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Clinical Advances and Challenges in Vascular and Endovascular Medicine
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Clinical Advances and Challenges in Vascular and Endovascular Medicine

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 July 2024 | Viewed by 1237

Special Issue Editor

Dr. Luca Bertoglio

E-Mail Website
Guest Editor
Division of Vascular Surgery, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
Interests: vascular surgery; vascular medicine; stents; aortic diseases; vascular diseases; medical and biomedical image processing; angiography; atherosclerosis

Special Issue Information

Dear Colleagues,

Vascular and endovascular medicine are specialized fields of medicine that focus on the diagnosis, treatment, and management of diseases affecting the blood vessels. Endovascular treatments such as angioplasty, stenting, and embolization have revolutionized the treatment of vascular diseases, reducing the need for open surgery and improving patient recovery times. Recent clinical advances in vascular imaging technologies, such as CT angiography and magnetic resonance imaging (MRI), have improved the accuracy of diagnosis, allowing for earlier detection and treatment of vascular disease. However, these advances have also brought challenges, include the development of better preventative measures and more effective treatments for vascular diseases such as arterial aneurysms, peripheral artery disease, and venous thromboembolism.

In conclusion, while recent clinical advances in vascular and endovascular medicine have greatly improved patient outcomes, they have also introduced new challenges that will require ongoing attention from the medical community. Addressing these challenges will require continued innovation, research, and collaboration among practitioners in these fields. We look forward to your enthusiastic participation in this Special Issue that will promote scientific communication of our knowledge with the ultimate goal of positively influencing treatment and care for our patients.

Dr. Luca Bertoglio
Guest Editor

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

  • vascular and endovascular medicine
  • minimally invasive cardiovascular surgery
  • vascular diseases
  • endovascular technologies
  • endovascular surgery
  • aortic dissection

Published Papers (2 papers)

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Research

12 pages, 516 KiB  
Article
Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease
by Konstantinos Avranas, Apostolos G. Pitoulias, Gergana T. Taneva, Efthymios Beropoulis and Konstantinos P. Donas
J. Clin. Med. 2024, 13(11), 3235; https://doi.org/10.3390/jcm13113235 - 30 May 2024
Viewed by 414
Abstract
Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are [...] Read more.
Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are no published mid-term outcomes evaluating the performance of atherectomy differentiated by sex. This study aims to evaluate sex-specific outcomes and prognostic factors affecting the results of atherectomy-assisted endovascular treatment in severe PAD. Methods: A retrospective analysis was conducted at a single centre in Germany, initiated by physicians and not sponsored by industry, on patients presenting with Rutherford categories ranging from III to V and featuring de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries. The intervention involved rotational atherectomy-assisted angioplasty utilising the Jetstream (Boston, US®) device. The point of interest of this study was postinterventional clinical improvement as well as mid-term outcomes, including primary patency, over a targeted 2-year follow-up period. Statistical analysis utilised Cox regression (survival analysis) to calculate hazard ratios according to sex category. Comparative survival analysis was performed using the log-rank test and visually represented through Kaplan–Meier curves. Risk factors associated with absence of clinical improvement were examined across both sex groups utilising the chi-square or Fisher exact test, as appropriate. Results: A total of 98 patients (103 limbs) were initially included, with >75% having moderate-to-severe lesion calcification (>50%). A total of 84 patients (97 limbs, 62 male and 35 female) proceeded to a 2-year follow-up (mean 16.4 months for males and 16.1 for females) after a successful index procedure. Age distribution, Rutherford class, diabetes, chronic kidney disease (CKD), target vessel, lesion type, and length were balanced among both groups. Similar primary patency rates, of 89% among female and 91% among male limbs, were observed (p = 0.471). Female patients exhibited a lower rate of clinical improvement based on the Rutherford scale in comparison to males (80.6% vs. 94.5%, p = 0.048). CDK was the only significant prognostic factor across pooled data (odds ratio for CKD: 15.15, p < 0.001). Conclusions: Rotational atherectomy showed comparably high rates of mid-term primary patency, with low rates of bailout stent placement. These findings highlight the beneficial use of atherectomy in female patients who are per se at risk for higher rates of complications during and after endovascular interventions. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)
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15 pages, 2161 KiB  
Article
Analysis of Target Vessel Instability in Fenestrated Endovascular Repair (f-EVAR) in Thoraco-Abdominal Aortic Pathologies
by Daniel Becker, Laura Sikman, Ahmed Ali, Selim Mosbahi, Carlota F. Prendes, Jan Stana and Nikolaos Tsilimparis
J. Clin. Med. 2024, 13(10), 2898; https://doi.org/10.3390/jcm13102898 - 14 May 2024
Viewed by 558
Abstract
Objective: The aim of this study was to evaluate the influence of target vessel anatomy and post-stenting geometry on the outcome of fenestrated endovascular aortic repair (f-EVAR). Methods: A retrospective review of data from a single center was conducted, including all consecutive fenestrated [...] Read more.
Objective: The aim of this study was to evaluate the influence of target vessel anatomy and post-stenting geometry on the outcome of fenestrated endovascular aortic repair (f-EVAR). Methods: A retrospective review of data from a single center was conducted, including all consecutive fenestrated endovascular aortic repairs (f-EVARs) performed between September 2018 and December 2023 for thoraco-abdominal aortic aneurysms (TAAAs) and complex abdominal aortic aneurysms (cAAAs). The analysis focused on the correlation of target vessel instability to target vessel anatomy and geometry after stenting. The primary endpoint was the cumulative incidence of target vessel instability. Secondary endpoints were the 30-day and follow-up re-interventions. Results: A total of 136 patients underwent f-EVAR with 481 stented target vessels. A total of ten target vessel instabilities occurred including three in visceral and seven instabilities in renal vessels. The cumulative incidence of target vessel instability with death as the competing risk was 1.4%, 1.8% and 3.4% at 1, 2 and 3 years, respectively. In renal target vessels (260/481), a diameter ≤ 4 mm (OR 1.21, 95% CI 1.035–1.274, p = 0.009) and an aortic protrusion ≥ 5.75 mm (OR 8.21, 95% CI 3.150–12-23, p = 0.027) was associated with an increased target vessel instability. In visceral target vessels (221/481), instability was significantly associated with a preoperative tortuosity index ≥ 1.25 (HR 15.19, CI 95% 2.50–17.47, p = 0.045) and an oversizing ratio of ≥1.25 (HR 7.739, CI % 4.756–12.878, p = 0.049). Conclusions: f-EVAR showed favorable mid-term results concerning target vessel instability in the current cohort. A diameter of ≤4 mm and an aortic protrusion of ≥5.75 mm in the renal target vessels as well as a preoperative tortuosity index and an oversizing of the bridging stent of ≥1.25 in the visceral target vessels should be avoided. Full article
(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)
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