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

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

Deadline for manuscript submissions: 10 February 2025 | Viewed by 2807

Special Issue Editors

Dr. Antonio Rizza

E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals
Dr. Simona Sica

E-Mail
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

E-Mail Website
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

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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 Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

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

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Published Papers (2 papers)

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Research

15 pages, 1775 KiB  
Article
The Value of Aortic Volume and Intraluminal Thrombus Quantification for Predicting Aortic Events after Endovascular Thoracic Aneurysm Repair
by Mariangela De Masi, Carine Guivier-Curien, Sébastien Cortaredona, Virgile Omnes, Laurence Bal, Baptiste Muselier, Axel Bartoli, Marine Gaudry, Philippe Piquet and Valérie Deplano
J. Clin. Med. 2024, 13(10), 2981; https://doi.org/10.3390/jcm13102981 - 18 May 2024
Viewed by 985
Abstract
Objectives: To assess the ability of the aortic aneurysm volume (AAV), aneurysmal lumen volume (ALV), and aneurysmal thrombus volume (ATV) to predict the need for aortic reintervention when using the maximal aortic diameter as a reference. Methods: This monocentric retrospective study included 31 [...] Read more.
Objectives: To assess the ability of the aortic aneurysm volume (AAV), aneurysmal lumen volume (ALV), and aneurysmal thrombus volume (ATV) to predict the need for aortic reintervention when using the maximal aortic diameter as a reference. Methods: This monocentric retrospective study included 31 consecutive patients who underwent successful thoracic endovascular aortic repair (TEVAR) to treat an atheromatous thoracic aortic aneurysm. All patients underwent clinical and computed tomography angiography (CTA) for 3 years after TEVAR. The patients were categorized into group 0 if no aortic reintervention was required during the follow-up period and categorized into group 1 if they experienced a type I or III endoleak or aneurysm diameter increase requiring intervention. The maximum aneurysm sac diameter and the AAV, ALV, and ATV were calculated using CTA images obtained preoperatively (T0) and at 6–12 months (T1), 24 months (T2), and 36 months (T3) postoperatively, and their changes over time were analyzed. Correlations between diameter and changes in AAV, ALV, and ATV were assessed, and the association between diameter and volume changes and reintervetion was examined. The cutoff values for predicting the need for reintervention was determined using a receiver operating characteristic (ROC) curve. The accuracy of volume change versus diameter change for predicting the need for reintervention was analyzed. Results: There were no significant differences in terms of the mean aneurysm diameter or AAV, ALV or ATV between the groups at preoperative CTA or after one year of follow-up imaging. The mean ATV was higher in group 1 than in group 0 at 2 years (187.6 ± 86.3 mL vs. 114.7 ± 64.7 mL; p = 0.057) and after 3 years (195.0 ± 86.7 mL vs. 82.1 ± 39.9 mL; p = 0.013). The maximal diameter was greater in group 1 than in group 0 at 3 years (67.3 ± 9.5 mm vs. 55.3 ± 12.6 mm; p = 0.044). The rate of AAV change between T0 and T1 was significantly higher in group 1 (7 ± 4.5%) than in group 0 (−6 ± 6.8%; p < 0.001). The rate of ATV change between T1-T3 was significantly higher in group 1 than in group 0 (34 ± 40.9% vs. −13 ± 14.4% (p = 0.041)); similar results were observed for the rate of ATV change between T2 and T3 (27 ± 50.1% for group 1 vs. −8 ± 49.5% in group 0 (p < 0.001)). According to our multivariate analysis, the annual growth rate for AAV between T0 and T1 was the only independent factor that was significantly associated with aortic reintervention (area under the curve (AUC) = 0.84, OR = 1.57, p = 0.025; optimal cutoff +0.4%). An increase in the annual growth rate of the ATV between T0 and T3 was independently associated with the need for aortic reintervention (area under the curve (AUC) = 0.90, OR = 1.11, p = 0.0347; optimal cutoff +10.1%). Conclusions: Aortic volume analysis can predict the need for aortic reintervention more accurately and earlier than maximal aortic diameter. 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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14 pages, 3472 KiB  
Article
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
Cited by 4 | Viewed by 1310
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 [...] Read more.
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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