Search Results (232)

Background: In the population of patients with ischemic cardiomyopathy (IC) and reduced left ventricular ejection fraction, the benefits of prophylactic implantable cardioverter-defibrillator (ICD) therapy are not uniform. Identifying predictors of ventricular arrhythmias to estimate the risk of appropriate therapy is crucial. Methods: Patients with IC and an ICD for primary prevention implanted between 2006 and 2019 were retrospectively analyzed for appropriate therapy (ATh). The primary objective was to assess predictors of ATh development. The secondary objective was to assess the impact of ATh on survival. Results: Overall, 260 patients (age 67.3 ± 9.4 years, 15.4% female) were analyzed with a follow-up of 4.47 ± 3.02 years. ATh occurred in 79 patients (30.4% of the study group). Independent risk factors for ATh were as follows: non-sustained ventricular tachyarrhythmias (nsVTs) detected before ICD implantation, extensive area of ischemic left ventricular damage on echocardiographic assessment, left ventricular end-diastolic dimension (LVEDd) ≥ 68 mm, history of coronary artery bypass grafting (CABG), and presence of chronic total occlusion (CTO). A multiparameter logit model was created to estimate the probability of ATh. Patients with a score ≥ 0.6 had more than a six-fold higher risk of developing ATh compared with patients with a score < 0.6. Patients after ATh had significantly lower survival compared to patients without intervention (HR 1.69, p = 0.008). Conclusions: Patients with the independent risk factors listed above are at higher risk for ATh. A multiparameter logit model based on these risk factors is effective in estimating the risk of ATh. The occurrence of ATh was associated with a significantly higher risk of all-cause mortality. Full article

Background: Hemodialysis access dysfunction can lead to missed treatments and increased mortality. Traditional monitoring methods, such as physical examination and ultrasound, have limitations, emphasizing the need for a more efficient approach. This study investigates the use of digitized acoustic data to identify and monitor vascular access dysfunction. Methods: This prospective study involved patients undergoing hemodialysis with either arteriovenous fistulas (AVF) or arteriovenous grafts (AVG) between June 2023 and February 2025. All patients underwent vascular imaging (either angiography or ultrasound) to confirm the degree of stenosis. Acoustic data were recorded using a standardized procedure at various puncture sites. Pre- and post-angioplasty data were also collected to assess the effects of vascular intervention. The digitized acoustic data were analyzed for changes in relative loudness, peak-to-valley ratios, and frequency distribution. Results: A total of 157 patients with 236 audio recordings (mean age: 67 ± 11 years; 58% male) were included. Significant acoustic differences were found at the arterial puncture and anastomosis sites in AVF patients with dysfunction, particularly in venous site dysfunction, which exhibited a more pronounced reduction in sound volume and an increased peak-to-valley ratio. After angioplasty, acoustic changes were observed in both arterial and venous sites, with values moving toward normal levels. However, no significant acoustic changes were observed in AVG patients. Additionally, frequency distribution ratios showed minimal clinical relevance. Conclusions: Digitized acoustic data, particularly from the arterial puncture and anastomosis sites, can be an effective tool for detecting and monitoring hemodialysis access dysfunction. These findings suggest potential for acoustic analysis in clinical practice, especially when integrated with AI models for better diagnostics. Full article

Total Coronary Revascularization via left Anterior Thoracotomy (TCRAT) represents a modern evolution of sternum-sparing, on-pump multivessel coronary artery bypass grafting. In this review, we will summarize the historical development, detail the surgical principles, and provide a comprehensive overview of the clinical outcomes of TCRAT. The technique combines cardiopulmonary bypass using peripheral arterial as well as venous cannulation and cardioplegic cardiac arrest using transthoracic aortic cross-clamping with surgical access through a left anterior minithoracotomy. By applying special slinging and rotational maneuvers, both a stable exposition of all coronary territories—in particular those of the right and the circumflex coronary artery—and a quiet, bloodless operating field enable complete anatomical revascularization and complex coronary surgery procedures, including all variations in multiarterial grafting in unselected patients. Data from all published clinical series were integrated, and a weighted analysis of a total of 2282 patients was performed. TCRAT proved to be very effective with regard to complete anatomical revascularization and modern grafting strategies, and it showed excellent perioperative safety in an all-comers population. Both the 30-day mortality and perioperative stroke incidence were distinctly below 1.0%. Data from mid-term follow-up, although rare so far, are promising and compare well to those of the important RCTs. The TCRAT approach eliminates sternal complications completely and accelerates recovery. As an on-pump arrested-heart surgery, TCRAT inherently permits the combination of minimally invasive multivessel CABG with a variety of other cardiac operations, mainly the combination with valve procedures. The integration of robotic and endoscopic assistance represents the next evolutionary step. With its reproducibility and broad applicability, TCRAT holds strong potential to become a standard routine technique in the field of minimally invasive cardiac surgery. Full article

Background and Objectives: In this study, we aim to analyze the impact of risk predictors on long-term outcomes in patients with diabetes undergoing isolated coronary artery bypass grafting (CABG). Materials and Methods: All consecutive patients undergoing isolated CABG between May 2005 and June 2021 were included in the study. Patients with and without diabetes were compared for baseline demographics and pre-operative characteristics. A propensity-matched analysis was used to compare the two groups. The primary outcome was long-term incidence of all-cause death. Results: Of a total of 4871 patients, propensity matching identified 1589 pairs of patients with and without diabetes that were included in the current study. Median follow-up was 5.8 years. All-cause death was recorded in 215/1589 (13.5%) vs. 169/1589 (10.6%) patients with and without diabetes, respectively (HR 1.3, p = 0.013). MACCE was also significantly higher in diabetic patients (HR 1.3, p = 0.049). Diabetes mellitus was identified as one of the independent predictors for all-cause mortality (HR 1.4, CI 1.2, 1.7) and MACCE (HR 1.2, CI 1.0, 1.3). Chronic obstructive pulmonary disease, peripheral vascular disease, and serum creatinine levels >2.0 mg/dL were found to be the only predictors of all-cause mortality in both diabetic and non-diabetic patient groups, when individually analyzed. Conclusions: Patients with diabetes undergoing isolated CABG had a significantly higher incidence of late all-cause death and MACCE compared to those without diabetes. The presence of diabetes mellitus predicts poorer long-term outcomes following CABG. Full article

Background and Objectives: Chronic kidney disease (CKD) is frequently observed among patients with non–ST elevation myocardial infarction (NSTEMI) and is associated with increased morbidity and mortality. Evidence comparing long-term outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in this high-risk population remains limited. The objective was to compare long-term major adverse cardiac event (MACE) outcomes between PCI and CABG in NSTEMI patients with CKD and multivessel disease. Materials and Methods: A total of 150 consecutive NSTEMI patients with CKD who underwent PCI or CABG were included in this retrospective observational cohort study. Patients were classified as having mild or moderate-to-severe CKD based on eGFR. Long-term outcomes included MACE (death, myocardial infarction, or ischemia-driven revascularization). Kaplan–Meier analysis was used to compare long-term MACE-free survival between groups. Results: PCI (n = 68) and CABG (n = 82) groups demonstrated comparable long-term MACE-free survival (log-rank p = 0.41). One-year MACE-free survival rates were 78% and 82%, respectively. Ischemia-driven revascularization was more frequent after PCI (p = 0.028), whereas major bleeding occurred more commonly after CABG (p = 0.003). Conclusions: In NSTEMI patients with CKD and multivessel disease, PCI and CABG provide comparable long-term MACE-free survival. Despite higher rates of repeat revascularization after PCI and greater bleeding risk after CABG, overall long-term outcomes were similar. CKD severity did not significantly modify treatment-related differences. Full article

Background and Aims: Hypothermic oxygenated machine perfusion (HOPE) improves outcomes in orthotopic liver transplantation (OLT), but reliance on University of Wisconsin machine perfusion solution (UW-MPS) increases costs and logistical burden. Histidine-tryptophan-ketoglutarate (HTK) has potential as a single-solution alternative for HOPE. This study evaluated the safety and efficacy of HTK versus UW-MPS during HOPE. Methods: A retrospective, propensity score-matched cohort study including 46 patients who received donation after brain death (DBD) grafts that were preserved with HOPE at the Medical University of Vienna between May 2018 and October 2024 was conducted. A total of 23 patients received grafts perfused with HTK; another 23 patients transplanted with organs perfused with UW-MPS were matched based on recipient age and sodium model of end-stage liver disease score, donor age and sex, cold ischemia time, and perfusion time. Postoperative outcomes, perfusion parameters, and cost differences were assessed. Results: The HTK and UW-MPS cohorts demonstrated comparable perfusion dynamics and vascular resistance. While arterial pressure and flow were higher in the UW-MPS group, clinical outcomes—including early allograft dysfunction (47.8% each), ICU stay, and comprehensive complication index—were statistically similar. A trend toward fewer biliary complications (13.0% vs. 30.4%) and reduced hemodialysis requirement (17.4% vs. 30.4%) was observed in the HTK group. Use of HTK reduced perfusion-related costs by approximately EUR 560 per procedure. Conclusion: HTK is a viable alternative to UW-MPS during HOPE in OLT of DBD grafts, offering comparable short-term outcomes and relevant cost savings. Prospective studies are warranted to validate these findings and explore broader applications of single-solution perfusion strategies. Full article

Background/Objectives: Various pathophysiological mechanisms play a role in the development of cardiovascular diseases (CVDs). There is a need for new biomarkers that can complement existing clinical findings, particularly in the early diagnosis and prognostic assessment of coronary artery disease (CAD) and that can also contribute to more effective management of the diagnosis and treatment process. Therefore, both blood and pericardial fluid samples can provide important diagnostic information. This study aims to investigate Stromal Cell-Derived Factor 4 (SDF4) levels and thiol/disulfide homeostasis in the blood and pericardial fluid of patients with established CAD undergoing open-heart surgery with cardiopulmonary bypass (CPB), in order to better characterize oxidative stress-related and redox-mediated pathophysiological processes associated with the development and progression of coronary heart disease. Comparisons with a healthy control group were performed to elucidate disease-related biochemical alterations rather than to propose these markers as diagnostic tools for CAD. Methods: In this study, intraoperatively collected venous blood and pericardial fluid samples from 45 patients undergoing on-pump coronary artery bypass grafting were analyzed. SDF4 levels were measured using enzyme-linked immunosorbent assay (ELISA), while thiol–disulfide homeostasis was assessed via spectrophotometric analysis. Results: The study revealed statistically significant differences in parameters such as SDF-4, native thiol, total thiol, disulfide, and disulfide/total thiol ratio among the control, patient serum, and pericardial fluid groups (p < 0.05). Notably, SDF-4 and disulfide levels were elevated, while thiol levels were reduced in the pericardial fluid group, suggesting increased oxidative stress and disrupted redox balance. Principal Component Analysis (PCA) and Variable Importance in Projection (VIP) analyses successfully demonstrated the discriminative power of these parameters among the groups. Conclusions: The increased SDF-4 levels and disturbances in the thiol–disulfide balance observed in this study indicate elevated oxidative stress and impaired cellular redox homeostasis in CAD. These findings suggest that SDF-4 and thiol–disulfide parameters may serve as important biochemical markers in the pathophysiology of CVD and hold potential as diagnostic and prognostic biomarkers. Full article

Background: Tight blood pressure control is a cornerstone of postoperative cardiac surgery patients. In addition, plasma lactate levels are frequently monitored in this setting as it is a marker for malperfusion, with early elevated levels being associated with increased morbidity and mortality. Elevations from malperfusion may be due to decreased cardiac output, hypovolemia, or persistent post-bypass vasoplegic response. Here, we investigate whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery. Methods: This is a retrospective cohort observational study of patients who have undergone coronary artery bypass graft (CABG) and valve replacement or repair surgeries at NYU Langone Long Island Hospital over a 6-month period. Postoperative blood pressures and lactate levels were examined over the first 16 h of care. Primary outcome: The relationship between blood pressure parameters and lactate clearance. Secondary outcomes: ICU length of stay, hospital length of stay, and mortality. Results: A total of 81 patients met inclusion criteria. The average pre-operative mean arterial blood pressure (MAP) was 95.4 mmHg and the average MAP in the first 6 h post-operatively was 78.4 mmHg. The average change in MAP from baseline was a decrease of 16.7%. The average cleared lactate fraction by 16 h postoperatively was 85.9%. Lactate clearance was associated in a statistically significant way only with the need for inotropic support on postoperative day 1, p = 0.03. There was a slight trend toward a delay in lactate clearance in those with lower early systolic blood pressures, p = 0.14. Conclusions: Lactate clearance appears to occur largely independently of postoperative blood pressures in the first 16 h after surgery but may be delayed in those requiring inotropic support through the morning or postoperative day one. Full article

Background: A sternum-sparing approach of minimally invasive total coronary revascularization via left anterior thoracotomy (TCRAT) demonstrated favorable early and midterm results in unselected patients with coronary artery multivessel disease. However, safety and outcomes in elderly patients remain less well defined. Particularly in octogenarians with relevant comorbidities, data are scarce, and the role of TCRAT compared to conventional coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate in-hospital and midterm outcomes of TCRAT in patients aged ≥ 80 years. Method: From 11/2019 to 10/2025, CABG via left anterior minithoracotomy on cardiopulmonary bypass and cardioplegic arrest was performed as a routine procedure in 859 consecutive, nonemergency patients. Among them, 82 patients (9.5%) were octogenarians, all presenting with multivessel coronary artery disease. Results: In the group of octogenarians, mean BMI was 26.5 ± 3.1 kg/m², left ventricular ejection fraction was 49.2 ± 9.1% (range 20–55%), and mean EuroSCORE II was 5.1 ± 2.4. Comorbidities included diabetes mellitus (24.4%), chronic lung disease (7.3%), prior PCI (23.2%), and peripheral vascular disease (78.5%). The mean follow-up (100%) was 9.1 months. Left internal thoracic artery was used in 98.8% and radial artery was used in 43.9%. A mean of 3.0 ± 0.9 (range 2–5) anastomoses per patient was performed. Total operation time was 299 ± 64 min (range 164–480). In-hospital mortality was 1.2%, stroke rate was 1.2%, myocardial infarction rate was 0%, and repeat revascularization rate was 1.2%. At follow-up, all-cause mortality, myocardial infarction, repeat revascularization, and stroke were 4.9%, 0%, 2.4%, and 1.2%, respectively. The overall major adverse cardiac and cerebrovascular events rate (MACCE) was 7.3% at follow-up. Conclusion: TCRAT enables complete coronary artery revascularization in multivessel coronary artery disease without sternotomy and can be safely performed in octogenarians. Both in-hospital and midterm outcomes were favorable and comparable to reported contemporary outcomes of conventional CABG in elderly patients. Full article

Background: The aim of this study was to investigate the effect of preoperative statin use on postoperative bleeding and related complications in patients undergoing isolated coronary artery bypass grafting (CABG). Methods: Between 2023 and 2025, 627 patients who underwent isolated CABG were evaluated. The patients were divided into two groups: Group A (n = 241, received preoperative statins) and Group B (n = 386, did not receive preoperative statins). All preoperative, intraoperative parameters, and postoperative outcomes were compared. Results: Patient demographics, comorbidities, laboratory parameters, EuroSCORE II, echocardiographic findings, operative data, cross-clamp times, and cardiopulmonary bypass times were similar. Intraoperative and postoperative blood product use were comparable between the groups. Postoperative total bleeding was higher in Group A than in Group B, but no statistical difference was found. The postoperative exploration rate was higher in Group A than in Group B, but no statistically significant difference was found. There were no significant differences between the groups in terms of gastrointestinal bleeding. Postoperative atrial fibrillation (POAF) was significantly lower in Group A than in Group B (21 (8.7%)–74 (19.2%), p < 0.001). Mortality was higher in Group B than in Group A, but no statistically significant difference was found (3 (1.2%)–14 (3.6%), p = 0.07). Intensive care unit stay was longer in Group B than in Group A. A significant negative association was found between statin usage and POAF (p = 0.001, OR = 0.418). Conclusions: We found no statistically significant increase in postoperative bleeding or blood product use with preoperative statin therapy in isolated CABG patients. However, we found that preoperative statin therapy was protective against POAF. Full article

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre. Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via left anterior thoracotomy at our institution between January 2023 and June 2025. Data collected included patient demographics, operative details, and postoperative outcomes. Endpoints were 30-day mortality, conversion to sternotomy, and postoperative complications. Results: The cohort included 41 males (82%) with a mean age of 63.1 ± 8.7 years (range 40–80) and mean BMI 27.8 ± 4.3 kg/m². Comorbidities included diabetes mellitus in 26%, COPD in 12%, and chronic kidney disease in 8%. Canadian Cardiovascular Society angina classes III–IV were present in 46%. The majority of patients (64%) had single-vessel CAD while 34% had two-vessel and 2% had three-vessel involvement. The mean Logistic EuroSCORE I was 2.19 ± 1.53. Left internal mammary artery (LIMA) grafting was performed in 96% of cases. Additional conduits included left radial artery in 32% and saphenous vein in 8%, with T-grafts in 26% and sequential grafting in 4%. The average number of grafts per patient was 1.35 ± 0.53 (range 1–3). The procedure was performed off-pump in 96% of cases, with two patients (4%) requiring CPB support during conversion from mini-thoracotomy. The overall conversion rate to sternotomy was 16% (eight patients), predominantly due to difficult or injurious IMA harvest or anatomical limitations. The mean operative time was 197.8 ± 76.8 min and decreased significantly after the first 25 cases (220 min vs. 175 min). Atrial fibrillation occurred in 18%, pleural effusion in 28% (10% requiring drainage), and chest infection in 8%. Wound complications arose in 4%. There was no 30-day mortality. ICU stay averaged 2 ± 2.2 days (range 1–14), and total hospital stay was 5.7 ± 2.7 days where institutional coronary bypass stay is normally 7.9 +/− 7.0 days. Conclusion: These results demonstrate that MICS-OPCAB is a safe and feasible approach for selected patients requiring multivessel coronary artery bypass grafting. There are some technical challenges during the learning curve for which conversion to open surgery can confer good outcomes. Traversing the early learning curve can confer additional benefits to later patients. Full article

Background: The radial artery (RA) is one of the terminal branches of the brachial artery, extending along the lateral forearm, crossing the anatomical snuffbox, and contributing to the palmar arches. Anatomical variations in the RA are of great clinical relevance due to their implications in procedures such as transradial catheterization, arterial cannulation, and bypass grafting. These variants may alter the course, branching pattern, or origin of the vessel, potentially increasing procedural complexity and the risk of iatrogenic injury. In critically ill patients and in surgical or interventional settings, accurate identification of RA anatomy is essential. The objective of this study was to systematically identify and describe RA variants reported in the scientific literature and to analyze their clinical relevance. Methods: A systematic search was conducted across six electronic databases: Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Latin American and Caribbean Literature in Health Sciences (LILACS), covering publications up to July 2025. Eligible studies included anatomical, radiological, and surgical investigations reporting RA variants. Study quality was evaluated using the Assessment of Quality in Anatomical Studies (AQUA) tool. Quantitative synthesis was performed using a random-effects model to estimate the pooled prevalence of RA variants and subgroup differences. Twenty-three studies met the inclusion criteria, and eleven were included in the meta-analysis, encompassing a total of 6320 participants. Results: Radial artery variants were categorized into three main types: variations in origin, course, and branching pattern. The pooled global prevalence of RA variants was 12% (95% CI: 6–18%), with substantial heterogeneity (I² = 97.7%). Higher prevalence was found in imaging-based studies (14%) compared with donor-based studies (12%). Sex-based subgroup analysis revealed a higher prevalence in females (18%; CI: 9–28%) compared with males (3%; CI: 3–4%), with moderate heterogeneity (I² = 61.3%). Regionally, European populations demonstrated a higher prevalence (20%) than Asian populations (11%), both showing high heterogeneity (I² > 98%). Notably, only one study from the Americas and none from Africa or Oceania were identified, representing a major geographical limitation in the available data. The findings of this study highlight the considerable variability in RA anatomy across populations. Such variations hold significant clinical importance, particularly in the context of transradial interventions, arterial cannulation, and reconstructive procedures where vascular integrity is critical. The high degree of heterogeneity observed may reflect differences in population genetics, sample size, and imaging or dissection methodologies. The limited representation of certain regions underscores the need for further anatomical and radiological studies to obtain a more comprehensive understanding of global RA variability. Preoperative or pre-procedural imaging using Doppler ultrasonography or computed tomography angiography is recommended to identify anomalous patterns and minimize iatrogenic complications. Conclusions: Radial artery variants are frequent and diverse. Their recognition is fundamental for the safety and success of invasive and surgical procedures in the upper limb. A standardized approach to vascular evaluation, particularly through preoperative imaging, is essential to improve procedural outcomes and reduce the risk of arterial injury in clinical practice. Full article

Background: This study examines the use of the E-liac stent-graft system for the endovascular treatment of aortoiliac or isolated common iliac aneurysms. Methods: Consecutive patients between January 2014 and December 2024 were included. Data on patient characteristics, clinical presentation, lesion features, procedural aspects, and follow-up outcomes were collected and examined. Complications during the perioperative period and subsequent reinterventions were also documented. Results: A total of 81 patients met the inclusion criteria (65 men, 80.2%, median age 71.2 ± 11.43 (range 61–86 years). Technical success was achieved in all cases. A total of 97 internal iliac arteries were revascularized; in 54 cases (66.7%), the endovascular technique was EVAR + unilateral iliac branch device (IBD), in 16 cases (19.8%), it was EVAR + bilateral IBDs, and unilateral isolated IBD was conducted in 11 (13.6%) patients. The median patient follow-up time was 64.7 months (range 1–120). During follow-up, the mortality rate was 22.2%, with an iliac branch patency of 90.1%. Buttock claudication was observed in five (6.2%) patients and nerve ischemia in one (1.2%). One type I endoleak (1.2%) occurred following endovascular treatment of an isolated common iliac artery aneurysm, and three type II endoleaks (3.7%) were observed; none of them were associated with aneurysm sac enlargement. Three type III endoleaks (3.7%) occurred due to disconnection of the iliac branch from the extension of the concomitant EVAR. Conclusions: This long-term study, with 11 years of follow-up, reports outcomes with the E-liac stent-graft for the treatment of aorto-iliac or iliac aneurysms and demonstrates that it can be safely applied with low mortality and reintervention rates, and high patency rates. Full article

Background and Objectives: Postoperative atrial fibrillation (POAF) remains one of the most frequent complications after cardiac surgery, increasing the risk of morbidity, prolonged hospitalization, and adverse long-term outcomes. Although several clinical and echocardiographic factors have been associated with POAF, the integrated contribution of atrial conduction delay, biatrial mechanics, and atrioventricular coupling to arrhythmogenesis remains unclear. Materials and Methods: This retrospective study included 131 adult patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Preoperative echocardiography within one week before surgery provided detailed assessment of atrial phasic function, valvular motion, and total atrial conduction time (TACT). Univariate analysis was followed by multivariable modeling using penalized logistic regression (Elastic Net) to identify the most robust predictors of POAF. Discriminative performance and calibration were evaluated via receiver operating characteristic (ROC) and calibration analysis. An exploratory Extreme Gradient Boosting (XGBoost) model with SHapley Additive exPlanations (SHAP) analysis was used to confirm the stability and directionality of nonlinear feature interactions. Results: POAF occurred in 47 (36%) patients. The Elastic Net model identified prolonged TACT, reduced right atrial active emptying fraction (RAAEF), increased indexed minimal left atrial volume (MIN LA/BSA), and lower tricuspid annular plane systolic excursion (TAPSE) as the most informative predictors. The model demonstrated excellent internal discrimination (AUC = 0.95; 95% CI 0.91–0.99) and satisfactory calibration (Hosmer–Lemeshow p = 0.41). Exploratory XGBoost analysis yielded concordant feature hierarchies, confirming the physiological consistency of the results. Conclusions: POAF arises from an identifiable electromechanical substrate characterized by atrial conduction delay, biatrial mechanical impairment, and reduced atrioventricular coupling. A parsimonious, regularized statistical model accurately delineated this profile, while complementary machine-learning analysis supported its internal validity. These findings underscore the potential of echocardiographic electromechanical parameters for refined preoperative risk stratification, pending prospective multicenter validation. Full article

Background and Objectives: current guidelines recommend surgical treatment for asymptomatic popliteal artery aneurysm > 20 mm in diameter, although without any suggestion about the preferred treatment choice. The two main treatment options are open surgical repair (OPAR) and endovascular repair (EPAR). Although ER has emerged as a promising technique due to being less invasive, OPAR remains the standard in many centers. The aim of the study is to report and compare outcomes of both endovascular and open repair of asymptomatic PAAs to provide an extensive overview of their current management. Materials and Methods: the present review was conducted in accordance with the Preferred Reporting Items for Review and Meta-Analyses (PRISMA) Guidelines. Preliminary searches were conducted on MEDLINE, Pubmed, Scopus, and Web of Science from January 2010 to September 2025. Articles were divided into three main groups based on the preferred treatment modality. Early outcomes were technical success, mortality, major adverse cardiovascular events (MACEs), and graft occlusion(s). In mid- and long-term periods, the evaluated outcomes were overall survival, amputation-free survival, primary patency, primary assisted patency, secondary patency, and freedom from reintervention. Results: 21 articles were identified for a total of 9760 patients and 10,062 limbs treated. Technical success was up to 100% for both OPAR and EPAR with low complication rates. Primary patency (79.8% vs. 63.8%; p = 0.012) and freedom from reintervention (82.2% vs. 68.4%; p = 0.021) seem to be better for OPAR than EPAR. Overall survival, amputation free-survival, and secondary patency rates are comparable between the two techniques. Conclusions: although endovascular repair has emerged as a safe and effective approach to treat elective PAAs, long-term data on a large scale are still lacking. Indeed, open surgical repair remains the milestone, due to excellent primary patency rates, regardless of the conduit used. Full article