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Introduction The Perclose ProGlide and, more recently, MANTA Large-Bore Closure Device are commonly used vascular closure devices (VCDs) for managing large-bore vascular access haemostasis. The extent of calcification in the common femoral artery (CFA) plays a crucial role in choosing between these devices. ProGlide may face challenges with anterior calcification, while MANTA may have issues with posterior calcification. Our study compared their effectiveness, adjunct usage, calcification impact and early/late complications. Methods A retrospective analysis of procedures involving large-bore CFA access from 2017 to 2022 was conducted. Closure was grouped according to VCD as Group A (ProGlide) and Group B (MANTA). Calcification was designated as anterior and posterior and combined on pre-operative computed tomography angiography along 10 mm segments with 0.625 mm slice thickness. The success of haemostasis was graded as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts) and Grade 3 (failed haemostasis needing rescue); Grades 1 and 2 were pooled as successful haemostasis. Statistical analysis was undertaken in Minitab 21 for Windows, particularly analysing calcification and its impact on the success of haemostasis. Results We evaluated 370 large-bore CFA accesses, distributed across two groups: Group A(64.9%, n=243) and Group B (35.1%, n=127), for a total of 205 endovascular procedures (93.1% (191) EVAR and 5.3% (11) TEVAR). The mean age was 74.9±8 years, predominantly males (88.2%, n=181). The average body mass index (BMI) was 28±5.8, with 20.9% (43) individuals having diabetes and 18.5% (37) current smokers. The mean sheath size OD was 16±2.5, with 4.5% (11) re-do groins in Group A and 6.2% (8) in Group B. Successful haemostasis was achieved in 91.8% (n=223) in Group A (44.8%, n=109 Grade 2) and 90.5% (n=115) in Group B (21%, n=27 Grade 2). Rescue operations were needed in 8.2% (20) in Group A and 9.1% (12) in Group B. Pseudoaneurysms developed more commonly in Grade 2 haemostasis with 9.9% (11) in Group A and 1.6% (2) in Group B (p=0.3). Anterior calcification was observed in 14.8% (36) in Group A and 18.8% (24) in Group B. In comparison, posterior calcification was present in 62.5% (152) in Group A and 66.9% (85) in Group B. Notably, calcification did not significantly impact haemostasis (p=0.79). Additional VCD deployment was necessary due to device failure in 4.5% (11) cases in Group A and 1.5% (2) cases in Group B. Conclusion The overall success rate was comparable between the two groups. However, Group A required more adjuncts to achieve successful haemostasis. The site of calcification did not impact the efficacy of closure devices. Pseudoaneurysm formation was more frequent when adjuncts were needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hakeem et al.)

Objective: The use of Natural Language Processing (NLP) has attracted increased interest in healthcare with various potential applications including identification and extraction of health information, development of chatbots and virtual assistants. The aim of this comprehensive literature review was to provide an overview of NLP applications in vascular surgery, identify current limitations, and discuss future perspectives in the field., Data Sources: The MEDLINE database was searched on April 2023., Review Methods: The database was searched using a combination of keywords to identify studies reporting the use of NLP and chatbots in three main vascular diseases. Keywords used included Natural Language Processing, chatbot, chatGPT, aortic disease, carotid, peripheral artery disease, vascular, and vascular surgery., Results: Given the heterogeneity of study design, techniques, and aims, a comprehensive literature review was performed to provide an overview of NLP applications in vascular surgery. By enabling identification and extraction of information on patients with vascular diseases, such technology could help to analyse data from healthcare information systems to provide feedback on current practice and help in optimising patient care. In addition, chatbots and NLP driven techniques have the potential to be used as virtual assistants for both health professionals and patients., Conclusion: While Artificial Intelligence and NLP technology could be used to enhance care for patients with vascular diseases, many challenges remain including the need to define guidelines and clear consensus on how to evaluate and validate these innovations before their implementation into clinical practice., Competing Interests: None., (© 2023 The Author(s).)

Introduction: The use of natural language processing (NLP) for a literature search has been poorly investigated in vascular surgery so far. The aim of this pilot study was to test the applicability of an artificial intelligence (AI) based mobile application for literature searching in a topic related to vascular surgery., Technique: A focused scientific question was defined to evaluate the performance of the AI application for a literature search and compare the results with the ground truth provided via a traditional literature search performed by human experts. Using pre-defined keywords, the literature search was performed automatically by the AI application through different steps, including quality assessment based on evaluation of the information available and quality filters using indicators of level of evidence, selection of publications based on relevancy filters using NLP, summarisation, and visualisation of the publications via the mobile app. A traditional literature search performed by human experts required 10 hours to check 154 original articles, among which 26 (16.9%) were truly related to the question, 63 (40.9%) related to the field but not to the specific question, and 65 (42.2%) were unrelated. The AI based search was performed in less than one hour, and, compared with traditional search, the method identified 17 original articles (48.6%) truly related to the question ( p < .010), 18 (51.4%) related to the field but not to the specific question ( p  = .26), and no unrelated publications ( p < .001). Fifteen truly related articles (88.2%) were identified jointly by the two methods. No significant difference was observed regarding the median number of citations, year of publications, and impact factor of journals., Discussion: The AI based method enabled a targeted, focused, and time saving literature search, although the selection of publications was not completely exhaustive. These results suggest that such an AI driven application is a complementary tool to help researchers and clinicians for continuous education and dissemination of knowledge., Competing Interests: None., (© 2023 The Author(s).)

Cardiovascular disease represents a source of major health problems worldwide, and although medical and technical advances have been achieved, they are still associated with high morbidity and mortality rates. Personalized medicine would benefit from novel tools to better predict individual prognosis and outcomes after intervention. Artificial intelligence (AI) has brought new insights to cardiovascular medicine, especially with the use of machine learning techniques that allow the identification of hidden patterns and complex associations in health data without any a priori assumptions. This review provides an overview on the use of artificial intelligence-based prediction models in vascular diseases, specifically focusing on aortic aneurysm, lower extremity arterial disease, and carotid stenosis. Potential benefits include the development of precision medicine in patients with vascular diseases. In addition, the main challenges that remain to be overcome to integrate artificial intelligence-based predictive models in clinical practice are discussed., Competing Interests: Declaration of Competing Interest The authors declare no competing interest, (Copyright © 2023 Elsevier Inc. All rights reserved.)

Despite advances in prevention, detection, and treatment, cardiovascular disease is a leading cause of mortality and represents a major health problem worldwide. Artificial intelligence and machine learning have brought new insights to the management of vascular diseases by allowing analysis of huge and complex datasets and by offering new techniques to develop advanced imaging analysis. Artificial intelligence-based applications have the potential to improve prognostic evaluation and evidence-based decision making and contribute to vascular therapeutic decision making. In this scoping review, we provide an overview on how artificial intelligence could help in vascular surgical clinical decision making, highlighting potential benefits, current limitations, and future challenges., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: Antithrombotic strategies are currently recommended for the treatment of lower extremity artery disease (LEAD) but specific scores to assess the risk of bleeding in these patients are scarce. To fill the gap, the OAC3-PAD bleeding score was recently developed and validated in German cohorts. The aim of this study was to determine whether this score performs appropriately in another real world nationwide cohort., Methods: This 10 year retrospective, multicentre study based on French national electronic health data included patients who underwent revascularisation for LEAD between January 2013 and June 2022. The OAC3-PAD score was calculated and from this, the population was classified into four groups: low, low to moderate, moderate to high and high risk. A binary logistic regression model was applied, with major bleeding occurring at one year (defined using the International Classification of Diseases ICD-10) as the dependent variable. The performance of the OAC3-PAD bleeding score was investigated using a receiver operating characteristic curve., Results: Among 161 205 patients hospitalised for LEAD treatment in French institutions, the one year incidence of major bleeding was 13 672 patients (8.5%). The distribution of the population according to the OAC3-PAD bleeding score was: 88 835 patients (55.1%), 34 369 (21.3%), 27 914 (17.3%), and 10 087 (6.3%) in the low, low to moderate, moderate to high, and high risk groups, respectively; with an incidence of one year major bleeding of 5.0%, 9.8%, 13.2%, and 21.3%. The OAC3-PAD model achieved an AUC of 0.650 to predict one year major bleeding following LEAD repair (95% CI 0.645 - 0.655), with a sensitivity of 0.67 and a specificity of 0.57., Conclusion: This nationwide analysis confirmed the accuracy of the OAC3-PAD model to predict one year major bleeding and served as external validation. Although further studies are required, it adds evidence and perspectives to further generalise its use to guide the management of patients with LEAD., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Objective: To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR)., Methods: A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014-May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality., Results: 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru's zones 0-2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related., Conclusions: The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.

Introduction: Visceral arterial aneurysms (VAAs) are life threatening. Due to the paucity of symptoms and rarity of the disease, VAAs are underdiagnosed and underestimated. Artificial intelligence (AI) offers new insights into segmentation of the vascular system, and opportunities to better detect VAAs. This pilot study aimed to develop an AI based method to automatically detect VAAs from computed tomography angiography (CTA)., Methods: A hybrid method combining a feature based expert system with a supervised deep learning algorithm (convolutional neural network) was used to enable fully automatic segmentation of the abdominal vascular tree. Centrelines were built and reference diameters of each visceral artery were calculated. An abnormal dilatation (VAAs) was defined as a substantial increase in diameter at the pixel of interest compared with the mean diameter of the reference portion. The automatic software provided 3D rendered images with a flag on the identified VAA areas. The performance of the method was tested in a dataset of 33 CTA scans and compared with the ground truth provided by two human experts., Results: Forty-three VAAs were identified by human experts (32 in the coeliac trunk branches, eight in the superior mesenteric artery, one in the left renal, and two in the right renal arteries). The automatic system accurately detected 40 of the 43 VAAs, with a sensitivity of 0.93 and a positive predictive value of 0.51. The mean number of flag areas per CTA was 3.5 ± 1.5 and they could be reviewed and checked by a human expert in less than 30 seconds per CTA., Conclusion: Although the specificity needs to be improved, this study demonstrates the potential of an AI based automatic method to develop new tools to improve screening and detection of VAAs by automatically attracting clinicians' attention to suspicious dilatations of the visceral arteries., Competing Interests: None., (© 2023 The Author(s).)

Introduction: The treatment of abdominal aortic aneurysm relies on surgical repair and the indication mainly depends on its size evaluated by the maximal diameter (Dmax). The aim of this study was to evaluate a new automatic method based on artificial intelligence to measure the Dmax on computed tomography angiography., Methods: A fully automatic segmentation of the vascular system was performed using a hybrid method combining expert system with supervised deep learning. The aorta centreline was extracted from the segmented aorta and the aortic diameters were automatically calculated. Results were compared to manual segmentation performed by two human operators., Results: The median absolute error between the two human operators was 1.2 mm (IQR 0.5-1.9). The automatic method using the deep learning algorithm demonstrated correlation with the human segmentation, with a median absolute error of 0.8 (0.5-4.2) mm and a coefficient correlation of 0.91 (P < 0.001)., Conclusions: Although validation in larger cohorts is required, this method brings perspectives to develop new tools to standardize and automate the measurement of abdominal aortic aneurysm Dmax in order to help clinicians in the decision-making process., (Copyright © 2021. Published by Elsevier Inc.)

Background: There is currently a lack of consensus and tools to easily measure vascular calcification using computed tomography angiography (CTA). The aim of this study was to develop a fully automatic software to measure calcifications and to evaluate the interest as predictive factor in patients with aorto-iliac occlusive disease., Methods: This study retrospectively included 171 patients who had endovascular repair of an aorto-iliac occlusive lesion at the University Hospital of Nice between January 2011 and December 2019. Calcifications volumes were measured from CTA using an automatic method consisting in three sequential steps: image pre-processing, lumen segmentation using expert system, and deep learning algorithms and segmentation of calcifications. Calcification volumes were measured in the infrarenal abdominal aorta and the iliac arterial segments, corresponding to the common and the external iliac arteries., Results: Among 171 patients included with a mean age of 65 years, the revascularization was performed on the native external and internal iliac arteries in, respectively: 83 patients (48.5%), 107 (62.3%), and 7 (4.1%). The mean volumes of calcifications were 2,759 mm 3 in the infrarenal abdominal aorta, 1,821 mm 3 and 1,795 mm 3 in the right and left iliac arteries, respectively. For a mean follow-up of 39 months, target lesion re-intervention was performed in 55 patients (32.2%). These patients had higher volume of calcifications in the right and left iliac arteries, compared with patients who did not have a re-intervention (2,274 mm 3 vs. 1,606 mm 3 , P = 0.0319 and 2,278 vs. 1,567 mm 3 , P = 0.0213)., Conclusions: The development of a fully automatic software would be useful to facilitate the measurement of vascular calcifications and possibly better inform the prognosis of patients., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Advances in virtual, augmented and mixed reality have led to the development of wearable technologies including head mounted displays (HMD) and smart glasses. While there is a growing interest on their potential applications in health, only a few studies have addressed so far their use in vascular surgery. The aim of this review was to summarize the fundamental notions associated with these technologies and to discuss potential applications and current limits for their use in vascular surgery., Methods: A comprehensive literature review was performed to introduce the fundamental concepts and provide an overview of applications of HMD and smart glasses in surgery., Results: HMD and smart glasses demonstrated a potential interest for the education of surgeons including anatomical teaching, surgical training, teaching and telementoring. Applications for pre-surgical planning have been developed in general and cardiac surgery and could be transposed for a use in vascular surgery. The use of wearable technologies in the operating room has also been investigated in both general and cardiovascular surgery and demonstrated its potential interest for image-guided surgery and data collection., Conclusion: Studies performed so far represent a proof of concept of the interest of HMD and smart glasses in vascular surgery for education of surgeons and for surgical practice. Although these technologies exhibited encouraging results for applications in vascular surgery, technical improvements and further clinical research in large series are required before hoping using them in daily clinical practice., (Copyright © 2021. Published by Elsevier Inc.)

Objective: There have only been a few studies on the stiffness and load bearing characteristics of guidewires used to deliver devices during endovascular procedures, particularly endovascular aneurysm repair. The aim of this study was to compare the load bearing characteristics of typical stiff and floppy wires, including in the context of consistency for each wire type., Methods: Two sets of stiff guidewires (Lunderquist Extra-Stiff and Amplatz Super Stiff [0.035" × 260 cm]), were compared with a floppy hydrophilic guidewire (Radifocus Stiff M [0.035" × 260 cm]). Radial stiffness was defined as the force (newtons [N]) needed to deform the wires on an electromechanical dynamometer. Tests were repeated with three runs on three sets of the same wire to check for consistency. Data were logged on proprietary dynamometric software and peak load values assessed per wire. Peak deformation forces (PDFs) from straight configuration to midwire deformation at 15 mm was translated into Microsoft Excel for statistical analysis in Minitab 19 for Windows., Results: There was good agreement within each wire set, with no difference in PDFs from runs for each wire ( p > .10). Mean ± standard deviation PDFs were 7.83 ± 0.23 N for the Lunderquist, 9.87 ± 0.92 N for the Amplatz, and 7.84 ± 0.52 N for the Radifocus wires. The Amplatz wire exhibited the greatest resistance to deformation vs. both the Lunderquist and Radifocus wires ( p < .001, one way analysis of variance). Both Amplatz and Radifocus wires had non-linear deformation characteristics., Conclusion: This study confirmed that the represented hydrophilic wire is more deformable than the stiff wires. The Amplatz wire has complex construction features that yielded surprising baseline stiffness characteristics. The linear stiffness characteristics of the Lunderquist wire possibly contribute to it being the preferred choice for large endograft delivery., (© 2021 The Author(s).)

Objective: COVID-19 has caused a global healthcare crisis with increasing number of people getting infected and dying each day. Different countries have tried to control its spread by applying the basic principles of social distancing and testing. Healthcare professionals have been the frontline workers globally with different opinions regarding the preparation and management of this pandemic. We aim to get the opinion of healthcare professionals in United Kingdom regarding their perceptions of preparedness in their workplace and general views of current pandemic management strategy., Method: A questionnaire survey, drafted using Google Forms, was distributed among healthcare professionals working in the National Health Service (NHS) across the United Kingdom. The study was kept open for the first 2 weeks of April 2020., Results: A total of 1007 responses were obtained with majority of the responses from England (n = 850, 84.40%). There were 670 (66.53%) responses from doctors and 204 (20.26%) from nurses. Most of the respondents (95.23%) had direct patient contact in day to day activity. Only one third of the respondents agreed that they felt supported at their trust and half of the respondents reported that adequate training was provided to the frontline staff. Two-thirds of the respondents were of the view that there was not enough Personal Protective Equipment available while 80% thought that this pandemic has improved their hand washing practice. Most of the respondents were in the favour of an earlier lockdown (90%) and testing all the NHS frontline staff (94%)., Conclusion: Despite current efforts, it would seem this is not translating to a sense of security amongst the UK NHS workforce in terms of how they feel trained and protected. It is vital that healthcare professionals have adequate support and protection at their workplace and that these aspects be actively monitored., Competing Interests: Declaration of competing interest No conflicts of interest., (Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

A 56-year-old man developed mid-gut bowel ischaemia following an elective aortobiprofunda bypass for short-distance claudication. The bowel was resected and he was commenced on lifelong total parenteral nutrition. He was found to have developed heparin-induced thrombocytopenia and thrombosis, confirmed by high levels of heparin-platelet factor 4-antibody on enzyme-linked immunosorbent assay (ELISA). He subsequently had foregut ischaemia with a second bout of thrombocytopenia despite not being on heparin. The case describes the first report of bowel ischaemia as a consequence of heparin-induced thrombocytopenia causing sequential superior mesenteric and coeliac arterial thrombosis in this scenario and highlights the importance of the awareness of the association of these pathological entities and subsequent management.

True aneurysms of the superficial temporal artery (STA) are quite uncommon. Only 14 such cases are described in the literature. Ultrasound scan (USS) is an appropriate and easily accessible non-invasive diagnostic modality, as it can show both the anatomical and flow characteristics of the aneurysmal vessel. Other conditions to be included in the differential diagnosis are haematoma, angiofibroma, eroding middle meningeal artery aneurysm, abscess or a parotid mass. Operative intervention is indicated to relieve symptoms as in this case, and to prevent rupture.

Purpose: To describe the use of the Amplatzer vascular plug to treat a partially uncovered left subclavian artery (LSA) causing digital embolism following thoracic endovascular aneurysm repair., Case Report: A 70-year-old man presented with digital ischemia of the left index and middle fingers due to embolism from a partially covered LSA orifice during thoracic endovascular aneurysm repair for a type I thoracic aortic aneurysm. The orifice was successfully occluded using the vascular plug, supplemented by a left carotid-subclavian bypass to treat ongoing arm and hand claudication. The patient has had no further embolic episodes., Conclusion: A partially uncovered LSA during thoracic endovascular aneurysm repair poses a risk of thromboembolism, with resultant upper limb claudication or tissue loss. If recognized at the time of the procedure, this should be treated by proximal extension; otherwise, proximal LSA occlusion using an Amplatzer occluder may be a safe and effective option in preventing further embolic episodes.

Purpose: To construct life-like non-axisymmetrical abdominal aortic aneurysm models from latex., Technique: A computed tomographic 3-dimensional reconstruction of an actual abdominal aortic aneurysm was cast in plastic to provide a core for a "chemical metal" mould. The mould was then coated with nonadhesive prevulcanized dipping latex and cured to provide an idealized hollow reconstruction of the aneurysm., Conclusions: Chemical metal can be manipulated quite easily to make a mould of any required size or surface character, which then allows the manufacture of a well-matched latex model for biophysical studies of non-axisymmetrical abdominal aortic aneurysms.