Shape memory polymers (SMPs) have emerged as versatile and adaptive materials in healthcare, offering transformative solutions for tissue repair and biomedical device interfaces. Their ability to undergo controlled shape changes in response to external stimuli has driven significant interest in developing smart implants for minimally invasive procedures. Precise material design and engineering that leverage physiological conditions, such as body temperature and bodily fluids, can unlock their potential for biomedical applications. This review focuses explicitly on SMPs activated by physiological stimuli, referred to here as "body-responsive" SMPs. By categorizing SMPs into temperature-responsive, water-responsive, and dual-responsive variants, their shape memory behavior is analyzed, with an emphasis on how the structural design governs the body-responsiveness of the SMPs. Current biomedical applications, including tissue engineering, vascular interventions, bioelectronic devices, and targeted drug delivery, are also highlighted to demonstrate the practical relevance and versatility of body-responsive SMPs. Additionally, emerging fabrication technologies are discussed to provide insight into current scalable production methods suitable for SMPs. Finally, challenges in the design and performance of SMPs are explored, and a vision for future advancements is presented, outlining a roadmap for translating SMPs into biomedical applications within clinical settings.

Feasibility of Magnetic Resonance Imaging-Guided Pulmonary Artery Stenting in a Commercial Wide-Bore 0.55-T Scanner.

Robot-assisted vascular interventions demand precise manipulation within tortuous millimeter-scale vessels, where surgical outcomes remain critically dependent on surgeon skill. Conventional metrics such as completion time or navigation success are too coarse to capture the subtle, yet decisive control differences between experts and novices, while sensor-heavy external approaches obscure the surgeon's intrinsic dynamics. This article introduces a task-aware spectral modeling (TASM) framework that directly extracts skill signatures from joystick control signals, revealing how surgical expertise manifests in the time-frequency domain. In vivo rabbit experiments demonstrate that expert manipulation emerges as smooth, deliberate low-frequency rhythmic control, whereas novice performance degenerates into fragmented, high-frequency corrections. Spectral analysis indicates that approximately 96% of control energy lies below 5Hz, suggesting that low-frequency components may serve as an indicative spectral characteristic associated with expert-novice differentiation under similar experimental and task conditions. By deriving interpretable spectral descriptors, the framework achieves an average ROC-AUC of 0.992 across nine classifiers. Clinically, the proposed framework may support quantitative assessment of surgical skill and control stability in robot-assisted endovascular procedures, with potential value for identifying inconsistent control behaviors and informing future training and evaluation pipelines.

Society of Interventional Radiology Position Statement on Genicular Artery Embolization for Symptomatic Knee Osteoarthritis.

Free flap reconstruction after recent lower limb revascularization: a matched cohort analysis of safety and limb salvage outcomes.

Chronic limb-threatening ischaemia (CLTI) not amenable to conventional revascularization options (no-option CLTI) is associated with high rates of major amputation and mortality. Promising results were reported following percutaneous deep venous arterialization (pDVA) using the LimFlow system. This study reports mid-to-long-term clinical and patency outcomes of pDVA in real-life single-centre settings. Retrospective, single-arm cohort study. The study included patients with no-option CLTI (Rutherford classes 5 and 6) who underwent pDVA using the LimFlow between January 2020 and June 2024. Patients were designated "no-option" by a multidisciplinary team after exhausting conventional revascularization options. Primary outcome was amputation-free survival (AFS). Secondary outcomes included technical success, limb salvage (LS), primary and secondary patency (PP/SP), freedom from reintervention (FFR) and wound healing rates. Thirty-four patients (median age of 67 years; 79.4% diabetic) were included, with a median follow-up of 21 months (4-62 months). Technical success was 100%. At 24 months, AFS was 72% and LS was 88.6%. Full wound healing was achieved in 66% of patients, with a median time of 262 days from the index procedure. Kaplan-Meier analysis showed 24-month PP and SP rates of 46.3% and 76%, respectively. Freedom from reintervention was 58% at 24 months. Four major amputations (11.7%) were required. Percutaneous deep venous arterialization using the LimFlow system provides acceptable mid-term outcomes. Satisfactory AFS, LS, PP, SP and wound healing rates were achieved in these no-option CLTI options. Strict post-procedure surveillance and reintervention protocols are essential to maintain satisfactory outcomes.Clinical ImpactThe LimFlow system introduces a novel option for patients with no revascularization alternatives. It enables limb salvage in severe CLTI cases previously destined for amputation. By creating arterial flow through the venous system, it redefines vascular intervention strategies. Clinicians gain a new tool for "no-option" patients, expanding treatment eligibility. This may reduce major amputation rates and improve quality of life. The approach requires new technical skills and multidisciplinary collaboration. It shifts practice toward advanced endovascular innovation rather than palliative care. Patient selection and procedural expertise become critical for success. The study highlights the feasibility and safety of transcatheter arterialization. Overall, it represents a paradigm shift in managing advanced peripheral artery disease.

Clinical Research, Clinical Outcomes of Open Repair for Small Popliteal Artery Aneurysms.

To determine the rate of occult vascular abnormalities in high-energy tibial plateau fractures using Computed Tomography Angiography (CTA). Prospective Cohort Study. Single Academic Level I Trauma Center. Adult subjects with a tibial plateau (OTA/AO 41) fracture, without clinical indication for CTA, that underwent knee-spanning external fixation were prospectively enrolled. Following external fixation, subjects underwent CTA to evaluate fracture morphology and the vascular tree. Fisher's exact test was utilized to determine correlations between arterial abnormalities and wound complications in patients with ≥90 days of follow-up. Twenty-six subjects with 27 high-energy tibial plateau fractures were enrolled. Subjects were predominantly male (n=16, 61.5%) with a mean age of 45.1±13.3 years. All patients had a blunt injury mechanism resulting in mostly closed (n=25, 92.6%) bicondylar (n=22, 81.5%) tibial plateau fractures. CTA demonstrated non-atherosclerosis vascular abnormalities in three patients (11.5%). Two had disrupted flow in the popliteal artery, and one had disrupted flow in the anterior tibial artery. No subjects required vascular intervention. Atherosclerosis was appreciated in six (26.9%) subjects. One of three subjects (33%) with non-atherosclerosis vascular abnormalities had wound complications. Four of 24 subjects (16.7%) without non-atherosclerosis vascular abnormalities had wound complications. There was no significant correlation between non-atherosclerosis vascular abnormalities and wound complications (abnormality present: 33.3% wound complication rate vs. no abnormality: 16.7%, p=0.47). Non-atherosclerotic vascular abnormalities on CTA were found in approximately a tenth of high-energy tibial plateau fractures. In this cohort, vascular abnormalities were not associated with wound complications. CTA is likely not necessary in tibial plateau fracture patients without clinical indications for CTA. Level II.

This study presents a novel mathematical model for the progression of diabetic foot complications, integrating the ankle-brachial index (ABI) as a key physiological marker of vascular health. The model, formulated as a system of ordinary differential equations, stratifies the patient population into compartments based on neurological and vascular status. We apply principles of optimal control theory to derive time-dependent strategies for glycemic control, vascular intervention, and preventive podiatric care. Numerical simulations, parameterized with clinical data, demonstrate that the proposed optimal control policy significantly reduces the incidence of severe outcomes, such as ulcers and amputations, compared to standard constant treatment protocols. The results highlight the critical role of dynamic treatment adaptation based on individual vascular profiles (ABI) and system state. This framework provides a quantitative tool for optimizing resource allocation and improving long-term patient management in diabetic foot care programs.

ObjectiveCurrent treatment strategies for acute lower extremity deep vein thrombosis (DVT) have shifted from merely preventing pulmonary embolism to actively removing thrombus and preserving valve function. However, there is limited evidence comparing the indications and perioperative outcomes of different endovascular strategies. This study aims to investigate the differences in indications, perioperative characteristics, and efficacy trends among three strategies: Angiojet mechanical thrombectomy alone, other thrombus removal devices alone, and a combination of Angiojet with other devices.MethodsA retrospective analysis was conducted on the clinical data of 232 DVT patients who underwent endovascular treatment in the Vascular Surgery Department of our hospital between January 2022 and April 2025. Based on the core thrombus removal method, patients were divided into three groups: Group A (Angiojet alone, n = 22), Group B (other devices alone, including manual aspiration and catheter-directed thrombolysis CDT, n = 35), and Group C (Angiojet combined with other devices, n = 175). Baseline characteristics, thrombus anatomical extent, and perioperative parameters were compared across the groups. Chi-square test, analysis of variance, or Kruskal–Wallis test were used for intergroup comparisons.ResultsThere were fundamental differences in thrombus burden among the three groups (P < 0.001). Groups A and B primarily treated limited (femoral/popliteal) thrombosis (50.0% and 51.4%, respectively), while Group C was the predominant approach for extensive thrombosis (iliofemoral-popliteal, 50.9%) and thrombosis involving the inferior vena cava (22.3%). The operative time for Group C (134 ± 48 min) was significantly longer than for Group A (98 ± 36 min) and Group B (115 ± 45 min) (P < 0.001), and blood loss (66 ± 39 mL) was also higher compared to the other two groups (P = 0.008). In terms of treatment intensity, the balloon angioplasty rate (96.0%) and stent implantation rate (58.9%) in Group C were significantly higher than in Groups A and B (P < 0.001). Group B showed the highest trend for documented “partial thrombus residue” (22.9%).ConclusionCurrent endovascular DVT treatment has formed a clear risk-stratified decision-making pathway. Angiojet alone is an efficient and streamlined option for limited acute DVT; for extensive and complex DVT, the intensified strategy of Angiojet combined with other thrombus removal devices has become the standard choice, with its longer operative time and higher rate of vascular interventions reflecting disease complexity. This study provides real-world evidence for individualized endovascular DVT treatment.

Clopidogrel was added to the national formulary of the Veterans Health Administration (VHA) in 2000, with national guidance in the form of Criteria for Use (CFU) generated in 2007 by the Pharmacy Benefits Management office. Although the national CFU restricted the duration of clopidogrel to no more than 30 days following peripheral vascular intervention (PVI) for peripheral artery disease (PAD), each local VHA Veterans Affairs Medical Center (VAMC) determined its own strategies of implementation. Strategies ranged from passive diffusion of information to electronic health record-mandated pharmacist approval for noncompliant CFU prescribing. To characterize patterns of compliance to restricted duration of clopidogrel and determine the factors associated with compliance. In a retrospective cohort study, we used the Veterans Affairs Surgical Quality Initiative Program (2007-2022) to identify index PVI performed for PAD and integrated post-PVI medication information from the VA Clinical Data Warehouse. Our primary outcome was to evaluate compliance with the CFU. During the active CFU period (2007-2018), we compared patient, procedural, and VAMC features by CFU compliance and determined their associations with compliance using multivariable logistic regression. We also characterized variation in compliance across the Veterans Integrated Service Network (VISN), VAMC, and surgeons. Among 7,206 PVIs with postoperative clopidogrel, 35% and 26% had post-PVI clopidogrel durations of no more than 30 days during and after the CFU period, respectively. During the active CFU period, we found no strong association among patient, PVI, and VAMC characteristics with compliance. Compliance during the active CFU period varied significantly among VISNs (16%-55%), VAMCs (0%-93%), and surgeons (0%-100%). Adherence to no more than 30 days of clopidogrel post-PVI was low during and after the active CFU period and varied substantially among the VISNs, VAMCs, and surgeons. Given that national guidance implementation was directed by local VHA pharmacies, this study highlights the importance and limitations of local implementation strategies on national guidance compliance.

Nitric Oxide-releasing Nanofibers Prevent Restenosis After Arterial Injury in a Renal Failure Model.

In Vivo Evaluation of a Disposable Endovascular Robotic System for Arterial Peripheral Vascular Interventions: A Multicenter Feasibility Study.

Remote ischemic preconditioning for prevention of contrast-induced acute kidney injury in chronic kidney disease patients undergoing percutaneous vascular interventions: a systematic review and meta-analysis of randomized trials.

Life-threatening epistaxis as the initial manifestation of an internal carotid artery aneurysm is rare and diagnostically challenging, particularly in the absence of trauma or surgical history. Rupture into the sphenoid sinus may mimic gastrointestinal or neurological emergencies, delaying appropriate vascular intervention. We report the case of a 71-year-old French Canadian woman with a history of hypertension and aspirin use who presented with recurrent syncope, melena, visual disturbances, and intermittent epistaxis. She was initially found to have profound anemia, bradyarrhythmia following nasal packing, and posterior circulation ischemia. Gastrointestinal investigations were unremarkable. Clinical deterioration prompted cardiac management with vasopressors and pacemaker placement. Following a massive epistaxis episode and transfusion, computed tomography angiography revealed a 7mm paraophthalmic internal carotid artery aneurysm projecting into an opacified sphenoid sinus. Cerebral angiography confirmed aneurysmal rupture, and endovascular coiling was successfully performed. The patient stabilized postintervention, with complete resolution of epistaxis and no neurologic or hemodynamic sequelae at discharge. This case underscores the importance of considering massive epistaxis from a ruptured internal carotid artery aneurysm in patients presenting with melena, severe anemia, and a negative upper endoscopy, particularly when nasal bleeding is suspected. Posterior nasal packing may trigger bradycardia through reflex mechanisms that can be avoided. It should be removed early if associated with conduction abnormalities, as this improved our patient's hemodynamics without necessitating further invasive solutions. Early vascular imaging and multidisciplinary coordination are crucial for the diagnosis and management of ruptured internal carotid artery aneurysms.

Background: Vascular access is crucial for hemodialysis patients but prone to complications like infections and thrombosis, leading to morbidity. Many patients lack self-efficacy in maintenance despite nurse-led education's proven benefits, with limited evidence from Indian settings. Methods: A quasi-experimental design assessed a structured vascular access care intervention's effect on self-efficacy in 30 hemodialysis patients with permanent access at Billroth Hospital, Chennai, using purposive sampling. Pre- and post-tests employed a validated self-efficacy questionnaire after one-month intervention in experimental vs. control groups. Results: Experimental group self-efficacy improved significantly (pre-test mean 4.87 ± 2.42 to post-test 7.6 ± 2.24, t=4.1, p&lt;0.05); high self-efficacy rose from 26.6% to 80%. Control showed no change. Dialysis frequency associated with baseline self-efficacy (χ²=13.909, p&lt;0.05). Conclusion: The intervention effectively boosted self-efficacy, advocating nurse-led education integration to enhance self-management and reduce complications in resource-limited dialysis units.

Preoperative antifibrinolytics association with reduced blood transfusions after vascular surgery procedures.

High-energy open fractures are complex orthoplastic problems. Limb salvage surgical goals include achieving bony stabilisation and adequate soft tissue coverage, while minimising bone and soft tissue complications. Soft tissue coverage often requires free flap coverage due to thin overlying native soft tissue. Successful free flaps depend on multiple factors, including diabetes mellitus (DM), a prevalent modifiable disease in Singapore that represents a unique host factor. The objective of the study was to elucidate the effect of DM on the outcomes of free flaps done for open lower limb fractures. The primary outcome was the presence of partial or complete flap failure. Secondary outcomes included length of stay, osteomyelitis (OM) status, vascular intervention and requirement of bone reconstruction. A retrospective cohort study was performed in patients with open lower limb fractures requiring free flap coverage over a 3-year period from March 2018 to December 2021 in Khoo Teck Puat Hospital, Singapore. Relevant parameters were obtained from the hospital's electronic medical records for statistical analyses to investigate primary and secondary outcomes. We obtained statistically significant data showing that the rates of flap failure (P < 0.01) and postoperative free flap complications (P < 0.05) were higher in diabetic patients. Statistically significant correlations were observed between DM and rates of OM, vascular interventions and requirement of bone reconstruction (P < 0.05), while increased length of stay was not statistically significant (P > 0.05). Patients with DM have statistically significant increased rates of flap failure and surgical complications. Holistic multidisciplinary perioperative optimisation of DM can potentially improve surgical outcomes.

Achieving safe and effective closure of large-bore femoral arterial access after venoarterial extracorporeal membrane oxygenation (VA-ECMO) decannulation remains challenging. Percutaneous closure with suture-mediated devices is an established alternative to surgical repair for VA-ECMO decannulation. However, the optimal suture configuration is not well defined, and conventional cross-suture placement may have limitations. This study describes a parallel percutaneous closure technique with the potential to improve outcomes and evaluates its initial feasibility and safety. This prospective case series included 30 adult patients who underwent bedside decannulation from percutaneous femoral VA-ECMO between March 2024 and March 2025. The closure technique involved deploying two Perclose ProGlide devices (Abbott Vascular) in a parallel configuration. The primary endpoints of technical success and vascular complications were assessed clinically and by duplex Doppler ultrasound 24 hours post-procedure. Technical success was achieved in all 30 patients (100%) without surgical conversion or adjunctive vascular intervention. Duplex ultrasound confirmed normal arterial flow in 23 patients (76.7%). Vascular complications included arterial thrombosis (16.7%), dissection (3.3%), and hematoma (3.3%). No patient required reintervention or developed limb ischemia within 24 hours. This preliminary case series suggests that the parallel percutaneous closure technique is feasible and potentially safe for large-bore femoral decannulation following VA-ECMO. Its bedside application under local anesthesia and low rate of early complications support its utility in critical care. Further studies comparing closure configurations and evaluating long-term outcomes are warranted.

Vascular trauma demands rapid intervention to avert severe outcomes, yet current surgical treatments, including invasive autologous grafts and limited, potentially degrading synthetic prostheses, often fail to accommodate the requirements of variable vessel dimensions and shapes. To address these limitations, we present an additive manufacturing strategy for rapid, point-of-care fabrication of customizable vascular grafts using Focused Rotary Jet Spinning (FRJS). This technique enables the rapid, point-of-care fabrication of customizable small-caliber vascular grafts within minutes. FRJS facilitates independent control over nanofiber alignment and centimeter-scale vessel dimensions, yielding grafts with appropriate mechanical properties and flow characteristics. Four-week in vivo evaluation in a rat femoral vasculature replacement model demonstrated sustained vascular patency and early tissue remodeling, supporting the potential for intraoperative generation of tailored vascular conduits.