Journal of Clinical Medicine

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Dr. Antonio Rizza

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Guest Editor

Cardiology Unit, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy
Interests: coronary artery disease; cardiology; abdominal aortic aneurysm; thoracic aortic aneurysm; carotid disease; aortic disease
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Dr. Simona Sica

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Guest Editor

Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma—Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: coronary artery disease; cardiology; abdominal aortic aneurysm; thoracic aortic aneurysm; carotid disease; aortic disease

Dr. Giovanni Tinelli

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Guest Editor

1. Fondazione Policlinico Gemelli IRCCS, Rome, Italy
2. Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
Interests: thoracic surgery; abdominal aortic surgery; endovascular, surgical and hybrid treatment of aneurysms and dissections of the aortic arch; descending thoracic aorta; thoracic–abdominal and abdominal aorta

Special Issue Information

Dear Colleagues,

This Special Issue is intended to be a journey through innovations in the endovascular treatment of diseases of the aorta. It should tell the contemporary story and the future of therapeutic strategies for the entire aorta, from the valve to the iliac arteries, without anatomical barriers.

Nowadays, endovascular management represents an essential therapeutic tool, especially, but not only, in patients at high surgical risk.

Doctors have always tried to develop treatment strategies that are as non-invasive as possible. However, no other progress towards this goal has been quite as spectacular as that of aortic endovascular therapies. Progress as the result of the development of materials, technologies, and devices in the hands of doctors from different backgrounds and cultures has made it possible to create and optimize the most advanced endovascular techniques. We would like to produce a Special Issue with no borders of 'specialization' precisely because we are convinced that only a 'multidisciplinary approach' can serve as a model for a health service that is a 'lighthouse' in these first decades of the 21st century.

Dr. Antonio Rizza
Dr. Simona Sica
Dr. Giovanni Tinelli
Guest Editors

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Keywords

aortic dissection
aortic aneurysm
aortic valve disease
iliac artery disease
atherosclerosis
atherosclerosis
endovascular surgery

Published Papers (1 paper)

Research

14 pages, 3472 KiB

Open AccessArticle

Endurant Stent Graft for Treatment of Abdominal Aortic Aneurysm Inside and Outside of the Instructions for Use for the Proximal Neck: A 14-Year, Single-Center Experience

by Giulio Accarino, Francesco De Vuono, Giancarlo Accarino, Giovanni Fornino, Aniello Enrico Puca, Rodolfo Fimiani, Valentina Parrella, Giovanni Savarese, Sergio Furgiuele, Carmine Vecchione, Gennaro Galasso and Umberto Marcello Bracale

J. Clin. Med. 2024, 13(9), 2589; https://doi.org/10.3390/jcm13092589 - 28 Apr 2024

Viewed by 435

Abstract

Aim: To assess the medium and long-term performance of the Endurant stent graft in a cohort of consecutive patients treated with this device for an abdominal aortic aneurysm (AAA) both inside and outside of the instructions for use (IFU) and to find factors influencing the outcomes. Methods: Our observational, retrospective, single-center study included all patients who consecutively underwent endovascular aneurysm repair with the Endurant stent graft from February 2009 to January 2023. Patients with an AAA to treat according to current guidelines were included. Patients were divided into two groups: Group 1 inside of the IFUs and Group 2 outside of the IFUs for the proximal aortic neck. Patients were followed up after the procedure with computed angiography tomography, ultrasound examination, and interviews. Aneurysm-related mortality, procedure-related reinterventions, and type IA and III endoleaks were considered primary endpoints. Secondary endpoints included aneurysmal sac variations and graft thrombosis. Results: A total of 795 patients were included, 650 in Group 1 and 145 in Group 2; 732 were males, and the mean age was 74 ± 8. Anamnestic baseline did not differ between the two groups. Neck length, width, and angulation were different between the two groups (all p < 0.001). A total of 40 patients had a ruptured AAA, while 56 were symptomatic. At a mean follow-up of 43 ± 39 months, aneurysm-related mortality was less than 1%, and 82 endoleak (10.5%) were observed. Overall endoleak rate and type 1A endoleak, as well as procedure-related reintervention, were significantly more frequent in Group 2. Sac regression of at least 5 mm was observed in 65.9% of cases. AAAs larger than 60.5 mm carried a higher risk of endoleak (HR: 1.025; 95% CI: 1.013–1.37; p < 0.001) and proximal necks shorter than 13.5 mm carried a higher type 1A risk (HR: 0.890; 95% CI: 0.836–0.948; p < 0.001). Patients without chronic obstructive pulmonary disease and taking lipid-lowering drugs had an overall more consistent sac-shrinking rate. Conclusions: The Endurant stent graft proves safe and reliable. Out-of-IFU treatment has poorer medium and long-term outcomes. Some conditions influence medium and long-term reintervention risk and sac behavior. Patients with bigger aneurysms, proximal necks shorter than 13.5 mm, and chronic obstructive pulmonary disease should be more carefully evaluated during follow-up. Consistent follow-up is in keeping low aneurysm-related mortality. Personalized risk profiles and peri and postoperative management strategies are needed. Full article

(This article belongs to the Special Issue Endovascular Management of Diseases of the Aorta: From the Aortic Valve to the Iliac Arteries)

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Endovascular Management of Diseases of the Aorta: From the Aortic Valve to the Iliac Arteries

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