Badr Aljabri

Background/Objectives: Proximal glue migration toward the saphenofemoral junction (SFJ) and endovenous glue-induced thrombosis are recognised concerns during cyanoacrylate ablation. This exploratory pilot study compared standard and modified ultrasound-guided compression protocols. Methods: Thirty patients with incompetent great saphenous veins (GSVs) were allocated non-randomly, in two sequential cohorts, to a standard (n = 15) or modified (n = 15) protocol. The modified protocol added a “release-and-check” duplex assessment after the initial 3 min compression, a 1 min recompression, and an extra minute for veins > 5.5 mm. The primary outcome was glue migration distance from the compression level, measured immediately postoperatively. Clinical and thromboembolic outcomes were not systematically ascertained; follow-up was one week. Results: Baseline variables were comparable (standardised differences ≤ 0.31). Mean migration distance was lower with the modified protocol (0.80 ± 0.34 vs. 1.97 ± 0.51 cm; mean difference −1.17 cm, 95% CI −1.50 to −0.85; p < 0.0001), persisting after covariate adjustment. Residual stump length was greater (4.41 ± 0.34 vs. 2.49 ± 1.27 cm; p < 0.001), although this SFJ-referenced measure is confounded by the unrecorded compression distance. Deep venous extension occurred in 3/15 standard and 0/15 modified limbs (p = 0.22); all three were asymptomatic Cho grade III events, resolved at one week. Immediate migration was recorded in 7/15 versus 0/15 limbs (p = 0.006). Conclusions: In this small, non-randomised exploratory cohort, a “release-and-check” modification was associated with shorter immediate glue migration. These hypothesis-generating findings rest on an unblinded surrogate endpoint with one-week follow-up and do not establish clinical safety, effectiveness or durability; adequately powered randomised trials with blinded assessment and adjudicated endpoints are required.

Background: Thoracic endovascular aortic repair (TEVAR) and complex endovascular aneurysm repair (EVAR) are complex procedures that carry a significant risk of complications. While risk prediction tools can aid in clinical decision making, they remain limited. We developed machine learning algorithms to predict outcomes following TEVAR and complex EVAR. Methods: The Vascular Quality Initiative database was used to identify patients who underwent elective TEVAR and complex EVAR for noninfrarenal aortic aneurysms between 2012 and 2023. We extracted 172 features from the index hospitalization, including 93 preoperative (demographic/clinical), 46 intraoperative (procedural), and 33 postoperative (in‐hospital course/complications) variables. The primary outcome was 1‐year thoracoabdominal aortic aneurysm life‐altering event, defined as new permanent dialysis, new permanent paralysis, stroke, or death. The data were split into training (70%) and test (30%) sets. We trained 6 machine learning models using preoperative features with 10‐fold cross‐validation. Model robustness was evaluated using calibration plots and Brier scores. Results: Overall, 10 738 patients underwent TEVAR or complex EVAR, with 1485 (13.8%) experiencing 1‐year thoracoabdominal aortic aneurysm life‐altering event. Extreme Gradient Boosting was the best preoperative prediction model, achieving an area under the receiver operating characteristic curve of 0.96 (95% CI, 0.95–0.97), compared with 0.70 (95% CI, 0.68–0.72) for logistic regression. The Extreme Gradient Boosting model maintained excellent performance at the intra‐ and postoperative stages, with areas under the receiver operating characteristic curves of 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively. Calibration plots indicated good agreement between predicted/observed event probabilities, with Brier scores of 0.09 (preoperative), 0.08 (intraoperative), and 0.05 (postoperative). Conclusions: Machine learning models can accurately predict 1‐year outcomes following TEVAR and complex EVAR, performing better than logistic regression.

Background/Objectives: Since thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) are increasingly utilized, examining their outcomes and safety in real-world scenarios is crucial. This study investigated the management and outcomes of TEVAR and EVAR as alternatives to traditional open surgical repair for managing aortic pathologies. Methods: This was a retrospective cohort study. We analyzed the data from 59 consecutive patients who underwent TEVAR or EVAR between 2015 and 2022 at a single tertiary care center. The primary outcome was survival, and secondary outcomes were complications assessment, including re-intervention and occurrence of endoleaks. Results: TEVAR accounted for 47.5% of cases (n = 28), while EVAR comprised 52.5% (n = 31). Patients were mostly 61–70 years old (23.7%) and male (91.5%). Surgery indications differed, with aneurysmal repair being the prevalent indication for EVAR (90.3%, n = 28) and trauma being the main indication for TEVAR (67.9%, n = 19). Regarding the primary outcome, 11 patients (18.6%) died for various reasons; of those, 2 patients (3.4%) were determined to have died from vascular-related issues. Most patients (81.4%, n = 48) did not experience intraoperative complications. The most common intraoperative complications were endoleaks and access failure, each affecting 5.1% (n = 3) of patients. Re-intervention was necessary in 16.9% (n = 10) of cases, with endoleaks being the major indication (60%). Emergency intervention was more frequent in the TEVAR group (p = 0.013), resulting in significantly longer hospitalization (p = 0.012). Conclusions: Despite limitations, our analysis indicates a good safety profile with high success rates and a low incidence of adverse health outcomes and mortality in TEVAR/EVAR procedures. Nevertheless, the results emphasize the ongoing concern of endograft leaks, necessitating re-interventions.

Background: Lower extremity endovascular revascularization for peripheral artery disease carries nonnegligible perioperative risks; however, outcome prediction tools remain limited. Using machine learning, we developed automated algorithms that predict 30‐day outcomes following lower extremity endovascular revascularization. Methods and Results: The National Surgical Quality Improvement Program targeted vascular database was used to identify patients who underwent lower extremity endovascular revascularization (angioplasty, stent, or atherectomy) for peripheral artery disease between 2011 and 2021. Input features included 38 preoperative demographic/clinical variables. The primary outcome was 30‐day postprocedural major adverse limb event (composite of major reintervention, untreated loss of patency, or major amputation) or death. Data were split into training (70%) and test (30%) sets. Using 10‐fold cross‐validation, 6 machine learning models were trained using preoperative features. The primary model evaluation metric was area under the receiver operating characteristic curve. Overall, 21 886 patients were included, and 30‐day major adverse limb event/death occurred in 1964 (9.0%) individuals. The best performing model for predicting 30‐day major adverse limb event/death was extreme gradient boosting, achieving an area under the receiver operating characteristic curve of 0.93 (95% CI, 0.92–0.94). In comparison, logistic regression had an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.70–0.74). The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.09. The top 3 predictive features in our algorithm were (1) chronic limb‐threatening ischemia, (2) tibial intervention, and (3) congestive heart failure. Conclusions: Our machine learning models accurately predict 30‐day outcomes following lower extremity endovascular revascularization using preoperative data with good discrimination and calibration. Prospective validation is warranted to assess for generalizability and external validity.

Background: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair. Methods: We retrospectively reviewed the medical records of 59 patients who underwent a thoracic/abdominal endovascular aortic repair at a single tertiary care hospital between 2015 and 2022. Based on their femoral access type, the patients were categorized into the “percutaneous” or “cutdown” groups. Using a computerized sheet, relevant patient data (including demographic information and patient risk factors) were collected. The operative duration, complication rates, mortality rates, intensive care unit admission and stay durations, and total hospital stay were compared between the two groups. The primary outcomes were differences in the postoperative morbidity and mortality associated with the two approaches. Results: The cutdown and percutaneous groups comprised 24 (41%) and 35 (59%) patients, respectively. The two groups displayed comparable demographic and clinical characteristics (p > 0.05). However, the vascular anatomy differed with the common femoral artery diameter being larger in the percutaneous group compared to the cutdown group (9.63 ± 1.81 mm vs. 8.49 ± 1.54 mm, p = 0.028). The ratio of the sheath diameter to the common femoral artery diameter was significantly lower in the percutaneous group than in the cutdown group (0.73 ± 0.16 vs. 0.85 ± 0.20, p = 0.027). A ratio of ≥0.74 was associated with a higher risk of complications (odds ratio, 12.0; 95% confidence interval, 1.4–102.2; p = 0.023) and mortality (odds ratio, 5.79; 95% confidence interval, 1.13–29.6; p = 0.035). Additionally, the operative duration was significantly shorter in the percutaneous group than in the cutdown group (141.43 ± 97.05 min vs. 218.46 ± 126.31 min, p = 0.001). Compared to the cutdown group, the percutaneous group experienced a shorter total hospital stay (21.54 ± 21.49 days vs. 11.60 ± 12.09 days, p = 0.022) and lower intensive care unit-admission rates (66.7% vs. 40%, p = 0.044). Conclusion: The percutaneous approach is a viable and more time-efficient alternative to the traditional cutdown method for delivering vascular endografts. It is associated with a significantly shorter operative duration and briefer hospital stays. Additionally, the ratio of the sheath diameter to the common femoral artery diameter can help surgeons preoperatively predict and anticipate the risks of complications and mortality. Future in-depth research is necessary to better understand the association between this ratio and postoperative outcomes and complications.

Iatrogenic arteriovenous (AV) fistula is a rare complication of lumbar disc surgery. We report a 38-year-old man who presented with bilateral lower limb venous ulcerations and was diagnosed with an AV fistula from previous L4–L5 laminectomy between the right common iliac artery and left common iliac vein, which was successfully treated using an endovascular stent graft.

Carotid body tumors (CBTs) are rare and mostly benign. Research outcomes usually arise from single-center data. We conducted this study to present the characteristics and outcomes of patients who underwent surgical resection of CBT at our hospital over the past 20 years. In this retrospective review, the records of CBTs in our hospital were reviewed between 1998 and 2021. All patients who underwent CBT resection were included. The follow-up period was 12 months. A total of 44 CBTs were treated in our hospital. The male-to-female ratio was 1:2.4. Only 4.5% of patients had Shamblin I tumors. Patients with Shamblin II and III tumors were 56.8% and 38.6%, respectively. Duplex scan was used to diagnose CBT in all of the patients. The majority of our patients (97.7%) did not receive any preoperative embolization despite an average tumor size of 4.9 cm. Cranial nerve injuries were observed in 29.5% of cases. Meanwhile, stroke was reported in only two cases (4.5%). No deaths were encountered. Surgery is the definitive treatment for CBT. Size and local extension appear to be the main reasons for adverse events rather than surgical techniques. Our results are consistent with those of previously published studies. Good outcomes are expected in high-volume centers with appropriate preoperative imaging.

Aneurysms of the foot arteries are uncommon but can lead to devastating complications such as acute foot ischemia or arterial rupture if left untreated. In this case series, we present four cases of aneurysms of the foot: one true dorsalis pedis artery aneurysm and three cases of post-traumatic plantar artery pseudoaneurysms with arteriovenous fistulas. All four patients were successfully managed with surgical excision of the aneurysm with or without arteriovenous fistulas ligation. Our case series is followed by discussion on the etiology, clinical presentation and management strategy of patients with aneurysms of the foot arteries.