Search Results (212)

Background: Maxillary sinus floor augmentation (MSFA) is commonly used to increase posterior maxillary bone volume prior to implant placement. Although generally successful, late complications can impact long-term outcomes. The purpose of the study was to estimate the incidence and timing of atypical late complications following (MSFA) using bovine xenohybrid bone grafts. The study also aimed to evaluate whether preoperative bone volume is associated with the risk of complications. Methods: This retrospective cohort study was conducted at the Center of Oral and Maxillofacial Surgery, Danube Private University, Krems-Stein, Austria, and included patients who underwent MSFA with bovine xenohybrid bone grafts and either simultaneous or staged implant placement between January 2020 and December 2023. Preoperative bone volume of the posterior maxilla measured via cone beam computed tomography (CBCT) in the planned implant insertion position. The primary endpoint was the time (days) from MSFA to the occurrence of a graft-related complication (defined as atypical if occurring more than 6 months after MSFA and not related to peri-implantitis) The covariates included subjects’ age, sex, the quantity of graft used for MSFA, timing of dental implant insertion (simultaneous vs. staged) and implant dimensions. Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate time-to-event data. Only one graft site per patient was analyzed. Results: Atypical complications occurred in 9 out of 47 patients (19.1%), with an average time to onset of 645 days. In a multivariable analysis, a lower preoperative bone volume was found to be an independent predictor of an increased risk of complications (hazard ratio [HR]: 0.972; 95% confidence interval [CI]: 0.925–1.021; p = 0.252). However, the quantity of graft used for MSFA was not found to be a predictor (p = 0.46). Conclusions: Within the limitations of a retrospective study, reduced native bone volume appears to increase the risk of atypical late complications following MSFA with bovine xenohybrid grafts. This makes closer clinical and radiologic follow-up of patients over a longer period very necessary. Full article

Background: This systematic review evaluates the efficacy of rehabilitation-focused exercise interventions for lumbar degenerative disc disease (DDD), a leading cause of chronic low back pain. Methods: Following PRISMA guidelines, a comprehensive search was conducted across international and regional databases (PubMed, Scopus, Web of Science, Magiran, SID, and Noormags) covering the period from January 2010 to January 2025. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251088811. Using keywords such as “lumbar DDD,” “exercise therapy,” and “rehabilitation,” a total of 2495 records were identified. After screening, 20 studies—including clinical trials, quasi-experimental, and experimental designs—met the inclusion criteria and were assessed using the McMaster Critical Review Form for Quantitative Studies. Results: Interventions such as hydrotherapy, core stability training, Pilates, and suspension exercises were found to significantly reduce pain and improve functional outcomes. While multimodal approaches (e.g., aquatic exercise combined with acupuncture) showed positive effects, the comparative studies revealed no significant differences between modalities. Suspension training demonstrated superior efficacy in pain reduction compared to isolated core stability exercises. The methodological quality of included studies ranged from good to excellent, with the majority rated as very good or excellent (McMaster scores: 8 “excellent,” 7 “very good,” and 5 “good”). Common limitations among the studies included methodological heterogeneity, small sample sizes (n = 14–30), and insufficient long-term follow-up. Conclusions: Exercise-based rehabilitation is an effective strategy for managing lumbar DDD. Evidence particularly supports the use of suspension training and aquatic therapy for superior improvements in pain and functional outcomes. Future research should aim to adopt standardized protocols, recruit larger sample sizes, and include extended follow-up periods to produce more robust and generalizable findings. Full article

Background: Patient care following botulinum toxin injections has long been guided by anecdotal instructions, often based on theoretical considerations. This study evaluates the necessity of extended post-treatment instructions by analyzing outcomes and satisfaction in patients who followed only a 10 min precaution protocol. Materials and Methods: A retrospective, multicentric study was conducted across six Italian centers, analyzing 5014 patients treated with botulinum toxin for upper facial wrinkles between 2015 and 2020. Outcomes included adverse effects—particularly upper eyelid ptosis—and patient satisfaction. Follow-up was performed at two weeks. Results: No cases of upper eyelid ptosis were observed. Among 4000 patients who attended follow-up, adverse effects occurred in only 5.99%, notably lower than rates reported in the literature. Of the 2010 patients who completed the satisfaction questionnaire, 90% reported being very satisfied. These findings support the safety of limiting post-treatment instructions to 10 min. Conclusions: Our findings indicate that omitting extended post-injection instructions does not negatively impact patient satisfaction or complication rates. Given the toxin’s rapid internalization and localized effect, extended behavioral restrictions may be redundant. However, the absence of a control group and lack of statistical analyses limit the strength of these conclusions. In addition, this is a short-term study. Future prospective, randomized trials are needed to develop evidence-based post-care protocols to optimize esthetic outcomes, patient safety, and long-term efficacy. Full article

Spontaneous quadriceps tendon rupture is a very rare occurrence, notably for bilateral simultaneous ruptures. Its occurrence is commonly linked to an underlying condition that may weaken the tendons leading to rupture. We report the case of a 68-year-old Caucasian male afflicted with long-term gout who presented a bilateral simultaneous quadriceps tendon rupture (BSQTR). We showcase the clinical presentation, the surgical intervention, rehabilitation program, dynamic sonographic monitoring, and home-based rehabilitation techniques of this injury, which aimed to improve activities of daily living (ADL) and quality of life (QoL). The patient was included in a 9-week post-surgical rehabilitation program and a home-based rehabilitation program with subsequent pain management and gait reacquisition. The outcome measures included right and left knee active range of motion (AROM), pain intensity measured on Visual Analogue Scale (VAS), functioning measured through ADL score, and gait assessment on Functional Ambulation Categories (FAC). All endpoints were measured at different time points, scoring significant improvement at discharge compared to baseline (e.g., AROM increased from 0 degrees to 95 degrees, while VAS decreased from 7 to 1, ADL score increased from 6 to 10, and FAC increased from 1 to 5). Moreover, some of these outcomes continued to improve after discharge, and the effects of home-based rehabilitation program and a single hip joint manipulation were assessed at 6-month follow-up. Musculoskeletal ultrasound findings showed mature tendon structure, consistent dynamic glide, and no scarring. Full article

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Objectives: Frailty is increasingly recognized as a key determinant of surgical risk in elderly patients undergoing aortic valve replacement (AVR). This study aimed to evaluate the prognostic value of the modified Frailty Index (mFI) in a homogeneous cohort of octogenarians undergoing minimally invasive surgical AVR, to enhance risk stratification and guide surgical decision-making. Methods: We retrospectively analyzed 67 patients aged ≥ 80 years (mean 84.1 ± 3.2) who underwent isolated minimally invasive AVR. The mFI was calculated preoperatively using standardized clinical variables. Primary outcomes included 30-day mortality and perioperative complications; long-term survival was also assessed. Receiver operating characteristic (ROC) curves identified optimal mFI cut-offs. Kaplan-Meier and Cox regression analyses were used to evaluate survival and predictors of mortality. Results: The mFI demonstrated a strong prognostic accuracy. An mFI > 0.455 predicted 30-day mortality with 81.8% sensitivity and 88.4% specificity (AUC = 0.888, p < 0.001), while an mFI > 0.273 predicted perioperative complications (AUC = 0.818, p < 0.001). During a median follow-up of 51.8 ± 36.4 months, 24 patients (45.3%) died. One-year survival was 83.7%. The mFI > 0.455 was the strongest independent predictor of early mortality (HR 6.34, p = 0.001); mFI > 0.273, HFpEF with NT-proBNP > 1000 pg/mL, and chronic kidney disease were predictors of long-term mortality. Conclusions: The mFI is a simple, reproducible tool that reliably predicts early and late outcomes in very elderly patients undergoing minimally invasive AVR. Integrating frailty into preoperative evaluation may improve patient selection by prioritizing physiological over chronological age. Full article

Background: Primary focal hyperhidrosis, characterized by excessive sweating primarily affecting the hands and axillae, can significantly impact quality of life. Bilateral thoracic sympathectomy is the gold standard treatment, providing permanent resolution of palmar hyperhidrosis. Most studies evaluating outcomes and patient satisfaction after sympathectomy focus on short- to medium-term follow-up, typically up to 5 years. This study aimed to assess anxiety, satisfaction, and sweat redistribution 20 years after bilateral endoscopic thoracic sympathectomy. Methods: Between January 2002 and December 2003, 106 patients with primary hyperhidrosis underwent bilateral endoscopic thoracic sympathectomy targeting ganglia T2–T3 at our center. The patients were contacted via telephone in 2023 and asked to complete the same survey they had filled out preoperatively and 12 months postoperatively. The survey evaluated sweat redistribution, anxiety, hyperhidrosis-related symptoms, and satisfaction. Anxiety, satisfaction, and perceived sweating were rated using a 5-point visual analog scale (VAS) ranging from 0 (unsatisfied/no symptoms) to 4 (very satisfied/severe symptoms). Results: Of the 106 eligible patients, 24 (22.6%) completed the survey. Most reported persistent anhidrosis (palmar or palmar–axillary) 20 years post-surgery. The survey results remained consistent with those at the 1-year follow-up. Significant sweat redistribution to the abdomen and back was observed. Patient satisfaction remained high, with no significant differences between the 1-year and 20-year assessments. Anxiety significantly decreased compared to preoperative levels (p < 0.001). Conclusions: Bilateral endoscopic thoracic sympathectomy is an effective long-term treatment for reducing excessive sweating. Patient satisfaction remains high over time, despite the persistence of compensatory sweating. Full article

Background and Objectives: Pelvic organ prolapse (POP) is a prevalent condition that negatively impacts women’s quality of life. Uterine-preserving procedures are increasingly demanded by patients with uterine prolapse, particularly when associated with true cervical elongation. The Manchester procedure, historically used for uterine preservation, has regained interest due to its effectiveness and low morbidity. This study aims to evaluate the anatomical and functional outcomes of the Manchester procedure in women with uterine prolapse due to cervical elongation, assessing patient satisfaction and associated clinical factors. Materials and Methods: We conducted a retrospective, observational, single-center study at the Regional University Hospital of Málaga, Spain, including patients undergoing the Manchester procedure between January 2017 and December 2022. Inclusion criteria required a diagnosis of uterine prolapse due to clinically confirmed true cervical elongation. Surgical details, complications, and postoperative outcomes were recorded. Patient satisfaction was assessed using a Likert scale during follow-up visits. Results: A total of 38 patients were included, with a mean age of 48.7 years. All presented with symptomatic uterine prolapse and elongated cervix (>5 cm). The anatomical success rate was 97%, with only one case of symptomatic recurrence. The most common early postoperative complication was urinary tract infection (10.5%). The average follow-up duration was 18.6 months. A high level of satisfaction was recorded: 94.8% of patients were either “very satisfied” (73.7%) or “satisfied” (21.1%), and only 5.3% reported dissatisfaction. Multicompartmental repair (anterior and/or posterior colporrhaphy) improved satisfaction outcomes. Conclusions: The Manchester procedure is a safe, effective uterine-sparing surgical option for patients with cervical elongation-related uterine prolapse. It demonstrates a high anatomical success rate and low morbidity, with excellent patient satisfaction. Comprehensive preoperative assessment and addressing modifiable risk factors such as obesity and smoking are key to optimizing results. Further prospective studies are needed to assess long-term durability and quality-of-life outcomes. Full article

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound—POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes. Full article

Radical chemoradiotherapy has been used as a frontline treatment for squamous cell cancer of the anus for the last 30–40 years. Considerable acute and chronic adverse effects have been observed following radiotherapy using 2D and 3D techniques. A case of very late-onset severe chronic toxicity in a patient 26 years after radiotherapy is presented. The patient underwent radical chemoradiotherapy for squamous anal cancer stage T3N3M0 in 1998. In the anal region, cumulative doses up to 77.6 Gy (including electron boost) were administered. Durable complete regression of the disease was achieved. Fourteen years after treatment, the patient developed vast fibroatrophy of the anus and perineum, progressing within the subsequent four years to necrosis and sphincter loss. Twenty years after treatment, the asymptomatic osteonecrotic foci in the left femur appeared on MRI scans. Despite two courses of hyperbaric oxygen treatment, the fibroatrophy and subsequent necrosis of soft tissues remained progressive, but the osteonecrosis was stable. Twenty-six years after treatment, the progressive changes induced symptomatic osteomyelitis of the ischium and pubic bone. The patient now requires permanent supportive treatment. The presented case is exceptional in the very late-onset typical chronic adverse effects developing after non-conformal radiotherapy administered at high doses as part of contemporary treatment protocols. There is little evidence regarding the late onset of chronic adverse effects, since the follow-up period is usually shorter than that of the case presented. Moreover, a significant portion of patients do not survive to reach the late-onset period of adverse effects. The presented case shows that there may be long-term survivors of anal cancer in the population who were treated with outdated techniques and who still carry a risk of late-onset severe, progressive adverse effects. Full article

Purpose: To evaluate the long-term oncological outcomes and toxicity profile based on 24 years of follow-up in patients with localized very high-risk prostate cancer (VHR PCa) treated with a combination of high-dose-rate brachytherapy (HDR-BT) and pelvic external beam radiation therapy (EBRT). Methods: A retrospective analysis was conducted on 87 patients with VHR PCa, classified according to National Comprehensive Cancer Network (NCCN) criteria, who received HDR-BT and EBRT. Androgen deprivation therapy (ADT) was administered to 72 patients (82.8%). The primary endpoints were biochemical control and cancer-specific survival (CSS), while the secondary endpoints included local control rates, tumor-free survival (TFS), overall survival (OS), and treatment-related toxicity. Results: The 24-year biochemical control rate was 68% (standard deviation [SD]: ±4%), while CSS and TFS at 24 years were 82% (SD ±4%) and 78% (SD ±4%), respectively. Local control rates remained at 98% at 24 years. Furthermore, the OS rate at 24 years was 30%. Multivariate Cox regression analysis identified the T category in the TNM classification as the only factor significantly associated with biochemical control, with 24-year rates of 69%, 71%, and 50% for patients with T-classifications of ≤T2c, T3a, and T3b-T4, respectively (p = 0.024). Notably, no grade ≥3 late toxicities were observed during the follow-up period. Conclusions: The 24-year outcomes support the viability and therapeutic efficacy of EBRT combined with a conformal HDR-BT boost for patients with VHR PCa. Full article

This study aimed to evaluate prosthetic complications, implant survival rates, and marginal bone loss in implant-supported monolithic restorations compared to metal-ceramic restorations. The study was registered in PROSPERO (CRD420251022336) and conducted following the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. A systematic search was conducted in the electronic databases MEDLINE/PubMed, Web of Science, Scopus, Embase, and ProQuest for articles published up to December 2024. The inclusion criteria comprised studies evaluating only randomized clinical trials that evaluated implant-supported monolithic restorations directly compared to metal-ceramic restorations, considering any type of ceramic material and regardless of the fixation system (screw-retained or cemented), with a minimum follow-up of one year. A meta-analysis was performed using RevMan 5.4 software, and the risk of bias and certainty of evidence were assessed using the RoB 2.0 and GRADE tools, respectively. A total of six studies were included, all of which exclusively evaluated monolithic zirconia single crowns over follow-up periods ranging from 1 to 3 years. None of the included studies evaluated fixed partial dentures or restorative materials other than monolithic zirconia. In total, 267 patients (mean age range: 18–57 years) were analyzed, with a total of 174 implant-supported monolithic zirconia crowns and 165 metal-ceramic single crowns in the posterior region (premolars and molars). The meta-analysis revealed that implant-supported monolithic zirconia single crowns exhibited significantly fewer prosthetic complications compared to metal-ceramic single crowns (p < 0.0001; Risk Ratio [RR]: 0.26; Confidence Interval [CI]: 0.14–0.47). However, no statistically significant differences were observed between implant-supported monolithic zirconia and metal-ceramic single crowns regarding implant survival rates (p = 0.36; RR: 1.66; CI: 0.56–4.94) or marginal bone loss (p = 0.15; Mean Difference [MD]: −0.05; CI: −0.11–0.02). The risk of bias assessment indicated that four studies had a low risk of bias. However, the certainty of evidence was classified as low for prosthetic complications and implant survival rates and very low for marginal bone loss. Within the limitations of this review, it can be concluded that implant-supported monolithic zirconia single crowns can be considered a favorable treatment option as they show comparable implant survival and bone stability to metal-ceramic crowns, with a potential reduction in short-term prosthetic complications such as screw loosening and ceramic chipping. However, due to the limited number of studies included and low certainty of evidence, further long-term research is still needed to confirm their clinical performance over time. Full article

Background: Treating varicosities originating from a popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerves and complex morphology. Data on endovenous laser ablation (EVLA) for PFPV varicosis are limited. Methods: This retrospective, single-center study reviewed all primary varicose vein surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Patients with recurrent disease or primary truncal insufficiency due to reflux from the saphenopopliteal junction were excluded. EVLA was performed using 1470 nm radial laser catheters, targeting the reflux source and downstream varicose segments. Tumescent solution was applied to protect the surrounding structures. The primary outcome was early technical success via duplex ultrasound; the secondary outcome was the complication rate. Results: Of the 2375 limbs treated, 44 (1.9%) involved PFPV. The cohort included 16 men (36%) and 28 women (64%), with a mean age of 54. The median follow-up was 14 days. Technical success was achieved in 41 cases (93.2%). Foam sclerotherapy with polidocanol was performed in eight patients (18.2%), exclusively for superficial residual varicosities and never simultaneously with EVLA. Three treatment failures required re-operation, two of which were successfully re-treated. Minor postoperative complications occurred in two patients (4.5%). No nerve injuries or thrombotic events were observed. Conclusions: EVLA shows promising very early technical efficacy, with low morbidity, for treating PFPV varicosis. Based on our findings, prospective studies investigating the mid- and long-term outcomes of this technique are warranted to further validate its clinical utility. Full article

Introduction: The group of so-called “sellar-region masses” consists of a heterogeneous group of neoplasms and tumor-mimicking lesions, whose differential diagnosis may be challenging due to the overlapping of clinical and radiological features, which can be found both in “common” and “uncommon” lesions. The choice of a correct treatment strategy is still arduous and requires histological analysis. Gamma Knife Radiosurgery (GKRS) has already been reported as a safe and effective treatment in these cases. The objective of this study is to evaluate single-center pre-operative data, post-operative outcomes, and long-term follow-up in patients treated with GKRS for unusual sellar tumors. Methods: We retrospectively identified and analyzed nine patients treated with GKRS from 2004 to 2015, according to a standard protocol. Lesions consist of hypothalamic hamartoma (HH), Rathke’s cleft cist (RCC), Langerhans cell histiocytosis (LCH), spindle cell oncocytoma (SCO), choroid plexus papilloma (CPP), and ossifying fibroma (OF). The diagnosis was histologically confirmed in six patients that underwent surgery, while in three patients, diagnosis was based on characteristic clinical and radiological findings (two HH and one RCC). Pre-operative and post-operative data were retrieved from medical archives, and long-term follow-up was obtained through clinical and neuroradiological periodic examination. Results: In our series, all the “rare” sellar lesions treated, had a successful radiographic and clinical response in a medium-long follow-up period. Conclusions: The long-term follow-up results suggest that GKRS is a safe and effective treatment in rare sellar lesions, with very low toxicity. To the best of our knowledge, this report represents the largest series of unusual sellar lesions treated with GKRS in a single high-volume center, suggesting that GKRS might be an effective non-invasive adjuvant treatment option. Further studies and a larger number of patients are needed to confirm if residuals of these rare sellar lesions might regress on their own without treatment or if other non-invasive treatments could be as effective as GKRS. Full article

Increasing long-term observations suggest that coronavirus disease 2019 (COVID-19) vasculopathy may persist even 1.5 years after the acute phase, potentially accelerating the development of atherosclerotic cardiovascular diseases. This study systematically reviewed the variability of brachial flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) from the acute phase of COVID-19 through 16 months of follow-up (F/U). Databases including PubMed, Web of Science, MEDLINE, and Embase were screened for a meta-analysis without language or date restrictions (PROSPERO reference CRD42025642888, last search conducted on 1 February 2025). The quality of the included studies was assessed using the Newcastle–Ottawa Quality Scale. We considered all studies (interventional pre-post studies, prospective observational studies, prospective randomized, and non-randomized trials) that assessed FMD or cfPWV in adults (aged ≥ 18 years) with or after laboratory-confirmed COVID-19 compared with non-COVID-19 controls or that assessed changes in these parameters during the F/U. Twenty-one studies reported differences in FMD, and 18 studies examined cfPWV between COVID-19 patients and control groups during various stages: acute/subacute COVID-19 (≤30 days from disease onset), early (>30–90 days), mid-term (>90–180 days), late (>180–270 days), and very late (>270 days) post-COVID-19 recovery. Six studies assessed variability in FMD, while nine did so for cfPWV during the F/U. Data from 14 FMD studies (627 cases and 694 controls) and 15 cfPWV studies (578 cases and 703 controls) were included in our meta-analysis. FMD showed a significant decrease compared to controls during the acute/subacute phase (standardized mean difference [SMD]= −2.02, p < 0.001), with partial improvements noted from the acute/subacute phase to early recovery (SMD = 0.95, p < 0.001) and from early to mid-term recovery (SMD = 0.92, p = 0.006). Normalization compared to controls was observed in late recovery (SMD = 0.12, p = 0.69). In contrast, cfPWV values, which were higher than controls in the acute/subacute phase (SMD = 1.27, p < 0.001), remained elevated throughout the F/U, with no significant changes except for a decrease from mid-term to very late recovery (SMD= −0.39, p < 0.001). In the very late recovery, cfPWV values remained higher than those of controls (SMD = 0.45, p = 0.010). In the manuscript, we discuss how various factors, including the severity of acute COVID-19, the persistence of long-term COVID-19 syndrome, and the patient’s initial vascular age, depending on metrics age and cardiovascular risk factors, influenced the time and degree of FMD and cfPWV improvement. Full article