GSVA achieved 53% 12-month amputation-free survival in no-option CLTI patients. 91% of preserved limbs healed and all had pain improvement after GSVA. Most amputations occurred within 1.5 months; early failure predicts outcome. GSVA is a simpler, cheaper, and safer alternative to deep venous arterialization.

Researchers investigated how carboxymethyl cellulose (CMC) and calcium-crosslinked CMC coatings enhance the performance of 3D-printed hydroxyapatite scaffolds for biomedical applications. Hydroxyapatite is a calcium phosphate mineral closely resembling natural bone composition, making it valuable for bone tissue engineering. The study, led by Attapong Deedklin and colleagues and published in Frontiers in Bioengineering and Biotechnology, evaluated how these surface modifications influenced early hemostatic performance and osteoblastic compatibility. The calcium-crosslinked CMC coating represents an advanced surface treatment designed to improve blood-material interactions while promoting bone cell adhesion and growth. By modifying the scaffold surface with these biopolymers, the researchers aimed to create a more biocompatible material that would facilitate faster bone integration and minimize adverse reactions. These findings have significant implications for orthopedic and reconstructive surgery applications, offering potential improvements in bone regeneration therapies and scaffold-based tissue engineering approaches that could enhance clinical outcomes in bone repair procedures.

Arteriovenous access thrombectomy is a critical procedure for managing thrombosed dialysis access in patients with end-stage kidney disease. This clinical review examines best practices for percutaneous mechanical thrombectomy performed in outpatient settings. Early identification of access dysfunction through careful analysis of dialysis unit indicators—including difficult cannulation, elevated venous pressures, decreased blood flow, and prolonged bleeding—can predict thrombosis and guide intervention strategy. Successful thrombectomy requires systematic attention to four key procedural components: thrombus removal, pullback angiography to visualize the entire access circuit and central venous system, angioplasty of associated stenotic lesions, and arterial plug dislodgement. The underlying pathology differs between arteriovenous grafts, where venous outflow stenosis predominates, and arteriovenous fistulas, which exhibit variable stenosis patterns including juxta-anastomotic lesions and cephalic arch narrowing. Prompt, complete treatment prevents complications such as missed dialysis sessions, hospitalization, and permanent access loss. Understanding the access circuit anatomy and identifying contributing stenoses before intervention improves procedural efficiency and patient outcomes.

This Brazilian study analyzed 109,466 hospitalizations for critical lower limb ischemia between 2015 and 2024, demonstrating a significant technological shift within the SUS healthcare system. Endovascular approaches dominated at 83.9% of procedures compared to 16.1% for open surgical methods, substantially surpassing previous Brazilian datasets. This transition reflects global trends driven by reduced perioperative risk, improved accessibility, and advanced materials including stents and drug-coated balloons that have expanded treatment indications. The patient population demonstrated a median age of 66-67 years with male predominance, particularly in open procedures where men comprised 66.8% of cases. Women showed higher proportional participation in endovascular interventions at 45.3%, compared to 33.2% in open surgery, potentially reflecting anatomical considerations. Notably, brown and black populations represented 34.7% and 5.9% of angioplasty cases respectively, diverging from international patterns of reduced minority access to revascularization. These findings indicate Brazil's medical and structural strategy supporting broader treatment accessibility across demographic groups, marking a consolidated evolution in peripheral arterial disease management practices.

Stroke remains a leading global cause of death and disability, with carotid artery disease accounting for eight to fifteen percent of ischemic stroke cases. Carotid artery stenting (CAS) is an established preventive strategy in appropriately selected patients with symptomatic carotid artery stenosis. However, severe vascular calcification frequently impedes adequate lesion preparation, compromising stent expansion and procedural success. This case report demonstrates the clinical application of intravascular lithotripsy (IVL), an emerging plaque-modification technique, as salvage therapy for heavily calcified carotid lesions. An 83-year-old woman with critical right internal carotid artery stenosis underwent CAS with initial unsuccessful lesion preparation using cutting balloon angioplasty. Subsequent IVL application facilitated adequate plaque modification, enabling satisfactory stent expansion and angiographic results. The procedure resulted only in transient bradycardia, managed with atropine, with no perioperative neurological complications and no recurrent stroke during twelve-month follow-up. This case illustrates IVL's potential as an effective salvage strategy when conventional lesion preparation fails during CAS in patients with heavily calcified carotid lesions.

UC San Diego is conducting multiple peripheral artery disease clinical trials recruiting eligible adults in 2026. One trial investigates the relationship between carotid stenosis and cognitive decline through neurocognitive assessments, serum inflammatory markers, and neuroimaging at baseline and post-stenting intervals to determine whether improved blood flow restores cognitive function. A second trial examines whether metformin reduces mortality, myocardial infarction, and stroke risk in Veterans with pre-diabetes and cardiovascular disease. A multicenter registry collects data on percutaneous coronary intervention strategies and outcomes for chronic total occlusions in advanced coronary artery disease patients. Additional trials evaluate FFRangio-guided versus conventional pressure wire-guided coronary treatment and test an AI-based screening tool to identify undiagnosed peripheral artery disease patients. These studies address significant gaps in understanding cardiovascular disease pathophysiology and treatment efficacy, potentially improving patient outcomes through enhanced diagnostic approaches and personalized intervention strategies.

Researchers have developed an interpretable photoacoustic imaging approach for diagnosing peripheral artery disease by phenotyping the distal microcirculation. Photoacoustic imaging combines light and sound waves to visualize blood vessel characteristics and tissue perfusion at high resolution. The technique enables non-invasive assessment of microvascular function in patients with peripheral artery disease, a condition characterized by reduced blood flow to the extremities. The study includes exploratory perioperative evaluation, suggesting clinical applicability during surgical interventions. This interpretable imaging method addresses a significant diagnostic challenge in vascular medicine by providing detailed, actionable information about microcirculatory status. The approach's interpretability is particularly valuable, allowing clinicians to understand the underlying physiological mechanisms driving diagnostic conclusions. By enabling earlier and more accurate detection of peripheral artery disease through microvascular assessment, this photoacoustic phenotyping technology could improve patient stratification, guide treatment decisions, and potentially enhance perioperative planning and outcomes for at-risk populations.

Dialysis access angioplasty is a minimally invasive procedure that addresses stenosis in dialysis fistulas, grafts, and associated veins by using a small balloon to widen narrowed blood vessels and restore adequate blood flow. Performed in outpatient vascular centers, interventional radiology suites, or hospitals, the procedure typically lasts 30 to 90 minutes and is one of the most commonly used interventions to preserve hemodialysis access function. Patients are treated under local anesthesia with optional sedation and usually experience only mild discomfort. Following the procedure, most patients can resume dialysis shortly after treatment, though physician guidance is essential for optimal recovery. While serious complications are uncommon when performed by experienced specialists, potential risks include vessel perforation and hematoma formation. The procedure's success may result in improved blood flow, prolonged access lifespan, and reduced infection risk; however, recurrent narrowing can develop over time due to scar tissue formation, potentially necessitating repeat interventions. Regular monitoring remains critical for long-term access maintenance and function.

The SEISMIQ™ Intravascular Lithotripsy (IVL) System represents an advanced next-generation technology designed to treat complex calcified arterial lesions with enhanced precision and efficacy. Commercially available since late 2025, the system combines improved deliverability, visibility, and consistent acoustic pressure to maximize therapeutic impact. The technology has been evaluated in the RESTORE ATK 1 and RESTORE BTK 2 clinical studies, both achieving 100% procedural success rates with zero major adverse events at thirty days, low residual stenosis, and minimal need for adjunctive therapies. Early adopters from Advocate Health, interventional cardiologist Dr. Jaafer Golzar and vascular surgeon Dr. Gregory Stanley, provide clinical insights into the system's differentiated features. The innovation addresses a critical clinical challenge in peripheral artery disease treatment: the increasing prevalence of moderate-to-severely calcified plaque, particularly in aging populations with diabetes and chronic kidney disease. Traditional interventional approaches including balloon angioplasty, stenting, and atherectomy present significant limitations and safety concerns. SEISMIQ's targeted acoustic energy delivery offers clinicians superior control and improved patient outcomes in managing this growing patient population.

If you’ve been diagnosed with peripheral artery disease (PAD) and your doctor has recommended an endovascular procedure to restore blood flow to your legs, you may have heard terms like “angioplasty,” “stent,” and “drug-coated balloon.” These are all tools in the modern vascular specialist’s toolkit—but they work differently, and understanding the distinctions can help you have a more informed conversation with your care team.

SCB angioplasty resulted in sustained patient-reported and clinical outcomes comparable to PCB angioplasty through 2 years, with similar patency, revascularization, and safety.

Restenosis following balloon angioplasty remains a major cause of arteriovenous fistula (AVF) dysfunction in patients receiving maintenance hemodialysis. We evaluated whether the use of sirolimus-coated angioplasty balloons (SCBs) improves access circuit primary patency (ACPP) in patients with dysfunctional, nonthrombosed AVFs.

Hemodialysis access is the critical pathway through which blood exits the body, passes through a dialysis machine for filtration, and returns to the patient. The National Kidney Foundation outlines three primary access types: arteriovenous fistulas, grafts, and catheters, each with distinct advantages and considerations. Fistulas, created by surgically connecting an artery and vein typically in the arm using the patient's own blood vessels, offer superior longevity and lower infection rates but require weeks to months of healing before use. Grafts, soft synthetic tubes connecting blood vessels, provide faster accessibility than fistulas but carry higher infection and clotting risks. Catheters, placed in large veins such as the neck or chest, enable immediate use but pose elevated infection risks and perform poorly for long-term dialysis. Selection depends on individual vascular anatomy, health status, and dialysis urgency. Healthcare providers typically employ ultrasound imaging to assess blood vessel suitability before access placement. Daily monitoring and prompt reporting of changes prevent serious complications including infection, bleeding, or thrombosis, making access care essential for successful hemodialysis outcomes.

Peripheral Arterial Disease (PAD) is a prevalent circulatory condition characterized by plaque accumulation in leg and foot arteries, resulting in reduced blood flow to lower extremities. Affecting millions of Americans, PAD represents a leading cause of preventable limb loss. Early symptoms often go unrecognized, mistaken for arthritis or aging-related conditions, delaying critical intervention. The hallmark symptom is claudication—leg pain or cramping during walking that resolves with rest—alongside fatigue, cold extremities, numbness, slow-healing wounds, and skin discoloration. Significant risk factors include diabetes, smoking, hypertension, high cholesterol, chronic kidney disease, obesity, and family cardiovascular history. Diagnosis employs ankle-brachial index (ABI), duplex vascular ultrasound, CT angiography, MR angiography, or diagnostic angiography to assess arterial narrowing severity. Treatment prioritizes circulation improvement through lifestyle modifications including smoking cessation, exercise therapy, diabetes management, and cholesterol control. Advanced cases may require minimally invasive interventions such as angioplasty, atherectomy, drug-coated balloons, stenting, or surgical bypass. Early detection proves essential, as PAD signals systemic cardiovascular disease risk and, if untreated, can progress to tissue damage and amputation while compromising overall heart health.

# Summary This clinical research article examines the efficacy and safety outcomes of ultrasound-guided percutaneous procedures, a minimally invasive intervention technique. The study evaluated patient outcomes following this image-guided approach, which utilizes real-time ultrasound imaging to enhance procedural accuracy and precision. By leveraging ultrasound visualization, clinicians can target anatomical structures with improved accuracy compared to landmark-based techniques, potentially reducing complications and improving therapeutic success rates. The research synthesizes clinical data to assess both efficacy metrics and adverse event profiles associated with ultrasound-guided percutaneous interventions across patient populations. Key findings from this analysis contribute to understanding the clinical utility and safety profile of this imaging-guided procedural approach. These results have important implications for clinical practice, informing best practices for minimally invasive interventional procedures and supporting evidence-based decision-making regarding patient management strategies. The work underscores the value of ultrasound guidance in enhancing procedural outcomes and reducing iatrogenic complications in percutaneous medical interventions.

Maintaining vascular access for hemodialysis patients remains challenging, with arteriovenous fistulas (AVFs) being the preferred option due to lower infection risk and superior long-term durability. However, stenosis caused by neointimal hyperplasia frequently leads to access dysfunction and repeated interventions. While plain old balloon angioplasty (POBA) is the standard treatment, restenosis rates remain high, particularly in complex lesion locations such as the perianastomotic region and cephalic arch. Drug-coated balloons (DCBs) were developed to deliver antiproliferative agents locally during angioplasty, aiming to inhibit restenosis without permanent implants. Evidence for DCBs in hemodialysis access has been limited and inconsistent across key randomized controlled trials. The Lutonix AV trial showed modest improvement in target lesion primary patency at one year compared with POBA, while the PAVE trial found no patency advantage. Conversely, the IN.PACT AV Access trial demonstrated significantly higher target lesion primary patency and fewer reinterventions with DCB treatment, with benefits sustained through 36 months. Real-world registry data provides complementary evidence across diverse patient and lesion characteristics beyond RCT populations.

This preclinical study supports the feasibility of RFS implantation in peripheral arteries and demonstrates that the device undergoes early structural evolution after deployment. Virtual physiological assessment showed that these anatomical changes were accompanied by measurable reductions in flow indices, though most values remained above the 0.80 reference threshold. Together, these findings provide a basis for further development of the technology and for future studies incorporating both anatomical and virtual physiological assessment.

RFS implantation instated a largely homogeneous ESS profile that evolved with 3-month remodelling, consistent with a dynamic flow-healing interplay that warrants longer-term evaluation through full bioresorption.

Critical limb ischemia is the most advanced stage of peripheral artery disease - when blood flow to a leg or foot is so reduced that tissue is at risk of being lost. At MVM, our limb-preservation focus means many patients told they need amputation are candidates for revascularization instead.

This study suggests a potential clinical advantage of atherectomy for first-time revascularization in patients with critical limb ischemia and isolated tibial disease. The reductions in adverse outcomes suggest atherectomy offers long-term clinical benefits over angioplasty alone, warranting further investigation.