Search Results (891)

Objectives: To assess the feasibility, safety, and clinical effectiveness of a response-guided, stepwise endovascular treatment strategy for patients with refractory plantar fasciitis. Methods: This single-center retrospective study included consecutive patients with chronic plantar fasciitis refractory to conservative therapy who were treated between January and June 2025. All patients initially underwent ultrasound-guided direct puncture of the posterior tibial artery, followed by intra-arterial administration of imipenem/cilastatin as a temporary embolic agent. Clinical response was evaluated at 1 month using the visual analogue scale (VAS). Patients showing a <50% pain reduction were classified as non-responders and underwent second-line transcatheter arterial embolization (TAME) via transfemoral access, with selective embolization of pathological neovessels using bioresorbable microspheres. Technical success, pain outcomes, and procedure-related adverse events were assessed during follow-up for up to 6 months. Results: Twelve patients (13 treated feet) were included. First-line embolization was technically successful in all cases. At the 1-month follow-up, 6/13 feet (46.2%) demonstrated clinically meaningful pain reduction and required no further intervention. The remaining 7/13 feet (53.8%) underwent second-line TAME, which was technically successful in all cases and was associated with further pain reduction. Mean VAS scores decreased from 7.36 ± 1.12 at baseline to 1.37 ± 0.52 at 6 months. No major adverse events occurred; minor complications were self-limited. Conclusions: A stepwise endovascular treatment strategy for refractory plantar fasciitis appears feasible and safe, providing a high rate of symptom improvement while allowing procedural complexity to be escalated according to early clinical response. Full article

Background/Objectives: To evaluate the association of preoperative morphometric and morphovolumetric parameters with post-endovascular aneurysm repair (EVAR) sac remodeling, endoleak development, and secondary interventions, and to assess the role of volumetric analysis in post-EVAR surveillance. Methods: This retrospective single-center study included 383 patients who underwent elective EVAR for infrarenal abdominal aortic aneurysm between 2016 and 2024, with available pre- and postoperative computed tomography angiography and at least 1 year of follow-up. Diameter- and volume-based sac dynamics were analyzed using standardized morphometric and 3-dimensional morphovolumetric measurements. Endoleak subtype distribution, risk factors, secondary interventions, and survival were assessed using regression and survival analyses. Results: Endoleaks were detected in 26.1% of patients (n = 100), with type II endoleak being the most frequent subtype (12.3%, n = 47), followed by type Ib (6.8%, n = 26), type III (5.5%, n = 21), type Ia (4.2%, n = 16), and 1 patient with type V endoleak in the revised manuscript framework. Secondary interventions were required in 14.1% of patients (n = 54), mainly for type I and III endoleaks, with a mean time to reintervention of 21.7 ± 10 months. Diameter and volume changes were strongly correlated; a 10% increase in aneurysm volume corresponded to an average 4 mm increase in diameter (R² = 0.72, p < 0.001). Significant predictors of overall endoleak included dual antiplatelet therapy, aneurysm length > 133 mm, elevated pre- and postoperative D-dimer levels, aneurysm diameter > 59 mm, aneurysm volume > 164 cm³, and thrombus volume > 89 cm³. Subtype-specific analyses identified distinct risk profiles for type Ia, Ib, II, and III endoleaks. Overall survival did not differ significantly between patients with and without endoleaks (p = 0.227), although worse survival was observed in type Ia and III endoleaks than in type II and Ib endoleaks. Conclusions: Preoperative morphovolumetric parameters are significant predictors of post-EVAR endoleaks and secondary interventions. Volumetric analysis may provide a complementary early signal of aneurysm sac remodeling beyond conventional diameter-based assessment, particularly in patients with type II endoleaks. However, the proposed volumetric thresholds remain exploratory and require prospective external validation before routine clinical adoption. Post-EVAR management should integrate endoleak subtype, sac behavior, and patient-specific morphovolumetric risk factors to improve surveillance and treatment selection. Full article

Once considered a surgical frontier fraught with risk, aortic arch aneurysms now represent a domain of evolving innovation. Despite their rarity, they pose severe risks of dissection, rupture, and mortality if not adequately managed. Primarily caused by prior aortic dissections, atherosclerosis, or connective tissue disorders, these aneurysms are often found incidentally on CTA or MRA imaging. Medical management focuses on reducing aortic wall stress through blood pressure control, risk factor modification, and regular imaging to monitor growth. Surgical intervention is typically indicated when the aneurysm diameter exceeds 5.5 cm, exhibits rapid growth, or causes symptoms such as compression or dissection. Open repair remains the gold standard for treatment due to its superior long-term outcomes, though hybrid and endovascular approaches are favored for high-risk patients due to reduced perioperative morbidity. Innovations in hybrid techniques and endovascular devices, alongside advancements in cerebral perfusion strategies, are shaping the future of personalized and minimally invasive approaches to aortic arch repair. This comprehensive review delves into the current management strategies for these aneurysms. Full article

Background/Objectives: Endovascular treatment of cerebral arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is associated with substantial radiation exposure due to procedural complexity and repeated angiographic acquisitions. This study evaluates radiation exposure during AVM and AVF embolization and establishes local diagnostic reference levels (DRLs). Methods: A single-center retrospective dose audit was conducted, encompassing 114 endovascular procedures performed using a low-dose workflow. Radiation exposure was quantified using dose area product (DAP), reference air kerma (K_a,r), fluoroscopy time (FT), and the number of digital subtraction angiography (DSA) frames per procedure. Median values were defined as the median (P50), and local DRLs as the 75th percentile (P75). Comparative analyses were conducted between AVM and AVF procedures, between male and female patients, and within selected AVM subgroups. Results: The analysis comprised 86 AVM procedures and 28 AVF procedures. For AVMs, the local DRLs (P75) were 28.9 Gy·cm² for DAP, 400 mGy for K_a,r, 310 DSA frames per procedure, and 1619 s for FT. For AVFs, the respective values were 47.3 Gy·cm², 465 mGy, 478 DSA frames, and 1820 s. No statistically significant differences were identified between female and male patients. However, AVF procedures demonstrated significantly higher radiation exposure than AVM procedures for all parameters except FT. Within the AVM subgroup, no significant differences were observed between single-stage and other AVM procedures or between female and male patients. Conclusions: AVM and AVF embolization procedures are dose-intensive neuroendovascular interventions. Establishing local DRLs for AVM and AVF may enhance radiation monitoring and facilitate procedure-specific dose optimization. Full article

Background and Purpose: The integration of flow diverter (FD) treatment into hybrid operating rooms (HORs) raises concerns regarding radiation safety, especially when transitioning from biplane systems to single-plane configurations. In this study, we evaluated the impact of distinct procedural-imaging configurations on patient radiation exposure during FD treatment for unruptured cerebral aneurysms. Methods: We retrospectively reviewed 93 patients (HOR: 22; biplane neuroangiography suite [NIS]: 71) treated between 2020 and 2024. Key metrics included fluoroscopy time (FT) and dose area product (DAP), subdivided into 2D fluoroscopy and 3D rotational angiography (3D-RA). Linear regression was used to identify independent predictors of radiation dose. Results: While the HOR significantly reduced fluoroscopy time (19.3 vs. 26.1 min, p = 0.002), it was associated with a higher total DAP compared to the NIS (299.1 vs. 96.3 Gy·cm², p < 0.001). This increase was primarily driven by a substantially higher radiation dose delivered per 3D-RA acquisition in the HOR environment rather than an increased frequency of 3D imaging. Multivariate analysis confirmed that the surgical imaging configuration was the dominant factor influencing total radiation exposure rather than aneurysm complexity or patient characteristics. Conclusions: Hybrid ORs provide procedural efficiency but involve a significant risk of increased radiation dose due to the reliance on 3D imaging for single-plane navigation. These findings serve as preliminary institutional benchmark data, underscoring the need for adaptive radiation management and configuration-specific protocols to optimize patient safety across diverse surgical imaging suites. Full article

Background: Femoral arteriotomy closure after peripheral angiography and intervention is commonly achieved using vascular closure devices (VCDs) or compression-based strategies; however, comparative randomised data in contemporary peripheral endovascular practice remain limited. Methods: In this prospective randomised trial, adults undergoing femoral-access diagnostic angiography or peripheral endovascular intervention were assigned in a 1:1 ratio to haemostasis with the FemoStop™ II Gold pneumatic compression system or a contemporary VCD strategy. The primary endpoint was a composite of major or minor groin-site complications immediately after sheath removal. Secondary endpoints included composite complications at recovery, discharge, and 30 days, with separate analyses of major and minor complications. Patient-reported pain was assessed using the Verbal Numerical Rating Scale (VNRS). Efficacy and safety analyses were performed according to the intention-to-treat and as-treated principles, respectively. Risk ratios were estimated using modified Poisson regression with robust variance, with prespecified adjustment for sex, systolic blood pressure before sheath removal, and sheath size. Results: A total of 130 participants underwent randomisation, including 66 assigned to FemoStop™ II Gold and 64 assigned to VCDs. The primary composite endpoint occurred in 23/66 participants (34.9%) in the FemoStop™ II Gold group and 16/64 (25.0%) in the VCD group (absolute difference, 9.9 percentage points; 95% confidence interval [CI], −6.1 to 25.7; p = 0.25), with the numerical difference driven predominantly by minor-only events (28.8% versus 15.6%; p = 0.09). At 30 days, the composite endpoint occurred in 17/66 participants (25.8%) and 12/64 participants (18.8%), respectively (absolute difference, 7.0 percentage points; 95% CI, −13.3 to 26.4; p = 0.40). Serious access-site events remained infrequent both immediately post-procedure (6.1% versus 9.4%; p = 0.53) and at 30 days (6.1% versus 4.7%; p = 0.72). The adjusted risk ratios were 1.28 (95% CI, 0.74 to 2.21) for the primary composite endpoint and 1.23 (95% CI, 0.63 to 2.40) for the 30-day composite endpoint. Ordinal VNRS pain distributions did not differ significantly at any timepoint, although “any pain” immediately post-procedure was less frequent with FemoStop™ II Gold (22.7% versus 40.6%; unadjusted risk ratio, 0.56; 95% CI, 0.33 to 0.93); this association was attenuated after adjustment (adjusted risk ratio, 0.63; 95% CI, 0.38 to 1.03). Prespecified interaction testing suggested that the effect of treatment on composite complications varied according to sheath size both immediately post-procedure and at 30 days (p < 0.001 for both interactions). Conclusions: In patients undergoing femoral-access diagnostic angiography or peripheral endovascular intervention, haemostasis with FemoStop™ II Gold resulted in 30-day groin-site complication rates that did not differ significantly from those observed with contemporary VCD strategies. Serious access-site events remained infrequent in both groups, and the apparent early reduction in patient-reported pain with FemoStop™ II Gold was not definitive after adjustment. Larger, adequately powered multicentre studies are warranted to clarify sheath size-dependent effects and uncommon clinically consequential vascular events. Full article

The aortic arch remains one of the most complex segments of the thoracic aorta to treat, demanding strategies that safeguard cerebral and spinal perfusion while achieving durable proximal and distal repair. Contemporary management strategies include open hemi/total arch replacement, hybrid approaches such as frozen elephant trunk (FET) or debranching with thoracic endovascular aortic repair (TEVAR), and fully endovascular repair using branched or fenestrated devices. Updated guidelines (American College of Cardiology/American Heart Association [ACC/AHA] 2022; European Society of Cardiology [ESC] 2024) emphasize multidisciplinary, patient-specific decision-making grounded in standardized imaging, genetics, and lifelong surveillance. Procedurally, selective antegrade cerebral perfusion with moderate-to-low hypothermia has replaced routine deep hypothermic circulatory arrest for most open arch operations. Zone-based planning using Ishimaru’s map, complemented by the Modified Arch Landing Areas Nomenclature (MALAN), improves feasibility assessment and risk stratification, while entry-focused schemas like TEM (Type, Entry, Malperfusion) further refine management. Emerging data indicate that open repair remains the durability benchmark in younger populations and those with connective tissue disease, and FET enables single-stage treatment capability with acceptable early outcomes but requires vigilant neurologic protection and reintervention surveillance. An integrated, zone-driven approach guided by center expertise optimizes patient selection for open, hybrid, or endovascular options to maximize safety and durability. Full article

Cancer-associated thrombosis (CAT) is a leading cause of morbidity and mortality in patients with malignancy, yet its imaging manifestations extend far beyond the conventional diagnosis of deep vein thrombosis and pulmonary embolism. This comprehensive review examines the full spectrum of CAT as encountered by radiologists, from routine venous thromboembolism to unusual-site thromboses, arterial thromboembolic events, catheter-related complications, and endovascular management strategies. Patients with cancer face a four- to seven-fold increased risk of venous thromboembolism compared with the general population, and arterial thromboembolism occurs at more than twice the expected rate, particularly within the first six months following cancer diagnosis. The radiologist’s role spans detection, characterization, and therapeutic guidance across multiple vascular territories. Key diagnostic challenges addressed include the distinction between bland and tumor thrombus—a determination with direct implications for TNM staging, surgical planning, and systemic therapy selection—and the recognition of incidental thromboembolism, which carries prognostic weight equivalent to symptomatic events and warrants similar clinical management. Emerging applications of diffusion-weighted MRI, contrast-enhanced ultrasound, and FDG-PET/CT provide a multiparametric toolkit for thrombus characterization, while artificial intelligence and machine learning show promise for improving patient selection and reducing unnecessary imaging. The expanding recognition of cancer-associated arterial disease, including cerebrovascular, coronary, and peripheral arterial events, requires that cardiovascular structures receive systematic attention on routine oncologic imaging. Interventional radiology contributes actively to CAT management through inferior vena cava filtration, catheter-directed thrombolysis, and thrombolytic-sparing mechanical thrombectomy, the latter being particularly relevant in oncology patients with elevated bleeding risk. Conclusions: Realizing the full potential of imaging in CAT requires not only technical proficiency with individual modalities but a synthesized, oncology-informed interpretive approach that incorporates the patient’s treatment history, biomarker status, and thrombotic risk profile at the time of image interpretation, positioning the radiologist as a central rather than peripheral figure in oncologic care. Full article

Background: Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and substantial healthcare utilization. Length of hospital stay (LOS) after lower limb revascularization is influenced by procedural complexity, but patient physiological reserve may also play a role. We evaluated whether CT-derived lean psoas muscle area (LPMA) is independently associated with LOS in patients undergoing revascularization for CLTI. Methods: We retrospectively analyzed 234 consecutive patients treated with endovascular, hybrid, or open revascularization for CLTI (Rutherford 4–5) between 2018 and 2021. Sarcopenia markers were derived from preoperative CT at the L3 level, including psoas muscle area (PMA), muscle density (PMD), and LPMA. Multivariable linear regression models with log-transformed LOS were used to estimate relative effects on hospitalization duration. Results: Median age was 68 years and 65.4% were male; 76.5% of admissions were urgent. Median LOS was 6 days (IQR 4–9). Procedure type was the strongest determinant of LOS: hybrid (β = 0.69, p < 0.001) and open surgery (β = 0.73, p < 0.001) were associated with approximately 99% and 108% longer LOS compared with endovascular treatment. Higher LPMA was independently associated with shorter LOS (β = −0.00049, p = 0.004). Smoking (β = −0.21, p = 0.003) and history of myocardial infarction (β = −0.19, p = 0.030) were associated with shorter LOS, whereas dialysis showed a non-significant trend toward longer hospitalization (β = 0.36, p = 0.056). Conclusions: In patients undergoing lower limb revascularization for CLTI, CT-derived LPMA demonstrated a modest but independent association with hospital stay duration after adjustment for procedural and clinical factors. Given the exploratory nature of this study, these hypothesis-generating findings support further evaluation of imaging-based muscle assessment as an adjunct marker of physiological reserve in this high-risk population. Full article

Background: Anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) usually receive ethmoidal dural supply. Pial arterial supply has been described in intracranial DAVFs, including ACF DAVFs, but a dominant orbitofrontal pial feeder can create diagnostic overlap with mixed pial-dural arteriovenous malformation and make endovascular treatment hazardous. Case Presentation: A 75-year-old man with atrial fibrillation presented with right middle cerebral artery occlusion and underwent intravenous thrombolysis followed by mechanical thrombectomy. During right internal carotid angiography, transient arterial-phase opacification of a contralateral frontal draining vein through the anterior communicating artery prompted post-recanalization angiography. A high-grade left ACF DAVF was diagnosed, with dominant supply from the left orbitofrontal artery, minor anterior ethmoidal supply, two venous drainage routes, cortical venous reflux, and a varix. Although the DAVF was incidental to the ischemic presentation, it was considered to require treatment because of high-risk angioarchitecture, including Borden type III/Cognard type IV drainage, cortical venous reflux, and venous ectasia. No intraparenchymal nidus or normal venous-phase use of the refluxing veins was identified. Because pial transarterial access and complete transvenous closure were considered unsafe or uncertain, microsurgical draining-vein disconnection was performed. Postoperative angiography confirmed complete obliteration. Conclusions: In this case, microsurgical disconnection achieved angiographic cure, and the patient was transferred for rehabilitation with a modified Rankin Scale score of 1. The central diagnostic and therapeutic issue in pial-feeder-dominant ACF DAVF is not rarity alone, but angiographic differentiation from mixed pial-dural arteriovenous malformation and assessment of whether the shunt can be closed without compromising normal pial arteries or venous outflow. The thrombectomy angiogram provided the route to diagnosis, whereas pial arterial dominance and divided venous drainage determined the curative strategy. Full article

Background and Clinical Significance: Treatment options for chronic type B aortic dissections (TBADs) remain a topic of ongoing debate. Patients with post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) are typically younger than those with degenerative TAAAs, and their aortas undergo continuous remodeling over their lifetime. Fenestrated/branched endovascular aortic repair (F/B-EVAR) has shown promising results, but it can be challenged by the presence of a narrow true lumen, which hinders navigation and deployment of bridging components. Moreover, the presence of patent segmental arteries originating from the false lumen may prevent aneurysm shrinkage due to persistent flow, which may also result in insufficient spinal cord protection strategies and an increased risk of spinal cord ischemia. Consequently, multiple endovascular interventions are often necessary to address the persistent anatomical changes in these patients. Case Presentation: We present the case of a patient affected by a post-dissecting TAAA who underwent multiple open and endovascular treatment attempts. The presence of prior multiple laparotomies discouraged a new open surgical repair, while the hypertrophic segmental arteries and the presence of a narrow true lumen made standard F/B-EVAR unfeasible. The patient was successfully treated using a combination of different adjunctive advanced endovascular techniques, including minimally invasive segmental artery coil embolization (MiSACE) as a spinal cord preconditioning strategy and prevention of type II endoleak. Moreover, transcatheter electrosurgical septotomy (TES) was used to create a single aortic channel in the presence of a narrow true lumen, which allowed the deployment of a multifeatured, custom-made branched endograft. Conclusions: Endovascular repair of post-dissection TAAAs requires a thorough understanding of advanced endovascular adjuncts, which are often combined to overcome the complex anatomical challenges inherent to this disease. Although encouraging results have been reported, both segmental artery embolization for the indications described here and TES warrant further evaluation in prospective multicenter studies to confirm their safety and efficacy. Full article

Background: Deep medullary vein (DMV) drainage has been suggested as a new biomarker for predicting clinical outcomes in patients with acute ischemic stroke (AIS). We evaluated this hypothesis in patients who received endovascular treatment (EVT) within 24 h of symptom onset. Methods: We performed a retrospective study of consecutive AIS patients at a single institution treated with EVT achieving successful recanalization (final mTICI score ≥2b). DMV drainage was graded on a three-point scale (0-1-2) during the second peak venous phase of mCTA by assessing contrast filling, with grade 2 indicating a favorable DMV profile. Our primary outcomes were functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days, and ordinal mRS shift at 90 days. Secondary outcomes were excellent clinical status (mRS 0–1 at 90 days), hemorrhagic transformation, and symptomatic intracranial hemorrhage. We investigated independent associations using multivariable logistic and ordinal regression analyses as appropriate, adjusting for age, sex, baseline mRS, NIHSS at onset, occlusion site, intravenous thrombolysis, onset-to-CT time, and ASPECTS. Results: We included 506 patients; the mean age was 76 years. A favorable DMV profile was present in 394 (78%) patients. We found that DMV doubled the odds of achieving functional independence (OR = 2.22; 95% CI = 1.28–3.85) and was associated with a shift towards better functional outcomes in ordinal regression analysis (cOR = 1.93; 95% CI = 1.24–3.02), whereas we did not find any association between a favorable DMV profile and secondary outcomes. Conclusions: In AIS patients successfully recanalized with EVT, a favorable DMV profile was associated with better functional outcomes. Further investigations may clarify the clinical use and predictive ability of this novel radiological marker. Full article

Background/Objectives: The optimal upfront modality selection for real-world aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. We evaluated outcomes after an institutional change from an endovascular treatment (EVT)-first default to a modality-neutral individualized pathway. Methods: This single-center retrospective before-and-after cohort study included consecutive patients with aSAH who underwent aneurysm securing during two fixed time periods (pre-change: 1 May 2023 to 31 July 2024; post-change: 1 August 2024 to 31 October 2025). The primary outcome was a favorable 90-day modified Rankin Scale (mRS) score of 0–2. The primary analysis used Firth penalized logistic regression adjusted for age, pre-morbid mRS ≥ 2, and World Federation of Neurosurgical Societies grade IV–V. Conventional logistic regression and ordinal mRS shift analysis were performed as sensitivity analyses. Results: A total of 104 patients were included (pre-change, n = 48; post-change, n = 56). EVT decreased from 79.2% to 37.5%, and microsurgery increased from 20.8% to 62.5% (p < 0.001). Favorable outcomes occurred in 25/48 patients (52.1%) in the pre-change period and 36/56 patients (64.3%) in the post-change period (p = 0.235). In adjusted analyses, the post-change period was associated with favorable outcome (aOR 3.82; 95% CI, 1.31–12.79; p = 0.009), consistent with the sensitivity analysis (aOR, 4.41; 95% CI, 1.43–15.95; p = 0.009). Shift analysis also favored the post-change period (adjusted common OR, 2.36; 95% CI, 1.15–4.91; p = 0.021). Secondary outcomes and procedure-related complications were similar between the two periods. Conclusions: A shift from an EVT-first default to a modality-neutral individualized pathway was associated with more favorable adjusted 90-day functional outcomes. Multicenter confirmation is warranted. Full article

Background: Endovascular aortic aneurysm repair (EVAR) is considered the gold standard for the treatment of abdominal aortic aneurysms. However, the performance of stent-grafts used during this procedure may be affected by their structural design, particularly in anatomically challenging, tortuous iliac arteries. This study aimed to evaluate the hemodynamic performance of different stent-graft limb designs in an in vitro EVAR simulation using compliant three-dimensional (3D)-printed iliac artery models with controlled angulations. Methods: Four commercially available stent-grafts (Anaconda^®, Endurant II^®, Treo^®, Zenith Spiral-Z^®) representing different stent-strut configurations (including O-ring, Z-stent, and spiral designs) were deployed in compliant 3D-printed vascular phantoms simulating severe iliac angulations of 75°, 90°, and 105°. The models were incorporated into a pulsatile flow circuit, and pressure and flow velocity were measured proximally and distally to the angulated segment. Results: Across all tested angulations, the O-ring-based design demonstrated the most favorable hemodynamic performance. In particular, the Anaconda stent-graft showed the smallest pressure loss and the lowest increase in distal flow velocity, especially in the 90° and 105° models. These findings suggest that O-ring-supported structures provide greater flexibility and conformability in severely angulated iliac segments. Conclusions: In this controlled in vitro setting, stent-grafts with O-ring strut morphology better preserved flow conditions than other tested configurations in tortuous anatomy. These results suggest that stent-graft structural design may influence device behavior in challenging iliac anatomy under controlled in vitro conditions. These findings should be considered hypothesis-generating bench data and do not represent direct evidence for clinical device selection. Full article

Objective: Peripheral arterial occlusive disease (PAOD) is characterized by impaired tissue perfusion, chronic ischemia, and increased platelet reactivity. Hyperbaric oxygen therapy (HBOT) is used as adjunctive treatment in advanced PAOD, but its effect on platelet function remains insufficiently studied. This study examined the association between HBOT and platelet aggregation. Methods: This prospective observational study included 90 patients with Fontaine stage IV PAOD and chronic ulceration, assigned to an HBOT group (n = 60) or waiting-list control group (n = 30). Patients were predominantly male; mean age was 66.82 ± 9.42 years in the study group and 63.00 ± 8.31 years in controls, and diabetes mellitus was present in 55.0% and 63.3%, respectively. Prior revascularization included open surgery in 33.3% and 30.0%, endovascular treatment in 36.7% and 43.3%, and no option for revascularization in 30.0% and 26.7%, respectively. HBOT was administered over 4 weeks (20 sessions, 2.0–2.5 ATA). Platelet aggregation was measured by impedance aggregometry using arachidonic-acid-induced aggregation (ASPI), adenosine-diphosphate-induced aggregation (ADP), and thrombin-receptor-activating peptide-induced aggregation (TRAP) agonists. Changes were analyzed using generalized estimating equation models adjusted for antiplatelet therapy, diabetes mellitus, smoking, and C-reactive protein (CRP). Results: Significant group × time interactions were observed for all platelet activation pathways, indicating greater reductions in the HBOT group than controls: ASPI (β = −290.5; p < 0.001), ADP (β = −243.6; p < 0.001), and TRAP (β = −330.9; p < 0.001). No significant change was observed in controls. HBOT was associated with reduced pain intensity, while CRP and platelet-to-lymphocyte ratio (PLR) remained stable. Ulcer size showed no significant change after 4 weeks. Conclusions: In patients with PAOD, HBOT was associated with reduced platelet reactivity independent of antiplatelet therapy. Further randomized studies are needed to determine its clinical significance. Full article