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Vascular Surgery: Current Challenges and Future Perspectives
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Vascular Surgery: Current Challenges and Future Perspectives

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

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 2717

Special Issue Editors

Prof. Dr. Bruno Salvati

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; vascular medicine; surgery; aneurysm; vascular diseases; vascular surgery; cardiac surgery; T lymphocytes; arteries; atherosclerosis
Dr. Lidia Castagneto Gissey

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; minimally invasive surgery; laparoscopic surgery; general surgery; gastric surgery; gastrointestinal surgery; colorectal surgery; bariatric surgery; hernia repair; vascular surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Rita Mele

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; vascular medicine; surgery; aneurysm; vascular diseases; vascular surgery

Special Issue Information

Dear Colleagues,

The evolution of vascular surgery from the 1970s onwards has been entirely aimed at precision surgery with a minimally invasive nature. New techniques have obviously led to new complications and therefore to new challenges. With new techniques and complications, the introduction of endovascular treatments has greatly changed how aortic, peripheral, and carotid illnesses are treated. Despite recent modest innovations, open procedures continue to be an excellent choice in some circumstances.

Future challenges will be in the endovascular revascularization of leg vessels and in neoangiogenic therapy, in the safety of carotid surgery and in the innovation of prosthetic materials.

Long-term follow-up is required to assess aortic remodeling and the decline in the incidence of aortic events following endovascular procedures used to treat acute and chronic aortic dissection. The intricate recanalization and thrombectomy procedures required for endovascular therapy of acute and chronic mesenteric ischemia require technical expertise and specialized equipment.

The potential clinical advantages of these cutting-edge techniques must still be determined and contrasted with the open surgical strategy. Future decision-making will be aided by artificial intelligence, but the viewpoints solicited should be relevant to imaging and radioprotection employing electromagnetic guidance.

In this Special Issue, researchers are invited to discuss contemporary issues in handling various conditions, such as clinical advances in endovascular and vascular surgery, aortic dissection, carotid artery disease, and peripheral arterial disease, just to mention a few.

Prof. Dr. Bruno Salvati
Dr. Lidia Castagneto Gissey
Prof. Dr. Rita Mele
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

  • vascular surgery
  • endovascular surgery
  • peripheral arterial disease
  • carotid stenosis
  • aortic dissection
  • mesenteric ischemia
  • restenosis
  • vessel preparation
  • hostile neck
  • artificial intelligence
  • endoleaks

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Published Papers (2 papers)

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12 pages, 250 KiB  
Article
Elective Endovascular Aneurysm Repair (EVAR) for the Treatment of Infrarenal Abdominal Aortic Aneurysms of 5.0–5.5 cm: Differences between Men and Women
by Ombretta Martinelli, Simone Cuozzo, Francesca Miceli, Roberto Gattuso, Vito D’Andrea, Paolo Sapienza and Maria Irene Bellini
J. Clin. Med. 2023, 12(13), 4364; https://doi.org/10.3390/jcm12134364 - 28 Jun 2023
Cited by 1 | Viewed by 1408
Abstract
Background: There is significant debate regarding the existence of sex-related differences in the presentation, treatment, and outcomes of men versus women affected by abdominal aortic aneurysm (AAA). The purpose of this study is to compare endovascular aneurysm repair (EVAR) of infrarenal AAAs with [...] Read more.
Background: There is significant debate regarding the existence of sex-related differences in the presentation, treatment, and outcomes of men versus women affected by abdominal aortic aneurysm (AAA). The purpose of this study is to compare endovascular aneurysm repair (EVAR) of infrarenal AAAs with the current sex-neutral 5.0–5.5 cm-diameter threshold for intervention between the two sexes. Methods: Retrospective review of consecutive cases from a single teaching institution over a period of five years of patients who had undergone elective EVAR for AAAs between 5.0 and 5.5 cm in diameter. Outcomes of interest were compared according to sex. Results: Ninety-four patients were included in the analysis, with a higher prevalence of men (53%). Females were older at the time of repair, 78 ± 5.1 years, versus 71.7 ± 7 years (p < 0.01), and had higher incidence of underlying comorbidities, namely, arrhythmia, chronic kidney disease, and previous carotid revascularization. Women had higher incidence of immediate systemic complications (p = 0.021), post-operative AMI (p = 0.001), arrhythmia (p = 0.006), pulmonary oedema (p < 0.001), and persistent renal dysfunction (p = 0.029). Multivariate analysis for post-operative factors associated to mortality and adjusted for sex confirmed that AMI (p = 0.015), arrhythmia (p = 0.049), pulmonary oedema (p = 0.015), persistent renal dysfunction (p < 0.001), cerebral ischemia (p < 0.001), arterial embolism of lower limbs (p < 0.001), and deep-vein thrombosis of lower limbs (p < 0.001) were associated to higher EVAR-related mortality; a higher incidence of post-operative AMI (p = 0.014), pulmonary edema (p = 0.034), and arterial embolism of lower limbs (p = 0.046) were associated to higher 30-days mortality. In females there was also a higher rate of suprarenal fixation (p = 0.026), insertion outside the instruction for use (p = 0.035), and a more hostile neck anatomy with different proximal aortic diameter (p < 0.001) and angle (p = 0.003). Conclusions: A similar threshold of size of AAA for elective surgery for both males and females might not be appropriate for surgical intervention, as females tend to have worse outcomes. Further population-based studies are needed to guide on sex-related differences and intervention on AAA. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Challenges and Future Perspectives)
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8 pages, 2781 KiB  
Case Report
Hybrid Approach: Combining Surgical Thrombectomy and AngioJet™ Aspirational Thrombectomy in Limb Graft Occlusion Post-FEVAR with Fenestrated Anaconda™ and in ePTFE Bypass Graft Occlusion
by Gowri Kiran Puvvala, Karamperidis Loukas, Konstantinos P. Donas, Juergen Hinkelmann, Ba-Fadhl Faiz, Luna Vidriales Gerado and Anastasios Psyllas
J. Clin. Med. 2024, 13(14), 4002; https://doi.org/10.3390/jcm13144002 - 9 Jul 2024
Viewed by 908
Abstract
Acute limb ischemia due to limb-graft occlusion (LGO) after fenestrated endovascular aneurysm repair (FEVAR) and acute bypass graft occlusion with an ePTFE graft pose critical challenges, necessitating prompt intervention to prevent limb loss. This paper discusses two cases of acute limb ischemia treated [...] Read more.
Acute limb ischemia due to limb-graft occlusion (LGO) after fenestrated endovascular aneurysm repair (FEVAR) and acute bypass graft occlusion with an ePTFE graft pose critical challenges, necessitating prompt intervention to prevent limb loss. This paper discusses two cases of acute limb ischemia treated with a hybrid approach using the AngioJet™ Ultra Thrombectomy System as an adjunct to Fogarty thrombectomy. Case I involved a 69-year-old male post-FEVAR with contralateral iliac limb graft occlusion of the fenestrated Anaconda™, while Case II featured a 70-year-old male (ASA IV) post-bypass surgery (iliopopliteal arterial bypass with ePTFE Graft) with acute bypass graft occlusion. Both cases underwent successful recanalization using the AngioJet™ Ultra Thrombectomy System (ZelanteDVT™ 8F catheter, Solent™ Proxi 6F catheter) (Boston Scientific, Marlborough, MA, USA), combined with adjunctive techniques including Fogarty thrombectomy, balloon angioplasty, stenting, and local lysis. Immediate postoperative and follow-up assessments after 6 months revealed restored limb perfusion and improved clinical outcomes, with palpable pulses and improved ulcer healing. The aim of this treatment strategy is not only to alleviate limb ischemia but also to preserve future options in the event of graft failure. The use of the AngioJet™ Thrombectomy System in cases of LGO aims not only to clear the thrombus load but also to avoid the need for graft relining. In the case of acute arterial bypass graft occlusion in a patient with ASA IV, the goal of using the thrombectomy device is to preserve the native vessels for future procedures, such as long infragenual bypass, in addition to limb salvage. These cases demonstrate the efficacy of a hybrid surgical approach in managing acute limb ischemia following graft occlusion following FEVAR and bypass surgery. Long-term follow-up will further elucidate the durability of these interventions and their impact on limb salvage and overall patient outcomes. By combining mechanical thrombectomy with adjunctive techniques, such as balloon angioplasty and stenting, this hybrid approach offers a comprehensive solution to acute limb ischemia, addressing both the underlying occlusive pathology and ensuring optimal limb perfusion. Furthermore, the utilization of the AngioJet™ Ultra Thrombectomy System provides a minimally invasive yet effective method for thrombus removal, reducing procedural time and potential complications associated with open surgical techniques. As such, this approach represents a valuable addition to the armamentarium of treatments for acute limb ischemia, particularly in cases of graft occlusion following complex endovascular and bypass procedures. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Challenges and Future Perspectives)
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