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Postoperative Management in Vascular Surgery
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Postoperative Management in Vascular Surgery

A special issue of Journal of Personalized Medicine (ISSN 2075-4426).

Deadline for manuscript submissions: closed (1 July 2022) | Viewed by 8654

Special Issue Editor

Dr. Giovanni Tinelli

E-Mail Website
Guest Editor
Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
Interests: vascular surgery; personalized medicine; vascular pathologies; advanced imaging support; artificial intelligence and machine learning
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Vascular disease treatment is currently an area of great innovation; we are currently at the threshold of a new era of minimally invasive approaches. However, despite the great potential development in the expert technical execution of operations and anticipation of complications, vascular surgery patients are still affected by serious postoperative complications. Early identification and management of these complications are essential to improve the overall outcome of these patients. This Special Issue of the Journal of Personalized Medicine aims to highlight the principles of postoperative care, complications, and their management in vascular surgery patients.

Dr. Giovanni Tinelli
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

  • vascular surgery
  • aortic diseases
  • personalized medicine
  • vascular pathologies
  • postoperative management
  • endovascular

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Published Papers (2 papers)

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Research

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10 pages, 418 KiB  
Article
Incidence and Fate of Refractory Type II Endoleak after EVAR: A Retrospective Experience of Two High-Volume Italian Centers
by Pasqualino Sirignano, Nicola Mangialardi, Martina Nespola, Francesco Aloisi, Matteo Orrico, Sonia Ronchey, Flavia Del Porto and Maurizio Taurino
J. Pers. Med. 2022, 12(3), 339; https://doi.org/10.3390/jpm12030339 - 24 Feb 2022
Cited by 5 | Viewed by 2252
Abstract
Introduction: The aim of the present study is to report the outcome of patients presenting an isolated type II endoleak (TIIEL) requiring reintervention and to identify clinical and anatomical characteristics potentially implicated in refractory TIIEL occurrence and fate. Materials and Methods: A multicenter [...] Read more.
Introduction: The aim of the present study is to report the outcome of patients presenting an isolated type II endoleak (TIIEL) requiring reintervention and to identify clinical and anatomical characteristics potentially implicated in refractory TIIEL occurrence and fate. Materials and Methods: A multicenter retrospective study on TIIEL requiring reintervention was conducted between January 2003 and December 2020. Demographic and clinical characteristics, procedural technical aspects, reinterventions, and outcomes were recorded. TIIEL determining sac expansion greater than 10 mm underwent a further endovascular procedure aiming to exclude aneurismal sac. Redo endovascular procedures were performed via endoleak nidus direct embolization and/or aortic side branches occlusion. TIIELs responsible for persisting aneurysmal sac perfusion 6 months after redo endovascular procedures were classified as “refractory” and submitted to open conversion. Results: A total of 102 TIIEL requiring reintervention were included in the final analysis. Eighty-eight (86.27%) patients were male, the mean age was 77.32 ± 8.08 years, and in 72.55% of cases the American Society of Anaesthesiologists (ASA) class was ≥3. The mean aortic diameter was 64.7 ± 14.02 mm, half of treated patients had a patent inferior mesenteric artery (IMA), and 44.11% ≥ 3 couples of patent lumbar arteries (LA). In 49 cases (48.03%) standard endovascular aneurysm repair (EVAR) procedure was completed without adjunctive maneuvers. All enrolled patients were initially submitted to a further endovascular procedure once TIIEL requiring reintervention was diagnosed; 57 patients underwent LAs or IMA embolization (55.87%), 42 transarterial aneurismal sac embolization (41.17%), and three (2.96%) laparoscopic ostial ligations of the inferior mesenteric artery. During a mean follow-up of 15.22 ± 7.57 months (7–48), a redo endovascular approach was able to ensure complete sac exclusion in 52 cases, while 50 patients presented a still evident refractory TIIEL and therefore a surgical conversion or semiconversion was conducted. At the univariate analysis refractory TIIEL patients were significantly different from those who did not develop the complication in terms of preoperative clinical, morphological characteristics, and initial EVAR procedures: coronary artery disease occurrence (p = 0.005, OR: 3.18, CI95%: 1.3–7.2); preoperative abdominal aortic aneurysm (AAA) sac diameter (p = 0.0055); IMA patency (p = 0.016, OR: 2.64, CI95%: 1.18–5.90); three or more patent LAs; isolated standard EVAR without adjunctive procedures (p > 0.0001; OR: 9.48, CI95%: 3.84–23.4). Conclusions: Our experience seems to demonstrate that it is reasonable to try to preoperatively identify those patients who will develop a refractory TIIEL after EVAR and those with a TIIEL requiring reintervention for whom a simple endovascular redo will not be enough, needing surgical conversion. Full article
(This article belongs to the Special Issue Postoperative Management in Vascular Surgery)
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Review

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21 pages, 4747 KiB  
Review
Peri-Operative Management of Patients Undergoing Fenestrated-Branched Endovascular Repair for Juxtarenal, Pararenal and Thoracoabdominal Aortic Aneurysms: Preventing, Recognizing and Treating Complications to Improve Clinical Outcomes
by Andrea Xodo, Mario D’Oria, Bernardo Mendes, Luca Bertoglio, Kevin Mani, Mauro Gargiulo, Jacob Budtz-Lilly, Michele Antonello, Gian Franco Veraldi, Fabio Pilon, Domenico Milite, Cristiano Calvagna, Filippo Griselli, Jacopo Taglialavoro, Silvia Bassini, Anders Wanhainen, David Lindstrom, Enrico Gallitto, Luca Mezzetto, Davide Mastrorilli, Sandro Lepidi and Randall DeMartinoadd Show full author list remove Hide full author list
J. Pers. Med. 2022, 12(7), 1018; https://doi.org/10.3390/jpm12071018 - 21 Jun 2022
Cited by 12 | Viewed by 5334
Abstract
The advent and refinement of complex endovascular techniques in the last two decades has revolutionized the field of vascular surgery. This has allowed an effective minimally invasive treatment of extensive disease involving the pararenal and the thoracoabdominal aorta. Fenestrated-branched EVAR (F/BEVAR) now represents [...] Read more.
The advent and refinement of complex endovascular techniques in the last two decades has revolutionized the field of vascular surgery. This has allowed an effective minimally invasive treatment of extensive disease involving the pararenal and the thoracoabdominal aorta. Fenestrated-branched EVAR (F/BEVAR) now represents a feasible technical solution to address these complex diseases, moving the proximal sealing zone above the renal-visceral vessels take-off and preserving their patency. The aim of this paper was to provide a narrative review on the peri-operative management of patients undergoing F/BEVAR procedures for juxtarenal abdominal aortic aneurysm (JAAA), pararenal abdominal aortic aneurysm (PRAA) or thoracoabdominal aortic aneurism (TAAA). It will focus on how to prevent, diagnose, and manage the complications ensuing from these complex interventions, in order to improve clinical outcomes. Indeed, F/BEVAR remains a technically, physiologically, and mentally demanding procedure. Intraoperative adverse events often require prolonged or additional procedures and complications may significantly impact a patient’s quality of life, health status, and overall cost of care. The presence of standardized preoperative, perioperative, and postoperative pathways of care, together with surgeons and teams with significant experience in aortic surgery, should be considered as crucial points to improve clinical outcomes. Aggressive prevention, prompt diagnosis and timely rescue of any major adverse events following the procedure remain paramount clinical needs. Full article
(This article belongs to the Special Issue Postoperative Management in Vascular Surgery)
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