2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T4fb,Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.31:T540,ABSTRACT Nutcracker syndrome (NCS) refers to symptomatic compression of the left renal vein (LRV), most commonly between the aorta and superior mesenteric artery (anterior nutcracker) or, less frequently, between the aorta and vertebral column in the presence of a retro-aortic LRV (posterior nutcracker). This venous entrapment elevates renal venous pressure and promotes drainage through the gonadal and pelvic venous networks. Clinical manifestations typically include haematuria, left flank or abdominal pain, orthostatic proteinuria, and features of gonadal or pelvic venous congestion such as varicocele. Diagnosis relies on careful clinical evaluation, exclusion of alternative aetiologies, and targeted imaging modalities including Doppler ultrasonography, computed tomography, magnetic resonance angiography, venography, and intravascular ultrasound. Despite increasing recognition of NCS, standardized diagnostic criteria and imaging thresholds remain lacking. Management strategies range from conservative treatment to endovascular interventions and open or laparoscopic surgical procedures. Optimal care requires a multidisciplinary approach involving urology, radiology, nephrology, and vascular surgery to ensure accurate diagnosis and individualized treatment planning.32:T4af,Lower-extremity peripheral vascular interventions (PVIs) are increasingly used for treatment of peripheral artery disease. However, the relationship between hospital and operator PVI volume with in-hospital major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) is not well established. We used the NCDR PVI (National Cardiovascular Data Registry) registry, including procedural data from April 1, 2014, to December 31, 2019, assessing in-hospital MALEs and MACEs during hospitalization for PVI. Annualized PVI volumes were categorized on the basis of operator or site volume. Generalized linear mixed models assessed volume-outcome relationships after adjustment of covariates. Between 2014 and 2019, 55 785 PVI procedures were performed at 97 hospitals by 555 operators. Adjusted analysis showed no statistically significant association between hospital volume and MALEs (highest versus lowest volume: odds ratio, 0.91 [95% CI, 0.74-1.11]; In contemporary practice, a significant relationship was observed between operator volume and adjusted PVI outcomes. Highest-volume operators had lower rates of in-hospital MALEs and MACEs compared with lowest-volume operators.33:Tbe9, Background Lower‐extremity peripheral vascular interventions (PVIs) are increasingly used for treatment of peripheral artery disease. However, the relationship between hospital and operator PVI volume with in‐hospital major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) is not well established. Methods We used the NCDR PVI (National Cardiovascular Data Registry) registry, including procedural data from April 1, 2014, to December 31, 2019, assessing in‐hospital MALEs and MACEs during hospitalization for PVI. Annualized PVI volumes were categorized on the basis of operator or site volume. Generalized linear mixed models assessed volume–outcome relationships after adjustment of covariates. Results Between 2014 and 2019, 55 785 PVI procedures were performed at 97 hospitals by 555 operators. Adjusted analysis showed no statistically significant association between hospital volume and MALEs (highest versus lowest volume: odds ratio, 0.91 [95% CI, 0.74–1.11]; P =0.35) or hospital volume and MACEs (highest versus lowest volume: odds ratio, 1.23 [95% CI, 0.95–1.16]; P= 0.12). Notably, undergoing PVI with high‐volume operators was associated with lower odds of in‐hospital MALEs (odds ratio, 0.73 [95% CI, 0.55–0.97]; P= 0.03) and MACEs (odds ratio, 0.64 [95% CI, 0.44–0.95]; P= 0.03). Female sex and comorbidities including dyslipidemia, prior percutaneous coronary intervention, heart failure, and acute or chronic limb ischemia were associated with higher MALE risk. Older age and comorbidities including hypertension, dyslipidemia, end‐stage renal disease requiring dialysis, severe lung disease, prior myocardial infarction, heart failure, and acute limb ischemia were associated with greater MACE risk. Conclusions In contemporary practice, a significant relationship was observed between operator volume and adjusted PVI outcomes. Highest‐volume operators had lower rates of in‐hospital MALEs and MACEs compared with lowest‐volume operators. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Endovascular Intervention: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Endovascular Intervention (modality). Clinician-written summaries and actionable practice insights. 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Disease","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"modality","value":"Endovascular Intervention","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"sample_size","value":"n=55,785","value_numeric":55785},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"study_design","value":"Cohort","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"warning","value":"Only the hospital-volume association with MALEs is quantified; MACEs by hospital volume are not reported in the provided text.","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"warning","value":"Study design is inferred as a registry-based cohort from the NCDR PVI and may have nuances in the full text.","value_numeric":null},{"paper_doi":"10.1161/jaha.124.037165","tag_type":"warning","value":"The abstract excerpt is truncated; effect sizes for operator-volume associations and absolute event rates are not provided.","value_numeric":null}],"summaries":{"key_result":"Hospital PVI volume was not significantly associated with in-hospital MALEs (highest vs lowest volume: OR 0.91; 95% CI 0.74–1.11). In contrast, highest-volume operators had significantly lower in-hospital MALEs and MACEs than lowest-volume operators (effect sizes not reported here).","practice_takeaway":"For lower-extremity PVI, operator volume appears more closely linked to in-hospital limb and cardiovascular outcomes than hospital volume. When feasible, steer patients toward higher-volume operators for these procedures.","what_studied":"A registry-based cohort from the NCDR PVI examined whether annualized hospital and operator volumes for lower-extremity peripheral vascular interventions (PVIs) were associated with in-hospital major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) from April 1, 2014, to December 31, 2019. The analysis included 55,785 PVIs across 97 hospitals and 555 operators, using generalized linear mixed models with covariate adjustment."}}],"initialOffset":3,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Endovascular Intervention"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Endovascular Intervention"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Endovascular Intervention"}}}]]

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