowel ischemia5(1.3)1 (5.3).249Postopertive hospital stay length, days5.08 ± 6.27.39 ± 15.527AKI, Acute kidney injury; CMD, custom-manufactured device; EBL, estimated blood loss; MACE, major adverse cardiovascular events.Data are presented as the total number (%) or mean ± standard deviation. Open table in a new tab

The aim of this study was to analyze the 5-year incidence of target vessel occlusion (TVO) in fenestrated/branched endovascular aneurysm repair (F/BEVAR) cases, evaluating management, outcomes, and potential effects on long-term survival. A single-center, retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms who underwent a F/BEVAR procedure. The occlusion of any of the target visceral arteries, either incorporated in the repair by a branch or fenestration, was included in this study if the vessel was stented during the index procedure. Patients who presented TVO were compared with the ones who did not have this adverse event with respect to demographics, aneurysm extension, aneurysm sac size, and 5-year risk of death. Four hundred and thirty-three F/BEVAR cases performed between July 2012 and May 2023 incorporating 1648 TV were included in the study (mean age, 72 ± 7.9 years; 72.2% males), with 20 individuals (4.6%; mean age, 68 ± 5.7 years; 72.2% males) subsequently presenting with occlusion of 24 target vessels(12 renal, 1 accessory renal, 1 hepatic, 6 celiac, and 4 superior mesenteric arteries [SMA]; occlusion rate, 1.45%). In terms of demographics, aneurysm extent (P = .155), or aneurysm maximum diameter (P = .140), there was no significant difference between the patients with and without TVO. Twenty of the occluded TVs (83.3%) were incorporated into the repair by fenestrations, and four (16.6%) by using branches. Balloon-expandable stents were used in 22 (91.6%) occluded vessels. Only 20.8% of the occluded TVs presented significant stenosis prior to the F/BEVAR procedure. Among the TVO cases, 85% were taking aspirin, 30% clopidogrel, and 5% were taking oral anticoagulants at the time of the occlusion event. Only 20% of the patients with TVOs were active smokers when the adverse event happened. The mean time-to-occlusion was 16.7 ± 16.5 months. Nine patients underwent a TVO-related secondary intervention (mostly percutaneous) involving 12 target vessels, and flow was reestablished in 58% of the arteries. The celiac artery occlusions were managed conservatively in all cases when patent SMA vessels were present. There was one TVO-related death secondary to mesenteric ischemia complications. The 5-year risk of death was not significantly different when patients that presented TVO were compared with the ones without this adverse event (P = .304). TVO is a rare adverse event after F/BEVAR, potentially occurring even in patients on antiplatelet therapy who are not active smokers. TVO-related secondary interventions have a relatively low rate of success. The conservative management of celiac artery occlusions appears to be tolerated in patients with patent SMA vessels. The occurrence of a TVO does not impact the 5-year mortality in F/BEVAR cases, possibly due to the infrequency of this adverse event.

OBJECTIVE:To investigate which preoperative factors most impact the 5-year survival of patients undergoing fenestrated/branched endovascular aortic repair (F/BEVAR) and to identify modifiable elements that, if time allows, should be actively managed and adequately controlled preoperatively. METHODS:Patients treated for aortic aneurysms with complex anatomy using either patient-specific company-manufactured or off-the-shelf F/BEVAR devices were included. The exposure of interest was aneurysm type (group I: type I-III thoracoabdominal aneurysms vs group II: type IV thoracoabdominal aneurysms vs group III: juxtarenal or suprarenal aneurysms), and the primary outcome was 5-year risk of all-cause mortality. Generalized linear models were used to estimate each group's crude 5-year risk of death and the 5-year risk of death across groups. Each preoperative factor was added to the model individually, and a change in estimate was calculated between the new risks and the crude risk. Preoperative factors with a change of estimate of ≥10% were used to create an inverse probability of treatment weights for multivariable analysis. RESULTS:A total of 408 F/BEVAR patients were included, of whom 71.6% were male (mean age: 72.0 ± 7.9 years). Eleven of the 22 preoperative factors analyzed had a change in estimate ≥10%. The greatest changes in estimates were observed for history of congestive heart failure (CHF), arrhythmia, overweight, obesity, and chronic obstructive pulmonary disease. Almost 60% of patients with CHF in group I died within 5 years. Current smoking or overweight at the time of F/BEVAR increases the 5-year risk of death more significantly than having a history of myocardial infarction. After adjustment, patients in group I had a significantly higher risk of 5-year all-cause mortality than those in group III (log-rank, P value = .0082). CONCLUSIONS:The present findings suggest that cardiac arrhythmias, CHF, overweight, obesity, chronic obstructive pulmonary disease, and aneurysm diameter above 7 cm are the most relevant preoperative factors that impact the 5-year survival after F/BEVAR. More specifically, CHF and arrhythmias should be used to alter patient selection and identify those individuals more likely to benefit from repair. Moreover, modifiable risk factors such as weight loss and smoking cessation during the surveillance period before the F/BEVAR procedure might improve survival in this population. Considering that, preoperatively, many patients are periodically evaluated by a vascular surgery team until the aneurysm diameter meets criteria for repair, a multidisciplinary approach that could address these modifiable risk factors might be an impactful strategy.

INTRODUCTION:Chronic venous insufficiency (CVI) may lead to sustained elevated pressure (aka venous hypertension) in the dermal venous microcirculation. Risk factors include advanced age, obesity, female gender, pregnancy, and prolonged standing. CVI in the lower extremities may lead to cutaneous changes such as xerosis and venous leg dermatitis (VLD). This review explores skin barrier restoration using skincare for xerosis and VLD.&nbsp; &nbsp; Methods: Prior to the meeting, a structured literature search yielded information on fourteen draft statements. During the meeting, a multi-disciplinary group of experts adopted five statements on xerosis and VLD supported by the literature and the authors&rsquo; clinical expertise.&nbsp;&nbsp; Results: VLD and associated xerosis is a common condition requiring more attention from healthcare providers. Compression therapy is the standard CVI and should be combined with good-quality skincare to enhance adherence to treatment. Maintaining an intact skin barrier by preventing and treating xerosis using gentle cleansers and ceramide-containing moisturizers may improve the skin sequelae of CVI. Skincare is frequently lacking or overlooked as part of the treatment of patients with CVI and VLD. This skin treatment is an unmet need that can be addressed with ceramides-containing pH balanced cleansers and moisturizers. CONCLUSION:Compression therapy is the mainstay of treatment for CVI and VLD. Quality skincare can improve treatment adherence and the efficacy of compression therapy. Using a skincare agent may reduce friction and help patients avoid skin trauma while putting on compression garments. A ceramide-containing moisturizer sustained significant improvements in skin moisturization for 24 hours and may offer synergistic benefits together with compression treatment.&nbsp; J Drugs Dermatol. 2024;23(2):61-66.&nbsp; &nbsp;&nbsp; doi:10.36849/JDD.7588.

The aim of this study was to investigate the outcomes of F/BEVAR patients comparing individuals with and without a prior diagnosis of peripheral arterial disease (PAD) A single-center retrospective analysis was performed, including patients with the diagnosis of complex aortic aneurysms treated with an F/BEVAR procedure, using either an off-the-shelf or a patient-specific device. The diagnosis of PAD was determined by an ankle- brachial index <0.9 or a toe-brachial index <0.7 in non-diabetic and diabetic patients, respectively. No individuals presenting active wounds or foot infection were included; therefore, only the ischemia grade of the WIFi classification was applied to categorize PAD patients into "mild PAD" (grades 0 and 1) and "severe PAD" (grades 2 and 3), and both groups were compared with the non-PAD cases. The primary outcomes were 30-day and long-term mortality. Secondary outcomes included 30-day major adverse events (bowel ischemia, acute kidney injury [AKI], spinal cord ischemia [SCI]), long-term major complications (myocardial infarction [MI], stroke, and kidney function deterioration), and aneurysm-related adverse events. Four hundred one patients (72.3% males; mean age, 71.7 ± 8.9 years) who underwent a F/BEVAR procedure between July/2012 and October/2023 were included in the study, 95 (24%) with a prior diagnosis of PAD (22 mild; 73 severe). In terms of demographics, aneurysm extent, aneurysm maximal diameter, and comorbidities, no significant difference was observed across the three groups, except for the history of tobacco use (P = .033) and prior diagnosis of diabetes (P = .036) that were significantly higher amongst the patients with severe PAD. The 30-day survival (P = .483) and 30-day major adverse events (Table I) such as MI (P = .237), stroke (P = .222), AKI (P = .566), and SCI (P = .183) were similar across the groups. However, when all PAD cases were compared with non-PAD patients, they presented a significantly higher incidence of postoperative mesenteric ischemia (3 cases in PAD group, 1 case in non-PAD group; P = .043). Despite a similar incidence of long-term complications such as MI (P = .330), stroke (P = .353), and kidney function deterioration requiring dialysis (p = .093) observed across the groups, time- to-event analysis demonstrated that patients with severe PAD have a lower long-term survival when compared to the ones without this diagnosis (Fig 1) (Log-rank P = .035). As for aneurysm-related adverse events, there was no significant difference in terms of types I, II, and III endoleaks, access complications, target vessel occlusions, and freedom from secondary interventions across the groups. Significantly lower 5-year survival is observed in the F/BEVAR cases with a preoperative diagnosis of PAD and severe ischemic component. In addition, patients with PAD might require a higher index of suspicion of mesenteric ischemia in the perioperative period.TableOutcomesCounts (percentages)P-valueMild PAD, n = 73 casesSevere PAD, n = 22 casesNon-PAD, n = 30630-day MI2 (2.73)0 (0)1 (0.32).23730-day stroke1 (1.37)2 (9.09)1 (0.32).222Spinal cord ischemia4 (5.47)0 (0)6 (1.96).183Long-term MI5 (6.84)1 (4.54)10 (3.26).330Long-term stroke5 6.84)3 (13.63)18 (5.88).353Long-term renal failure requiring dialysis5 6.84)7 (31.81)0 (0).093Spinal cord ischemia4 (5.47)0 (0)6 (1.96).183Types 1a + 1b endoleaks3 (4.11)0 (0)20 (6.53).519Type 2 endoleak16 (21.92)7 (31.81)108 (35.29).089Type 3 endoleaks12 (16.43)0 (0)30 (9.8).066 Open table in a new tab