Validation of the Society for Vascular Surgery Appropriate Use Criteria for management of intermittent claudication.

Important outcomes for patients with frailty admitted to hospital with peripheral arterial disease, their caregivers and their health professionals: A Nominal Group Technique study.

Health Insurance Payor Type as a Predictor of Clinical Presentation and Mortality in Patients Undergoing Urgent or Emergent TEVAR for Type B Aortic Dissection: Insights from Society for Vascular Surgery Vascular Quality Initiative Database.

Bibliometric mapping of the use of taping in the control of post-surgical edema.

Impact of multidisciplinary surgical team involvement on outcomes of radical nephrectomy with IVC thrombectomy

Contemporary Outcomes of Thoracic Endovascular Aortic Repair in Patients with Syndromic Genetic Aortopathy: A Multi-Centre National Study.

A Novel Risk Calculator for Nonhome Discharge after Lower Extremity Bypass.

Impact of Prophylactic Postoperative Vasopressors on Outcomes of Patients Undergoing Thoracic Endovascular Aortic Repair.

The aim of this study is to systematically retrieve, appraise, and synthesize high-level evidence related to ultrasound-guided Autologous Arteriovenous Fistula (AVF) cannulation and to develop evidence-based recommendations to support standardized and safe clinical practice in vascular access management. All evidence on ultrasound-guided autologous AVF cannulation were searched from January 1, 2015, to December 30, 2024, including UpToDate, DynaMed, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Registered Nurses' Association of Ontario, National Kidney Foundation, European Society for Vascular Surgery, American Institute of Ultrasound in Medicine, Infusion Nurses Society, Joanna Briggs Institute (JBI), Medlive, PubMed, Embase, the Cochrane Library, CNKI, WanFang Data, and VIP Database. Eligible literature included clinical decision-making tools, practice guidelines, practice recommendations, evidence summaries, systematic reviews, and expert consensus statements. The quality of all included studies was assessed using appropriately critical appraisal tools. A total of 20 articles were included, comprising 2 clinical decision-making documents, 9 guidelines, 4 expert consensus statements, 2 systematic reviews, 1 practice recommendations, 2 evidence summaries. Ultimately, 17 items of best evidence were synthesized, covering five major domains: Indications, vascular assessment, equipment preparation, cannulation implementation, and education and training. This study summarized the best available evidence on ultrasound-guided autologous AVF cannulation, thereby providing scientific evidence to support clinical practice in vascular access management for hemodialysis. However, as the included studies originated from different countries, the applicability of the evidence should be carefully considered within the context of specific clinical settings to ensure standardization and safety.Reporting method:This study reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The protocol was prospectively registered with the Fudan University Center for Evidence-Based Nursing (Registration No. ES20257908).Patient or public contribution:No Patient or Public Contribution. This study is a systematic evidence summary based on published literature and did not involve the collection of primary data from patients or the public.

Parity in medical school admissions has improved, yet female representation remains disproportionately low in many competitive surgical specialties. Although initiatives promoting equity by sex in medicine have gained momentum, their long-term impact on surgical residency programs across various specialties remains unclear. This study evaluated 12-year trends (2013-2025) in sex representation among applicants and residents in five highly competitive US surgical specialties: neurosurgery, orthopedic surgery, plastic surgery (integrated), thoracic surgery (integrated), and vascular surgery (integrated). Publicly available data from the Accreditation Council for Graduate Medical Education (ACGME) and Association of American Medical Colleges (AAMC) were analyzed to assess sex-based trends among U.S. medical school matriculants and quantify yearly changes in the number and percentage of female applicants and active residents. Longitudinal trends were assessed to evaluate both proportional representation and retention across specialties. From 2013 to 2025, female matriculants to US M.D.-granting schools rose from 47.20% to 55.10%, exceeding 50% since 2017. All five surgical specialties showed an increase in the number of female applications, with orthopedic surgery showing the greatest number of applicants (127-419). Plastic surgery showed the highest percentage of female applicants in 2024-2025 (53.38%), followed by vascular surgery (33.19%), thoracic surgery (31.58%), neurosurgery (27.43%), and orthopedic surgery (23.77%). Representation of active female residents and acceptance rates also increased across all surgical specialties. Upward trends were consistent in neurosurgery, orthopedic surgery, and plastic surgery, whereas thoracic surgery and vascular surgery exhibited more fluctuation. Despite rising acceptance rates, sex-based inequity remains in competitive surgical specialties. Plastic surgery is an outlier, with female applicants constituting the majority, in line with trends in medical school matriculation. However, women remain underrepresented in orthopedic surgery and neurosurgery. Sustaining progress will require targeted efforts to address cultural and institutional barriers, expand mentorship, and foster supportive training environments.

Monitoring Patient Blood Management (PBM) practices against evidence-based standards is essential for quality improvement; however, current approaches are limited. In the UK, perioperative tranexamic acid (TXA) use is a national quality standard, yet monitoring relies on manual audit cycles that are resource-intensive and limited in scope. We evaluated whether an audit could be automated using routinely collected electronic health record (EHR) data. We performed a retrospective study at a tertiary NHS center using linked perioperative and transfusion datasets. Automated compliance indicators were constructed using coded procedures (denominator) and digitally documented TXA administration from WHO Surgical Safety Checklists and electronic prescribing records (numerator). A structured validation framework assessed data extractability, completeness, denominator coverage, coding accuracy, and concordance between electronic sources. Outputs were assessed by specialty and procedure and compared with contemporaneous manual audit findings. Between July-September 2025, 800 eligible procedures were identified. Comparison with an independent dataset demonstrated procedural coverage of 96.2% and miscoding rate of 3.9%. Overall automated TXA compliance was 86.3%. Concordance between WHO checklist and electronic prescription was 74.2%, with explainable discordance patterns. Substantial inter-specialty variation was identified, ranging from 98.2% (trauma and orthopedics) to 0% (vascular surgery). Compared with October-December 2024, overall compliance increased by 7.6%. Automated EHR-based audit of perioperative TXA compliance is feasible and demonstrates good validity. Structured validation confirmed data reliability, and full-population extraction revealed granular specialty- and procedure-level variation, likely undetectable by manual audits, supporting its wider evaluation as a continuous PBM quality monitoring tool.

Acute mesenteric ischemia (AMI) remains one of the most lethal vascular emergencies, with in-hospital mortality rates frequently exceeding 50%. Although early diagnosis and timely revascularization are critical, clinical practice remains highly variable. This study aimed to evaluate the real-world management of AMI in Spain, identifying gaps in resources, protocols, and interhospital coordination. A national cross-sectional survey was conducted between March and August 2024 using the Survio® platform. The questionnaire was distributed to general surgeons through national surgical societies and included 27 items covering hospital infrastructure, clinical protocols, diagnostic and therapeutic availability, personal experience, and perceived system-level barriers. A total of 291 surgeons responded. The median age was 40 years (IQR: 17). Most were consultants (76.3%) working in tertiary (42.6%), secondary (33%), or community hospitals (24.4%). While 97.6% reported access to 24/7 multiphasic CT and 90.4% to round-the-clock radiology, only 51.9% had 24/7 interventional radiology and 60.1% vascular surgery. Just 26.8% had institutional AMI protocols. The median distance to a referral center was 25km (range: 2-250km), and 68.4% reported difficulty in patient transfers. While 96.9% felt competent managing AMI, only 36.4% were familiar with the term "intestinal stroke." A total of 76.3% expressed interest in joining a national AMI registry. Spanish surgeons report high self-perceived clinical competence in AMI management, but systemic fragmentation, lack of protocols, and logistical barriers limit optimal care. These findings underscore the urgent need for coordinated regional networks, standardized care pathways, and multidisciplinary collaboration to improve outcomes in acute mesenteric ischemia across European healthcare systems. Retrospectively registred and recorded in Clinical Trials. NCT06428240, registration date on 20th/05/2024.

Predictive value of 2D phase contrast magnetic resonance imaging in patients with suspected chronic mesenteric ischemia.

Recurrent endometrial carcinoma involving major pelvic vasculature poses significant surgical challenges, particularly when residual disease persists after systemic therapy and radiation is contraindicated. Robotic-assisted surgery offers a minimally invasive solution for precise tumor dissection near critical vessels. A 67-year-old woman with recurrent endometrial carcinoma presented with deep vein thrombosis and pulmonary embolism 3 years after primary treatment with hysterectomy, chemotherapy, and brachytherapy. Imaging revealed a 5-cm pelvic mass encasing the right external iliac vessels and two lung nodules. After six cycles of carboplatin and liposomal doxorubicin, lung lesions resolved, but the pelvic mass persisted. A multidisciplinary team, including gynecologic oncologists and vascular surgeons, performed a robotic-assisted secondary cytoreductive surgery. A prophylactic iliac vein balloon was placed by the vascular team but remained uninflated. The procedure involved adhesiolysis, retroperitoneal dissection, and careful tumor separation from the external and internal iliac vessels with vascular preservation. Metal clips were applied to guide postoperative radiation planning. The tumor was completely resected without vascular injury. The patient recovered uneventfully and was discharged on postoperative Day 1. This case underscores the feasibility and safety of a multidisciplinary robotic-assisted approach for pelvic tumor resection involving major vasculature. Preoperative vascular planning and endovascular readiness enhance surgical safety, while minimally invasive techniques offer improved recovery and precision in managing recurrent endometrial carcinoma.

Transformative Advances in Vascular Surgery: Five Decades of Innovation in the Management of Aortic, Carotid, and Peripheral Arterial Disease.

(1) To describe cognitive trajectory patterns over 6 years after major surgery in older adults, and (2) To identify patient characteristics associated with severe cognitive decline. Group-based semiparametric trajectory modeling was performed on longitudinal cognitive data from the SAGES study, which enrolled patients aged ≥ 70 years undergoing major elective noncardiac surgery. Participants received comprehensive neuropsychological testing prior to surgery and postoperatively every 6-12 months up to 72 months. The primary outcome was change in general cognitive performance score, a composite of neuropsychological tests, at each of 11 follow-up timepoints relative to baseline. Generalized linear models were used to assess the associations of pre-surgical patient characteristics and incidence of postoperative delirium with cognitive trajectory. Of 560 participants, 326 were women (58%) and the average age was 76.7 (standard deviation 5.2) years. They underwent orthopedic (81%), gastrointestinal (13%), and vascular surgeries (6%), and 24% experienced postoperative delirium. We found the 3-group cognitive trajectory model to be optimal, with the groups characterized as severe decline trajectory (SDT) (15% of the cohort), slight decline (59%), or stable (26%). Of pre-surgical factors, age (relative risk [RR]: 1.06, 95% confidence interval [CI] 1.03-1.10 per 1 year increase) and 3MS (Modified-Mini-Mental) score (RR 0.95, 95% CI 0.92-0.99 per one point increase) were significantly associated with SDT. Participants who developed delirium had over two-fold higher risk of SDT compared to those who did not (RR: 2.15, 95% CI: 1.35-3.42). Among older adults undergoing major surgery, 15% experienced severe cognitive decline over the ensuing 6 years, 59% experienced slight decline, and 26% remained stable. Older age, baseline cognitive impairment, and delirium were associated with severe decline, with delirium having the strongest association. Our findings provide valuable information for older patients considering major surgery and may help clinicians target interventions.

Antiplatelet Therapy After Endovascular Intracranial Aneurysm Surgery: Comparative Effectiveness and Safety Insights from Systematic Review and Meta-Analysis.

IntroductionOlder patients admitted under surgical care have longer length of stay (LOS) and are at risk of functional decline, hospital-acquired complications and geriatric syndromes. Embedded specialist geriatrician models within surgical care teams can reduce length of stay and perioperative complications. Evidence gaps remain regarding the implementation of these models of care and their impact on patient outcomes. This study aims to measure hospital, patient and implementation outcomes of an embedded perioperative geriatric service in a large Australian tertiary referral hospital.Methods and analysisThis hybrid type 1 effectiveness-implementation trial involves four services (emergency general, elective general, urology and vascular surgery), with a predicted reach of >2000 patients over 24 months. The intervention consists of a proactive geriatrician-led service providing a comprehensive geriatric assessment and ongoing review during the acute admission. Service evaluation will be via (1) traditional hospital outcomes (primary outcome LOS); (2) implementation outcomes; and (3) patient reported outcomes across three 6 month phases: (1) prior to service implementation; (2) during service implementation and (3) continued service but without active implementation. Data analysis will include descriptive statistics of patient demographics, clinical characteristics and implementation outcomes; cost-effectiveness; univariate and multivariate analysis of outcomes against demographic and clinical characteristics and thematic analysis of qualitative data.Ethics and disseminationThis trial has been approved by the Hunter New England Research Ethics Committee (2024_ETH023259). The findings will be disseminated via peer-reviewed publications and conference presentations. The research team will facilitate adoption more broadly within the health service.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12625000404426)

Quality of Life and Clinical Outcomes After Large Bore Mechanical Thrombectomy for Submassive Pulmonary Embolism.

Patients who require major vascular surgery often receive antiplatelet therapy for primary or secondary prevention of cardiovascular disease. Clopidogrel resistance and variability in platelet recovery after drug discontinuation pose clinical challenges, particularly for regional anaesthesia and blood management. The aim of this study was to characterise platelet function and determine the prevalence of antiplatelet resistance using near-patient viscoelastic testing in patients undergoing major, elective non-cardiac vascular surgery. We conducted a single-centre, prospective, observational cohort study at a tertiary vascular surgery centre. Adults scheduled for elective vascular surgery were recruited into four groups: aspirin; clopidogrel; dual antiplatelet therapy; and control (no antiplatelet therapy). Blood samples were obtained at pre-operative assessment and on the day of surgery. Platelet function was assessed using thromboelastography and von Willebrand factor antigen levels. The primary outcome was the proportion of patients with antiplatelet resistance. Eighty patients were enrolled, of whom 64 proceeded to surgery. Antiplatelet resistance was common, affecting 25-70% of patients at baseline depending on regimen and 15-83% on the day of surgery. Clopidogrel resistance was most frequent (70%). Two patients experienced early graft or stent thrombosis, both with evidence of clopidogrel resistance and elevated von Willebrand factor; von Willebrand factor levels exceeded the normal range in two-thirds of patients. In an exploratory analysis, clopidogrel cessation 5-7 days pre-operatively did not result in a statistically significant change in platelet inhibition. High rates of clopidogrel resistance and elevated von Willebrand factor were observed in patients with planned vascular surgery, suggesting that current peri-operative discontinuation guidelines may not restore normal platelet function. Larger multicentre studies that incorporate standardised platelet and near-patient genetic testing are required to validate these findings and guide personalised peri-operative antiplatelet management.