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

Deadline for manuscript submissions: 30 June 2025 | Viewed by 8623

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Special Issue Editor

Prof. Dr. Toshifumi Kudo

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Guest Editor

Department of Cardiovascular Surgery, Division of Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
Interests: aortic aneurysm; peripheral arterial disease; chronic limb-threatening ischemia; endovascular anerysm repair; endovascular treatment; non-invasive blood flow measurements

Special Issue Information

Dear Colleagues,

The purpose of this Special Issue is to describe the current diagnostic methods and treatment outcomes for vascular diseases, particularly aortic aneurysms, peripheral artery diseases, and venous diseases, and identify current issues while also discussing possible solutions for the future. Regarding aortic aneurysms, including dissection, endovascular aneurysm repair (TEVAR/EVAR) has become the gold standard. We would particularly welcome authors to discuss complications, such as endoleaks, that influence treatment outcomes. For peripheral artery diseases, particularly CLTI, we would like authors to discuss a wide range of treatment methods, including bypass surgery, endovascular treatment (EVT), and foot care, aimed at improving treatment outcomes. Additionally, we would like authors to discuss the latest findings on venous diseases, such as varicose veins and deep vein thrombosis, as well as non-atherosclerotic peripheral artery diseases, including visceral artery aneurysms, popliteal artery entrapment syndrome, and adventitial cystic disease. This Special Issue welcomes original articles on vascular diseases, including those affecting the arteries and veins.

Prof. Dr. Toshifumi Kudo
Guest Editor

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Keywords

aortic aneurysm
peripheral arterial disease
chronic limb-threatening ischemia
endovascular aneurysm repair
endovascular treatment
non-invasive blood flow measurements
varicose veins
deep venous thrombosis

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Related Special Issue

Advances in Vascular and Endovascular Surgery in Journal of Clinical Medicine (5 articles)

Published Papers (9 papers)

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Research

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8 pages, 519 KiB

Open AccessArticle

Chronic Kidney Disease Requiring Hemodialysis as a Significant Predictor of Target Lesion Revascularization After Endovascular Treatment of Femoropopliteal Occlusive Lesions with a Drug-Coated Balloon

by Tsuyoshi Ichinose, Toshifumi Kudo and Yohei Yamamoto

J. Clin. Med. 2025, 14(5), 1474; https://doi.org/10.3390/jcm14051474 - 22 Feb 2025

Viewed by 355

Abstract

Background: Drug-coated balloons (DCBs) have been reported to have lowered the rate of restenosis and revascularization after endovascular treatment (EVT) of femoropopliteal (FP) lesions. Meanwhile, chronic kidney disease requiring hemodialysis (HD), which is becoming more prevalent in Japanese clinical settings, has been associated with poorer outcomes after EVT for FP lesions. This study aimed to retrospectively analyze the impact of HD on the outcomes of EVT using a DCB in a single center. Methods: This study included 161 consecutive FP lesions in 127 patients treated with a DCB between September 2018 and May 2023, stratified into HD (34.6%) and non-HD (65.4%) groups. The primary endpoint was clinically driven target lesion revascularization (CDTLR), and the secondary endpoints were major amputation and all-cause mortality. Results: The median observation period after EVT using a DCB was 336 days. Although a Rutherford’s category of 4 or higher was significantly predominant in the HD group (82.3%) than the non-HD group (53.5%), a Rutherford’s category of 4 or higher itself was not a statistically significant factor of the primary endpoint. The ratio of occluded lesion was significantly higher in the non-HD group (21.2%) than the HD group (8.1%). The duration of freedom from clinically driven target lesion revascularization (CDTLR) assessed via the Kaplan–Meier method was significantly shorter in the HD group (744 days) compared to the non-HD group (1533 days). The HD group had a higher incidence of CDTLR (odds ratio 4.48, p = 0.03) compared to the non-HD group. Conclusions: HD patients had significantly worse prognoses in EVT of FP lesions using a DCB. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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11 pages, 958 KiB

Open AccessArticle

Preoperative Neutrophil-to-Lymphocyte Ratio as a Predictor of Clinical Outcomes in Patients Undergoing Femoral Endarterectomy

by Yohei Yamamoto, Ai Kazama, Toru Kikuchi and Toshifumi Kudo

J. Clin. Med. 2025, 14(1), 211; https://doi.org/10.3390/jcm14010211 - 2 Jan 2025

Viewed by 582

Abstract

Background/Objectives: This study aimed to evaluate the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with peripheral arterial disease (PAD) undergoing femoral endarterectomy. Methods: We performed a retrospective analysis of our institutional data, evaluating consecutive patients with PAD who underwent femoral endarterectomy between January 2013 and March 2023. The main objective was to assess the prognostic value of preoperative NLR for 5-year mortality. Additionally, we examined its relationship with perioperative clinicopathological features and 5-year major adverse limb events (MALEs). Results: During the study period, 200 consecutive patients underwent femoral endarterectomy. Of these, 128 patients with available NLR values within 30 days prior to surgery were analyzed. According to the receiver operating characteristic curve, the cut-off value of NLR was 4.0. Eighty-seven patients (68.0%) were assigned to the low-NLR group, and 41 patients (32.0%) to the high-NLR group. The frequency of postoperative complications did not differ significantly between the two groups. Freedom from MALEs up to five years was significantly lower in the high-NLR group (66.0% vs. 46.5%, p = 0.006). The overall survival rates were significantly lower in the high-NLR group (p < 0.001). At 1, 3, and 5 years, the survival rates in the low-NLR group were 96.4%, 91.6%, and 84.5%, respectively, while those in the high-NLR group were 84.2%, 59.5%, and 42.5%. Univariate analysis showed that cerebrovascular disease, end-stage renal disease, Rutherford category ≥ 4, a low albumin concentration (<3.5 g/dL), and a high NLR were significantly associated with 5-year mortality. Multivariate analysis indicated that a high NLR was the only independent factor associated with 5-year mortality. Conclusions: Preoperative NLR > 4.0 was significantly associated with 5-year rates of MALE and mortality in patients with symptomatic CFA occlusive disease who underwent femoral endarterectomy. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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18 pages, 3325 KiB

Open AccessArticle

Demographic Characteristics and Treatment Outcomes of Intracranial Atherosclerosis Stenting: A Retrospective Case-Series of 216 Consecutive Patients

by Marat Sarshayev, Botagoz Turdaliyeva, Gulnur Tanbayeva, Shayakhmet Makhanbetkhan, Maxat Mussabekov, Dimash Davletov, Aiman Maidan and Mynzhylky Berdikhojayev

J. Clin. Med. 2025, 14(1), 125; https://doi.org/10.3390/jcm14010125 - 28 Dec 2024

Viewed by 1326

Abstract

Background/Objectives: Intracranial atherosclerosis (ICAS) is a major cause of ischemic stroke, disproportionately affecting populations with significant vascular risk factors. Although ICAS imposes a considerable health burden, research on this condition in Central Asia remains scarce, especially among the Kazakh population. This study analyzes demographic characteristics, treatment outcomes, and procedural challenges associated with ICAS in 216 patients treated at a single institution. Methods: This retrospective study included patients with ≥70% intracranial artery stenosis confirmed by imaging and presenting with ischemic symptoms. All patients underwent angioplasty and stenting with dual antiplatelet therapy (DAPT). Data collected included demographics, comorbidities, stenosis characteristics, procedural details, and outcomes assessed by the modified Rankin Scale (mRS). Results: The median age was 63.5 years (IQR: 57–68.6), and 73.7% were male. Hypertension was the most common comorbidity (98%), followed by ischemic heart disease (58%) and diabetes mellitus (40.9%). Multi-location ICAS was significantly associated with patients over 75 years of age (p = 0.025). Additionally, obesity and stenosis severity greater than 70% showed trends toward significance, with p-values of 0.064 and 0.079, respectively. Stenosis predominantly affected the internal carotid artery (54.5%) and vertebrobasilar system (31.6%). The average hospital stay was longer for posterior circulation stenosis (7.1 days) compared to anterior circulation (4.7 days). The periprocedural complication rate was 0.7%, with two deaths attributed to ischemic complications. At follow-up, four patients experienced worsening mRS scores (>2), particularly those with severe stenosis in the basilar artery and M1 segment. Conclusions: ICAS in the Kazakh population is strongly associated with hypertension and aging, with posterior circulation stenosis contributing disproportionately to worse outcomes. The low complication rates highlight the safety of modern endovascular techniques. However, further research is needed to optimize treatment strategies for severe and multi-location ICAS, particularly in Central Asian populations. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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10 pages, 984 KiB

Open AccessArticle

Initial Outcomes of Physician-Modified Inner-Branched Endovascular Repair for Distal Aortic Arch Aneurysm

by Shingo Tsushima, Tsuyoshi Shibata, Yutaka Iba, Tomohiro Nakajima, Junji Nakazawa, Shuhei Miura, Ayaka Arihara, Kei Mukawa, Yu Iwashiro and Nobuyoshi Kawaharada

J. Clin. Med. 2025, 14(1), 39; https://doi.org/10.3390/jcm14010039 - 25 Dec 2024

Viewed by 523

Abstract

Background/Objectives: Few clinical studies have reported on physician-modified inner-branched endovascular repair (PMiBEVAR) for aortic arch aneurysm. Herein, we evaluate the outcomes of proximal landing zone 2 PMiBEVAR. Methods: This retrospective study analyzed data from six patients who underwent zone 2 PMiBEVAR for aortic arch aneurysms at a single center between October 2021 and June 2024. The outcomes were in-hospital mortality and postoperative complications. Results: The median follow-up period was 12.5 (7.3–25) months. Males constituted four out of six cases and females constituted two out of six cases. The patients had a median age of 78.5 (76.5–79.0) years, and the aneurysm diameter was 56 (50–61) mm. Technical success was achieved in 5/6 (83.3%) cases. The median modification and operative times were 56 (45–60) min and 92 (79–308), respectively. Postoperatively, delayed type Ia endoleak and vascular access-site pseudoaneurysm occurred in one patient each. However, no patients experienced other complications. The median hospital stay was 10 (7–41) days, and no deaths or reinterventions occurred after 30 days. During the post-discharge follow-up, the aneurysm diameter remained “unchanged” in four patients, including the one with delayed type Ia endoleak, while two patients experienced “shrinkage”. Conclusions: PMiBEVAR for distal aortic arch aneurysm might be effective in improving postoperative outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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11 pages, 1506 KiB

Open AccessArticle

Contemporary Outcomes of Infrainguinal Vein Bypass Surgery for Chronic Limb-Threatening Ischaemia: A Two-Centre Cross-Sectional Study

by Thomas Lovelock, Sharan Randhawa, Cameron Wells, Anastasia Dean and Manar Khashram

J. Clin. Med. 2024, 13(17), 5343; https://doi.org/10.3390/jcm13175343 - 9 Sep 2024

Viewed by 1167

Abstract

Background/Objectives: Chronic limb-threatening ischaemia (CLTI) is a significant life and limb-threatening condition. Two recent seminal trials, BEST-CLI and BASIL-2, have provided seemingly conflicting results concerning the optimal treatment modality for patients with CLTI. We sought to investigate the outcomes of patient undergoing infrainguinal bypass at two centres in Aotearoa New Zealand. Methods: A cross-sectional retrospective review of all patients who underwent infrainguinal bypass grafting for CLTI at Auckland City Hospital and Waikato Hospital between January 2020 and December 2021 was performed. The primary outcome was a composite of death, above-ankle amputation, and major limb reintervention. The secondary outcome was minor limb reintervention. Kaplan–Meier survival analysis was performed to determine time to the primary and secondary endpoints. Demographic factors were examined using the log-rank test to examine the effect on the outcome. Results: One hundred and nineteen patients who underwent infrainguinal bypass for CLTI in the study period were identified. Of these, 93 patients had a bypass with ipsilateral or contralateral GSV. The median follow-up time was 1.85 years. The most common indication for surgery was tissue loss (69%, n = 63), with the most common distal bypass target being the below-knee popliteal artery (45%, n = 41). The primary composite outcome occurred in 42.8% of the cohort (n = 39). Death was the most common component of the primary outcome (26%, n = 24). Male sex (HR 0.48, 95% CI 0.26–0.88, p = 0.018) and statin use (HR 0.49, 95% CI 0.24–0.98, p = 0.044) were independent predictors of protection from the composite outcome on multivariate analysis. Dialysis dependence (HR 3.32, 95% CI 1.23–8.99, p = 0.018) was an independent predictor for patients meeting the composite outcome. Conclusions: This study’s results are consistent with the published outcomes of BEST-CLI. The patient cohorts examined, anatomical disease patterns, and conduit use may explain some of the differences observed between this study, BEST-CLI and BASIL-2. Further work is required to define the specific patient populations who will benefit most from an open surgical or endovascular first approach to the management of CLTI. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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12 pages, 1733 KiB

Open AccessArticle

The Incidence and Outcomes of Major Limb Amputation in New Zealand from 2010 to 2021

by Odette Hart, Oliver Bernau and Manar Khashram

J. Clin. Med. 2024, 13(13), 3872; https://doi.org/10.3390/jcm13133872 - 30 Jun 2024

Cited by 1 | Viewed by 1431

Abstract

Background: Major limb amputation (MLA) can be a common outcome due to severe peripheral artery disease (PAD) and diabetic foot disease (DFD), and it carries a significant mortality burden. In New Zealand (NZ), there is little documentation of the incidence rate and mortality after MLA. The aim was to report the national crude and standardised rates and the mortality post MLA. Methods: This retrospective observational study included all MLAs that occurred within NZ from 1/1/2010 to 31/12/2021 due to DFD and/or PAD. Two national databases (National Minimum Dataset and the Australasian Vascular Audit) were utilised. The crude rates were calculated as cases per 100,000 in the NZ population per year including all ages (using the 2013 and 2018 NZ census figures). The age-standardised rates used the World Health Organization standard population. Post-operative mortality was calculated from the date of first hospitalisation for MLA. Results: From 2010 to 2021, there were 5293 MLA procedures in 4242 patients. On average, there were 8.5 MLAs per week and 441.1 MLAs annually. The overall crude rate was 9.44 per 100,000, and the standardised rate was 6.12 per 100,000. Over the 12 years, the crude rate decreased by 22% (p < 0.001), and the standardised rate decreased by 20.4% (p < 0.001). After MLA, the 30-day and 1-year mortality was 9.5% and 29.6%, respectively. From 2010 to 2021, the relative reduction in 30-day mortality was 45.1% (p < 0.001), and the reduction in 1-year mortality was 24.5% (p < 0.001). Increasing age, female sex and end-stage renal failure were predictors of 30-day and 1-year mortality. Conclusions: A considerable number of MLAs occur in NZ, with substantial perioperative mortality; however, the national incidence rates and mortality have improved over the last 12 years. This data might serve as benchmark to further reduce MLAs and improve patient outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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Review

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19 pages, 14587 KiB

Open AccessReview

Management of Extra-Pelvic Varicose Veins of Pelvic Origin in Female Patients

by Aleksandra Jaworucka-Kaczorowska, Roshanak Roustazadeh, Marian Simka and Houman Jalaie

J. Clin. Med. 2025, 14(8), 2707; https://doi.org/10.3390/jcm14082707 - 15 Apr 2025

Viewed by 433

Abstract

Extra-pelvic varicose veins (VVs), originating from incompetent pelvic veins, present a significant clinical challenge, due to their complex anatomy, etiology, and symptomatology. This review aims at providing a comprehensive overview of the diagnostic and therapeutic strategies for these cases and emphasizes the importance of a tailored, evidence-based approach to the effective management of these varicosities, particularly regarding the interplay between the pelvic and extra-pelvic venous systems. Diagnostic workup should be multifaceted, incorporating patient-reported symptoms, physical examinations, and duplex ultrasound imaging. Specific diagnostic assessments include evaluation of the pelvic escape points and the transvaginal and transabdominal ultrasonography, to analyze venous hemodynamics and identify anatomical abnormalities in the pelvic floor and pelvis. In patients presenting with additional pelvic venous insufficiency (PVI)-related pelvic symptoms, advanced diagnostic techniques, such as cross-sectional imaging, venography, and intravascular ultrasound can be valuable to confirm and establish the appropriate treatment strategy. Since most patients with extra-pelvic VVs of pelvic origin do not report pelvic symptoms, minimally invasive procedures, using the “bottom-up” approach, such as ultrasound-guided foam sclerotherapy of the pelvic escape points and extra-pelvic VVs, or surgical ligation and miniphlebectomy for these incompetent veins, are usually sufficient. There are several advantages of these local procedures: they are simple, radiation exposure and injection contrast agents are avoided, they are convenient for the patient since they are performed on an outpatient basis, and they can be easily repeated, if required. When the “bottom-up” treatment fails and the extra-pelvic VVs recur quickly or the patient develops pelvic symptoms, management of the pelvic veins including embolization of the ovarian veins or stenting of the iliac veins should be considered. Careful patient selection is essential to avoid overtreatment and achieve optimal clinical outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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22 pages, 6210 KiB

Open AccessReview

General Information and Applications of Najuta Fenestrated Stent Grafts for Aortic Arch Aneurysms

by Seiji Onitsuka, Atsuhisa Tanaka, Hiroyuki Otsuka, Yusuke Shintani, Ryo Kanamoto, Shinya Negoto and Eiki Tayama

J. Clin. Med. 2025, 14(1), 36; https://doi.org/10.3390/jcm14010036 - 25 Dec 2024

Viewed by 803

Abstract

Endovascular stent graft repair was developed to minimize the invasiveness of open surgery for thoracic and abdominal aortic diseases. This approach involves covering the diseased segment with a stented artificial graft. However, in thoracic endovascular aortic repair (TEVAR) for aortic arch diseases, special consideration is needed to preserve the aortic arch vessels. Standard stent grafts often require additional procedures, such as bypass surgery, to reconstruct the arch vessels. The semi-custom-made Najuta fenestrated stent graft was developed to address this issue. It is a three-dimensional patient-specific stent graft with fenestrations that allow for the preservation of the arch vessels. This study discusses the unique features of the Najuta stent graft and the techniques for its deployment, and it provides an analysis of treatment outcomes based on the current literature. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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Other

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8 pages, 1843 KiB

Open AccessCase Report

A Case of Diabetic Ischemic Ulcer with Toe Deformity Successfully Treated with Revascularization and Surgical Offloading

by Kazuhito Nagasaki, Kyota Kikuchi, Masuomi Tomita, Katsuya Hisamichi and Yuko Izumi

J. Clin. Med. 2025, 14(3), 646; https://doi.org/10.3390/jcm14030646 - 21 Jan 2025

Viewed by 948

Abstract

Background: Diabetic ischemic ulcers with toe deformities are challenging to manage due to combined ischemia, infection, and mechanical stress. This case report highlights the successful treatment of a complex diabetic ischemic ulcer using a multidisciplinary approach that included revascularization and surgical offloading. Case Presentation: A 70-year-old male with type 2 diabetes mellitus presented with non-healing ulcers on the right third toe. The ulcers, located at the dorsal PIP joint and plantar MTP joint, were attributed to ischemia, infection, and progressive toe deformity. Angiography revealed significant arterial stenosis, which was treated with percutaneous transluminal angioplasty (PTA) to restore in-line flow and improve skin perfusion pressure. Surgical offloading included PIP resection arthroplasty and metatarsal shortening osteotomy. Postoperative management ensured complete ulcer healing, and no recurrence was observed during the three-year follow-up. Discussion: This case underscores the importance of combining revascularization to improve perfusion and surgical offloading to alleviate mechanical stress. Key factors for success included the restoration of in-line flow, achieving sufficient skin perfusion pressure, and reducing plantar pressure. Multidisciplinary collaboration among vascular surgeons, orthopedists, and wound care specialists played a critical role in achieving excellent long-term outcomes. Conclusions: Revascularization followed by surgical offloading provided effective treatment for a diabetic ischemic ulcer with toe deformity. This multidisciplinary approach demonstrates the necessity of individualized strategies to manage complex diabetic foot cases and prevent recurrence. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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