Patients with peripheral artery disease (PAD) are at risk for amputation. The aim of this study was to assess the type of revascularisation prior to and the 30-day mortality rate after major amputation due to PAD. Retrospective analysis of consecutive patients undergoing major amputation for PAD between 01/2000 and 12/2017 at a tertiary referral center. The number and target level of ipsilateral revascularisations prior to amputation were analyzed per patient and over the years. There were three types of revascularisation (open, endovascular and combined treatment) at three levels: aortoiliac, femoropopliteal and infrapopliteal. Univariate and multivariate logistic regression models were used to assess the association of level of amputation and patient characteristics with 30-day mortality. 312 patients (65.7% male) with a mean age of 73.3 ± 11 years underwent 338 major amputations: 70 (21%) above/through knee and 268 (79%) below knee. A median of 2 (interquartile range, IQR 1-4) revascularisations were performed prior to amputation, with a slight decrease of 1.4% per year from 2000 to 2017 (incidence rate ratio of 0.986 0.974-0.998; Poisson regression analysis, p=0.021). 16% (53/338) of patients underwent primary amputation without revascularisation; this number remained relatively stable throughout the study period. The proportion of exclusively open treatment before amputation decreased substantially from 35% in 2006 to none in 2016, while exclusively endovascular revascularisations were performed increasingly from 17% in 2002 to 64% in 2016. Amputation occurred after a median of 9.5 months (IQR 0.9-67.6 months) if the first revascularisation was aortoiliac or femoropopliteal and after 2.1 months (IQR 0.5-13.8 months) if the first intervention was infrapopliteal (p<0.001) with no significant change over the years (normal linear regression, p=0.887). Thirty-day mortality was 8.9% (22/247) after below knee and 27.7% (18/65) after above/through knee amputation (adjusted OR 3.84, 95% CI 1.74-8.54, p=0.001) with a slight increase of mortality over the study period (adjusted OR 1.09, 95% CI 1.018-1.159, Poisson regression analysis, p= 0.021). The uni- and multivariate analysis of patient characteristics did not show an association with mortality, except higher ASA classification (adjusted OR 2.65, 95% CI 1.23-5.72, p= 0.012). Mortality, especially after above/through knee amputation, remains high over the past two decades. There is a clear shift towards endovascular treatment of patients with PAD prior to major amputation. In patients needing infrapopliteal revascularisations, amputation was performed much sooner than in those with aortoiliac or femoropopliteal interventions, with no improvement over the years. Strategies to extend limb salvage in these patients should be the focus of further research.

Evidence is lacking to guide the management of infective native aortic aneurysm (INAA). The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured. Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, 3 weeks each, using an online questionnaire with initially 28 statements. The panelists rated the statements on a 5 point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach's α > 0.80. All 49 panelists fulfilled all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: n = 3 on need for consensus, n = 20 on treatment, n = 5 on follow up, and n = 1 on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach's α increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements. INAA is rare, and high level evidence is lacking to guide optimal management. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.

This study examines outcome and durability of self made bovine pericardial tube grafts in aortic infections of all anatomic locations. This was a retrospective and prospective international multicentre study. Peri-operative and long term outcomes of patients undergoing aortic in situ reconstruction for native or graft infections with self made bovine pericardial tube grafts between January 2008 and December 2020 in four European tertiary referral centres were analysed. The primary endpoint was recurrent aortic infection. Secondary endpoints were persistent infection, aortic re-operation for infection, graft related complications, and mortality. One hundred and sixty eight patients (77% male, mean age 67 ± 11 years) were identified: 38 (23%) with native and 130 (77%) with aortic graft infection. Thirty day mortality was 15% (n = 26) overall, 11% (n = 4), and 17% (n = 22) for native and aortic graft infections, respectively (p = .45). Median follow up was 26 months (interquartile range [IQR] 10, 51). Estimated survival at one, two, three, and five years was 64%, 60%, 57%, and 50%, and significantly better for native (81%, 77%, 77%, and 69%) than for graft infections (58%, 55%, 51%, and 44%; p = .011). Nine patients (5.3%) had persistent infection and 10 patients (6%) had aortic re-infection after a median of 10 months (IQR 5, 22), resulting in an estimated freedom from re-infection at one, two, three, and five years of 94%, 92%, 90%, and 86%. Estimated freedom from graft complications at one, two, three, and five years was 91%, 89%, 87%, and 87%. This multicentre study demonstrates low re-infection rates when using self made bovine pericardial grafts, comparable to those of other biological grafts. The rate of graft complications, mainly anastomotic aneurysms and stenoses, was low, while graft degeneration was absent. Self made bovine pericardial tube grafts are an excellent tool for in situ reconstruction in the setting of native aortic infection or aortic graft infection.

Purpose: Bronchial artery aneurysms (BAA) and pseudoaneurysms (BAP) are uncommon vascular lesions that may present incidentally with hemoptysis or following rupture. This systematic review and pooled analysis examined their clinical presentation, diagnostic assessment, management, and reported outcomes. Materials and Methods: PubMed, Embase, and the Cochrane Library were searched for case reports and case series published between January 2000 and December 2025. Studies reporting patients with BAA or BAP and sufficient clinical information were included, following the modified PRISMA guidelines. Results: Of 1431 identified records, 152 studies comprising 170 patients were included. Overall, 80% of patients were symptomatic, and most aneurysms were solitary and mediastinal. Rupture was reported in 28.4% of published cases. Endovascular treatment was the most frequently reported approach (83.7%). Technical success was achieved in 94.6% of cases overall and in 93.9% of endovascular procedures. Exploratory univariable analyses identified no significant association between technical success and treatment modality (p > 0.05). Reported complication rates were similar following endovascular and open treatment (3.8%, vs. 4.5%, p = 1.000). Conclusions: Rupture was frequently described among published BAA and BAP cases and endovascular treatment was the most commonly reported management strategy, with high observed success and few complications. However, the case-based evidence and associated selection and reporting biases, limit comparative or causal conclusions. Standardized outcome definitions, improved reporting, and multicenter registries are needed to clarify natural history and inform management strategies.