Weekly vascular bulletin — September 21, 2026

Week of September 14–21, 2026. A slow week in the specialty press (Vascular News, Venous News, Endovascular Today and TCTMD published little of clinical substance) but an active one in the journals: almost everything below is an online publication from JVS, JVS-VL, EJVES, JET, CCI and Phlebology. Fourteen items are included; seven come from outside North America and Western Europe (Japan, Czechia, Italy, India, China, Saudi Arabia). Searches in Russian, Arabic, Turkish, Korean and Portuguese returned nothing verifiable and dated to this week; in Chinese and Japanese, what turned up is already captured below via PubMed.

1. Peripheral arterial disease, calcium and critical limb ischemia

JOKER: Jetstream atherectomy in calcified femoropopliteal lesions, 238 patients in Japan

[Publication] [Japan]
Retrospective study at four Japanese centers (Nov 2022–Oct 2024) of Jetstream rotational atherectomy (Boston Scientific) in calcified femoropopliteal lesions; mean age 75, more than a third on hemodialysis, drug-coated balloon added in 95.4%. Composite safety outcome 4.2%; 1-year primary patency 83.8% and freedom from target-lesion revascularization 91.1%. Independent predictors of loss of patency: non-de novo lesion, occlusion, smaller vessel diameter and smaller device size.
Why it matters: one of the largest Jetstream cohorts in severe calcium with a dialysis population, but with no control group and no comparison with IVL; 84% patency at one year is similar to DCB-only series, so it does not show an incremental benefit of atherectomy.
https://pubmed.ncbi.nlm.nih.gov/42736702/ (Catheter Cardiovasc Interv, Sep 14, 2026)

IVUS-defined circumferential calcification and minimal lumen area predict patency after DCB

[Publication] [Japan]
Exploratory subanalysis of 222 femoropopliteal lesions treated with DCB under IVUS guidance at 14 institutions (Kobata, Fukuoka University). One-year restenosis in 37 lesions (16.7%). IVUS-defined circumferential calcification was an independent predictor of loss of patency, while the angiographic calcium score lost significance in the adjusted model. Each 1 mm² less of minimal lumen area raised restenosis risk by 32%; heavily calcified lesions with adequate MLA reached 90.6% patency, close to mildly calcified ones.
Why it matters: supports the argument that the goal of plaque preparation (IVL, atherectomy, cutting balloon) is the acute lumen area measured by intravascular imaging, not the angiographic "look"; it is a retrospective subanalysis and does not compare preparation devices against each other.
https://pubmed.ncbi.nlm.nih.gov/42745693/ (Catheter Cardiovasc Interv, Sep 16, 2026)

BEST-CLI registry: 1 in 4 CLTI patients dies within the first year

[Publication] [USA]
Prospective registry at 40 BEST-CLI trial sites (2019–2023) of 1,009 CLTI patients, including those not eligible for revascularization; 34.5% women, 28.1% Black, 74.2% with tissue loss. At one year: death 25.6% (95% CI 22.3–29.1), MALE 17.0%, MALE or death 38.9%, major amputation 8.2%, any revascularization 20.6%, MACE 27.3%. No differences by race or sex.
Why it matters: the rates are clearly worse than in the randomized trial, which questions the generalizability of BEST-CLI to real-world CLTI and underlines that mortality, not the limb, dominates prognosis; multiple authors with industry ties, although the registry is descriptive.
https://pubmed.ncbi.nlm.nih.gov/42749068/ (J Vasc Surg, Sep 16, 2026)

PROSCAD-CLTI: SELUTION SLR sirolimus balloon in femoropopliteal CLTI

[Publication] [Italy]
Prospective single-center series (Palermo) of 24 CLTI patients with 152 ± 55 mm femoropopliteal lesions treated with the SELUTION SLR sirolimus balloon (MedAlliance), Oct 2022–Jul 2024, excluding occlusions > 25 cm. Technical success 100%; one early death on day 3 from pre-existing heart failure. At 30 months: primary patency 95.5% and freedom from major amputation 95.7%.
Why it matters: with 24 patients nothing can be concluded about safety or efficacy, but it keeps alive the interest in peripheral sirolimus as an alternative to paclitaxel; no visible conflict-of-interest statement and the device is named by brand, which calls for a cautious reading.
https://pubmed.ncbi.nlm.nih.gov/42751879/ (J Endovasc Ther, Sep 17, 2026)

Femoropopliteal claudication: endovascular and bypass with similar 5-year outcomes (Medicare)

[Publication] [USA]
Analysis of VQI data linked to Medicare (Bellomo, Massachusetts General Hospital) comparing 720 bypasses with 3,259 endovascular interventions as the index procedure in claudicants, with propensity matching (demographics, comorbidity, center volume). At 5 years, MALE and progression to CLTI were similar between groups.
Why it matters: reinforces current practice of treating femoropopliteal claudication endovascularly in well-selected patients, although matching does not remove indication bias and the abstract gives no absolute figures.
https://pubmed.ncbi.nlm.nih.gov/42733139/ (Ann Surg, Sep 14, 2026)

2. Venous disease

PRAGUE-26: catheter-directed thrombolysis reduces early decompensation in intermediate-high-risk PE

[Clinical trial] [Czechia]
Academic open-label randomized trial at 11 Czech centers with 558 patients with intermediate-high-risk pulmonary embolism: conventional catheter-directed thrombolysis (1 mg alteplase bolus and 1 mg/h for 9 h via pulmonary artery, no ultrasound) plus anticoagulation versus anticoagulation alone. Primary outcome at 7 days (death, recurrence or cardiorespiratory decompensation): 0.7% vs 6.8% (RR 0.10; 95% CI 0.02–0.44), driven by decompensation (0.7% vs 5.4%). Clinically relevant bleeding 4.6% vs 5.0%; intracranial hemorrhage 2 cases vs 0. Published in NEJM and presented at ESC on August 31; TCTMD coverage on September 14.
Why it matters: the first randomized trial with clinical outcomes favoring catheter-directed thrombolysis, publicly funded and without a proprietary device, but it is open-label, with very few events and near-zero mortality; discussant Irene Lang asked to wait for PEITHO-3 before adopting it as first line. Included outside the 7-day window because of its weight.
https://www.tctmd.com/news/prague-26-catheter-directed-thrombolysis-beneficial-intermediate-high-risk-pe · ESC press release (https://www.escardio.org/news/press/press-releases/positive-news-for-the-treatment-of-pulmonary-embolism/)

VQI: 2014–2025 benchmarks in varicose vein treatment; thermal ablation still performs better

[Publication] [USA]
VQI varicose vein registry (Ochoa Chaar, Yale): 44,883 patients and 71,889 procedures. Thermal ablation fell from 91.5% to 53.0% of procedures and non-thermal rose from 0 to 30.9% (p < 0.001). In 23,598 patients with initial truncal ablation (92.9% thermal, 7.1% non-thermal), thermal achieved greater improvement in VCSS (−4.3 vs −3.2) and HASTI (−6.9 vs −3.8), and a higher proportion of improvement (VCSS 83.9% vs 74.6%); systemic complications 0.3% vs 0.7%.
Why it matters: this is the reference standard against which any new saphenous occlusion technique will have to be compared; the groups differ at baseline (non-thermal has more ulcers and more non-great-saphenous veins) and the lead author declares consulting and support from Medtronic, Boston Scientific and others.
https://pubmed.ncbi.nlm.nih.gov/42753971/ (JVS-VL, Sep 17, 2026)

Excluded-saphenous technique: 6% recanalization at 5 years without full saphenous ablation

[Publication] [Italy]
Retrospective series on a prospective base (Pagano, Andrea Tortora Hospital, Pagani) of C2 patients with great saphenous reflux treated in 2017–2019 with selective crossectomy, distal saphenous ligation at the level of the incompetent thigh tributary, catheter-directed foam sclerotherapy of the excluded segment and phlebectomy, all as day surgery. 239 patients and 349 limbs with full 5-year follow-up; median saphenous diameter 11 mm. Recanalization of the excluded segment 22/349 limbs (6.3%); varicose vein recurrence 24.7%; persistent dyschromia 2.1%; superficial vein thrombosis 2.1%; no DVT or PE.
Why it matters: long-term evidence that segmental saphenous occlusion by ligation plus foam, preserving the trunk, is durable, a direct benchmark for endovenous ligation devices; single-institution series, no comparator, and varicose recurrence in one of every four patients.
https://pubmed.ncbi.nlm.nih.gov/42765171/ (Vasc Specialist Int, Sep 21, 2026)

VELVERT: three-arm randomized trial in venous ulcer

[Clinical trial] [India]
Open-label, multicenter (Jhansi and Hyderabad), post-marketing trial of 66 patients with venous ulcer (61 completed) randomized to VELVERT dressing alone, VELVERT plus VELSOFT compression bandage, or the VELFOUR four-layer system, followed for 60 days. Mean area reduction: 57.7%, 67.0% and 65.8%; complete closure 36.4%, 50.0% and 42.1% (overall 42.6%); mild adverse events.
Why it matters: suggests that a single-layer compression system with an advanced dressing is not inferior to four layers, but with 20 patients per arm, no p values or CIs in the abstract and all three products from the same manufacturer, it is a hypothesis, not evidence.
https://pubmed.ncbi.nlm.nih.gov/42732804/ (JVS-VL, Sep 13, 2026)

Mechanical thrombectomy of post-thrombotic obstruction and venous ulcer healing

[Publication] [USA]
Multicenter retrospective series (Mouawad) of 22 patients, 29 limbs and 37 venous ulcers secondary to DVT (median duration 13 months; more than half after failed conservative care and three referred for amputation) treated in a single session with ClotTriever, ClotTriever BOLD, VenaCore or RevCore (Stryker/Inari), with venoplasty in 79% and stenting in 52%, no thrombolytics. Technical success 100%; at a median of 2.8 months all wounds healed or improved: 76% (19/25) fully closed and mean area reduction 91.4%.
Why it matters: reinforces the concept of treating outflow obstruction in refractory post-thrombotic ulcers, but it is a small, uncontrolled series with very short follow-up and centered on one manufacturer's devices.
https://pubmed.ncbi.nlm.nih.gov/42762889/ (JVS-VL, Sep 19, 2026)

AngioJet versus AcoStream in acute iliofemoral thrombosis: more hemolysis and more post-thrombotic syndrome with AngioJet

[Publication] [China]
Single-center retrospective case-control study (Shaanxi Provincial Hospital, Xi'an) of 243 patients with acute iliofemoral DVT treated with AngioJet (group A) or AcoStream (group B) and 36 months of follow-up. AngioJet aspirated faster (4.6 vs 5.9 min) but with more blood loss, higher urokinase dose and hematuria in 91.9% vs 0%. At 36 months: recurrence 8.9% vs 2.5% (p < 0.05) and post-thrombotic syndrome 34.95% vs 21.67% (p = 0.016).
Why it matters: points to a possible long-term cost of rheolytic hemolysis versus aspiration, but allocation was not random, urokinase differed between groups and AcoStream has almost no data outside China; no conflicts declared. (Source in English, Chinese group.)
https://pubmed.ncbi.nlm.nih.gov/42759096/ (Clinics, São Paulo, Sep 18, 2026)

Venoactive drugs after great saphenous radiofrequency ablation: fewer complications and better quality of life

[Publication] [China]
Retrospective cohort (Nanjing/Huai'an) of 500 patients undergoing great saphenous radiofrequency ablation (2022–2024), 250 with standard care and 250 with an added postoperative venoactive drug. Total complications 3.6% vs 12.8% (p < 0.05); lower VCSS at 1 week and 3 months, less pain (NRS) at 1 day, 1 week and 3 months, and higher CIVIQ at 3 months and 1 year.
Why it matters: consistent with the weak European guideline recommendation to add venoactives after ablation, but retrospective, unblinded, with only "p < 0.05" in the abstract and no drug specified. (Source in English, Chinese group.)
https://pubmed.ncbi.nlm.nih.gov/42758054/ (Phlebology, Sep 18, 2026)

3. Aorta and vascular access

Type Ia endoleak after EVAR: meta-analysis of 63 studies and 2,284 patients

[Meta-analysis] [Italy]
Systematic review (Parma) of 63 non-randomized studies on treatment of type Ia endoleak; mean EVAR-to-repair interval 47 months. Overall technical success 95.2% (95% CI 93.9–96.4) and clinical success 91.9%; early mortality 3.5%; sustained resolution 96.0% at 19 months. F/BEVAR was the most used option (n = 1,220; technical success 94.4%), followed by open conversion (94.7%), proximal extension (97.9%), chimneys (94.1%), embolization (95.4%) and endoanchors (76%).
Why it matters: confirms fenestrated/branched repair as the de facto standard and that endoanchors perform worse, but certainty of evidence is very low and the studies are heterogeneous and selected.
https://pubmed.ncbi.nlm.nih.gov/42764102/ (EJVES, Sep 20, 2026)

Lower-limb hemodialysis access: meta-analysis of 45 studies

[Meta-analysis] [Saudi Arabia]
Systematic review (Alanezi and Alofisan, Riyadh) of surgical lower-limb hemodialysis access up to April 2026. Pooled primary patency 69% at 6 months, 62% at 12 months and 35% at 24 months; secondary 80%, 81% and 67%. At 12 months, autologous fistula/femoral vein transposition outperformed prosthetic graft in primary patency (79% vs 53%; RR 1.23) and secondary patency (88% vs 77%), with less infection (7% vs 19%). Thrombosis 22%, infection 16%, leg ischemia 10%, steal 7%, mortality 17%.
Why it matters: useful for the patient with exhausted upper-limb access, but heterogeneity is very high (I² > 78%) and all evidence is observational.
https://pubmed.ncbi.nlm.nih.gov/42754185/ (J Vasc Surg, Sep 17, 2026)

Also this week, in brief: zone 2 TEVAR, comparison of carotid-subclavian bypass (n = 406), branched TEVAR (205) and fenestrated TEVAR (112) with comparable perioperative mortality and stroke (J Vasc Surg, Sep 17: https://pubmed.ncbi.nlm.nih.gov/42754184/); the FDA authorized Humacyte to extend the shelf life of the bioengineered vessel Symvess from 18 to 36 months, with a dialysis-access submission expected in November (Vascular News, Sep 14: https://vascularnews.com/humacyte-announces-us-fda-authorisation-extending-symvess-shelf-life-to-36-months/); umbrella review in JVS-VL (Gloviczki) of 26 systematic reviews on lymphatic microsurgery, with 34–47% volume reduction and not a single randomized trial (Venous News, Sep 17: https://venousnews.com/systematic-review-deems-microsurgical-treatment-safe-effective-and-durable-for-lower-extremity-lymphoedema-prevention/); mechanical thrombectomy in 14 patients with upper-limb DVT in Athens and Milan, no major events and 9/14 asymptomatic at 26 months (Phlebology, Sep 18: https://pubmed.ncbi.nlm.nih.gov/42760274/); and the Solaris covered stent in 99 patients with iliac disease in Ankara, 97.6% primary patency at 12 months, single-center retrospective series (Diagn Interv Radiol, Sep 14: https://pubmed.ncbi.nlm.nih.gov/42733970/).

Upcoming meetings and dates

• Oct 1–3: 13th EVF HOW, European Venous Forum hands-on workshop on venous disease, Kraków.
• Oct 3–4: The VEINS 2026, Las Vegas; Oct 4–7: VIVA 2026, Las Vegas (Bellagio), with late-breaking trials announced.
• Oct 6–9: ESVS 40th Annual Meeting, Belgrade.
• Oct 14–16: SITE Santiago 2026, Santiago de Compostela.
• Oct 29–31: CCT 2026, Kobe (coronary and peripheral courses Oct 29–30).
• Nov 17–21: VEITHsymposium, New York.

Automated weekly curation. Every item was verified by opening the source on September 21, 2026; figures come from the published abstracts. It does not replace reading the full article.

Weekly vascular bulletin — September 21, 2026

Fourteen verified items from JVS, JVS-VL, EJVES, JET, CCI and Phlebology, seven of them from outside North America and Western Europe.

Three worth your time:
• PRAGUE-26 (NEJM): catheter-directed thrombolysis cut 7-day death, recurrence or decompensation in intermediate-high-risk PE from 6.8% to 0.7%. Open-label, few events; PEITHO-3 still pending.
• BEST-CLI registry: 1 in 4 real-world CLTI patients died within a year, far worse than in the trial. Mortality, not the limb, drives prognosis.
• VQI 2014–2025: thermal ablation still beats non-thermal on VCSS and HASTI improvement, the benchmark any new saphenous occlusion technique must clear.

Full bulletin, with a critical reading of each study and links to the primary sources:
https://boletinesmedicos.com/en/vascular/2026-09-21.html

#VascularSurgery #Endovascular #VenousDisease #PulmonaryEmbolism #CLTI

Weekly vascular bulletin, Sep 21: PRAGUE-26 (NEJM) shows catheter thrombolysis cuts early decompensation in intermediate-high-risk PE (0.7% vs 6.8%); BEST-CLI registry: 1 in 4 CLTI patients dies within a year. 14 verified items with critical reading: https://boletinesmedicos.com/en/vascular/2026-09-21.html