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Clinical Advances in Aortic Disease and Revascularization
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Clinical Advances in Aortic Disease and Revascularization

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 2695

Special Issue Editor

Dr. Andrej Udelnow

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Guest Editor
Department of Endovascular and Vascular Surgery, Brandenburg Medical School Theodor Fontane, Brandenburg University Hospital, Brandenburg an der Havel, Germany
Interests: probabilistic programming; neural networks; intravascular ultrasound; quality of life

Special Issue Information

Dear Colleagues,

Although the management of aortic diseases (AD) has undergone evolutionary and fundamental changes in recent decades due to the establishment of more or less complex endovascular procedures and has become much safer and less invasive, many issues remain and new problems have emerged. There is still limited evidence regarding the differential indications for the (non-operative, endovascular or open-surgical) treatment of aneurysms, penetrating ulcers, dissections, etc. Demographic changes have led to much older patients with a range of comorbidities, often with limited operability, and new questions, such as those of the patient’s quality of life vs. overall survival, have arisen. Major randomized controlled trials investigating the outcomes of endovascular vs. non-operative vs. open-surgical treatment no longer fully reflect the realities of today, and new, more real-world-focusing approaches are needed, including registry data, artificial intelligence, Bayes statistics or other prediction models enabling clinicians to judge with empathy and intuition, supported by patient-individual prognosis. Moreover, new contrast media and radiation-sparing technology, such as intravascular ultrasound, image fusion and virtual reality, will rapidly bring about new perspectives for the treatment of difficult anatomies. Last but not least, the molecular base of ADs will fundamentally change our point of view, since the course of AD has to be associated with a specific etiology rather than with the morphology (i.e., diameter) alone.

Dr. Andrej Udelnow
Guest Editor

Manuscript Submission Information

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Keywords

  • aortic disease
  • aortic aneurysm
  • endovascular aortic repair
  • atherosclerosis
  • aortic dissections
  • overall survival
  • quality of life
  • intravascular ultrasound

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Published Papers (3 papers)

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Research

13 pages, 929 KiB  
Article
A Decade-Long Retrospective Study of Factors Influencing Survival in Ruptured Abdominal Aortic Aneurysm
by Günay Kalender, Thomas Weissmann and Ugur Dinç
J. Clin. Med. 2024, 13(21), 6431; https://doi.org/10.3390/jcm13216431 - 27 Oct 2024
Viewed by 651
Abstract
Background: Ruptured abdominal aortic aneurysm (rAAA) carries a high mortality risk, requiring rapid diagnosis and intervention. This study assesses various clinical factors influencing rAAA management outcomes in alignment with evolving guidelines from 2011 to 2024. Methods: A retrospective analysis of 62 rAAA patients [...] Read more.
Background: Ruptured abdominal aortic aneurysm (rAAA) carries a high mortality risk, requiring rapid diagnosis and intervention. This study assesses various clinical factors influencing rAAA management outcomes in alignment with evolving guidelines from 2011 to 2024. Methods: A retrospective analysis of 62 rAAA patients treated at Vivantes Clinic, Berlin, from July 2014 to May 2024 was conducted. Data were obtained from medical records, focusing on vital parameters at admission and during treatment. Both numerical and categorical variables were analyzed to identify survival determinants. Results: The overall survival rate was 55%. Significant differences in systolic and diastolic blood pressures during surgery were noted between survivors and non-survivors, with lower pressures observed in non-survivors at critical surgical stages. Other vital signs showed no significant variations. Survival was significantly associated with gender, fluid therapy, and aneurysm location. Conclusions: Effective blood pressure management during surgery is crucial for improving survival in rAAA cases. This study emphasizes adherence to current clinical guidelines and highlights the need for ongoing research to fill existing knowledge gaps. Further investigations are essential to enhance patient care and outcomes in rAAA. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)
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Graphical abstract

16 pages, 1752 KiB  
Article
Custom-Made Device (CMD) for the Repair of Thoraco-Abdominal Aneurysm (TAA): Mid-Long Term Outcomes from a Single Southeast Asian Centre Experience in Singapore
by Nick Zhi Peng Ng, Jolyn Hui Qing Pang, Charyl Jia Qi Yap, Victor Tar Toong Chao, Kiang Hiong Tay and Tze Tec Chong
J. Clin. Med. 2024, 13(20), 6145; https://doi.org/10.3390/jcm13206145 - 15 Oct 2024
Viewed by 617
Abstract
Introduction: Given the high risk of peri-operative morbidity and mortality associated with open repair, endovascular repair for thoraco-abdominal aneurysms is increasingly performed. This study aims to describe mid to long-term results for patients who were treated with COOK Custom-Made Endograft Device at a [...] Read more.
Introduction: Given the high risk of peri-operative morbidity and mortality associated with open repair, endovascular repair for thoraco-abdominal aneurysms is increasingly performed. This study aims to describe mid to long-term results for patients who were treated with COOK Custom-Made Endograft Device at a single Southeast Asian tertiary centre. Methods: Mid to long-term results of patients treated from 2012 to 2022 were retrospectively reviewed. Indications for treatment were aortic diameter > 5.5 cm, enlargement > 5 mm in 6 months or high-risk morphology. Clinical, operative, early to late complications and reintervention details were captured. The endpoints were technical success, primary patency and primary assisted patency. Results: Electronic medical records of 29 consecutive patients (64.4 ± 1.6 years old; 26/29 males 89.6%) were reviewed. 24/29 (83%) were hypertensive, and 20/29 (69%) were smokers. The mean diameter was 5.5 cm, and the majority were treated for Crawford type IV (19/29, 65.5%). Endograft deployment was 100%. Catheterisation of fenestration was successful in 109/116 (94%). 30-day mortality and morbidity were observed in 12/29 (41%), for which access site complications were most common. No significant haemorrhage or graft explant was recorded. The mean follow-up period was 32.4 months (range 1–108 months). Primary patency was 92.9% (95% CI: 83.8–100.0) at 6 months and decreased to 77.7% (95% CI: 63.4–95.2) at 24 months. Sac shrinkage or stability was noted in 17/29 (58.6%). Re-intervention was performed in 9/29 (31%) for limb occlusion (2/9, 22.2%), renal artery stent occlusion (1/9, 11.1%) and endoleaks (6/9, 66.6%). Assisted patency was maintained at 100% for 12 months before decreasing to 66.7% (95% CI: 37.9–100.0) at 24 months. Conclusions: The study reports the first mid-long-term result in this region, though limited by the sample size. Re-intervention at 30% suggests that disease and procedures remain challenging, emphasising the need to assimilate lessons and experience at high-volume centres. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)
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11 pages, 1277 KiB  
Article
Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair
by Yuhan Qi, Chengxin Weng, Ding Yuan, Tiehao Wang, Yukui Ma, Yi Yang, Jichun Zhao and Bin Huang
J. Clin. Med. 2023, 12(23), 7500; https://doi.org/10.3390/jcm12237500 - 4 Dec 2023
Viewed by 1081
Abstract
Consideration for oversizing the proximal stent graft is suggested in endovascular aortic repair. However, a special recommendation for the proximal oversizing ratio (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA) is ambiguous. This study aims to evaluate the effect of different degrees [...] Read more.
Consideration for oversizing the proximal stent graft is suggested in endovascular aortic repair. However, a special recommendation for the proximal oversizing ratio (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA) is ambiguous. This study aims to evaluate the effect of different degrees of the proximal oversizing ratio (OSR) on risk of type IA endoleak (TIAEL) in hemodynamically stable and unstable patients with rAAA undergoing emergency endovascular aortic repair (EVAR). Our study included 134 rAAA patients undergoing emergent EVAR, and we did not observe a significant association between hemodynamic instability and risk of T1AEL (HR 3.89, 95%CI 0.40–37.75, p = 0.24). All three T1AELs in the hemodynamically unstable subgroup were observed in patients with OSR ≤ 30%, but no significant difference was found regarding T1AEL between patients with OSR > 30% and OSR ≤ 30% (0.00% vs. 11.11%, p = 0.19). As for hemodynamically stable patients, OSR > 20% was associated with a significantly decreased risk of T1AEL (HR 0.03, 95%CI 0.01–0.53, p = 0.016). In conclusion, a proximal OSR > 20% is associated with a decreased risk of T1AEL in hemodynamically stable patients, while an OSR > 30% did not add an additional advantage of lowering the risk of T1AEL in hemodynamically unstable patients. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)
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