Researchers have proposed an innovative theoretical framework combining quaternion-based recurrent neural networks (QRNNs) with machine learning to address limitations in superficial femoral artery (SFA) assessment and restenosis prediction. The superficial femoral artery is highly susceptible to atherosclerotic disease, with restenosis rates exceeding 30–50% following endovascular intervention. Current diagnostic methods, including two-dimensional angiography and duplex ultrasound, fail to capture the complex three-dimensional spatiotemporal dynamics of vessel remodeling during physiological motion. The proposed integrated pipeline combines 3D convolutional neural network encoders for feature extraction, QRNN cores for temporal modeling using Hamilton product operations, and conditional generative adversarial networks for synthetic geometry generation. Quaternions provide singularity-free representations of 3D rotations, enabling superior fidelity in modeling dynamic vessel behavior compared to Euclidean approximations. A multi-objective loss function balances quaternion prediction accuracy, geometric feature errors, and probability calibration. Once validated, this framework could enable predictive 3D vessel remodeling modeling, personalized intervention planning, and quantitative risk stratification for peripheral artery disease, potentially transforming management of this condition affecting over 200 million individuals globally.

Central venous occlusion (CVO) affects 25–40% of hemodialysis patients, causing significant complications including vascular access dysfunction. This condition stems from prolonged catheter use and elevated blood flow from vascular accesses, which promote venous intimal hyperplasia. Standard symptoms include facial and limb edema and access failure. While endovascular treatment is the first-line management strategy, some rigid occlusions resist conventional recanalization techniques. The sharp recanalization technique (SRT), first described by Ferral in 1996, offers an alternative approach for failed conventional interventions. SRT employs specialized instruments including stiff guidewires, Chiba and Colapinto needles, transjugular hepatic puncture needles, transseptal puncture systems, or radiofrequency and laser technology to traverse impassable occlusions. This case report documents a 68-year-old hemodialysis patient with right brachiocephalic venous trunk occlusion who failed conventional antegrade crossing attempts using standard catheters and guidewires. SRT proved effective for successful recanalization, demonstrating its clinical value when conventional endovascular methods are exhausted, thereby preserving vascular access and alleviating debilitating symptoms.

The NEO-MINDSET trial substudy, presented at EuroPCR 2026, compared P2Y12 inhibitor monotherapy against dual antiplatelet therapy (DAPT) in acute coronary syndrome patients undergoing complex percutaneous coronary intervention. This research addresses a critical clinical question regarding optimal antiplatelet regimens in high-risk coronary disease management. The study evaluated whether single-agent P2Y12 inhibitor therapy could safely replace traditional DAPT, potentially reducing bleeding complications while maintaining efficacy. Presented as a late-breaking trial during the hotline sessions, the NEO-MINDSET substudy provides important evidence for interventional cardiologists managing complex cases. The findings are particularly relevant for determining individualized antiplatelet strategies, balancing ischemic and bleeding risks in acute coronary syndromes. This research contributes to evolving treatment protocols in percutaneous coronary intervention, potentially influencing clinical practice guidelines for antiplatelet therapy duration and intensity in complex coronary lesions.

Compared with PTA, DCBs and DES demonstrated higher primary patency and lower binary restenosis, and DCBs reduced late lumen loss, percentage in-lesion diameter stenosis, and clinically driven target lesion revascularization.

Lower extremity peripheral artery disease (PAD) is associated with considerable morbidity, diminished quality of life, and mortality; reducing the risk of cardiovascular events is the primary goal of medical treatment. Intermittent claudication is the most common symptom of PAD; treatment aims to improve ambulatory function through smoking cessation, medical therapy, exercise, and (selective) revascularization. Chronic limb-threatening ischaemia is associated with increased amputation risk and mortality; treatment is based on effective revascularization, which aims to relieve pain, heal wounds, and preserve limb function. Advances in endovascular technologies and open surgical approaches have created a growing range of revascularization options for PAD, although their outcomes are highly dependent on the anatomical pattern of disease. Active areas of investigation in PAD include cell-based and gene-based therapies, tissue-engineered vascular conduits, and drug-eluting, biomimetic, and bioresorbable scaffolds.

This clinical trial, sponsored by DK Medical Technology (Suzhou) Co., Ltd., evaluates scoring balloon and high-pressure balloon techniques for treating arteriovenous graft stenosis in hemodialysis patients. The study enrolled patients aged 18–80 years with mature AVGs and target lesions in the return vein or venous anastomosis showing ≥50% stenosis combined with clinical indicators such as elevated venous pressure, increased puncture difficulty, or reduced blood flow. Primary and restenotic lesions measuring 4.0–8.0mm in reference diameter and up to 80mm total length were included. The trial excluded patients with central vein stenosis, prior stent placement, severe calcification, acute thrombosis, recent percutaneous transluminal angioplasty treatment, or planned kidney transplantation. This research addresses a critical clinical challenge in vascular access maintenance, as stenosis is a leading cause of dialysis access failure. The findings will inform optimal balloon angioplasty strategies for preserving AVG function and reducing intervention frequency in hemodialysis populations.

Discussion on managing complex peripheral artery disease, particularly in the femoropopliteal region, and a relevant case study to highlight specific challenges.

Researchers have demonstrated a novel approach to treating complex femoropopliteal arterial lesions using rotational atherectomy accessed through the retrograde popliteal route without embolic protection devices. This technique addresses challenging calcified or fibrotic blockages in the femoral-popliteal artery segment, which supplies blood to the leg. The retrograde popliteal access approach—entering from behind the knee rather than traditional antegrade methods—provides improved angles and maneuverability for the rotational atherectomy device, which mechanically abrades plaque buildup. Notably, the procedure was performed without embolic protection filters, suggesting adequate safety despite potential debris generation. This advancement published in CVIR Endovascular represents a significant technical innovation in peripheral arterial interventions. The findings matter because they expand treatment options for complex lesions previously difficult to manage, potentially improving outcomes for patients with peripheral artery disease while potentially reducing procedural complexity and cost by eliminating embolic protection requirements.

Abbott has introduced the Diamondback 360 Peripheral Orbital Atherectomy System (OAS), a minimally invasive device designed to treat peripheral artery disease (PAD) by removing arterial plaque through orbital atherectomy. The system features a low-profile design compatible with 4-6 French sheath sizes, an electric-powered handle with one-touch activation, and three-speed controls for adjustable treatment during procedures. The innovative GlideAssist mode enables the 1.25 micro crown to operate at reduced speed (5,000 RPM), reducing friction and facilitating device tracking and removal. Clinical studies demonstrate that OAS successfully modifies calcified peripheral lesions while maintaining low complication rates. This advancement is significant given that PAD affects over 236 million people globally and presents in 15-20 percent of individuals over seventy years old. By effectively removing calcified plaque, the system can reduce amputation rates and improve patient quality of life. Abbott positions the Diamondback 360 as a new standard of care for below-the-knee treatment, complementing its broader PAD treatment portfolio including guide wires, balloon catheters, and stent systems.

Drug-eluting stents represent an evolving treatment option for symptomatic femoropopliteal peripheral artery disease in adult patients. Paclitaxel-eluting stents have emerged as a potential first-line endovascular intervention, offering improved outcomes compared to bare-metal stents by reducing restenosis rates through drug delivery that inhibits smooth muscle cell proliferation. The selection of paclitaxel-eluting stents as initial treatment depends on patient-specific factors including lesion characteristics, vessel diameter, and anatomical considerations of the femoropopliteal segment. Dual antiplatelet therapy, typically combining aspirin with a P2Y12 inhibitor such as clopidogrel, ticagrelor, or prasugrel, is recommended following stent placement to prevent thrombotic complications and maintain long-term patency. The duration and specific antiplatelet regimen should be individualized based on bleeding risk, ischemic risk, and patient tolerance. Current evidence supports paclitaxel-eluting stents as an effective endovascular strategy for managing symptomatic femoropopliteal disease, though careful patient selection and appropriate antiplatelet management remain critical for optimizing clinical outcomes and reducing restenosis and thrombosis rates.

This retrospective study examined 334 consecutive patients treated with aortoiliac artery stenting (AIS) between 2009 and 2024 to determine whether simultaneous infrainguinal revascularization affects long-term stent patency. Patients were stratified into two groups: those receiving AIS with concurrent infrainguinal treatment (114 patients) and those receiving AIS alone (220 patients). The primary outcome was 10-year primary patency rate, assessed using Kaplan-Meier analysis with propensity score matching to control for clinical and anatomical risk factors. Results demonstrated excellent overall patency stability at 85.3% from years seven to ten. While the combined treatment group exhibited higher disease burden, including greater calcification and external iliac artery involvement, propensity-matched analysis revealed no statistically significant difference in patency between groups. Stent type did not significantly influence outcomes. These findings indicate that aortoiliac stenting provides durable long-term patency exceeding ten years, and simultaneous infrainguinal treatment does not independently compromise upstream stent performance, supporting comprehensive revascularization strategies for multilevel atherosclerotic disease affecting both aortoiliac and infrainguinal vessels.

The GORE VIABAHN five-year outcomes study evaluates the long-term efficacy and safety of the GORE VIABAHN endoprosthesis, a vascular graft device developed by W.L. Gore & Associates for treating vascular access complications and peripheral arterial disease. This extended follow-up analysis tracked patient outcomes over a five-year period, measuring critical endpoints including patency rates, functional durability, and adverse event incidence. The study provides essential clinical data on the device's sustained performance beyond the initial implantation phase, documenting rates of thrombosis, infection, and need for reintervention. These findings are significant for vascular surgeons and interventional radiologists as they inform clinical decision-making regarding graft selection and patient management strategies. The five-year data contributes to the growing evidence base supporting the GORE VIABAHN's utility in challenging vascular access cases, helping clinicians evaluate long-term outcomes and optimize treatment protocols for patients requiring durable vascular solutions.

At 3 years, DRS demonstrated sustained advantages over PTA in preserving vessel patency, with lower restenosis and fewer reinterventions while maintaining a comparable safety profile. These findings support the use of DRS in selected patients with CLTI and infrapopliteal disease.

This clinical case report documents a rare complication involving delayed arteriovenous fistula (AVF) maturation in a patient with an ipsilateral transvenous implantable cardioverter defibrillator (ICD) lead. The patient experienced compromised vascular access development following placement of an ICD lead in the same upper extremity designated for AVF creation. The clinical team identified suspected functional hemodynamic obstruction as the underlying mechanism, where the ICD lead physically interfered with normal venous flow and hemodynamic conditions necessary for fistula maturation. This anatomical obstruction prevented the expected vascular remodeling and enlargement required for functional hemodialysis access. The case highlights an important clinical consideration for patients requiring both cardiac device implantation and vascular access procedures, demonstrating that ipsilateral lead placement can compromise subsequent AVF development. The findings underscore the need for careful procedural planning and coordination between cardiology and vascular surgery teams to optimize outcomes when patients require multiple interventions on the same extremity.

The complete covered stent procedure in dialysis fistula performed by the Dr. Ramón Saiz, at the Son Llàtzer Hospital in Palma de Mallorca, can be seen in the app SurgSchoolThe case addresses a recurrent stenosis at the junction of the coronary artery arch in a hemodialysis fistula, previously treated with conventional angioplasty and a drug-eluting balloon, with three restenosis episodes in less than two months. The indication for a covered stent is understood within this context: not as an indiscriminate first-line treatment, but as a response to a resistant, recurrent, and hemodynamically significant lesion.

Viabahn VBX showed higher long-term freedom from TLR compared with BNS in patients undergoing AI intervention. Further investigation is needed for an appropriate device (Viabahn VBX or BNS) in patients with AI occlusive lesion.

At 3 years, DRS demonstrated sustained advantages over PTA in preserving vessel patency, with lower restenosis and fewer reinterventions while maintaining a comparable safety profile. These findings support the use of DRS in selected patients with CLTI and infrapopliteal disease. (Pivotal Investigation of Safety and Efficacy of Drug-Eluting Resorbable Scaffold Treatment-Below the Knee [LIFE-BTK]; NCT04227899)

This comprehensive vascular and endovascular surgery training manual serves as an essential educational resource for medical professionals specializing in vascular interventions. The document provides systematic instruction on surgical techniques, procedural protocols, and clinical best practices pertinent to vascular and endovascular procedures. Designed for surgical trainees and practitioners, this manual consolidates theoretical knowledge with practical guidance, covering fundamental principles through advanced interventional techniques. The structured content facilitates professional development within the vascular surgery discipline, supporting evidence-based clinical decision-making and skill acquisition. This training resource represents a valuable reference tool for maintaining surgical competency standards and advancing professional expertise in vascular and endovascular medicine.

This study presents five-year clinical outcomes for the GORE VIABAHN endoprosthesis, a significant advancement in vascular intervention technology. The research evaluates the long-term efficacy and safety profile of this device in treating vascular conditions over an extended follow-up period. The findings provide valuable data on patency rates, clinical success, and complication profiles, contributing to the evidence base for informed clinical decision-making. These results are essential for healthcare professionals assessing treatment options and understanding the durability of endovascular interventions in patient populations requiring vascular repair or reconstruction therapies.

Below-the-knee (BTK) arterial disease is associated with a high risk of limb loss, yet evidence supporting the use of paclitaxel-coated balloons (PCB) in routine clinical practice remains limited. This study aimed to evaluate the safety and clinical performance of Peripherics™ PCB catheter (Sahajanand Medical Technologies Limited, Surat, India) in the treatment of BTK arteries during routine clinical practice.