Annals of Vascular Diseases (AVD) is an international, peer-reviewed, open access journal publishing articles on vascular disease. Published continuously online, the journal is fully indexed in J-STAGE and PubMed Central. AVD welcomes submissions from around the world.
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The licensing policy for our journal has been updated. Starting from January 1, 2025, newly published articles will generally be licensed under the CC BY (Attribution) license.
– Articles published on or after January 1, 2025: Licensed under CC BY (Attribution).
– Articles published before January 1, 2025: Retain their original license, CC BY-NC-SA (Attribution-NonCommercial-ShareAlike).
– Secondary publications (e.g., translations) may follow the licensing terms of the primary publication.
For more details, please refer to the “Copyright, Open Access and Fees” section of the Instructions to Authors.
About the journal
AVD is an official journal of Asian Society for Vascular Surgery (ASVS) and Asian Venous Forum, sponsored by Japanese College of Angiology, Japanese Society for Vascular Surgery and the Japanese Society of Phlebology.
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Editorial Committee of Annals of Vascular Diseases
c/o Academy Center, Yamabuki-cho 358-5, Shinjuku-ku, Tokyo 162-0801, Japan
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Latest articles
Original ArticleFebruary 7, 2026
Cost Analysis of Abdominal Aortic Aneurysm Repair: The Economic Impact of Rising Surgical Material Costs on Public Health Insurance
Etsuji Umeda, Kiyoshi Doi, Osamu Sakai, Takayoshi Kato, Hiroki Ogura, Masayuki Sato
Objectives: We conducted a detailed comparison of inpatient medical costs between endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) for abdominal aortic aneurysms.
Methods: We evaluated 312 EVAR and 205 OAR cases performed at our institution between January 2007 and December 2017. Patient background characteristics were adjusted between the EVAR and OAR groups using propensity score matching (PSM). Surgical outcomes and inpatient medical costs were compared.
Results: After PSM, 161 cases were included in each group for comparison. Operative time, blood loss, intensive care unit (ICU) stay, and hospital stay were significantly lower in the EVAR group than in the OAR group. Total inpatient medical costs were significantly higher in the EVAR group (3111× 103 vs. 2156 × 103 JPY [Japanese yen], p <0.01). The surgical material costs in the EVAR group were significantly higher than those in the OAR group, accounting for 58% of total medical expenses. Other costs (diagnosis procedure combination, ICU management, surgical procedure, transfusion, intraoperative injection, and room) were all lower in the EVAR group than in the OAR group.
Conclusions: The cost-saving effects of EVAR, such as reduced transfusion costs and ICU stay fees, were offset by the significantly higher cost of surgical materials.
Review ArticleFebruary 7, 2026
Physician-Modified Endografts for Complex Aortic Aneurysms in Japan: Current Status, Clinical Outcomes, and Guideline Integration
Tsuyoshi Shibata, Yutaka Iba, Shingo Tsushima, Tomohiro Nakajima, Junji Nakazawa, Ayaka Arihara, Kenichi Kato, Shigeki Komatsu, Masato Yonemori, Kenta Yoshikawa, Shun Hayasaka, Hirokazu Sugiura, Hajime Maeda, Nobuyoshi Kawaharada
In Japan, the absence of commercially available fenestrated and/or branched endografts has necessitated widespread adoption of physician-modified endografts (PMEGs) for complex aortic aneurysms. This paper compares PMEG use in Western countries and Japan, summarizes multicenter outcome data, and highlights the gap between real-world practice and current Japanese aortic disease guidelines. Recent Japanese series report high technical success and acceptable mid-term outcomes, comparable to Western reports. While long-term durability remains uncertain, structured training, national registries, and standardized protocols are essential. Guideline acknowledgment of PMEGs could improve safety, consistency, and international alignment in complex endovascular therapy. Establishing structured training, national registries, and evidence-based policy recognition of PMEGs is essential to ensure safe and standardized practice in Japan.
Case ReportFebruary 6, 2026
Thoracic Endovascular Aortic Repair with Reverse Aortic Arch Debranching Technique for Ascending Aortic Pseudoaneurysm
Hiroki Tada, Keiwa Kin, Tsubasa Mikami, Kazuma Handa, Junya Yokoyama, Yukitoshi Shirakawa
Ascending aortic pseudoaneurysm is a rare but life-threatening complication after cardiac surgery, typically requiring redo open repair with substantial risk. We report a 58-year-old male with an incidental 85-mm ascending pseudoaneurysm discovered during evaluation for recurrent hepatocellular carcinoma. Due to prior sternotomy, cirrhosis, and urgent oncologic need, open surgery was deemed prohibitive. He successfully underwent thoracic endovascular repair with reverse extra-anatomical aortic arch debranching technique. He recovered uneventfully and proceeded to cancer treatment without delay. This case highlights the feasibility of hybrid endovascular strategies for ascending aortic pathology in high-risk patients.
Original ArticleFebruary 5, 2026
Prediction of Functional Outcomes at Discharge Using Plasma Concentration of von Willebrand Factor Antigen at Admission in Hospitalized Patients with COVID-19
Masayuki Oki, Daisuke Yamasawa, Shinichi Goto, Hidetaka Yanagi, Saki Manabe, Takako Kobayashi, Ayumi Tsuda, Shota Sato, Seiji Morita, Yoshihide Nakagawa, Tsuyoshi Oguma, Koichiro Asano, Norio Yamamoto, Hideki Ozawa, Shinya Goto
Objectives: Coronavirus disease 2019 (COVID-19) causes endothelial injury through inflammatory and hypoxic stress, leading to vascular dysfunction and immunothrombosis. The plasma level of von Willebrand factor (VWF) could serve as a biomarker of vascular injury. While elevated VWF predicts mortality in severe COVID-19, its relationship with post-discharge functional outcomes remains unclear. This study aimed to determine whether plasma VWF antigen (VWF:Ag) levels at admission predict functional status at discharge in patients hospitalized for COVID-19.
Methods: This was a single-center prospective cohort study conducted at Tokai University Hospital from July to September 2021. We evaluated the relationship between plasma VWF:Ag levels at admission and a Clinical Frailty Scale (CFS) score ≥4 at discharge using univariable and multivariable logistic regression analyses.
Results: A total of 97 patients were enrolled in the study. The median VWF:Ag level at admission was 330.0% (95% confidence interval [CI]: 273.0–391.8). Univariable analysis showed a significant association between elevated VWF:Ag levels and CFS score ≥4 at discharge. This association remained significant after adjusting for age and sex (odds ratio 1.010, 95% CI: 1.000–1.010, p = 0.005).
Conclusion: Elevated VWF:Ag levels at admission predict poor functional outcomes at discharge in COVID-19 patients, independent of age and sex.
Original ArticleFebruary 4, 2026
Clinical Impact of Familial Hypercholesterolemia on Lower Extremity Artery Disease in Premature Patients
Eisaku Ito, Takao Ohki, Hiroshi Yoshida, Kenjiro Kaneko
Objectives: Familial hypercholesterolemia (FH) accelerates systemic atherosclerosis and worsens prognosis from youth. While present in 5%–10% of premature coronary artery disease (pCAD) cases, its prevalence and impact in lower extremity artery disease (LEAD) remain unclear. This study investigated FH prevalence and prognostic impact in premature LEAD (pLEAD).
Methods: We retrospectively analyzed LEAD patients aged ≤70 years undergoing first revascularization. FH was diagnosed according to the 2022 Japan Atherosclerosis Society Guidelines, based on dyslipidemia and Achilles tendon thickness. Primary outcomes were survival, amputation-free rate, and secondary intervention-free rate.
Results: Among 66 pLEAD patients (median age 66 years, 76% male), 10 (15%) met the FH criteria. Compared with non-FH patients, FH patients more frequently presented with chronic limb-threatening ischemia (CLTI) (90% vs. 36%, p = 0.001), bilateral lesions (100% vs. 36%, p <0.001), and dialysis dependence (90% vs. 25%, p <0.001). Three-year survival (28% vs. 90%, p <0.001), amputation-free rate (64% vs. 89%, p = 0.028), and secondary intervention-free rate (38% vs. 63%, p = 0.031) were significantly lower in FH patients. In the CLTI subgroup, survival was markedly reduced in FH (17% vs. 71%, p = 0.011).
Conclusions: FH was present in 15% of pLEAD patients and associated with poor outcomes. Routine FH screening, including pCAD history and Achilles tendon evaluation, may improve prognosis.
Original ArticleJanuary 29, 2026
Short- and Mid-Term Outcomes of Bovine Pericardial Patch vs. Saphenous Vein Patch in Femoral Endarterectomy
Takashi Harada, Daisuke Futagami, Yuki Echie, Saeki Watanabe, Hironobu Morimoto, Keijiro Katayama, Shogo Mukai, Masahito Taniguchi
Objectives: Femoral endarterectomy often requires patch angioplasty, and saphenous vein patch (SVP) was the standard. However, bovine pericardial patch (BPP) provides potential advantages, including no requirement for vein harvest, use of the access site for concomitant endovascular procedures, and favorable handling characteristics. We compared the short- and mid-term outcomes of BPP and SVP in femoral endarterectomy.
Methods: This retrospective, single-center study included 42 patients (49 limbs) who underwent elective femoral endarterectomy with patch closure between September 2016 and January 2025. The patients were grouped by patch type as follows: 28 limbs with BPP and 21 limbs with SVP. Primary endpoints included patency and freedom from target lesion revascularization at the endarterectomy site. Secondary endpoints included perioperative complications, limb salvage, and intraoperative arterial clamp time.
Results: No patch-site restenosis or re-intervention occurred in either group. There were no patch infections, and the perioperative complications were similar. Limb salvage at 40 months was 87.5% with BPP vs. 95.0% with SVP (p = 0.42). Intraoperative arterial clamp time was significantly shorter in the BPP group (55.0 vs. 69.5 min, p = 0.01).
Conclusions: BPP represents a safe and valuable alternative option for femoral endarterectomy.
Featured articles
GuidelineJune 6, 2025
Supplement of Clinical Practice Guidelines for Endovenous Thermal Ablation for Varicose Veins 2019: Laser Ablation of Varicose Tributaries
Masayuki Hirokawa, Junichi Utoh, Satoru Sugiyama, Osamu Suzuki, Takashi Yamamoto, Tomohiro Ogawa, Makoto Mo, on behalf of the Guideline Committee, Japanese Society of Phlebology
In the treatment of saphenous varicose veins with endovenous laser ablation, simultaneous treatment of varicose tributaries using stab avulsion or sclerotherapy is commonly performed. To address the limitations of these conventional treatments, laser ablation for varicose tributaries has recently gained widespread acceptance. This guideline, developed by the Japanese Society of Phlebology, outlines appropriate treatment protocols for laser ablation of varicose tributaries. Indications include primary varicose veins requiring concurrent treatment of the saphenous trunk and varicose tributaries. The procedure utilizes slim radial fibers, with puncture and ablation performed using either short- or long-axis approaches. Although rare, adverse events such as skin burns, nerve injury, and fiber breakage have been reported. A learning curve is necessary to ensure the safe execution of the procedure. Further clinical studies are essential to enhance the safety and efficacy of laser ablation for varicose tributaries. (This is a secondary publication from Jpn J Phlebol 2025; 36: 51–58.)
Overview of type 2 endoleak following endovascular aneurysm repairMarch 25, 2023
Surgical Treatment of Sac Enlargement Due to Type II Endoleaks Following Endovascular Aneurysm Repair
Seiji Onitsuka, Hiroyuki Ito
An aneurysm sac enlargement caused by type II endoleak (T2EL) following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms may cause serious complications such as rupture. Consequently, methods that preoperatively prevent or postoperatively treat T2EL have been employed.
Therapeutic Angiogenes UpdateDecember 25, 2022
Therapeutic Angiogenesis Using Autologous CD34-Positive Cells for Vascular Diseases
Yasuyuki Fujita, Atsuhiko Kawamoto
CD34 is a cell surface marker, which is expressed in various somatic stem/progenitor cells such as bone marrow (BM)-derived hematopoietic stem cells and endothelial progenitor cells (EPCs), skeletal muscle satellite cells, epithelial hair follicle stem cells, and adipose tissue mesenchymal stem cells. CD34+ cells in BM and peripheral blood are known as a rich source of EPCs.
Updates on Image Diagnosis in Aortic DiseaseDecember 25, 2018
Update on Cardiovascular Echo in Aortic Aneurysm and Dissection
Kazuhiro Nishigami
The majority of aortic aneurysms comorbid with atherosclerosis can be asymptomatic and are discovered incidentally on routine physical examination or on imaging studies for other indications. Transthoracic echocardiography is a basic modality to assess patients with coronary artery disease and can be used for the screening of aortic aneurysm. Acute aortic dissection is a highly lethal cardiovascular emergency and requires prompt recognition. Although cardiovascular echo has a suboptimal accuracy rate for detecting aortic dissection, it is noninvasive, readily available, and easy to use. Recently, the concept of point-of-care ultrasound (POCUS) refers to ...
Updates on Image Diagnosis in Aortic DiseaseSeptember 25, 2019
Updates on Ultrasonography Imaging in Abdominal Aortic Aneurysm
Shinichi Iwakoshi, Toshiko Hirai, Kimihiko Kichikawa
Abdominal aortic aneurysms (AAAs) are life-threatening and are associated with >80% mortality when they rupture. Therefore, detecting these aneurysms before they rupture is critical. Ultrasonography is a non-invasive tool that is used for screening AAAs by measuring abdominal aorta diameter. A recent meta-analysis demonstrated the positive effects of ultrasonography. To date, aneurysm diameter is the most reliable predictor for aneurysm rupture and is used as a criterion for surgical intervention. However, some AAAs rupture at small diameters. Therefore, a better predictor for AAA rupture that is independent of aneurysm diameter is needed. Recently, an aortic wall strain examined using ultrasonography has been reported to have a potential in predicting AAA rupture....
Updates on Image Diagnosis in Aortic DiseaseMarch 25, 2020
Updates on Computed Tomography Imaging in Aortic Aneurysms and Dissection
Ryoichi Tanaka, Kunihiro Yoshioka, Akihiko Abiko
Computed tomography (CT) is a primary imaging modality for the diagnosis of aortic diseases, because of its minimal invasiveness and agility. Prompt and accurate diagnosis is crucial especially for acute aortic diseases, and the guidelines for acute aortic dissection recommend the use of CT for initial diagnosis. For the follow-up observation of longstanding aortic diseases, the strategy of imaging management by CT must be different from that for emergency and acute phases. In this review, we document the differences in characteristics and clinical course between aortic aneurysm and aortic dissection and explain the use of recent CT techniques in diagnosing short- and longstanding aortic diseases.