J. Vasc. Dis., Volume 5, Issue 4 (August 2026) – 5 articles

Purpose: Bronchial artery aneurysms (BAA) and pseudoaneurysms (BAP) are uncommon vascular lesions that may present incidentally with hemoptysis or following rupture. This systematic review and pooled analysis examined their clinical presentation, diagnostic assessment, management, and reported outcomes. Materials and Methods: PubMed, Embase, and the Cochrane Library were searched for case reports and case series published between January 2000 and December 2025. Studies reporting patients with BAA or BAP and sufficient clinical information were included, following the modified PRISMA guidelines. Results: Of 1431 identified records, 152 studies comprising 170 patients were included. Overall, 80% of patients were symptomatic, and most aneurysms were solitary and mediastinal. Rupture was reported in 28.4% of published cases. Endovascular treatment was the most frequently reported approach (83.7%). Technical success was achieved in 94.6% of cases overall and in 93.9% of endovascular procedures. Exploratory univariable analyses identified no significant association between technical success and treatment modality (p > 0.05). Reported complication rates were similar following endovascular and open treatment (3.8%, vs. 4.5%, p = 1.000). Conclusions: Rupture was frequently described among published BAA and BAP cases and endovascular treatment was the most commonly reported management strategy, with high observed success and few complications. However, the case-based evidence and associated selection and reporting biases, limit comparative or causal conclusions. Standardized outcome definitions, improved reporting, and multicenter registries are needed to clarify natural history and inform management strategies. Full article

Background/Objectives: Venous thromboembolism (VTE) is a common and potentially preventable complication after hemorrhagic stroke, yet the optimal timing of pharmacologic prophylaxis remains uncertain because of concern for hematoma expansion or rebleeding. Repeat neuroimaging is frequently used to assess hemorrhage stability before initiating deep vein thrombosis (DVT) chemoprophylaxis, although the value of radiographic stability alone remains unclear. This review evaluates the evidence supporting imaging-guided initiation of prophylaxis after intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (aSAH). Methods: A narrative review of the literature was performed focusing on hemorrhage expansion, thrombotic risk, repeat neuroimaging, and timing of pharmacologic prophylaxis in spontaneous ICH and aSAH. Observational studies, limited randomized data, and current guideline recommendations were assessed. Results: In spontaneous ICH, hematoma expansion risk is greatest within the first 24 h, whereas thrombotic risk increases over subsequent days because of immobility and systemic inflammation. Available evidence suggests that early low-dose anticoagulant prophylaxis may be safe in selected patients with stable hemorrhage, although definitions of stability vary and no prospective study has validated repeat imaging as an independent decision trigger. In aSAH, rebleeding risk depends more heavily on aneurysm securement and procedural factors than on imaging appearance alone. Conclusions: Repeat neuroimaging provides important reassurance after hemorrhagic stroke but does not fully capture ongoing biological risks. Current evidence supports a cautious, individualized approach in which radiographic stability informs, but does not independently determine, the timing of pharmacologic VTE prophylaxis. Full article

Objective: Giant thrombosed intracranial aneurysms (GTIAs) are aneurysmal dilatations containing partial or complete intraluminal thrombus. Representing approximately 2–5% of intracranial aneurysms, GTIAs present diagnostic and therapeutic challenges. Optimal management remains controversial and may involve microsurgical, endovascular, or hybrid strategies. Methods: A systematic review was performed in accordance with PRISMA guidelines using PubMed and Embase to identify relevant studies published between January 2000 and August 2025. Eligible studies reported clinical, anatomical, or treatment-related data for patients with GTIAs. Extracted variables included patient demographics, aneurysm characteristics, treatment modality, and outcomes. Data were standardized and analyzed using Python. Complication and recurrence rates were pooled in subsets of studies reporting explicit event counts; comparisons between treatment modalities were assessed using chi-square analysis. Results: In total, 101 studies including 536 patients met our criteria. Mean patient age was 50.2 years. Most aneurysms arose from the anterior circulation (88.2%) involving the internal carotid artery (46.6%) and middle cerebral artery (39.9%). The unweighted mean aneurysm diameter was 39.0 mm, with a patient-weighted mean of 24.3 mm. Hybrid treatment strategies were most frequently reported (62.7%), followed by endovascular (23.3%) and microsurgical (14.0%) approaches. Among studies reporting explicit counts, the pooled complication rate was 17.0% and the recurrence rate was 21.0%. Complication rates did not differ significantly between treatment modalities (p = 0.48), whereas recurrence differed significantly (p = 0.00013). Conclusions: Management of GTIAs remains heterogeneous, with increasing reliance on multimodal and hybrid treatment strategies. However, inconsistent outcome reporting and the predominance of retrospective studies limit definitive comparisons between treatment modalities. Full article

Background: Increasing access to Electronic Health Records (EHRs) has enabled the development of Machine Learning (ML) models to predict early cardiovascular disease (CVD) risk. Nevertheless, real EHR data is usually limited in availability and distribution because of confidentiality issues, legal limitations, and insufficient access. Synthetic data generation has become a promising approach to overcome such difficulties. Objectives: This study proposes a Large Language Model (LLM)-guided retrieval-aware framework for generating realistic synthetic EHR data on a large scale to train ML models to predict cardiovascular risks accurately. Methods: The framework uses a Tabular Denoising Diffusion Probabilistic Model to learn the underlying distribution of the original dataset and generate an initial synthetic dataset. To improve the clinical plausibility of the generated data, a knowledge-guided refinement module with LLaMA 2 13B combined with Retrieval-Augmented Generation (RAG) is introduced. The LLM analyzes statistical trends in real and synthetic data while retrieving relevant medical information to detect and correct clinically implausible correlations. Results: Experimental findings show that the optimized synthetic dataset preserves important statistical features of the original data and achieves high performance in predicting CVD. Conclusions: Thus, the framework offers a scalable, privacy-conservative method for generating realistic synthetic healthcare data suitable for medical research. Full article

Background/Objectives: Prior U.S. surveillance studies described changes in pulmonary hypertension mortality through 2020, but contemporary national data focused specifically on deaths coded as primary pulmonary hypertension (PPH; ICD-10 I27.0) are limited. We examined temporal, sex, racial, and geographic patterns in I27.0-coded mortality in the United States from 2018 to 2024. Methods: CDC WONDER Underlying Cause of Death data were analyzed. Annual deaths and mortality rates were examined by year, sex, Single Race 6 category, and U.S. Census region. Results: A total of 1831 deaths were coded as I27.0. Annual deaths declined from 344 in 2018 to 199 in 2024, while the exact crude rate declined from 0.105 to 0.059 per 100,000. Women accounted for 69.5% of deaths. Black individuals had a higher age-adjusted mortality rate than White individuals (0.10 vs. 0.06 per 100,000). The South accounted for the largest share of deaths (43.1%), although the West had a marginally higher exact crude rate. Conclusions: Deaths assigned to I27.0 declined substantially during 2018–2024. This trend occurred during a period of major evolution in PAH care, but the ecological design cannot determine whether therapeutic advances caused the decline. Changes in coding, classification, and assignment of underlying cause may also have contributed. Persistent demographic disparities warrant further investigation. Full article