Annals of Vascular Surgery

The authors regret that we have identified a graphical labelling error affecting the forest plots in Figures 2, 3, 4, 5, 6, and 7. While the statistical data (Odds Ratios, P-values, and Confidence Intervals) and the written Results section are entirely correct, the

OBJECTIVES: Recurrence in the inguinal region following surgery for saphenofemoral insufficiency remains a major challenge in venous surgery. Histologically, a distinction can be made between residual stump and neovascularization. Using hematoxylin-eosin and Elastica-van Gieson staining, this study systematically analyses samples from recurrent saphenofemoral lesions. METHODS: Patient demographic data, the clinical CEAP stage, and the Venous Clinical Severity Score were recorded. A preoperative duplex ultrasound was performed. The resected specimens were processed using standard staining methods. During histological examination, a distinction was made between residual venous tissue and neovascularisation. RESULTS: A total of 203 samples were available for histopathological evaluation. In the histological evaluation, 197 samples were classified as stump tissue (97.0%) and 6 samples as neovascularization (3.0%). The diagnostic specificity and predictive value of duplex sonography and intraoperative macroscopic classification between residual stump and neovascularisation was limited. CONCLUSION: Residual venous structures represent the predominant morphological substrate of groin recurrences after saphenofemoral surgery. True neovascularisation occurs only in a few cases and should be regarded as a secondary phenomenon rather than a primary cause of recurrence. Surgical precision during the initial intervention may play an important role in recurrence prevention.

BACKGROUND: Aneurysm sac shrinkage after endovascular aortic repair (EVAR) is a surrogate marker of effective aneurysm exclusion and favorable outcomes. Radiomics enables quantitative imaging analysis beyond visual assessment and is increasingly applied in cardiovascular imaging. Analysis of intraluminal thrombusmay may provide additional information for identifying patients with different patterns of sac remodeling after EVAR. METHODS: This single-center retrospective study assessed whether radiomic features of the intraluminal thrombus extracted from preoperative computed tomography angiography (CTA), alone and in combination with clinical and anatomical variables, were associated with aneurysm sac shrinkage after EVAR. Patients undergoing elective EVAR for infrarenal abdominal aortic aneurysm were included and stratified according to sac shrinkage at 12-month follow-up. Preoperative arterial-phase CTA scans were analyzed. The aneurysm sac was manually segmented using 3D Slicer, and the intraluminal thrombus was selected as the region of interest. A total of 530 radiomic features were extracted using PyRadiomics with Laplacian of Gaussian filtering. Features were standardized and evaluated using the Wilcoxon-Mann-Whitney test, Pearson correlation filtering, and Akaike Information Criterion-based feature selection. Predictive performance was compared among combined clinical-radiomic, radiomic-only, and clinical-only models. RESULTS: Among 94 patients, 29 showed aneurysm sac shrinkage. Two radiomic features were significantly associated with shrinkage. Younger age (p=0.02), larger aneurysm diameter (p=0.02), and homogeneous thrombus texture were associated with shrinkage, while the absence of COPD was associated with lack of shrinkage. None of the other evaluated clinical or anatomical variables showed a significant association with sac shrinkage. The combined clinical-radiomic model achieved the best performance (AUC 0.76, sensitivity 0.70, specificity 0.75, accuracy 0.73). CONCLUSION: Preoperative thrombus radiomic features were associated with subsequent sac shrinkage and provided complementary information when integrated with clinical variables. These findings support the potential role of thrombus radiomics in the characterization of sac remodeling after EVAR and warrant validation in larger cohorts.

OBJECTIVES: To investigate the impact of open (OR) and endovascular repair (ER) on Health-Related Quality of Life (HRQOL) in patients treated for Aortoiliac Occlusive Disease (AIOD). METHODS: We conducted a single-center prospective observational cohort study on consecutive patients treated by OR and ER for AIOD between January 2020 and July 2025. HRQOL was assessed using the 36-Item Short Form Health (SF-36) questionnaire at baseline, 1, 6, and 12 months. Physical (PCS) and Mental (MCS) Component Summary scores were compared between treatment groups using linear mixed-effects models with fixed effects for time, treatment, and their interaction. Linear regression models were used to assess factors associated with baseline HRQOL, while Firth's penalized logistic regression was used to evaluate factors associated with changes in HRQOL during follow-up. RESULTS: Eighty-one patients were included: 20 (24.7%) underwent OR and 61 (75.3%) ER, for claudication (74.1%), rest pain (13.6%), or tissue loss (12.3%). No postoperative mortality occurred. Baseline PCS was associated with higher Rutherford class (p = .033) and TransAtlantic Inter-Society Consensus (TASC) lesion complexity (p = 0.02), while baseline MCS was associated with disease severity (p = .018) and comorbidities (p = .048). PCS improved significantly over time (p < 0.001), with a faster early improvement in the ER group (p for interaction= .005) especially within the first month from the procedure (p = .011). MCS also improved over time (p = .005), with no differences between groups. Early reintervention (p = .049 for PCS), late complications (p = .018 for PCS; p = .031 for MCS), chronic kidney disease (CKD) (p = .012 for PCS), coronary artery disease (CAD) (p = .014) and limb loss (p = .049 for PCS) were associated with reduced likelihood scores of HRQOL improvements at follow-up. CONCLUSIONS: Both OR and ER were associated with significant improvements in HRQOL. ER provided faster early physical recovery, whereas mental health outcomes were comparable between treatment strategies. Patient characteristics and postoperative adverse events had a greater influence on HRQOL recovery than the revascularization strategy itself.