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Optimal postoperative antithrombotic therapy after open repair of popliteal artery aneurysms (PAAs)remains undefined, with current recommendations largely extrapolated from peripheral arterial diseasestudies. This study compared postoperative antithrombotic strategies and their association with graftpatency and survival following elective open posterior PAA repair.

This multicenter retrospective cohort study analyzed data from the PARADE registry, including 40 vascular centers across 10 European countries. Consecutive patients undergoing elective open posterior PAA repair between January 2010 and December 2023 were included; endovascular repairs were excluded.Postoperative antithrombotic therapy was classified as single antiplatelet therapy (SAPT), dual antiplatelettherapy (DAPT), oral anticoagulation (OAC or DOAC), or combination therapy (CT: anticoagulant plusantiplatelet). Primary outcomes were long-term primary patency and overall survival. Secondary outcomes included secondary patency and major adverse cardiovascular events (MACE). Kaplan–Meieranalysis and multivariable Cox regression were used.

A total of 638 patients were included (median age 70 years; 96% male), with a median follow-up of 30months. Autologous vein grafts were used in 46.6% of cases and prosthetic grafts in 50.7%. SAPT was themost common postoperative regimen (56.3%), followed by CT (17.7%), DAPT (14.4%), and anticoagulationalone (11.6%). Early outcomes were favorable, with 2.0% early graft occlusion and 1.1% early MACE. Long-term overall survival was 90.3%. Combination therapy was independently associated with worse overallsurvival compared with all other regimens (HR 1.30, p=0.018). Primary patency at follow-up was 86.1%,with CT associated with a significantly increased risk of primary patency loss (HR 1.43). Similar findingswere observed for secondary patency. Overall MACE rate was 1.1%, with no differences between patients under CT versus others. No significant differences were observed between antiplatelet versus anticoagulant therapy alone, nor between OAC and DOAC for all the endpoints.

After open posterior PAA repair, intensified antithrombotic therapy combining anticoagulation andantiplatelet agents was associated with inferior graft patency and survival, without apparent benefit oversimpler antithrombotic strategies.

Lower-limb revascularization in elderly, frail, and multimorbid patients remains challenging, particularly when autologous vein is unavailable. Prosthetic grafts with a distal cuff, such as the Distaflo prosthesis, may represent a pragmatic alternative. We report our single-center experience, focusing on clinical outcomes and predictors of mortality.

We retrospectively analyzed 26 consecutive patients undergoing infragenicular peripheral bypass with a Distaflo prosthesis between June 2020 and December 2024. Primary endpoints were 30-day and 1-year mortality. Secondary endpoints included 1-year amputation-free survival (AFS) in patients >80 years, primary patency, functional status, major amputation rate, perioperative complications, length of hospital stay, and discharge destination. Predictors of 1-year mortality were assessed by univariate analysis.

Most procedures were performed for chronic limb-threatening ischemia (Rutherford 4: n=20). Thirty-day mortality was 11.5% (95% CI 2.4–30.2%), and 1-year mortality was 16.7% (survival 83.3%). In patients >80 years, 1-year AFS was 58.3%. One-year primary patency was 64.3%.
Patency by target vessel was 75% for fibular, 60% for anterior tibial, 50% for posterior tibial, and 100% for popliteal bypasses, without a consistent trend. Similarly, the level of distal anastomosis did not significantly affect patency.
At 1 year, 79% of patients were ambulatory (21% independent, 58% assisted), 5% wheelchair-bound, and 16% bedridden. The 1-year major amputation rate was 14.3%. Perioperative complications occurred in 37.5% of cases, with 30.4% classified as Clavien–Dindo ≥III. Median hospital stay was 15 days, and 52.2% of patients were discharged home.
Older age (p=0.034) and higher ASA score (p=0.045) were associated with increased 1-year mortality.

In elderly high-risk patients without suitable vein, Distaflo prostheses enable limb salvage with acceptable patency and functional outcomes. Outcomes appear primarily driven by patient-related risk factors rather than distal target or anastomotic level. Careful patient selection and preoperative risk assessment remain essential.

Handedness is an overlooked determinant of surgical training and operative performance. Operative workflows, instrumentation and teaching remain largely designed for right-handed surgeons. Little is known about how left-handed (LH) surgeons adapt to this environment or how it affects training and career development. We aimed to assess handedness profiles, functional adaptation and training-related difficulties among surgeons across Germany, Austria and Switzerland (DACH region).

An anonymous REDCap-based survey was conducted among surgeons of all training levels in the DACH region. Handedness was assessed using self-reported handedness, the Edinburgh Handedness Inventory and a Surgical Handedness Questionnaire. Training experiences, operative practice, adaptive strategies, perceived barriers and career impact were analysed.

A total of 471 surgeons, including 135 vascular surgeons, were included. LH surgeons accounted for 15%, exceeding the expected prevalence in the general population. Overall, 10% demonstrated a mismatch between daily and surgical handedness, rising to 23% among LH surgeons, suggesting functional adaptation during surgical training. Among LH surgeons, 78% reported actively training themselves to become ambidextrous. LH surgeons reported significantly more handedness-related difficulties than right-handed surgeons (60% vs. 12%, p<0.001). Left-handedness remained the strongest independent predictor of training-related difficulties (adjusted Odds ratio (aOR): 11.2, 95% CI 6.4–20.3, p<0.001). Within the LH subgroup, perceived pressure to adopt right-handed operating techniques independently predicted consideration of changing specialty (aOR: 3.45, 95% CI 1.55–10.1, p=0.008). A greater awareness among trainers (78%) and handedness-specific training (71%) were considered as the most important measures to improve surgical education.

Surgical handedness is a dynamic construct that differs from daily handedness in a substantial proportion of surgeons, particularly among LH individuals. Despite this adaptation, LH surgeons remain significantly more likely to experience training-related difficulties, suggesting that current surgical training is still largely tailored to right-handed practice. Implementation of handedness-aware teaching strategies, mentorship and operating environments may improve equity in surgical training.

Wound-healing complications after major lower-limb amputation remain common in chronic
limb-threatening ischaemia (CLTI). Recent studies suggest surgical technique has limited
influence on stump healing, whereas impaired perfusion and diabetes are independent
predictors of wound failure. Conventional tools (ankle-brachial index, transcutaneous oxygen
pressure [TcPO2], Doppler) do not directly assess flap perfusion. Indocyanine green (ICG)
near-infrared fluorescence imaging enables intraoperative visualization of cutaneous
microcirculation. We report our initial experience evaluating the feasibility of ICG imaging and
its association with early wound healing.

Consecutive patients undergoing major lower-limb amputation for CLTI were prospectively
assessed in a single-centre observational case series with standardized surgical technique.
After flap construction, 0.1 mg/kg ICG was administered intravenously and near-infrared
fluorescence imaging performed. Flap perfusion was assessed qualitatively as homogeneous
fluorescence or a clearly demarcated deficit (hypoperfused or delayed-filling areas). Findings
were compared with early postoperative outcomes: primary healing, wound dehiscence,
cutaneous-fat flap necrosis and reintervention.

Seven patients (6 transtibial, 1 transfemoral) were included. Six amputations showed
homogeneous fluorescence; five healed primarily. One developed superficial blistering from
postoperative oedema and compression, resolving with conservative care without revision. One
transtibial amputation showed a central fluorescence deficit despite an apparently viable flap at
closure; this patient subsequently developed cutaneous-fat necrosis and wound dehiscence
precisely matching the intraoperative perfusion deficit. The patient later died from unrelated
medical complications. No ICG-related adverse events occurred.

In this proof-of-concept series, intraoperative ICG near-infrared fluorescence imaging was
feasible and qualitative perfusion findings were concordant with early wound healing. Although
limited by the small sample size, these findings support prospective evaluation of ICG imaging
as an adjunct for intraoperative assessment of amputation flap viability, including
transmetatarsal amputations, where wound healing is influenced by both tissue perfusion and
local biomechanical factors.

Hypertension is a major risk factor for cardiovascular disease and acute aortic syndromes. Following aortic dissection (AD), lifelong blood pressure (BP) control and surveillance are essential. However, repeated healthcare visits, fear of unrecognized BP elevation, and limited adherence may impair quality of life and increase the risk of complications, reintervention, and rehospitalization. This review summarizes recent developments in remote and cuffless BP monitoring and explores their potential role in post-acute and long-term care after AD.

A structured search of PubMed, MEDLINE, and Google Scholar identified articles published within the past five years. The terms “Wearable Electronic Devices,” “Remote Patient Monitoring,” and “Blood Pressure” were used to assess cuffless wearable BP devices, including design, clinical utility, and monitoring applications. Additional searches for “Rehabilitation,” “Quality of Life,” and “Aortic Dissection” evaluated their potential role in post-dissection rehabilitation and patient outcomes.

Conventional home BP monitoring is predominantly intermittent and depends on patient activation and adherence, while ambulatory 24-hour monitoring is limited for repeated long-term use. Both may insufficiently capture BP variability during sleep, exercise, and daily activities. Cuffless wearable devices may enable automatic and unobtrusive monitoring, support individualized exercise guidance, facilitate rehabilitation and the transition to ambulatory care, and improve adherence. Their integration into remote patient monitoring and telehealth could reduce hospital admissions, healthcare use, and costs while strengthening patient self-management. However, concerns remain regarding measurement accuracy, reimbursement, and cost-effectiveness. Validation according to the developing ISO 81060-7 standard is required.

Patients after AD require lifelong BP surveillance and often experience anxiety, reduced quality of life, and restrictions in physical activity. Wearable cuffless devices, including wristbands, rings, and chest patches, may provide better insight into BP variability during daily life, sleep, and exercise while reducing the burden of repeated cuff-based measurements. Although further validation is necessary, these technologies may reshape post-acute rehabilitation and long-term ambulatory care after AD.

Acute aortoiliac occlusion (AAO) and heparin-induced thrombocytopenia (HIT) are rare but life-threatening conditions, with reported mortality rates of 15–20% and 6–26%, respectively. Their coexistence is rare and poses major diagnostic and therapeutic challenges. We report a case of AAO as first manifestation of catastrophic HIT with rapidly progressive arterial and venous thrombosis.

A 69-year-old woman, hospitalized for acute heart failure due to severe mitral prosthesis stenosis and pneumonia, received intravenous unfractionated heparin (UFH) for 7 days before undergoing preoperative coronary angiography via right femoral access. One hour later, she developed sudden lumbar pain and bilateral acute lower limb ischemia. CT angiography revealed acute infrarenal aortoiliac occlusion with left femoral occlusion and a suspected right ventricular thrombus. Emergency revascularization included aortoiliac thromboembolectomy, covered endovascular reconstruction of the aortic bifurcation (CERAB) and bilateral common femoral artery reconstruction.

Postoperatively, retrospective analysis of serial blood counts showed a >50% drop in platelet count over the preceding 2 days after 7 days of UFH exposure. Given the association of thrombocytopenia with new arterial thrombosis, HIT was suspected (4Ts score: 7) and subsequently confirmed by positive anti-PF4 antibodies and functional testing. Heparin was immediately discontinued and replaced with argatroban. Despite therapeutic anticoagulation, she developed left atrial and right ventricular thrombi, brachiocephalic vein and superior vena cava thrombosis and pulmonary embolism, resulting in refractory cardiogenic and obstructive shock. Rescue systemic thrombolysis was unsuccessful and she died from multiorgan failure on postoperative day 7.

This case illustrates that acute aortoiliac occlusion occurring after coronary angiography should not automatically be attributed to an access-site complication. In patients presenting with acute arterial thrombosis after an invasive procedure, particularly following exposure to UFH and an unexplained platelet count decrease, HIT should be considered promptly. Early discontinuation of heparin, initiation of alternative anticoagulation and systematic screening for additional arterial and venous thromboses are essential, although prognosis remains poor in catastrophic presentations.

The clinical significance of type II endoleak (T2EL) after endovascular aneurysm repair (EVAR) remains controversial. Although typically considered harmless, T2EL has been associated with postoperative aneurysm sac enlargement, with some advocating for preventive embolization of the inferior mesenteric or lumbar arteries. To evaluate aneurysm sac diameter changes and redo surgery in patients with T2EL after EVAR in a single-center cohort.

We performed a retrospective single-center review of patients undergoing infrarenal EVAR between 2014 and 2024. Patients with ≥1.5 years of follow-up with CT angiography were included. Four patients were excluded due to discontinuation of follow-up because of severe comorbidities. Sac growth or shrinkage was defined as a ≥5 mm increase or decrease in diameter. Aneurysm sac changes and redo surgery due to isolated T2EL were analyzed further.

The cohort included 195 patients with a mean follow-up of 54 months. Overall, sac shrinkage occurred in 116 patients (59.5%), sac growth in 31 (15.9%), and no relevant change in 48 (24.6%). Sac growth within the first postoperative year occurred in 2.6%. Patients without endoleak (n=78) demonstrated a higher rate of shrinkage (n=63, 80.8%) and minimal growth (n=1, 1.3%). Patients with isolated T2EL (n=87) had less shrinkage (n=45, 51.7%) and increased sac growth (n=18, 10.7%). Of those, 12 patients (13.8%) underwent redo surgery, mainly due to proximal or distal sealing zone dilation. No secondary ruptures occurred. Coiling was performed in 4 (4.6%) cases, 2 of which showed sac shrinkage afterwards.

Isolated T2EL is associated with significantly higher aneurysm sac growth compared to patients without endoleak. In these patients redo surgery was necessary in 13.8%. The absence of rupture suggests that sac growth related to T2EL may be managed safely with strict CT surveillance to detect complications such as device migration or progressive sealing zone dilation.

While endovascular techniques have become increasingly popular in treating thoracoabdominal aneurysms (TAAA), open surgery remains a cornerstone in TAAA treatment. Short-term results have been extensively described in the literature, but long-term data reporting remains scarce. The aim of this study was to report short- and long-term results following open TAAA repair.

Single-center consecutive series of patients who underwent elective open TAAA repair over two decades. Patients were stratified by etiology of the aneurysm (postdissection aneurysm [PDA] or degenerative aneurysm [DEGA]). In-hospital data were extracted from the institutional clinical information system. Long-term follow-up was obtained from follow-up reports and by contacting general practitioners for patients with no current follow-up data available in the system.

Of 336 patients, 172 were operated for DEGA and 164 for PDA. Mean age was 67.9 years in the DEGA cohort and 58.5 years in the PDA cohort respectively (p<0.001). Heritable thoracic aortic disease was present in 0.6% in the DEGA and 14% in the PDA cohort (p<0.001). Extents of repair according to the modified Crawford classification were in DEGA vs PDA: Type I 15% vs 20%, Type II 26% vs 60%, Type III 17% vs 15%, Type IV 41% vs 9%, Type V 2% vs 0%. Perioperative outcomes are presented in table 1. During follow-up, 24% of DEGA and 28% of PDA patients underwent aortic reoperation (p=0.378). Five-, ten-, and fifteen-year survival for DEGA vs PDA was 81% vs 80%, 51% vs 69% and 27% vs 56%, respectively. Hazard ratio for mortality at 10 years for patients with PDA vs DEGA was 0.55 (95% CI: 0.40-0.77 p<0.001). Aortic related mortality was 12% for DEGA vs 28% for PDA (p=0.015).

Long-term survival after elective open TAAA repair differed significantly in favor of patients with postdissection aneurysms compared to those with degenerative aneurysms. Approximately 25% of patients in each group underwent aortic reoperation, which underscores the importance of a structured follow-up program.