Vascular Surgery — Weekly Evidence Brief

Advances in complex vascular surgery continue to refine patient management and improve outcomes. For patients with diffuse superior mesenteric artery occlusive disease causing chronic mesenteric ischemia, open mesenteric bypass with endarterectomy demonstrates similar survival and complication rates to bypass alone, supporting an aggressive surgical approach 1. In aortic arch repair for acute aortic dissection, the SD-FET technique safely reduces circulatory arrest time and offers protection against death or neurological events 2. Furthermore, the Neo-Aorto-Iliac System procedure provides robust long-term efficacy and excellent patency for life-threatening aortic infections 3. Long-term data also confirm the Gore Excluder Iliac Branch Endoprosthesis is effective and safe for aorto-iliac aneurysms, showing favorable patency and sac remodeling over five years 4.

Regarding cardiac revascularization, coronary artery bypass grafting (CABG) significantly outperforms percutaneous coronary intervention (PCI) for left main coronary artery disease, showing lower rates of all-cause mortality, myocardial infarction, and repeat revascularization over a follow-up of up to 14 years 5. For patients undergoing aortic valve replacement (AVR), presenting with acute valve syndrome (AVS) is associated with a significantly increased risk of 1-year all-cause death and heart failure hospitalization, along with higher healthcare costs, compared to stable valve syndrome 6. Importantly, early postoperative atrial fibrillation after CABG carries a lower risk for morbidity and mortality than late new-onset AF, suggesting distinct prognostic implications 7. Additionally, a lower Prognostic Nutritional Index (PNI) is independently linked to higher long-term mortality after CABG, potentially aiding in risk stratification 8.

Optimal stroke management is evolving with new insights into specific interventions and risk factors. Intravenous thrombolysis (IVT) significantly reduces unfavorable functional outcomes at 3 months for patients with acute ischemic stroke due to small artery occlusion, a clear advantage over early antiplatelet therapy 9. Furthermore, lower admission folate and higher homocysteine levels are identified as independent predictors for 90-day futile recanalization following successful endovascular thrombectomy, offering potential for enhanced risk stratification and personalized secondary prevention 10. For patients with aneurysmal arteriovenous malformations, endovascular embolization, especially curative or targeted approaches, is associated with a lower rate of long-term hemorrhagic stroke or death 11. A multispecialty consensus emphasizes stratifying carotid stenosis patients by predicted stroke risk and clinical features, noting that best medical therapy alone is often insufficient for symptomatic cases and high-risk asymptomatic individuals may benefit from revascularization 12.

Novel techniques and improved risk tools are enhancing challenging procedures. The subclavian loop catheterization technique (SLOT) provides a valuable salvage option for challenging vertebral artery ostial stenosis, achieving successful stenting where standard transradial access failed without major complications 13. For mitral valve repair, a modified J-MACS score has been validated to stratify patients undergoing transcatheter edge-to-edge mitral valve repair into distinct risk groups for adverse outcomes, guiding patient selection and post-procedural care 14. Furthermore, snuffbox arteriovenous fistulas are a safe and viable first-line approach for dialysis access, demonstrating comparable patency and complication rates to wrist AVFs, thus extending vascular access options for suitable candidates 15. A wireless, implantable sensor is also under development for continuous monitoring of blood leakage (endoleaks) after endovascular aneurysm repair, potentially enabling earlier detection and intervention for this critical complication 16.