J. Vasc. Dis., Volume 5, Issue 1 (February 2026) – 9 articles

The Middle Meningeal Artery (MMA) occupies a pivotal role in the pathophysiology of migraine, functioning as a vascular and neuroimmune interface that precipitates the characteristic pulsatile pain. The inhibition of this pathophysiological cascade has been investigated as a therapeutic strategy. However, fewer than a dozen centers globally have disseminated procedural or mechanistic data. Given the nascency of this field and the imperative for standardization, the present review synthesizes mechanistic and clinical evidence underpinning intra-arterial pharmacological modulation of the MMA for migraine management. Methods: A focused narrative review was undertaken, drawing upon select but influential studies from pioneering research groups investigating intra-arterial interventions targeting the MMA. The extant literature was thematically categorized and organized according to the loci of cascade interruption and their corresponding clinical outcomes. Results: Since 2009, intra-arterial therapies for severe headache syndromes have evolved, initially utilizing nimodipine for vasospasm-related headaches, progressing to verapamil for reversible cerebral vasoconstriction, and more recently, lidocaine for refractory or status migrainosus, occasionally in conjunction with MMA embolization. Contemporary research uses language that conceptualizes migraine as an immunologically mediated neurovascular disorder, as opposed to a purely vascular or neuronal entity. Recent investigations have identified interleukins such as Interleukin-1β, Tumor Necrosis Factor-α, and Interleukin-6 as critical amplifiers of trigeminovascular activation. Purinergic signaling through the P2X3 receptor and the P2Y13 receptor, in conjunction with pituitary adenylate cyclase-activating polypeptide and vasoactive intestinal peptide pathways, has been implicated in the modulation of MMA excitability and neuropeptide release. The development of novel calcitonin gene-related peptide receptor antagonists, such as zavegepant, further substantiates the artery’s significance as a pharmacological target. Conclusions: These findings support a shift toward immune-modulating intra-arterial therapeutic strategies, with migraine interventions targeting cytokine and neuroimmune signaling within the MMA, rather than relying exclusively on vasodilatory mechanisms. Full article

Ventricular–arterial coupling (VAC) describes the dynamic interaction between left ventricular (LV) systolic elastance and the time-varying elastance/impedance of the arterial tree, a relationship that governs the instantaneous generation of aortic flow and ultimately cardiac output. VAC, typically expressed as the ratio of effective arterial elastance (Ea) to LV end-systolic elastance (Ees), has provided valuable mechanistic and prognostic insights, but is limited by its lumped, largely steady-state nature and by the need for pressure–volume modeling or complex surrogate formulas. Contemporary time-domain and wave-intensity approaches have underscored that the shape of proximal aortic pressure–flow waveforms encodes rich beat-by-beat information about ventricular–arterial interaction and energy transfer. Doppler echocardiography of the ascending aorta provides a readily available, high-temporal resolution measure of proximal aortic flow that is already used to quantify stroke volume, cardiac output and valvular lesions. We propose that proximal aortic flow, as recorded by Doppler echocardiography, may serve as a clinically practical proxy for beat-by-beat VAC, reflecting the instantaneous matching of ventricular and aortic elastances, which regulates the ejected flow towards peripheral tissues according to metabolic needs. Full article

Off-pump coronary artery bypass grafting (OPCAB) represents one of the most significant technical innovations in contemporary cardiac surgery. Developed as an alternative to conventional on-pump coronary artery bypass grafting (ONCAB), OPCAB avoids cardiopulmonary bypass and its associated systemic inflammatory response, aiming to reduce perioperative morbidity and improve recovery. Over the past three decades, advances in stabilization devices, intracoronary shunts, anesthetic management, and surgical training have refined the procedure, making it safer and more reproducible. Despite these developments, OPCAB adoption remains inconsistent worldwide, reflecting ongoing debate about its relative benefits and limitations. Evidence from randomized controlled trials, meta-analyses, and large registries suggests that OPCAB achieves comparable early mortality to ONCAB, with potential advantages in reducing renal dysfunction, neurocognitive decline, and perioperative bleeding. These benefits appear most pronounced in high-risk subgroups, including elderly patients and those with significant comorbidities. However, concerns persist regarding long-term graft patency, completeness of revascularization, and variability in outcomes depending on surgeon experience and institutional expertise. Cost-effectiveness analyses have suggested potential resource savings, but these are offset by training requirements and the technical complexity of the procedure. Global practice variation highlights the influence of surgical culture, guideline ambiguity, and institutional resources. Barriers to universal adoption include technical challenges, inconsistent long-term outcomes, and limited exposure in training programs. In the future, robotic and minimally invasive OPCAB, as well as hybrid revascularization strategies, may expand its role. This review synthesizes current evidence, explores barriers to widespread implementation, and outlines future directions for integrating OPCAB into balanced, evidence-based clinical practice. Full article

Background: We present our experience of carrying out endovascular therapy (EVT) of a pseudo-aneurysm of the posterior tibial artery (PTA) with an associated arteriovenous fistula (AVF). We also present results of a systematic review which was carried out to cast light on endovascular treatment modalities. Methods: A 31-year-old patient with a history of war trauma presented with pain of increasing severity in the lower leg. A CT angiogram confirmed an aneurysm of the PTA with an AVF. With a bidirectional endovascular approach, the aneurysm was occluded with coils and excluded with a Viabahn endoprosthesis. Aspirin and clopidogrel were recommended postoperatively. After 18 months of follow-up, the patient was free of symptoms, with patent endoprosthesis. Multiple databases (Scopus, Pubmed, Medline, OVID) were systematically searched using MeSH terms. The studies were scrutinized, and data on demographics, procedural details, and follow-up were collected and aggregated. Results: A total of 44 studies (56 patients) were eligible and were included. Average age was 50 (15–87 years). The most common etiology was trauma (iatrogenic 29/56 (51.7%); non-iatrogenic 15/56 (26.7%)). EVT strategies included coil embolization (n = 29), stent implantation (n = 25), and a combination of both (n = 2). Median stent diameter was 3 mm (2.5–6). The follow-up period ranged from 1 week to 60 months. Aggregated reported primary patency was 18/27 (66.6%) with no documented complications—an observation that likely reflects reporting and publication bias, rather than a true absence of adverse events. Conclusions: EVT offers a feasible and safe alternative to simple ligation or occlusion of crural aneurysms, to preserve distal flow to the foot. Dedicated stents for crural arteries are not available. Studies with long-term follow-up are lacking. Full article

Vascular diseases remain a major global health burden despite remarkable technological advances in vascular surgery and endovascular therapies. Conditions such as peripheral arterial disease, abdominal aortic aneurysm, carotid stenosis, chronic venous disease, diabetic vasculopathies, and vascular chronic ulcers are not only biological entities but are deeply shaped by social structures, cultural norms, and economic inequalities. This article introduces Vascular Sociology as an interdisciplinary field that integrates vascular surgery with medical sociology to provide a more comprehensive understanding of vascular health and disease. Drawing on classical and contemporary sociological theory, including concepts such as social determinants of health, embodiment, illness narratives, and the disease–illness–sickness triad, the article argues that vascular pathology reflects cumulative social exposures across the life course. Socially patterned behaviors, work conditions, food environments, healthcare access, gender norms, and geographic inequalities profoundly influence disease onset, progression, treatment decisions, and outcomes. The paper highlights how surgical success is contingent not only on technical excellence but also on patients’ social contexts, including health literacy, trust in institutions, caregiving resources, and the capacity to adhere to long-term follow-up and rehabilitation. By outlining conceptual foundations, epidemiological evidence, and mixed-methods research strategies, the article positions Vascular Sociology as a framework capable of bridging biomedical knowledge with lived experience. This approach expands the definition of vascular outcomes to include social reintegration, identity transformation, and equity of care, ultimately aiming to improve patient-centered practice, reduce disparities, and inform more socially responsive vascular health policies. Full article

Introduction: Accurate knowledge of the external carotid artery (ECA) anatomy is essential for head and neck surgery, interventional procedures, and imaging interpretation. Although its branching pattern is classically described as relatively constant, clinically relevant anatomical variations are frequently encountered. Cadaveric dissection remains fundamental for identifying rare vascular configurations. Materials and Methods: During an anatomical teaching dissection of a 72-year-old male cadaver, a right-sided lateral cervicotomy was performed to expose the carotid sheath. After mobilisation of the sternocleidomastoid muscle, the ECA and its proximal branches were skeletonised, allowing detailed three-dimensional assessment of their origin, calibre, and neurovascular relationships. Results: The superior thyroid artery originated from the proximal segment of the external carotid artery, in close proximity to the carotid bifurcation. The main anatomical finding was a lingual artery of relatively small initial calibre exhibiting an atypical superior trajectory: after its origin, it crossed superior to the hypoglossal nerve before continuing toward the tongue. This configuration differs from classical descriptions and modified the anatomical arrangement of Beclard’s and Pirogoff’s triangles, creating a potential site of close neurovascular contact. Conclusions: This cadaveric study describes a rare trajectory-based variant of the external carotid artery characterised by a lingual artery crossing superior to the hypoglossal nerve. Awareness of such rare patterns is essential for improving anatomical interpretation and enhancing surgical safety in the head and neck region. Full article

Background/Objectives: Vascular calcification is a major contributor to cardiovascular mortality and disability. Here, we investigated whether dietary nitrate, an exogenous source of nitric oxide (NO), could inhibit vascular calcification in a rat model induced by excess vitamin D₃. Methods: The rats were injected subcutaneously with phosphate-buffered saline or 200,000 IU/kg cholecalciferol and the abdominal aorta was isolated 7 and 14 d after injection. Results: Von Kossa staining revealed mild vascular calcification 7 d after injection, with the positive area expanding by 14 d. Vasorelaxation induced by the NO donor sodium nitroprusside was normal 7 d after injection but weakened 14 d after injection. In a separate experiment, sodium nitrate (3 or 10 mM in drinking water) was administered for the last 7 and 13 d, prior to sacrifice, 14 d after cholecalciferol injection. Von Kossa staining-positive areas and calcium content in the abdominal aortas did not decrease with short-term administration of sodium nitrate but decreased with long-term administration; no difference in effect based on dosage was observed in either short-term or long-term administration. Low-dose sodium nitrate tended to increase plasma nitrite and nitrate levels, which are indicators of NO bioavailability, similar to both short- and long-term administration, which increased significantly at higher doses. Conclusions: These findings suggest that NO homeostasis in blood vessels deteriorates with the progression of vascular calcification, and that dietary nitrate may be a useful therapeutic approach. Full article

Background: Type B Aortic Dissection (TBAD) management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in National Health Services (NHSs). Bridging the gap between Emergency Medicine (EM) and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improve outcomes and reduce mortality. Methods: A cross-sectional survey of EM consultants yielded n = 173 valid responses from n = 33 units across the UK. Subgroup analyses were conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland–Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to a rapid Computed Tomography Angiogram (CTA) was 70% (95% CI: 63.3–76.8%, p < 0.001), while 32% had standard operating procedures (SOPs) for TBAD (95% CI: 25.3–39.1%), and 26% were aware of any decision tool (95% CI: 20.6–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with a reported bias of 23.58% (−38.20% to 85.36%) (p = 0.02). Conclusions: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks. Furthermore, upon recognition of the most prevalent factors, CTA and specialist referral is advocated. Full article

Background: Intracranial atherosclerotic disease (ICAD) remains a major global cause of ischemic stroke—particularly in Asian, Black, and Hispanic populations—and is characterized by high recurrence rates despite advances in intensive medical management. Objectives: This review synthesizes current evidence on surgical and endovascular approaches for ICAD, including extracranial–intracranial bypass, encephaloduroarteriosynangiosis, angioplasty, and hybrid revascularization strategies. Methods: We performed a structured narrative literature search of PubMed and Scopus. Searches were conducted up to 1 October 2025 using combinations of subject headings and keywords, including “intracranial atherosclerotic disease”, “ICAD”, “intracranial stenosis”, “bypass”, “encephaloduroarteriosynangiosis”, “angioplasty”, “stenting”, “revascularization”, and “stroke”. We also scanned reference lists of key articles and relevant reviews. Non-English language articles were excluded. Results: While randomized trials such as SAMMPRIS, VISSIT, and CASSISS reaffirm intensive medical management as first-line therapy, emerging data suggest that surgical revascularization may benefit select patients with hemodynamic compromise refractory to medical therapy. Recent studies incorporating physiologic imaging—such as PET, SPECT, and perfusion MRI—have refined patient selection, reducing perioperative risk and improving long-term outcomes. Innovations in indirect revascularization, hybrid procedures, and intraoperative imaging continue to expand therapeutic possibilities. However, evidence remains heterogeneous, underscoring the need for well-powered randomized trials integrating modern surgical techniques, objective hemodynamic endpoints, and AI-enhanced imaging analytics. Conclusions: While intensive medical management remains the first-line standard of care, select patients with refractory, hemodynamically significant ICAD may benefit from direct, indirect, or hybrid surgical revascularization. Future directions emphasize personalized, physiology-based management frameworks that combine medical, surgical, and technological advances to optimize stroke prevention and long-term vascular outcomes in ICAD. Full article