Summary: Background: Inferior vena cava (IVC) obstruction may cause acute descending thrombosis, post-thrombotic syndrome, or chronic venous insufficiency. Endovascular IVC stent reconstruction may improve clinical outcomes but the risk of patency loss is considerable. Stent design might impact the patency rates, but data comparing the performance of open-cell versus closed-cell IVC stents are lacking. Patients and methods: We investigated long-term clinical outcomes of 130 patients (median age 39 years, 26% women) who underwent endovascular reconstruction of an IVC obstruction with self-expandable nitinol stents of whom 52 (40%) received closed-cell stents and 78 (60%) open-cell stents between 2012 and 2024 in two Swiss university hospitals. At baseline, 41 (32%) patients presented with acute iliocaval thrombosis, 84 (65%) with post-thrombotic syndrome, and 5 (4%) with non-thrombotic IVC compression. Overall, kissing iliocaval Y-stent reconstruction was performed in 106 patients (82%). Clinical outcomes included patency rates and sustained clinical success defined as Villalta score <5 points and absence of venous stent occlusion or any re-intervention. Results: Median follow-up after endovascular stent reconstruction was 37 months (Q1-Q3: 18 to 68). Primary and secondary patency rates at 24 months were 62.1% (95% CI 50.0-77.2) and 93.8 (95% CI 87.3-100) for closed-cell stents and 79.6% (95% CI 70.3-90.0) and 100% (95% CI 100-100) for open-cell stents, respectively. Sustained clinical success was observed in 22 (42%) patients from the closed-cell group and in 55 (71%) patients from the open-cell stent group. Conclusions: In patients undergoing endovascular IVC reconstruction, self-expandable open-cell nitinol stents might offer favorable patency and clinical outcomes during follow-up.

Background: To evaluate the ability of atherectomy combined with scoring and drug coated balloon (DCB) angioplasty for the treatment of atherosclerotic common femoral artery (CFA) disease. Patients and methods: This dual-center retrospective study analyzed data from consecutive patients who underwent atherectomy-assisted endovascular revascularization followed by scoring and DCB angioplasty and if required stent placement in the CFA. The primary endpoints included target-lesion revascularization (TLR) and improvement in clinical symptoms as measured by Rutherford categories (RC). Lesion calcification was evaluated using the Peripheral Arterial Calcification Scoring System (PACSS). Results: Of 111 patients, 64 (57.7%) had lifestyle limiting claudication, whereas 47 (42.3%) had chronic limb-threatening ischemia (CLTI). Mean age was 71.9 ± 7.8 years, 45 (40.5%) were female and 32 (28.8%) had diabetes mellitus. CFA median lesion length was 3.2 (2.4-3.7cm) and median lesion calcification by PACSS was 3.0 (3.0-3.0), whereas 13 (11.7%) were chronic total occlusions. Atherectomy was performed in 46 (41.4%) patients using the Phoenix and in 65 (58.6%) patients using the Jetstream atherectomy device with low complication rates (zero perforations and 4 (3.6%) distal embolizations). Bail-out stenting was necessary in 6 (5.4%) patients. During median follow-up of 2.0 (1.5-2.2) years, TLR was necessary in 9 (8.1%) patients, whereas RC improvement of ≥2 categories was noticed in 79 (71.2%) patients. Severe calcification PACSS four was associated with higher TLR rates (p < .001). Conclusions: Atherectomy- and scoring balloon assisted lesion preparation combined with DCB resulted in a low rate of bail-out stenting, low TLR and clinically acceptable RC improvement rates in CFAD patients. Long-term prospective trials are warranted.

Background: Severe arterial calcification poses a major challenge to endovascular therapy (EVT) in peripheral artery disease (PAD). Orbital atherectomy (OAS) is used to modify plaque and enhance luminal gain, potentially improving EVT outcomes, but long-term evidence remains limited. Patients and methods: This retrospective single-center study assessed the mid-term outcomes of OAS in heavily calcified infrainguinal disease. We included symptomatic PAD patients (Rutherford 2-6) with ≥70% stenosis undergoing OAS for above- and below-the-knee (BTK) arterial lesions. Results: From 2018 to 2023, 78 patients underwent EVT for 83 infrainguinal lesions with OAS. Most were male (84.6%; 66/78) and had significant cardiovascular risk factors. Lesions were located in the femoropopliteal (FP) segment in 28.9% (24/83) and in BTK in 71.1% (59/83). Chronic limb threatening ischemia (CLTI) was significantly more frequent in BTK disease (13.0% [3/23] vs. 76.4% [42/55], p < .001). Mean lesion length was 101.8 ± 72.9 mm in FP and 133.0 ± 102.7 mm in BTK lesions, with chronic total occlusions in 25.0% (6/24) and 49.2% (29/59), respectively. One-year freedom from target lesion revascularization was 90.5% ± 6.5% for FP and 73.1% ± 7.7% for BTK lesions. One-year survival was 95.7% ± 4.3% in claudicants and 62.4% ± 7.8% CLTI patients (logrank p = .001). Major limb amputation occurred in .0% (0/22) of FP and 4.4% (2/45) of BTK cases at 30 days. Conclusions: OAS demonstrated feasibility in this highly selected cohort; however, its comparative efficacy remains uncertain.

Background: Blunt thoracic aortic injury (BTAI) is a life-threatening condition. Comprehensive nationwide data from European healthcare systems are limited. This study aims to analyse temporal trends in hospital incidence, treatment strategies, and outcomes of BTAI in Germany. Materials and methods: This retrospective secondary analysis used nationwide German Diagnosis-Related-Groups hospital episode statistics. All BTAI cases between 2010 and 2023 were included. Treatment strategies were classified as open repair, endovascular repair or conservative management based on Operations and Procedures Classification codes. Primary outcome was in-hospital mortality. Adjusted multivariable logistic regression was performed. Age, sex, Elixhauser comorbidity score, treatment modality, treatment period, and treatment in a vascular surgery department were included in the statistical model. Results: In total 3,530 cases were identified (Mdnage 58 years; 70.1% male). TEVAR was performed in 30.5%, open repair in 16.4%, and 53.1% were managed conservatively. Overall, in-hospital mortality was 24.4% (16.0% after endo, 25.8% after open repair and 28.7% in not-treated cases). Increasing age (adjusted odds ratio [aOR] 1.12 per 10 years, 95% Confidence interval [CI] 1.07-1.17) and higher comorbidity burden (aOR 1.03 per point, CI 1.02-1.04) were independently associated with mortality. Both endo (aOR 0.55, CI 0.44-0.68) and open repair (aOR 0.69, CI 0.54-0.89) were associated with lower mortality compared with conservative management. Conclusions: In Germany, BTAI hospital incidence showed temporal variation with pandemic-related decline. Endovascular repair was the predominant active treatment and was associated with lower in-hospital mortality. Outcomes were strongly influenced by age, comorbidity, and specialised vascular care.

The patient population treated by vascular medicine is becoming older, which goes along with an increasing number of patients presenting with frailty syndrome. The level of frailty determines the outcomes after vascular surgery or interventions. This position paper written by the German Society for Vascular Surgery and Vascular Medicine, the German Society for Geriatrics, and the German Society for Angiology - Society for Vascular Medicine summarizes the current evidence on the impact of frailty on the outcome after treatment for vascular diseases, and calls for a closer collaboration between geriatrics and vascular medicine and an integration of geriatric assessment in the preoperative or preinterventional evaluation of patients. Concrete and practical demands and tasks are formulated aiming at increasing awareness of geriatrization of the patient population, promoting research on the impact of frailty on the treatment of vascular patients and improving patients' safety, reducing complications and enhancing quality of care of older vascular patients.

Background: To assess the mid-term outcome of endovascular treatment for popliteal artery restenosis. Patients and methods: This retrospective study included patients with peripheral artery disease (Rutherford class (RC) 2-5) and popliteal artery restenosis treated between January 2007 and December 2017. Patients were classified into four groups based on lesion extent: isolated popliteal lesions and lesions extending to femoral and/or below-the-knee arteries (BTK). The primary endpoint was target lesion revascularization (TLR) at 12 months. Secondary endpoints included TLR at 24 months, changes in RC, ankle-brachial index (ABI), amputation and mortality rates. Results: A total of 332 patients were analyzed. Ninety-two patients received popliteal treatment only (group I), in 81 patients lesion extended into the femoral artery (group II), 112 lesions extended into the BTK arteries (group III), and 47 lesions involved both, femoral and BTK arteries (group IV). At 12 months, the overall TLR rate was 34.6%, with no significant differences between subgroups. Drug-coated balloon (DCB) angioplasty showed a significant benefit during the first 12 months (p = .035), but this advantage was not sustained thereafter (p = .798). TLR rates did not differ significantly between patients treated with stent angioplasty and those without stenting (p = .087). Significant improvements in ABI and RC were observed in all groups. Major amputation rates were 0.9% at 12 months and 1.8% at 24 months. Mortality rates were 1.5% and 7.5%, respectively. Conclusions: Reintervention rate after endovascular treatment of popliteal artery restenosis is high. The potential benefits of drug-coated balloon angioplasty and stent angioplasty require further clarification through prospective studies.

Background: The Fenestrated TREO[®] is a new custom-made device for fenestrated endovascular aortic repair (FEVAR). Its 19Fr low-profile delivery system may be effective for patients with low-calibre or hostile access vessels (AV), reducing trauma risk, improving limb perfusion during percutaneous procedures, and broadening FEVAR indications. This study evaluates short- and mid-term outcomes of the device and its viability in patients with hostile AV. Materials and methods: Only patients with hostile AV treated with the Fenestrated TREO[®] between 2022 and 2025 at a tertiary-care university centre were included. The primary endpoint was technical success. Secondary endpoints included AV-related intraoperative procedures, short- and mid-term morbidity, mortality, reintervention rate, AV-related complications and reinterventions, and stability of target vessels (TV). A sub-analysis compared patients with AV calibre >6.3 mm (group A) and <6.3 mm (group B). Results: Twenty-eight patients were included: 18 in group A and 10 in group B. Technical success was 100%, with target vessel cannulation achieved in 99.1% (one failure). Additional intraoperative AV preparation/adjunctive procedures were required in eight patients (28.6%; 1 vs. 7, p < .001). No perioperative or late deaths occurred. AV reinterventions were required in four patients (14.3%; 2 vs. 2, p = .561). Major complications occurred in four patients (14.3%), and three of 4 AV reinterventions were observed in this subgroup. One major reintervention was necessary. Early TV instability occurred in two patients (7.1%; 1 vs. 1, p = .712). During a median follow-up of 13 months, no late deaths or reinterventions were observed. Conclusions: In patients with hostile AV, the Fenestrated TREO[®] graft showed high technical success rates and favourable short-term outcomes, with acceptable complication rates and excellent TV stability, aligning with results of other well-established endografts. Its low-profile design may be advantageous in complex AV anatomies. Additional intraoperative AV-related procedures mainly occurred in cases of very narrow AV (group B), while postoperative AV-related complications and reinterventions were similar between groups.

Background: Stent thrombosis (ST) is a rare but serious complication following peripheral endovascular interventions. The prognostic role of high on-treatment platelet reactivity (HTPR) and the optimal antithrombotic strategy, including adjunctive anticoagulation, remain unclear. To evaluate (I) the prognostic value of ADP-induced platelet function in femoropopliteal ST compared to matched controls, and (II) the impact of post-ST oral anticoagulation (OAC) on clinical outcomes. Materials and methods: In this retrospective cohort study, 148 endovascular procedures in 67 patients with documented femoropopliteal ST were compared to 492 matched procedures without ST. Propensity-score-matching for age, sex, and lesion length/type yielded 113 pairs. ADP-induced platelet aggregation was assessed and compared between groups. Within the ST cohort, 12-month outcomes were additionally stratified according to the postprocedural antithrombotic regimen, with or without oral anticoagulation (OAC). Time-to-reintervention was analysed via Kaplan-Meier and Cox regression. Results: ADP-induced platelet reactivity did not differ significantly between ST and control groups (p = .58). Additionally, among ST patients, postprocedural OAC use had no significant impact on 12-month target lesion revascularization (TLR) rates (HR 0.96; 95% CI 0.57-1.62; p = .90), with consistent findings across subgroups (VKA, standard-/low-dose NOAC). Conclusions: In this matched cohort, ADP-induced platelet reactivity did not differ significantly in patients with femoropopliteal stent thrombosis compared to controls. Similarly, no consistent benefit of specific anticoagulation strategies on 12-month target lesion revascularization was observed. Therefore, these findings do not support routine platelet function testing or intensified anticoagulation solely based on a history of ST.

Background: Apolipoprotein B (ApoB) levels and low-density-lipoprotein-cholesterol (LDL-c)/ApoB ratio have emerged as potential more accurate markers of cardiovascular (CV) risk, than LDL-c concentration alone. However, prognostic values in predicting CV outcomes, including major adverse cardiac and limb events (MACE and MALE) in peripheral artery disease (PAD) remains to be elucidated. Aim is to assess weather correlations exist between lipid parameters and PAD outcomes. Patients and methods: Consecutive PAD patient's first visit data from the Peripheral ARTEry Disease (PARTED) registry (2022-2024) were analysed. Demographic, clinical variables, and lipid parameters (LDL-c, Lp(a) and ApoB concentrations) were collected at time of inclusion. PAD patients were stratified in tertiles based on LDLc/ApoB ratio values. MACE and MALE outcomes arising prior to study inclusion were evaluated. Multivariate logistic regression analysis was performed. Results: A total of 339 chronic PAD patients were included. Mage was 71 years, 68% were males. M LDL-c concentration was 1.9 mmol/L, and only 27% of patients were on target (LDL-c ≤ 1.4 mmol/L). Significant association with prior MACE was found in the lowest and intermediate LDL-c/ApoB tertile group (low: OR 2.09, C-I 1.04-4.21, p < .05; intermediate: OR 2.06, C-I 1.04-4.09, p < .05) while no significant association was found between past MACE and LDL-c or ApoB tertiles. Conclusions: Lower LDL-c/ApoB ratios (LAR) remained associated with prior MACE after multivariable adjustment, highlighting the importance of a comprehensive lipid profile assessment. Whether LAR tracks with treatment intensification or retains associative value with historical events needs to be clarified.

Background: In routine clinical practice, patient's management may differ from scientific organizations' guidelines and compromise patient's safety. This discrepancy indicates either an educational gap to fill or a need to adapt the guidelines to better reflect the real-world practice. Aims: Describe the management of venous thromboembolism (VTE): deep vein thrombosis (DVT) and pulmonary embolism (PE) among Vascular Medicine Specialists (VMS) practicing in France between 2020 and 2023 and compare it to national and international VTE guidelines. Materials and methods: A random selection of VMS from the national VMS directory were asked to 1) complete a questionnaire on their own management of patients with VTE (VMS survey) and 2) report their personal management of five consecutive patients with acute VTE (VTE case series). The study period partly overlapped with the COVID-19 pandemic, during which outpatient management strategies were increasingly promoted. Results: Among the 163 VMS contacted, 85 agreed to participate. We found that a direct oral anticoagulant (DOAC) was preferentially prescribed as first line anticoagulant in VTE: 65% in the VTE case series and 80% in the VMS survey. Low molecular weight heparins (LMWH) was preferred in case of high-risk PE (60%) or ilio-femoral DVT (35%) and in cancer-associated thrombosis (91%) in the VMS survey. After the first 6 months therapy, 30% of the VMS taper to a reduced-dose DOAC. This management was consistent with the VTE case series. Conclusions: DOAC is the standard of care to treat most VTE conditions in routine clinical practice, in line with VTE guidelines. LMWH is still preferred in case of high risk-PE and cancer-associated thrombosis. ECS use to prevent post-thrombotic syndrome remains frequent after DVT. Outpatient management of PE was common during the study period, reflecting evolving care models that were reinforced during the COVID-19 pandemic.