ObjectivesFemoral endarterectomy often requires patch angioplasty, and saphenous vein patch (SVP) was the standard. However, bovine pericardial patch (BPP) provides potential advantages, including no requirement for vein harvest, use of the access site for concomitant endovascular procedures, and favorable handling characteristics. We compared the short- and mid-term outcomes of BPP and SVP in femoral endarterectomy.MethodsThis retrospective, single-center study included 42 patients (49 limbs) who underwent elective femoral endarterectomy with patch closure between September 2016 and January 2025. The patients were grouped by patch type as follows: 28 limbs with BPP and 21 limbs with SVP. Primary endpoints included patency and freedom from target lesion revascularization at the endarterectomy site. Secondary endpoints included perioperative complications, limb salvage, and intraoperative arterial clamp time.ResultsNo patch-site restenosis or re-intervention occurred in either group. There were no patch infections, and the perioperative complications were similar. Limb salvage at 40 months was 87.5% with BPP vs. 95.0% with SVP (p = 0.42). Intraoperative arterial clamp time was significantly shorter in the BPP group (55.0 vs. 69.5 min, p = 0.01).ConclusionsBPP represents a safe and valuable alternative option for femoral endarterectomy.

Long-Term Outcomes of Hybrid-Based Iliofemoral Endarterectomy for Severe, Extensive Occlusive Disease.

ObjectivesThe purpose of this study was to evaluate the results of endovascular therapy (EVT) with common femoral artery (CFA) endarterectomy site access for lower extremity artery disease (LEAD).MethodsRecords were reviewed retrospectively for patients who underwent EVT with CFA endarterectomy site access from 2014 to 2023 at 7 hospitals.ResultsA total of 74 EVT procedures with CFA endarterectomy site access were performed in 65 patients with LEAD. The median [interquartile range] interval between CFA endarterectomy and the first EVT access was 435 [237–1153] days. Technical success of EVT was achieved in 72 procedures (97%). Technical success of the puncture was achieved in all 74 procedures (100%). The median [interquartile range] puncture time and hemostasis time were 4 [2–6] and 13 [10–20] min, respectively. Two cases (3%) had access site hematoma, which was cured with conservative treatment.ConclusionsThe CFA after endarterectomy may be a safe and suitable access site for EVT.

Evaluation of femoral bifurcation endarterectomy and endovascular therapy for long tandem lesions involving the deep femoral artery

12/15-lipoxygenase deficiency attenuates disturbed flow-induced LDL oxidation in endothelial cells.

Outcomes of the Safety and Efficacy of Covered Stents Versus Bare Metal Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Single-Center Experience.

Introduction. Pulmonary thromboendarterectomy (TEE) is the gold standard of treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Residual pulmonary hypertension (PH) may worsen prognosis of disease after TEE, and incidence reaches 40%. Identification of risk factors of residual PH in long-term period after surgery is an actual issue. Material and methods. A retrospective observational study included 58 patients with CTEPH who underwent TEE in 2016—2020. We studied long-term results and obtained data in 96.6% patients (n=56); median follow-up was 66 (57—78) months. The primary endpoint was residual PH as mPAP ≥25 mmHg according to right heart catheterization (RHC) or sPAP ≥40 mmHg according to echocardiography. Statistical analysis was performed. Sensitivity and specificity of predictors of residual PH were analyzed using ROC analysis (cut-off value was established using Youden index). Results. The 5-year cumulative survival rate was 94.6%. Recurrence of pulmonary embolism was diagnosed in 1 patient (1.7%). Among survivors, residual PH was diagnosed in 12 (22.6%) patients. Patients in this group were older (61.2±8.7 vs. 49.8±13.2 years, p=0.007) and had higher PVR on the first day after TEE (361.8±130.3 vs. 250.7±82.2 dynes/sec/cm-5, p<0.001) with a cut-off PVR 321 dyne/sec/cm-5 (sensitivity 75.0%, specificity 80.5%). Patients with residual PH were treated with balloon angioplasty of pulmonary arteries (n=4, 33.3%) and PAH-specific therapy (n=10, 83.3%). Conclusion. The incidence of residual PH after successful TEE within 5 years was 22.6%. Predictors of residual PH were older age and high PVR in early postoperative period. PVR>321 dynes/sec/cm-5 on the 1st day after surgery is associated with high risk of residual PH.

Background: Coronary endarterectomy (CE) is used as an adjunct to coronary artery bypass grafting (CABG) in patients with severe diffuse coronary artery disease. The primary goal of performing CE is to achieve complete revascularisation by recreating a patent lumen when isolated CABG is not possible due to severe plaque burden. This study evaluates outcomes following CE-CABG at a tertiary centre and uniquely examines how vessel type, operative technique may influence mortality. Additionally, it highlights the heterogeneity in prescribing anti-thrombotic medications post-operatively. Methods: We analysed urgent and elective CE-CABG procedures from 2019 to 2024, excluding patients with concomitant valve surgery or incomplete records. The primary objective was to assess short- and mid-term survival after coronary endarterectomy combined with CABG at a tertiary centre. Secondary objectives included postoperative complications, changes in heart function, and the impact of anatomical and technical factors on outcome. Survival was estimated with Kaplan-Meier analysis.Results: The cohort comprised 48 patients (mean age 66.5 ± 9.1 years, 81.3% male), with high rates of dyslipidaemia (79.2%) and hypertension (62.5%). Most procedures were urgent (68.8%) and performed on-pump (72.9%). In-hospital mortality was 8.3%, and overall mortality during follow-up was 20.8%. Prolonged inotropic support (47.9%), extended ventilation (41.7%), and atrial fibrillation (20.8%) were the most common complications. Mortality differed by vessel: obtuse marginal (OM) endarterectomy demonstrated the highest mortality rate (42.9%), whereas left anterior descending (LAD) endarterectomy showed comparatively lower mortality (16.7%). Open endarterectomy was associated with numerically lower mortality (15%) compared with closed techniques. Considerable heterogeneity was observed in postoperative antithrombotic prescribing across the cohort. Kaplan-Meier curves demonstrated a high early postoperative risk with stable survival in the mid-term period.Conclusions: CE-CABG carries notable early morbidity and mortality, but mid-term survival remains acceptable. This study highlights vessel- and technique-specific risk, though the limited statistical power and absence of standardised perioperative protocols constrain generalisability. Larger studies are needed to refine patient selection, optimise surgical approach, and standardise antithrombotic strategies following CE.

Purinergic receptor P2X7 has been considered as a potential new target for detecting and treating high-risk plaque. Nanobodies are the smallest antibody fragments with high antigen binding ability and specificity, which are well-suited for radionuclide imaging. The present study aimed to develop a novel P2X7-targeted nanobody SPECT tracer and to investigate its potential for identification of atherosclerotic plaque (AP). The anti-P2X7 nanobody 1c81 was site-specifically conjugated with [99mTc]Tc-HYNIC-GGGC via sortase A-mediated transpeptidation to prepare [99mTc]Tc-1c81. Saturation binding experiments and cell-binding assays were performed to evaluate their affinity and specificity. Biodistribution studies in C57 mice were conducted at 0.5, 1, and 2 h postinjection (p.i.), and SPECT/CT imaging was performed in ApoE-/- (high-fat diet) and C57 mice (normal diet) at 2 h p.i, respectively. Specific binding was validated by blocking studies (coinjection of [99mTc]Tc-1c81 with excess unlabeled 1c81) in ApoE-/- mice. Target-to-background ratio (TBR) was calculated for AP at aortic arch. The harvested aortas were analyzed by autoradiography, Oil Red O lipid staining, and immunofluorescence staining (CD68, P2X7) to correlate tracer uptake with AP characteristics. To further validate the clinical relevance, human coronary endarterectomy (CE) specimens were analyzed for P2X7 and CD68 expression using immunohistochemistry. [99mTc]Tc-1c81 was synthesized with 53.77 ± 0.06% radiochemical yield, > 95% purity, 11.13 ± 2.78 MBq/nmol molar activity, and a binding dissociation constant of 6.38 nM. Biodistribution showed rapid clearance from the blood and normal organs except the kidneys. SPECT imaging at 2 h p.i. revealed clear aortic arch visualization, with significantly higher TBR in ApoE-/- mice compared to both C57 and blocking groups (4.49 ± 1.88 vs 0.96 ± 0.64, P = 0.012; 4.49 ± 1.88 vs 1.40 ± 0.28, P = 0.017). Autoradiography further confirmed specific tracer accumulation in APs, colocalizing with Oil Red O-positive lipid-rich regions. Immunofluorescence and immunohistochemical staining validated high P2X7 receptor expression in both mouse AP aortic valve sections and human CE specimens, which was colocalized with CD68+ inflammatory cells, confirming the clinical relevance of P2X7 as an imaging target for inflammation of AP. [99mTc]Tc-1c81 exhibited specific binding to the P2X7 receptor in AP in vivo. It may serve as a novel P2X7-targeted SPECT tracer to detect AP, with promising applications in clinical risk stratification and treatment response monitoring.

Severe arterial calcification is a challenging limitation in endovascular procedures leading to worsesuccess rates and outcomes. Conventional balloon angioplasty may provide limited luminal gain, calling for adjunctive strategies of plaque modification, such as intravascular lithotripsy (IVL). The aim of this study is to describe our institutional experience with IVL in the treatment of peripheral artery disease (PAD). A prospectively maintained database from a tertiary academic medical centre was retrospectively enquired from October 2021 to September 2024. The study included all patients who underwent IVL (Shockwave Medical, Inc., California, USA) for vessel preparation during endovascular treatment of PAD. 19 patients were included (79% male, median age 76 years) with a median follow-up period of 6 and total of 35 months. Most common risk factors were hypertension (90%), diabetes (68%), dislipidemia (63%) and ischaemic heart disease (63%). Clinical presentation was mostly chronic limb-threatening ischemia (Fontaine grade IV in 74% and Fontaine grade III in 10%). The target lesion undergoing IVL was most often femoropopliteal (68%). Intraprocedural lesion crossing was almost equally subintimal and intraluminal (53% vs. 47%) and definitive treatment was mostly performed with stenting (79%). Additionally, 3 patients (16%) underwent a hybrid procedure with femoral endarterectomy (11%) or femoro-femoral bypass (5%). There were no identified procedural complications. Major adverse limb events (MALE) included no reinterventions and 1 major amputation (5%), and the all-cause mortality rate was 16%. Regarding the 14 patients in Fontaine grade IV, the wound healing rate was 57%. IVL is a safe and effective adjunctive in vessel preparation during endovascular revascularisation procedures, particularly in the femoropopliteal sector. Procedure and/or device-related complications, MALE and mortality are infrequent. Further research is needed concerning aortoiliac and infrapopliteal sectors and comparison with other supplementary treatment alternatives.

IntroductionCoronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) has been associated with poor graft patency, which might be attributed to the activation of coagulation cascade caused by the exposure of the subendothelial tissue to the blood stream, which could necessitate anticoagulation therapy. However, the optimal antithrombotic therapy after CE+CABG remains unclear.Methods and analysisThe PATH-CARE is a double-centre, two-armed, blinded to outcome assessed, randomised controlled trial, aimed to determine the optimal antithrombotic therapy after CE+CABG. A total of 202 patients are expected to be recruited. Patients will be randomly assigned in a 1:1 ratio to the control (dual antiplatelet therapy (AT) group) and the intervention (dual AT+warfarin (ATW) group). Patients in the AT group will receive aspirin plus clopidogrel for 1 year, while patients in the ATW group receive aspirin plus clopidogrel for 1 year with extra warfarin therapy for the first 3 months postoperatively. All patients will receive life-long aspirin treatment after the first year. All of the patients will be required to complete a 6-month follow-up. The primary endpoint is the patency of CE-targeted coronary grafts, assessed through coronary CT angiography or coronary angiography. Secondary outcomes include the occurrence of major adverse cardiovascular and cerebrovascular events and bleeding events.Ethics approval and disseminationThis study was approved by the Institutional Review Board of Fuwai Hospital (No.: 2022–1849), and Yunnan Fuwai Cardiovascular Hospital (No.: 2023-048-01). Findings of this trial will be disseminated via peer-reviewed research papers and academic conference presentations.Trial registration numberNCT05782270.

ObjectiveCombined iliofemoral endarterectomy and iliac stenting (IFE + S) is a proven surgical approach for TransAtlantic Inter-society Consensus (TASC) C and D aortoiliac occlusive disease (AIOD). Iliac stenting alone (ISA) may be an attractive, minimally invasive option in select cases; however, untreated moderate-to-severe common femoral disease may threaten iliac stent patency and limit symptom improvement. This study evaluates the mid-term patency rates after IFE + S versus ISA for TASC C and D AIOD as well as the rate of interval femoral endarterectomies in those who underwent ISA.MethodsThis is a retrospective, single-center analysis of patients from 2011 to 2018 with TASC C or D AIOD and concomitant femoral artery stenosis of >50% who underwent IFE + S or ISA. Baseline lesion and patient characteristics such as TASC classification, degree of stenosis, calcification severity, lesion length, and baseline ankle-brachial index (ABI) were collected. Primary, primary-assisted, and secondary patency rates were calculated over threeyears with Kaplan-Meier estimates. The rate of interval femoral endarterectomies in the ISA cohort was measured at the same time endpoint.ResultsOf the 78 limbs identified, 64 (82.1%) underwent IFE + S and 14 (17.9%) underwent ISA. No significant differences in aortoiliac or femoral lesion characteristics existed. Iliac stent primary patency was significantly improved in the IFE + S group at three years [85.1% versus 55.6%, HR 3.96 (95% CI 1.54, 10.2, p = .004)]. Primary-assisted and secondary patency rates were not significantly different. Five (35.7%) patients in the ISA cohort required an interval femoral endarterectomy for ischemic symptoms over the three-year endpoint.Conclusions: In select patient populations with concomitant TASC C or D AIOD and common femoral artery disease, IFE + S may provide improved mid-term primary stent patency when compared to ISA. A subset of patients who undergo ISA may require future femoral endarterectomies for ischemic symptoms.

Introduction: Inflammatory pathways in vascular disease are the focus of intense interest. Multiple studies have shown that interleukin-6 (IL-6) is strongly implicated in the atherosclerotic process. Accumulating evidence suggests a similar role for growth differentiation factor-15 (GDF-15). Methods: In this study, we measured and compared circulating levels of IL-6 and GDF-15 in a cohort of 20 vascular surgical patients with atherosclerotic disease presenting for surgical revascularization (carotid endarterectomy or common femoral artery endarterectomy) and in a similar number of age-matched healthy volunteers. A cross-sectional analysis of prospectively collected data was performed, with serum GDF-15 and IL-6 levels measured and assessed using enzyme-linked immunosorbent assays (ELISAs). Results: We observed substantial circulating levels of GDF-15 in most patients (17/20) compared to the reference range upper limit of 1,500 pg/mL, irrespective of the type of vascular disease and revascularization procedure they were undergoing. In contrast, only 1 healthy control participant had a borderline high GDF-15 of 1,572 pg/mL. Indeed, the mean serum GDF-15 level between patients (2,515 pg/mL, SD 906) and healthy controls (1,016 pg/mL, SD 219) was highly significant (p value <0.001). On the other hand, although IL-6 levels between patients (mean 3.6, SD 2.54 pg/mL) and healthy controls (mean 2.2, SD 0.67 pg/mL) were significantly different (p = 0.020), only 7 patients had values above the reference range upper limit of 3.4 pg/mL. Conclusion: These results suggest that serum GDF-15, but not IL-6, is a strong candidate for use as a biomarker of atherosclerotic vascular disease and may allow for earlier risk factor modification to help prevent disease onset and progression. Large-scale studies aimed at determining whether a rising GDF-15 is an indication of worsening outcome in a wider spectrum of patients with vascular disease are clearly warranted.

This study examined mid-term outcomes in symptomatic patients with peripheral arterial disease (PAD) undergoing hybrid revascularisation (HYR) involving common femoral artery endarterectomy (CFAE) with inflow and/or outflow endovascular procedure in 2 vascular centres. A total of 366 consecutive patients (mean age 70.4 years, SD: 9.8 years; 271, 74% males) were identified. Overall, a total of 231 patients (63%) presented with chronic limb-threatening ischaemia. Patients were followed up for a median of 55 months (range 26-84 months). During follow-up, 105 patients (29%) required target lesion revascularisation (TLR). There were 33 patients (9%) who had a major amputation, and 37% (147) patients died resulting in an amputation-free survival (AFS) of 58% (213 patients) over the study period. HYR offers reasonable mid-term clinical and technical outcomes for multilevel PAD with diabetes adversely affecting outcomes such as AFS, primary patency (PP), and TLR, while patients on dual antiplatelet therapy post-operatively had favourable PP and TLR.Clinical ImpactHybrid lower limb arterial revascularization demonstrates acceptable mid-term outcomes and should be considered in patients with symptomatic multi-level PAD. By integrating open and endovascular techniques, it offers a practical solution for complex disease patterns. Given the paucity of contemporary data, this study provides meaningful evidence that may add to further studies and support the broader use of hybrid approaches in managing advanced PAD.

This study retrospectively evaluated the mid-term outcomes of thromboendarterectomy (TEA) for common femoral artery (CFA) disease in a Japanese cohort by comparing patients with chronic limb-threatening ischemia (CLTI) and intermittent claudication (IC). Sixty-three TEA procedures performed between 2011 and 2024 were analyzed. The primary endpoints focused on procedure-related outcomes such as patency and limb salvage, whereas overall survival was assessed as a key secondary outcome. The patients were divided into the CLTI (n=20) and IC (n=43) groups; the anesthesia type, additional revascularization, blood loss, hospital stay, complications, and survival were compared. Multivariable Cox regression analysis was performed to identify independent predictors of mortality. Patients with CLTI had higher rates of local anesthesia, additional revascularization (all performed concomitantly), greater blood loss, and longer hospital stays. Despite the 100% technical success in both groups, 30-day mortality and complications occurred only in the CLTI group. Kaplan-Meier analysis showed similar patency and limb salvage rates between groups, whereas survival rates were significantly lower in patients with CLTI (P=0.037). Multivariable analysis revealed that CLTI itself was not an independent predictor of mortality; rather, a worse systemic status (e.g., higher American Society of Anesthesiologists classification) showed a trend toward poorer outcomes (P=0.051). No significant differences were found between the patch types. TEA provides effective mid-term outcomes in patients with CFA disease, particularly those with IC. Although patients with CLTI show poorer survival, this appears to be driven more by systemic comorbidities than by the limb status itself. Careful preoperative assessment and holistic management of general health are essential to optimize outcomes, particularly in high-risk populations.

Ischemic monomelic neuropathy (IMN) is a rare peripheral neuropathy caused by limb ischemia and subsequent nerve degeneration, typically manifesting with unilateral pain, paresthesia, and numbness without overt signs of limb ischemia. This case report describes a 59-year-old female with extensive peripheral artery disease who developed IMN in her right lower extremity following an acute, intraoperative in-sheath thrombosis during a right femoral endarterectomy and external iliac artery stent placement, a rare etiology distinct from the more commonly reported associations with bypass surgery or hemodialysis access. Despite successful intraoperative revascularization, the patient developed diminished motor and sensory function with unremitting pain, and subsequent electromyography confirmed a length-dependent neuropathy with features of denervation, consistent with IMN. This case underscores the critical need for clinicians to consider IMN in the differential diagnosis of post-procedural neuropathic pain, even in the absence of classic ischemic signs and following seemingly successful vascular interventions, as acute thrombotic events during vascular procedures can precipitate this debilitating condition.

Previous studies suggest that the location of coronary artery disease cannot independently predict atrial fibrillation after coronary artery bypass grafting, but with little information, it has also been thought that simultaneous right coronary endarterectomy may cause this rhythm problem. In this study, we aimed to evaluate the effect of right coronary artery bypass grafting on early postoperative atrial fibrillation. Patients who underwent elective on-pump coronary artery bypass grafting operations in our hospital were included in the study, and patients who underwent a different open-heart surgery or those who had previously undergone open-heart surgery were not included. Patients included in the study were divided into Group 1 (patients who developed postoperative atrial fibrillation) and Group 2 (patients who did not develop postoperative atrial fibrillation) and compared in terms of right coronary artery bypass grafting and other follow-up parameters. The mean age of a total of 158 patients included in the study was determined as 63.25 ± 10.07 years (range 44 - 85 years), 120 were male, and 96% of them had hypertension. Postoperative atrial fibrillation developed in 43 patients, and right coronary artery bypass grafting was performed in 123 patients. We think that the frequency of postoperative atrial fibrillation development may be higher in cases where right coronary artery bypass grafting is performed, as it may play a role in processes related to the conduction system and right ventricular dysfunction, and multicenter studies with a large number of patients would be beneficial on this subject.

Objective To analyze the lipid composition of coronary endarterectomy (CE) plaques and explore the mechanisms affecting the mid- and long-term efficacy of CE. Methods Sixteen patients matched out of fifty patients with diffuse coronary artery disease performing coronary artery bypass grafting (CABG) with endarterectomy were enrolled from Beijing Anzhen Hospital between January 2024 and May 2024. Patients were divided into high-risk and low-risk groups to detect plaque tissue and CYP3A4 content, and analyze the restenosis rate by CATCH technique. Mendelian randomization consisting of univariate, mediation and sensitivity analysis were conducted to figure out the causal correlation. Results Lipidomics revealed significantly higher level of 4α-hydroxycholesterol (4αOH-CHO) in the high-risk group (0.050 μmol/g vs. 0.016 μmol/g, P &lt; 0.05). Plasma CYP3A4 levels in the experimental group were higher immediate and in long term. A better long-term patency in the control group was discovered [stenosis rate (9.0 ± 1.9)% vs. (22.3 ± 2.3)%, P &lt; 0.05)]. Genetical evidence showcased a causal relationship between hydroxycholesterol with atherosclerosis (AS) (P = 0.014), and increased CYP3A4 content may be due to the existing AS (P = 0.003). Conclusion High expression of 4αOH-CHO may accelerate AS and cause mid- and long-term restenosis after CE. In AS population, 4αOH-CHO may be identified as a practical marker of CYP3A4, assessing the progression mechanisms of AS after CE.

Coronary endarterectomy as an adjunct to coronary artery bypass grafting: Real-world outcomes from a decade-long experience

Endarterectomy, typically in patients with peripheral artery disease, involves arteriotomy closure with a 'patch.' One of its most common long-term complications is restenosis due to arterial wall hyperplasia induced by excessive mechanical stimulation. Methods to reduce surgically induced stress to promote positive long-term outcomes remain an open question. In this work, an arterial 'punch' approach is proposed to alleviate the stress concentration in arterial walls around the incision/patch anastomotic interface. Intraoperatively, coronary vascular punches are used to create proximal and distal circular arteriotomies for patients undergoing femoral endarterectomy. The surgical procedure is numerically simulated by first opening the vessel wall and subsequently adjusting the boundary condition of the incision to consider the patch's effect. An optimization study is performed by investigating the impact of incision/patch combinations on arterial wall stresses. The optimal punch tip size is identified by obtaining the minimum in-plane principal stress in the arterial wall. A beveled punched hole is also considered to optimize the stress field. Simulation results show that the stress magnitude in the arterial wall with a punched hole is significantly lower than that in an artery with a sharp vertex. The stress exponentially declines with increasing punch diameter. A beveled hole can further reduce the stress values and the number of high-stress regions. The arterial punch method can effectively alleviate stress concentration in arterial tissues. Importantly, stress concentration is shown to be sensitive to punched hole size and shape, suggesting potential practical implications for surgical techniques and patient outcomes.