Vascular Surgery

Age and conduit modify benefit of vein bypass vs endovascular therapy in CLTI

In BEST-CLI cohort 1, single-segment saphenous vein (SSGSV) bypass had lower MALE/death than endovascular therapy at all ages, with benefit attenuating near age 72. Amputation risk was lower with SSGSV than endovascular therapy up to about age 57, with no difference beyond that point. MALE risk remained lower with SSGSV up to roughly age 83, supporting preferential bypass in suitable younger and middle-aged patients. When alternative conduits were used, age did not modify outcomes versus endovascular therapy, reducing any age-based preference in that setting. 1

Inappropriate IC care by SVS AUC linked to more repeat revascularization and reintervention

This seven-center retrospective study applied SVS Appropriate Use Criteria (AUC) to 372 patients treated for intermittent claudication. Thirty-four percent were classified as receiving inappropriate care (R>B), often without prior exercise therapy or optimal medical therapy. At 2 years, freedom from any revascularization was markedly lower in R>B patients than in appropriate/indeterminate cases (19% vs 57%). After index revascularization, 2-year freedom from reintervention was also lower in R>B patients (64% vs 84%). 2

One-month type II endoleak after EVAR predicts sac expansion and reintervention

Among 292 degenerative abdominal aortic aneurysm EVAR patients with 1-month imaging, 22.3% had a type II endoleak (T2EL). Sac expansion occurred in 32.3% with early T2EL versus 7.0% without, and endoleak-related reintervention in 18.5% versus 4.0%. On multivariable analysis, 1-month T2EL independently increased risk of sac expansion (HR 4.75) and endoleak-related reintervention (HR 3.08). All-cause mortality was similar between groups, but early T2EL clearly signaled higher risk for adverse aortic events. 3

LEAF defines a national framework for 10-year real-world EVAR device surveillance

The LEAF program was developed after an FDA advisory panel called for robust long-term EVAR surveillance and 10-year real-world outcomes. It integrates Vascular Quality Initiative data, Medicare claims linkages, and Kaiser Permanente data to monitor stent-graft performance. Enhanced registry fields plus targeted clinical and imaging follow-up enable systematic capture of late complications and device failures. The framework offers a scalable model for postmarket EVAR surveillance and can inform protocols for other cardiovascular interventions. 4