VASCULAR INTERVENTIONS IN FRAIL ELDERLY PATIENTS: A BIBLIOMETRIC ANALYSIS OF GLOBAL RESEARCH OUTPUT AND CLINICAL...

Frailty is increasingly recognized as a major determinant of poor outcomes in elderly patients undergoing vascular interventions. With global population aging, the intersection between frailty and vascular disease has become a pressing clinical and research priority. However, research in this domain remains scattered, and no bibliometric synthesis has systematically mapped global trends.

This study aimed to (1) analyze global research trends on vascular interventions in frail elderly patients (2000-2025), (2) identify the most productive countries, institutions, authors, and journals, (3) evaluate co-authorship, keyword co-occurrence, and citation impact, and (4) highlight clinical outcomes studied and areas for future research.

A bibliometric analysis was conducted using PubMed, Medline, and Embase databases covering 2000-2024. The search strategy combined terms such as "vascular intervention," "frail elderly," "endovascular procedures," and "geriatric vascular surgery." A total of 276 relevant publications were included. Bibliometric indicators assessed annual scientific production, source impact (Bradford's Law), author productivity (Lotka's Law), institutional and country-level contributions, keyword evolution, and collaboration networks. Analytical tools included Bibliometrix (R package) for mapping and VOSviewer for visualization.

Research output demonstrated steady growth, with fewer than 10 publications annually before 2005, rising sharply after 2016, and peaking at 28 articles in 2025. The Journal of Vascular Surgery (n=23), Annals of Vascular Surgery (n=14), and Journal of Neurointerventional Surgery (n=11) were the most prolific sources. Author productivity was highly skewed, with 88.1% contributing only one article, while Pol RA and Brooke BS emerged as leading figures. Sichuan University (43 articles), the University of Utah (34), and Yale University (27) were the most productive institutions. By country, China (298 articles) and Japan (198) dominated total output, surpassing the USA (171). Keyword analysis revealed strong emphasis on "treatment outcomes," "risk factors," and "aged ≥80," but frailty-specific terms were underrepresented. Collaboration mapping showed strong Asia-Pacific ties, while US research remained largely domestic.

This is the first bibliometric study to systematically examine global research on vascular interventions in frail elderly patients. Findings demonstrate accelerated growth since 2016, with Asia emerging as a global leader. Despite rising output, gaps remain in standardized frailty assessment and integration of geriatric principles. Future research should prioritize consistent frailty evaluation, sustained collaborations, and clinical trials aligning vascular care with geriatric best practices.