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In clinical practice, a subset of patients with severe carotid artery stenosis fails to achieve the expected improvement in cerebral perfusion despite successful carotid revascularization and restoration of arterial patency. In these patients, cerebral ischemic symptoms persist or even deteriorate, reflecting a mismatch between macrovascular recanalization and cerebral tissue perfusion. This phenomenon is referred to as cerebral hypoperfusion syndrome (CHypoS). The pathogenesis of CHypoS is likely multifactorial, involving unfavorable cerebrovascular anatomy, persistent hemodynamic impairment, cerebrovascular vasoconstriction, and microcirculatory dysfunction, all of which may increase the risk of recurrent ischemic stroke. Currently, there is no universally accepted diagnostic criterion for CHypoS, and high-quality evidence to guide its management remains lacking. Consequently, current treatment strategies rely largely on empirical hemodynamic optimization. Future studies should focus on elucidating the underlying pathophysiological mechanisms of CHypoS and shifting the therapeutic goal of carotid revascularization from achieving anatomical vessel patency to restoring effective cerebral perfusion and improving clinically meaningful outcomes, thereby enhancing stroke prevention and long-term prognosis.

To investigate the predictive value of preoperative levator ani complex volume measured by magnetic resonance imaging for severe low anterior resection syndrome after intersphincteric resection, and to develop a nomogram prediction model.

This is a retrospective case series study. Clinical data of 134 patients who underwent intersphincteric resection for low rectal cancer at Shaanxi Provincial People′s Hospital from January 2016 to December 2023, and 43 patients from the First Affiliated Hospital of Air Force Medical University from January 2021 to December 2022, were retrospectively collected. The cohort included 110 males and 67 females, with an age of (64.7±8.6) years(range:32 to 78 years). Patients from Shaanxi Provincial People′s Hospital were randomly divided into a training cohort (94 cases) and an internal validation cohort (40 cases) in a 7∶3 ratio using computer-generated random numbers, while 43 patients from the First Affiliated Hospital of Air Force Medical University served as the external validation cohort. Clinical data were collected, and the volumes of defecation-related muscles, including the levator ani complex, were segmented and normalized using 3D Slicer software based on preoperative magnetic resonance imaging. Severe low anterior resection syndrome was defined as a low anterior resection syndrome score≥30 at six months after stoma closure. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for severe low anterior resection syndrome, and a nomogram model was established. Model performance was evaluated by receiver operating characteristic curve, calibration curve, and decision curve analysis.

In the training cohort of 94 patients, 41 (43.6%) developed severe low anterior resection syndrome. Multivariate analysis revealed that preoperative chemoradiotherapy (OR=4.901, 95%CI:1.806 to 13.300, P=0.002), total intersphincteric resection (versus partial intersphincteric resection, OR=7.001, 95%CI:1.679 to 29.197, P=0.008), and smaller normalized levator ani complex volume (OR=0.665, 95%CI:0.458 to 0.964, P=0.032) were independent risk factors for postoperative severe low anterior resection syndrome. The nomogram model achieved an area under the receiver operating characteristic curve of 0.778 in the training cohort, which was 0.761 after 1 000 Bootstrap corrections; the area under the curve was 0.759 in the internal validation cohort and 0.707 in the external validation cohort. The calibration curves demonstrated good agreement between predicted and observed probabilities, and decision curve analysis indicated clinical net benefit.

Levator ani complex volume, preoperative chemoradiotherapy, and ISR classification are independent predictors of severe low anterior resection syndrome after intersphincteric resection. The nomogram model constructed based on these factors exhibits favorable predictive performance and may assist in preoperative risk assessment.

To investigate the differences in clinical characteristics and prognosis between pancreatic ductal adenocarcinoma (PDAC) patients with and without concurrent acute pancreatitis (AP),and to analyze the impact of AP on the survival of PDAC patients.

This is a retrospective case-control study. Clinical data of 1 030 patients with PDAC admitted to Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi′an Jiaotong University from January 2019 to December 2023 were collected. There were 578 males and 452 females, with an age of (62.2±9.7) years (range: 31 to 90 years). Patients were divided into an AP group (n=92) and a non-AP group (n=938) based on whether they had concomitant AP. In the AP group, there were 56 males (60.9%) and 36 females (39.1%); in the non-AP group, there were 522 males (55.7%) and 416 females (44.3%). A 1︰2 propensity score matching (PSM) method was used to match the clinical data of the two groups to control for baseline confounders. Subgroup analyses were performed based on whether patients underwent radical surgery and whether they received chemotherapy. Survival curves before and after PSM were plotted using the Kaplan-Meier method, and the Log-rank test was used to compare the overall survival (OS) time between the two groups.

Survival analysis showed that, both before and after PSM, there was no statistically significant difference in OS between the AP group and the non-AP group (both P>0.05). Subgroup analysis results revealed that there was no statistically significant difference in OS between the two groups across all subgroups (all P>0.05). When stratified by whether patients received radical surgery,among those who underwent surgery,patients in the AP group were younger than those in the non-AP group,had a higher proportion of N0 stage,a higher proportion of tumors located in the body and tail of the pancreas,and lower levels of AST, alkaline phosphatase, GGT, direct bilirubin, and preoperative carcinoembryonic antigen compared to the non-AP group (all P<0.05). Among patients who did not undergo surgery, the AP group had a higher proportion of T1 stage (P<0.05), while no statistically significant differences were observed for other variables (all P>0.05). Patients in both groups who received radical surgery and concurrent chemotherapy had the best prognosis,while those who did not receive surgery or chemotherapy had the worst prognosis (P<0.05).

The presence of AP is not an independent predictor for long-term survival in PDAC patients; yet, among those undergoing radical surgery, PDAC patients with AP are younger, have earlier N stage, and show lower liver function and carcinoembryonic antigen levels.

To evaluate the efficacy of percutaneous mechanical thrombectomy combined with transjugular intrahepatic portosystemic shunt (PMT-TIPS) in patients with acute non-cirrhotic portal vein thrombosis (NCPVT).

This is a retrospective case series study. The clinical data of 61 patients with acute NCPVT who underwent PMT combined with TIPS at Department of Endovascular Surgery, the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2023 were retrospectively analyzed. There were 39 males and 22 females, with an age (M(IQR) of 49.0(24.5)years (range:21 to 73 years). Paired sample t-test or Wilcoxon signed-rank test were used to compare liver volume and biochemical parameters before treatment and at 1 year after treatment. Independent sample t-test was used to compare changes in liver volume between patients with different stent patency statuses. Kaplan-Meier analysis was used to estimate stent patency and symptom recurrence. Univariate and multivariate Cox proportional hazards regression models were used to analyze the factors associated with stent occlusion.

Among the 61 patients, 7 (11.5%) died during hospitalization and 5 (8.2%) died within 30 days after discharge, most commonly due to bowel necrosis. The remaining 49 patients were followed up for 43(34) months (range:4 to 94 months). During follow-up, stent occlusion occurred in 35 patients (71.4%), with a median primary patency of 13.0 months (95%CI: 7.3 to 18.7). Among the 35 patients with primary stent occlusion, 21 developed symptom recurrence, whereas symptom recurrence occurred in 4 of the 14 patients with sustained patency. Ten patients with stent occlusion underwent stent recanalization, with a median secondary patency of 21.0 months (95%CI: 16.8 to 25.2 months). Univariate Cox regression analysis showed that myeloproliferative neoplasms (HR=3.08, 95%CI: 1.48 to 6.42, P=0.003) and dual-stent implantation (HR=2.26, 95%CI: 1.09 to 4.70, P=0.036) were associated with an increased risk of stent occlusion (both P<0.05); multivariate Cox regression further revealed that only myeloproliferative neoplasms (HR=2.75, 95%CI: 1.31 to 5.78, P=0.008) was an independent risk factor. At one year post-procedure, inflammatory and coagulation markers improved, total liver volume decreased compared with baseline (P=0.005), and the reduction in liver volume was greater in patients with patent stents than in those with stent occlusion ((-215.6±205.5)cm³ vs.(-3.5±236.5) cm³,t=-3.505,P=0.001).

In patients with acute NCPVT, the PMT-TIPS technique is feasible, but long-term stent patency is limited. This technique can be used as a rescue strategy rather than a definitive treatment.

To explore the hemodynamic characteristics of multichanneled aortic dissection (MCAD).

This is a retrospective cohort study. Patients with acute uncomplicated Stanford-type B aortic dissection who presented at Zhongshan Hospital, Fudan University between January 2019 and December 2023 were enrolled. Patients were diagnosed as having either double-channeled aortic dissection (DCAD) or MCAD based on preoperative standardized computed-tomography angiography (CTA). Centered on 4 MCAD cases with preprocedural death, 4 non-preprocedural-death MCAD patients and 4 non-preprocedural-death DCAD patients with balanced baseline characteristics, complete preoperative CTA datasets and well-defined outcomes were matched, yielding a total of 12 male patients. The ages of patients in preprocedural-death MCAD group, non-preprocedural-death MCAD group and non-preprocedural- death DCAD group were (62.0±5.7) years (range:54 to 66 years), (61.5±5.8) years (range:54 to 67 years) and (61.3±8.1) years (range:52 to 71 years), respectively. Using computational fluid dynamics (CFD) and patient-specific aortic models, preoperative hemodynamic indices were quantitatively analyzed, including blood flow velocity, pressure distribution, flow distribution, wall shear stress (WSS) and time-averaged wall shear stress (TAWSS).

Hemodynamic analyses revealed a stepwise decreasing trend of false lumen (FL) flow rate across the three groups. The preoperative death MCAD group exhibited a significantly higher FL flow ((62.81±7.59)ml/s (range: 56.29 to 73.78 ml/s)) than the non-preoperative death MCAD group ((24.84±9.25)ml/s (range: 17.23 to 36.84 ml/s)) and the non-preoperative death DCAD group ((11.86±5.62)ml/s (range: 6.72 to 19.84 ml/s)). The intergroup variation patterns of FL flow ratio and maximum FL TAWSS were highly consistent. The preoperative death MCAD group yielded values of 0.77±0.16 (range: 0.56 to 0.93) and (34.44±6.50)Pa (range: 27.54 to 41.38 Pa),which were elevated compared with the non-preoperative death MCAD group (0.44±0.17(range: 0.33 to 0.70), (15.46±7.75)Pa (range: 6.69 to 25.01 Pa)) and the non-preoperative death DCAD group (0.22±0.11(range: 0.14 to 0.37), (20.80±7.34)Pa (range: 15.23 to 31.60 Pa)),whereas no obvious disparities were observed between the latter two groups. In addition,the maximum FL WSS in the preoperative death MCAD group reached (125.76±26.57)Pa (range: 87.55 to 147.91 Pa),markedly exceeding that of the non-preoperative death MCAD group ((64.89±30.45)Pa (range: 28.62 to 102.40 Pa)) and the non-preoperative death DCAD group ((91.15±28.16)Pa (range: 61.51 to 126.41 Pa)).

Elevated FL flow and abnormally high shear stress may correlate with poor outcomes in patients with MCAD,and these parameters could serve as potential biomechanical biomarkers. CFD simulation can act as an auxiliary tool to identify high-risk aortic dissection patients,which helps refine clinical management and facilitate individualized precision treatment for MCAD.

To develop a segmentation-guided multitask deep learning model for Society for Vascular Surgery (SVS) grades Ⅰ to Ⅳ classification of blunt thoracic aortic injury (BTAI) and validate its clinical utility for differentiating SVS grades Ⅱ and Ⅲ.

This is a retrospective case series study. Computed tomography angiography (CTA) data were collected from 317 patients with BTAI at 12 hospitals in China, including the First Medical Center of Chinese People′s Liberation Army General Hospital, West China Hospital of Sichuan University, the First Affiliated Hospital of Zhengzhou University, the Affiliated Hospital of Southwest Medical University, and other local hospitals, between January 2006 and May 2026. The cohort included 258 male and 59 female patients, with an age of (54.8±15.3) years (range:16 to 92 years). The 253-patient development cohort was divided using a patient-level random split stratified by SVS injury grade and source center at an approximate ratio of 8∶2 into a training set of 202 patients and an internal validation set of 51 patients. The 64 BTAI cases from the Affiliated Hospital of Southwest Medical University were locked in advance as an independent external test set. The model consisted of a shared encoder, a lesion-segmentation branch, and a mask-guided classification branch. The primary outcomes were the area under the receiver operating characteristic curve (AUC) and grade Ⅲ sensitivity for differentiating SVS grade Ⅱ (intramural hematoma) from grade Ⅲ (pseudoaneurysm) in the external test set. Secondary outcomes included segmentation, automated measurements, and offline reader-study results.

The internal validation set covered SVS grades Ⅰ to Ⅳ, with an overall grading accuracy of 92.2% (47/51) and a macro-averaged F1 score of 0.919. The external test set included 31 SVS grade Ⅱ (intramural hematoma) cases and 33 SVS grade Ⅲ (pseudoaneurysm) cases. The model had an AUC of 0.968 (95%CI:0.924 to 0.996), an accuracy of 92.2% (59/64), grade Ⅲ sensitivity of 93.9% (31/33), and grade Ⅱ specificity of 90.3% (28/31); two grade Ⅲ cases were misclassified as grade Ⅱ. The automated segmentation success rate was 96.9% (62/64), the overall lesion Dice similarity coefficient was 0.872±0.072 (range:0.46 to 0.99), and model inference time per case was (15.4±2.4) s (range:10.8 to 22.6 s). In the fixed-sequence reader study, six junior physicians had higher grade Ⅱ/Ⅲ accuracy and grade Ⅲ sensitivity and shorter interpretation times during the artificial intelligence-assisted phase than during the unaided phase.

The segmentation-guided CTA deep learning model developed in this study performed BTAI lesion segmentation, SVS grading, and measurement of key morphologic parameters, and maintained good discrimination between SVS grades Ⅱ and Ⅲ in the independent external test set. Model assistance may help reduce missed grade Ⅲ cases by junior physicians and shorten interpretation time, thereby supporting standardized imaging assessment of BTAI.

The International Society for the Study of Vascular Anomalies (ISSVA) classification is an internationally accepted framework for the diagnosis and communication of vascular tumors and vascular malformations. Since the tumor-versus-malformation dichotomy was established in 1996, the classification underwent major revisions in 2014 and 2018. In June 2025, the ISSVA Classification Group published an updated classification in the Journal of Vascular Anomalies and positioned it as a continuously updated “living document”, representing the most substantial revision to date. Key updates include: at the top level, the new category “potentially unique vascular anomaly” replaces the former “provisionally unclassified vascular anomalies”; a two-tier structure comprising a landing page and a full classification table is introduced, together with an independent glossary; for vascular malformations, vessel type (simple versus combined) is no longer the primary organizing criterion, and the classification is now organized by flow velocity (fast-flow versus slow-flow) together with developmental anomalies of named vessels; and molecular genetic information has been systematically incorporated. Using the 2018 version as a reference, this article reviews the key updates of the 2025 version and interprets them in the context of advances in molecular genetics, targeted therapy, and the practice of vascular anomaly diagnosis and treatment in China, aiming to provide a reference for standardized diagnosis, multidisciplinary communication, and individualized treatment decisions.

Standard endovascular aortic repair has been widely used for the treatment of abdominal aortic aneurysms and selected complex aortic diseases because of its minimally invasive nature, rapid recovery, and favorable perioperative safety profile. However, in hostile aortic landing zones characterized by a short neck, severe angulation, conical neck configuration, mural thrombus, or circumferential calcification, standard endovascular repair remains associated with inadequate proximal apposition, type I endoleak, endograft migration, and secondary intervention. Manual deployment techniques, including the push-up technique, reverse slider technique, Kabedon technique, and stepwise controlled deployment, may improve endograft axial alignment, proximal edge positioning, and local wall apposition to some extent; however, their role is mainly limited to optimization of the deployment process and cannot replace the principle of a durable sealing zone. This review summarizes the anatomical characteristics of hostile aortic landing zones, the mechanisms and clinical evidence of manual deployment techniques, the standardized value of fenestrated/branched endovascular aortic repair and physician-modified endografts, adjunctive fixation and intraoperative bailout techniques, and application scenarios in emergency repair of ruptured abdominal aortic aneurysms. The aim is to provide a practical reference for rational selection between optimized deployment of standard endografts and complex sealing-zone reconstruction in complex endovascular aortic repair.

Chronic limb-threatening ischemia (CLTI) represents the end stage of lower extremity arterial disease and is associated with high rates of disability and mortality. With the rapid advancement of endovascular techniques, an “endovascular-first” strategy has become widely adopted. However, for patients with complex, long-segment, heavily calcified, diffuse, inflammatory lesions, or those with repeated endovascular failure, distal bypass surgery remains an indispensable option for limb salvage. The success of distal bypass depends not only on advanced surgical expertise but also on appropriate patient selection, accurate assessment of inflow and outflow tracts, optimal conduit choice, and meticulous perioperative management. Based on recent international guidelines and clinical evidence, this review focuses on key technical aspects of distal bypass, including inflow selection, target artery assessment, conduit selection, graft tunneling, distal anastomosis, intraoperative flow assessment, postoperative antithrombotic therapy and wound management. It also discusses the appropriate role of these techniques in the comprehensive treatment of CLTI based on recent evidence-based medical findings. In addition, emerging developments such as alternative conduits, perfusion assessment technologies, and gene/cell therapy are discussed, aiming to provide insights into optimizing revascularization strategies for patients with CLTI.

Supra-aortic arch artery diseases,including lesions of the carotid,subclavian,and vertebral arteries,represent major causes of cerebral and upper extremity ischemia. The diagnostic and therapeutic strategies for these conditions are undergoing a profound transformation-from conventional open surgery toward minimally invasive endovascular treatment,and further to individualized precision medicine. Recent advances in imaging assessment have substantially improved lesion characterization and risk stratification. The iterative evolution of endovascular devices has enhanced procedural safety. Meanwhile,several topics have become research hotspots,the evidence-based comparison between transcarotid artery revascularization and transfemoral carotid stenting;the renewed pathophysiological understanding of subclavian steal syndrome and vertebral artery diseases;and the construction of individualized treatment decision-making frameworks. Nevertheless,current clinical practice still faces challenges such as controversies over optimal surgical approaches,insufficient prevention and management of complications,and a lack of robust long-term outcome data. From the perspective of vascular surgery,this article systematically reviews recent advances in endovascular devices,surgical techniques,and treatment concepts,aiming to provide front-line clinicians with up-to-date,practical,and actionable insights into the management of supra-aortic arch artery diseases.