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Pathogenesis and Treatment of Abdominal Aortic Aneurysm
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Pathogenesis and Treatment of Abdominal Aortic Aneurysm

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 (15 August 2022) | Viewed by 28549

Special Issue Editor

Prof. Dr. Kyriakos Oikonomou

E-Mail Website
Guest Editor
Department of Vascular Surgery, University Medical Centre Regensburg, 93053 Regensburg, Germany
Interests: aortic aneurysm; aortic dissection; EVAR; fenestrated/branched endovascular repair; complex aortic pathology

Special Issue Information

Dear Colleagues,

Despite a recent decrease in prevalence, abdominal aortic aneurysm (AAA) remains a very common disease in Western Countries and constitutes the most common extracranial aneurysm localization with a prevalence of 4–7% among males older than 65-years. Large AAAs are at an increasing risk for rupture, with a mortality rate of about 80% in the acute setting.

Higher awareness and structured screening programs, as well as the evolution of Endovascular Aortic Aneurysm Repair (EVAR) have allowed physicians to promptly identify and successfully treat an increasing number of patients, even those previously considered unfit for open repair. The development of increasingly complex endovascular techniques has expanded our treatment options in patients with hostile anatomic characteristics. However use of these techniques still has its limitations and carries the risk of late complications, rendering conventional open repair an important component of our treatment armamentarium.

In the coming years focus will be to optimize long term results while preserving the benefits of a minimal invasive approach and to tailor the treatment modality, including open repair, to specific patient characteristics. Furthermore, questions regarding pathogenesis, natural progression of the disease, indications to treat and long term surveillance need to be addressed. 

It is my honour and pleasure to invite you to contribute to this Special Issue on “ Pathogenesis and Treatment of Abdominal Aortic Aneurysm”. In this Special Issue we seek original contributions and literature reviews (including systematic review and meta-analysis) on pathogenesis and current treatment and follow-up concepts for AAA.

Prof. Dr. Kyriakos Oikonomou
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

  • Abdominal Aortic Aneurysm (AAA)
  • Endovascular Aneurysm Repair (EVAR)
  • Endoleak
  • Open Aortic Reconstruction
  • Endoanchors
  • Fenestrated Endograft
  • Chimney Technique

Published Papers (18 papers)

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Editorial

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4 pages, 192 KiB  
Editorial
The Ongoing Evolution of Abdominal Aortic Surgery
by Kyriakos Oikonomou and Carla Isabell Zimmler
J. Clin. Med. 2023, 12(1), 302; https://doi.org/10.3390/jcm12010302 - 30 Dec 2022
Cited by 1 | Viewed by 945
Abstract
Abdominal aortic surgery has witnessed significant paradigm shifts in recent years with the introduction of structured screening programs, as well as the evolution of endovascular aortic aneurysm repair (EVAR), which has allowed physicians to promptly identify and successfully treat an increasing number of [...] Read more.
Abdominal aortic surgery has witnessed significant paradigm shifts in recent years with the introduction of structured screening programs, as well as the evolution of endovascular aortic aneurysm repair (EVAR), which has allowed physicians to promptly identify and successfully treat an increasing number of patients, even including those previously considered unfit for open repair [...] Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)

Research

Jump to: Editorial

12 pages, 1545 KiB  
Article
Age and Oversizing Influence Iliac Dilatation after EVAR
by Daphne Elisabeth Gray, Carla Samaan, Kyriakos Oikonomou, Tatjana Gruber-Rouh, Thomas Schmitz-Rixen and Wojciech Derwich
J. Clin. Med. 2022, 11(23), 7113; https://doi.org/10.3390/jcm11237113 - 30 Nov 2022
Cited by 3 | Viewed by 1182
Abstract
In the past two decades, endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) has become the first line treatment for infrarenal AAA repair in many countries. While short-term results are good, concerns have been raised about long-term durability. Changes in aortoiliac anatomy, [...] Read more.
In the past two decades, endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) has become the first line treatment for infrarenal AAA repair in many countries. While short-term results are good, concerns have been raised about long-term durability. Changes in aortoiliac anatomy, especially at the landing zones, could play a role in EVAR failure over time. The current study aimed to determine certain morphological changes in the distal iliac landing zone after EVAR implantation, as well aspossible risk factors associated with iliac sealing failure. In a retrospective analysis of a tertiary single-centre registry, including patients treated with EVAR between January 2008 and July 2018, clinical follow-up data were assessed, and computer tomography (CT) imaging was evaluated regarding morphological changes in the iliac anatomy during follow-up. For clinical analysis all patients with a minimum follow-up of one year were included; for morphological analysis of iliac anatomy all patients with available CT follow-up of a minimum of one year and a minimum of two CT scans were included. Overall, 127 out of 241 treated patients (92.1% male) were included in the clinical follow-up. Complete CT imaging of 99 iliac arteries in 55 patients was available for morphological analysis. Median postoperative follow-up (FU) for these patients was 33 months (IQR 31; min–max: 12–124). Incidence of type 1b endoleak was 3% but iliac limb detachment from the vessel wall was seen in 18.2% of the target vessels. There was a significant difference in oversizing in iliac limbs with detachment (median 13.9%, IQR 23.1) vs. without detachment (median 23.1%, IQR 19.1) (p = 0.034). Iliac arteries at the landing zone showed a significant diameter increase independent of an endoleak presence (overall cohort median diameter increase at one year 23.1 mm; at two years 0 mm; at three years 4.9 mm). Iliac arteries with detachment (median 14.4%; IQR 23.9) showed a significantly higher diameter increase at the landing zone after four years compared to arteries without detachment (median 5.3%; IQR 9) (p = 0.042). Oversizing correlated positively with an iliac diameter increase at the landing zone over time (3 m: p= 0.001; one year: p < 0.001; two years: p < 0.001; three years: p = 0.006). Older patients showed a significantly lower diameter increase at the distal landing zone over time than younger patients in the first two years after EVAR (p < 0.001/r = −0.606 after two years). In the current study, iliac limb oversizing was associated with increased dilatation of the distal landing zone during a three-year follow-up, while iliac limb detachment was observed less often. An older age was inversely associated to the iliac diameter increase. Future studies should clarify the association between stent graft oversizing, age, and changes in the iliac anatomy in order to identify parameters that affect EVAR durability. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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8 pages, 328 KiB  
Article
Percutaneous Approach in Endovascular Aortic Procedures Using a Suture-Mediated Closure Device
by Kyriakos Oikonomou, Akaki Kvataia, Karin Pfister, Evgenia Zygouridou, Thomas Betz, Wilma Schierling and Georgios Sachsamanis
J. Clin. Med. 2022, 11(22), 6660; https://doi.org/10.3390/jcm11226660 - 10 Nov 2022
Cited by 1 | Viewed by 981
Abstract
Background: The purpose of this study is to assess the efficacy of a suture-mediated closure device during percutaneous endovascular aortic repair. Methods: A single-center, retrospective analysis of patients undergoing endovascular repair for infrarenal, thoracic and thoracoabdominal aortic aneurysms and aortic dissections via percutaneous [...] Read more.
Background: The purpose of this study is to assess the efficacy of a suture-mediated closure device during percutaneous endovascular aortic repair. Methods: A single-center, retrospective analysis of patients undergoing endovascular repair for infrarenal, thoracic and thoracoabdominal aortic aneurysms and aortic dissections via percutaneous femoral access between April 2017 and June 2021 was performed. The primary endpoint of the study was the efficacy and technical success of the Perclose ProGlide closure device during percutaneous endovascular procedures. The secondary endpoints were intraoperative and postoperative inguinal and vascular complications during and after device use. Results: A total of 376 punctures were performed in 263 patients with the deployment of the ProGlide vascular closure system. Twenty-two cases involved percutaneous re-puncture as part of a staged procedure. The primary and secondary technical success rates were 93.1% (350/376) and 94.7% (356/376), respectively. In 20 patients (5.3%), intraoperative femoral exposure due to complications was required. Postoperative complications occurred in 13 cases (3.5%), 2 of which required surgical reintervention. There was no statistical significance between the type of endovascular procedure and primary technical success (p = 0.56). The introduction of larger-diameter sheaths was not associated with increased intraoperative and postoperative complication rates (p = 0.75 and p = 0.78, respectively). Percutaneous re-puncture of the vascular access site did not result in a lower overall technical success rate (20/22, 90.9% primary technical success rate, p = 0.67; 21/22, 95.5% secondary technical success rate, p = 0.86) or an increased number of perioperative complications (1/22, 4.5% intraoperative complications, p = 0.86; 2/22, 9.1% postoperative complications, p = 0.13). Conclusion: The application of the ProGlide closure system is a safe and efficient method to achieve hemostasis during percutaneous endovascular aortic repair. Complex aortic pathologies, which often require a staged approach with re-puncture, can also be successfully treated with this closure system. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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22 pages, 4781 KiB  
Article
Three-Dimensional Geometric Analysis of Balloon-Expandable Covered Stents Improves Classification of Complications after Fenestrated Endovascular Aneurysm Repair
by Claire van der Riet, Richte C. L. Schuurmann, Eric L. G. Verhoeven, Athanasios Katsargyris, Ignace F. J. Tielliu, Timothy Resch, Reinoud P. H. Bokkers and Jean-Paul P. M. de Vries
J. Clin. Med. 2022, 11(19), 5716; https://doi.org/10.3390/jcm11195716 - 27 Sep 2022
Cited by 3 | Viewed by 1427
Abstract
In balloon-expandable covered stent (BECS) associated complications after fenestrated endovascular aneurysm repair (FEVAR), geometric analysis may determine the cause of failure and influence reintervention strategies. This study retrospectively classifies BECS-associated complications based on computed tomographic angiography (CTA) applied geometric analysis. BECS-associated complications of [...] Read more.
In balloon-expandable covered stent (BECS) associated complications after fenestrated endovascular aneurysm repair (FEVAR), geometric analysis may determine the cause of failure and influence reintervention strategies. This study retrospectively classifies BECS-associated complications based on computed tomographic angiography (CTA) applied geometric analysis. BECS-associated complications of FEVAR-patients treated in two large vascular centers between 2012 and 2021 were included. The post-FEVAR CTA scans of complicated Advanta V12 BECSs were analyzed geometrically and complications were classified according to its location in the BECS. BECS fractures were classified according to an existing classification system. In 279 FEVAR-patients, 34 out of the 683 included Advanta V12 BECS (5%) presented with a complication. Two Advanta V12 complications occurred during the FEVAR procedure and 32 occurred during follow-up of which five post-FEVAR CTA scans were missing or not suitable for analysis. In the remaining 27 BECSs complications were classified as (endoleaks (n = 8), stenoses (n = 4), occlusions (n = 6), fractures (n = 3), and a combination of complications (n = 6)). All BECSs associated complications after FEVAR with available follow up CTA scans could be classified. Geometric analysis of BECS failure post-FEVAR can help to plan the reintervention strategy. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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10 pages, 2561 KiB  
Article
Mid-Term Results of Fenestrated Endovascular Repair after Prior Open Aortic Reconstruction
by Pablo Marques de Marino, Melad Abu Jiries, Pavel Tesinsky, Anas Ibraheem, Athanasios Katsargyris and Eric L. Verhoeven
J. Clin. Med. 2022, 11(19), 5596; https://doi.org/10.3390/jcm11195596 - 23 Sep 2022
Cited by 3 | Viewed by 1142
Abstract
This study aims to assess the mid-term results of fenestrated endovascular aneurysm repair (FEVAR) for the treatment of proximal aortic pathology after previous open surgical repair (OSR). All patients with a previous history of OSR of an abdominal aortic aneurysm undergoing a FEVAR [...] Read more.
This study aims to assess the mid-term results of fenestrated endovascular aneurysm repair (FEVAR) for the treatment of proximal aortic pathology after previous open surgical repair (OSR). All patients with a previous history of OSR of an abdominal aortic aneurysm undergoing a FEVAR procedure between October 2010 and November 2021 were included. The endpoints of the study were technical success, mortality, target vessel patency and reinterventions during follow-up. Thirty-five patients (34 male, mean age 72.9 ± 7 years) were included. The median interval from the primary surgery to the FEVAR procedure was 136 months (range 47–261). The indication for treatment was a para-anastomotic aneurysm in 18 (51%) patients and a true aneurysm due to progression of disease in 17 (49%) patients. Technical success was achieved in 33 (94%) patients. There was one (3%) early death due to postoperative bleeding from a renal artery. Estimated survival at 12, 24 and 36 months was 89.1% ± 6%, 84.4% ± 7.3% and 84.4% ± 7.3%, respectively. There was no aneurysm-related mortality. One (3%) target vessel occluded during follow-up and three (9%) patients underwent late reinterventions. In conclusion, FEVAR is a safe and effective alternative for the endovascular treatment of para-anastomotic aneurysms/pseudoaneurysms after OSR showing high technical success, low mortality and morbidity, and good mid-term outcomes. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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10 pages, 2404 KiB  
Article
Relationship between the Levels of Calprotectin and Soluble Receptor for Advanced Glycation End Products with Abdominal Aortic Aneurysm Diameter: A Preliminary Clinical Trial
by Willy Hauzer, Jan Gnus and Joanna Rosińczuk
J. Clin. Med. 2022, 11(18), 5448; https://doi.org/10.3390/jcm11185448 - 16 Sep 2022
Cited by 3 | Viewed by 1340
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta greater than 50% of the diameter of a healthy aorta. Previous experimental studies confirm the effect of calprotectin (CAL) on the onset of arterial pathology. It has been suggested that low [...] Read more.
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta greater than 50% of the diameter of a healthy aorta. Previous experimental studies confirm the effect of calprotectin (CAL) on the onset of arterial pathology. It has been suggested that low levels of soluble receptors for advanced glycation end products (RAGEs) increase levels of cytokines that lead to the inhibition of matrix metalloproteinases (MMPs), affecting AAA formation. This study aimed to analyze the correlation of levels of RAGE and CAL with AAA diameter. A group of 32 patients aged 50–75 with diagnosed AAA was enrolled in the study. This group of patients was further divided into three subgroups based on AAA diameter: (1) <4.5 cm, (2) 4.5–5.5 cm, (3) >5.5 cm. Peripheral blood was drawn from all participants on admission to measure the serum CAL and RAGE levels. An enumeration survey was performed three months after AAA surgical treatment. CAL and RAGE plasma levels were measured with the enzyme-linked immunosorbent assay (ELISA). The median CAL levels were 2273.0 ng/mL before and 1217.0 ng/mL after treatment. There was a statistically significant decrease in CAL levels following the surgical treatment (p = 0.003). The correlation analysis between CAL levels and RAGE levels before and after surgical treatment showed no statistically significant correlations. In addition, there were no statistically significant correlations between CAL and RAGE levels with AAA size. In conclusion, CAL levels appear to be a significant marker in patients with AAA. There is an almost twofold decrease in CAL levels after AAA excision. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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9 pages, 2223 KiB  
Article
Treatment of Secondary Aortoenteric Fistulas Following AORTIC Aneurysm Repair in a Tertiary Reference Center
by Kyriakos Oikonomou, Karin Pfister, Piotr M. Kasprzak, Wilma Schierling, Thomas Betz and Georgios Sachsamanis
J. Clin. Med. 2022, 11(15), 4427; https://doi.org/10.3390/jcm11154427 - 29 Jul 2022
Cited by 2 | Viewed by 1664
Abstract
Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between [...] Read more.
Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between January 2005 and December 2018 was performed. Analyzed parameters included patients’ demographics, clinical presentation, diagnostic work-up, perioperative data and repair durability during follow-up. Results: Twenty-three patients with aortoenteric fistulas were treated in the target period. The fistulous connection was located in 21 cases (91.3%) in the duodenum and in two cases (8.7%) in the small intestine. Average time between the initial procedure and detection of the aortoenteric fistula was 69.4 ± 72.5 months. The most common presenting symptom was gastrointestinal bleeding (n = 12, 52.2%), followed by symptoms suggestive of chronic infection (n = 11, 47.8%). Open surgical repair was performed in 19 patients (bridging in 3 patients), and endovascular repair was carried out in two cases and one patient underwent a hybrid operation. One patient underwent abscess drainage due to significant comorbidities. Mean follow-up was 35.1 ± 35.5 months. In-hospital mortality and overall mortality were 43.5% (10/23) and 65.2% (15/23), respectively. Patients presenting with bleeding had a significantly higher perioperative mortality rate in comparison to patients presenting with chronic infection (66.7% (8/12) and 18.2% (2/11), respectively, p = 0.019). Patients who underwent stent-graft implantation for control of acute life-threatening bleeding showed significantly better perioperative survival in comparison to patients that were acutely treated with an open procedure (66.6%, (4/6) and 0% (0/6), respectively, p = 0.014). Perioperative mortality was also higher for ASA IV patients (71.4%, 5/7), when compared to ASA III Patients (31.2%, 5/16), although this did not reach statistical significance (p = 0.074). Conclusion: Treatment of secondary aortoenteric fistulas is associated with a high perioperative mortality rate. Patients who survive the perioperative period following open surgical repair in the absence of hemorrhagic shock show acceptable midterm results during follow-up. Stent-graft implantation for bleeding control in patients presenting with life-threatening bleeding seems to be associated with lower perioperative mortality rates. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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11 pages, 1489 KiB  
Article
Pulse Wave Velocity for Risk Stratification of Patients with Aortic Aneurysm
by Wilma Schierling, Julia Matzner, Hanna Apfelbeck, Dirk Grothues, Renate Oberhoffer-Fritz and Karin Pfister
J. Clin. Med. 2022, 11(14), 4026; https://doi.org/10.3390/jcm11144026 - 12 Jul 2022
Cited by 3 | Viewed by 1409
Abstract
Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or [...] Read more.
Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R2 = 0.838) and current systolic blood pressure (SBP) on PWV (page corrected < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWVnonaortic AVD 10.0 ± 1.8 m/s, PWVtreated AoD 10.0 ± 1.5 m/s, PWVuntreated AoD 9.8 ± 1.6 m/s; page corrected > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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10 pages, 238 KiB  
Article
Gene Expression Profiling in Abdominal Aortic Aneurysms
by Amelie L. Behrens, Susanne Dihlmann, Caspar Grond-Ginsbach, Andreas S. Peters, Bernhard Dorweiler, Dittmar Böckler and Philipp Erhart
J. Clin. Med. 2022, 11(12), 3260; https://doi.org/10.3390/jcm11123260 - 7 Jun 2022
Cited by 3 | Viewed by 1323
Abstract
Gene expression profiling of abdominal aortic aneurysms (AAA) indicates that chronic inflammatory responses, active matrix metalloproteinases, and degradation of the extracellular matrix components are involved in disease development and progression. This study investigates intra- and interpersonal RNA genome-wide expression profiling differences (Illumina HumanHT-12, [...] Read more.
Gene expression profiling of abdominal aortic aneurysms (AAA) indicates that chronic inflammatory responses, active matrix metalloproteinases, and degradation of the extracellular matrix components are involved in disease development and progression. This study investigates intra- and interpersonal RNA genome-wide expression profiling differences (Illumina HumanHT-12, BeadCHIP expression) of 24 AAA biopsies from 12 patients using a single gene and pathway (GeneOntology, GO enrichment) analysis. Biopsies were collected during open surgical AAA repair and according to prior finite element analysis (FEA) from regions with the highest and lowest wall stress. Single gene analysis revealed a strong heterogeneity of RNA expression parameters within the same and different AAA biopsies. The pathway analysis of all samples showed significant enrichment of genes from three different signaling pathways (integrin signaling pathway: fold change FC 1.63, p = 0.001; cholecystokinin receptor pathway: FC 1.60, p = 0.011; inflammation mediated by chemokine signaling pathway: FC 1.45, p = 0.028). These results indicate heterogeneous gene expression patterns within the AAA vascular wall. Single biopsy investigations do not permit a comprehensive characterization of activated molecular processes in AAA disease. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
12 pages, 1874 KiB  
Article
Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair
by Sébastien Michel Vedani, Séverine Petitprez, Eva Weinz, Jean-Marc Corpataux, Sébastien Déglise, Céline Deslarzes-Dubuis, Elisabeth Côté, Jean-Baptiste Ricco and François Saucy
J. Clin. Med. 2022, 11(11), 3232; https://doi.org/10.3390/jcm11113232 - 6 Jun 2022
Cited by 6 | Viewed by 2089
Abstract
Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). We evaluated the impact of sac shrinkage on secondary interventions, on survival and its association with endoleaks, and on compliance with instructions for use (IFU). Methods: This observational [...] Read more.
Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). We evaluated the impact of sac shrinkage on secondary interventions, on survival and its association with endoleaks, and on compliance with instructions for use (IFU). Methods: This observational retrospective study was conducted on all consecutive patients receiving EVAR for an infrarenal abdominal aortic aneurysm (AAA) using exclusively Endurant II/IIs endograft from 2014 to 2018. Sixty patients were entered in the study. Aneurysm sac shrinkage was defined as decrease ≥5 mm of the maximum aortic diameter. Univariate methods and Kaplan–Meier plots assessed the potential impact of shrinkage. Results: Twenty-six patients (43.3%) experienced shrinkage at one year, and thirty-four (56.7%) had no shrinkage. Shrinkage was not significantly associated with any demographics or morbidity, except hypertension (p = 0.01). No aneurysm characteristics were associated with shrinkage. Non-compliance with instructions for use (IFU) in 13 patients (21.6%) was not associated with shrinkage. Three years after EVAR, freedom from secondary intervention was 85 ± 2% for the entire series, 92.3 ± 5.0% for the shrinkage group and 83.3 ± 9% for the no-shrinkage group (Logrank: p = 0.49). Survival at 3 years was not significantly different between the two groups (85.9 ± 7.0% vs. 79.0 ± 9.0%, Logrank; p = 0.59). Strict compliance with IFU was associated with less reinterventions at 3 years (92.1 ± 5.9% vs. 73.8 ± 15%, Logrank: p = 0.03). Similarly, survival at 3 years did not significantly differ between strict compliance with IFU and non-compliance (81.8 ± 7.0% vs. 78.6 ± 13.0%, Logrank; p = 0.32). Conclusion: This study suggests that shrinkage ≥5 mm at 1-year is not significantly associated with a better survival rate or a lower risk of secondary intervention than no-shrinkage. In this series, the risk of secondary intervention regardless of shrinkage seems to be linked more to non-compliance with IFU. Considering the small number of patients, these results must be confirmed by extensive prospective studies. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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9 pages, 640 KiB  
Article
Open Treatment of Abdominal Aortic Aneurysm in the Endovascular Era
by Abdulhakim Ibrahim, Miroslav Dimitrov Yordanov, Mohammad Hasso, Benjamin Heine and Alexander Oberhuber
J. Clin. Med. 2022, 11(11), 3050; https://doi.org/10.3390/jcm11113050 - 28 May 2022
Cited by 2 | Viewed by 1592
Abstract
The aim of the study was to analyse outcomes and determine the early and late complications in patients after open surgical treatment of AAA in the endovascular era. Two hundred and fourteen patients between January 2012 and December 2021 with open repair in [...] Read more.
The aim of the study was to analyse outcomes and determine the early and late complications in patients after open surgical treatment of AAA in the endovascular era. Two hundred and fourteen patients between January 2012 and December 2021 with open repair in primary infrarenal and juxtarena aneurysm in elective setting were included in the study. Pre-, intra-, and postoperative clinical data were statistically analysed. The mean age of the 214 patients was 65.5 ± 9.3 years. The mean follow-up was 22.1 ± 2.1 months. Men represented the majority of the studied group (85.5%). The mean aortic diameter was 58.2 ± 13.4. The median ICU (days) stay was 5 ± 4.9 days for infrarenal aneurysm and 6 ± 6.1 days for juxtarenal aneurysm. Four patients died within 30 days, giving an in-hospital mortality rate of 1.9%. In multivariate logistic regression, COPD (p = 0.015) was the only predictor significantly associated with the mortality. A comparison of survival and reintervention using a Kaplan–Meier curve showed no significant difference between the groups in terms of risk stratification and the groups with juxtarenal versus infrarenal aneurysms. In conclusion, open aneurysm repair is in the era of endovascular aneurysm repair, being safe and effective, especially when performed in specialised high-volume centres with large expertise. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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7 pages, 1226 KiB  
Article
Arterial Aneurysm Localization Is Sex-Dependent
by Daniel Körfer, Caspar Grond-Ginsbach, Maani Hakimi, Dittmar Böckler and Philipp Erhart
J. Clin. Med. 2022, 11(9), 2450; https://doi.org/10.3390/jcm11092450 - 27 Apr 2022
Cited by 2 | Viewed by 1640
Abstract
The aim of this study was to investigate sex-dependent aneurysm distributions. A total of 3107 patients with arterial aneurysms were diagnosed from 2006 to 2016. Patients with anything other than true aneurysms, hereditary connective tissue disorders or vasculitides (n = 918) were [...] Read more.
The aim of this study was to investigate sex-dependent aneurysm distributions. A total of 3107 patients with arterial aneurysms were diagnosed from 2006 to 2016. Patients with anything other than true aneurysms, hereditary connective tissue disorders or vasculitides (n = 918) were excluded. Affected arterial sites and age at first aneurysm diagnosis were compared between women and men by an unpaired two-tailed t-test and Fisher’s exact test. The study sample consisted of 2189 patients, of whom 1873 were men (85.6%) and 316 women (14.4%) (ratio m:w = 5.9:1). Men had considerably more aneurysms in the abdominal aorta (83.4% vs. 71.1%; p < 0.001), common iliac artery (28.7% vs. 8.9%; p < 0.001), internal iliac artery (6.6% vs. 1.3%; p < 0.001) and popliteal artery (11.1% vs. 2.5%; p < 0.001). In contrast, women had a higher proportion of aneurysms in the ascending aorta (4.4% vs. 10.8%; p < 0.001), descending aorta (11.1% vs. 36.4%; p < 0.001), splenic artery (0.9% vs. 5.1%; p < 0.001) and renal artery (0.8% vs. 6.0%; p < 0.001). Age at disease onset and further aneurysm distribution showed no considerable difference. The infrarenal segment might be considered a natural border for aneurysm formation in men and women suspected to have distinct genetic, pathophysiologic and ontogenetic factors. Screening modalities for women at risk might need further adjustment, particularly thoracic cross-sectional imaging complementation. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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10 pages, 4657 KiB  
Article
Quality of Life of Patients Treated for Abdominal Aortic Aneurysm: Open Surgery and Endoprosthesis
by Silvestra Barrena-Blázquez, Manuel Díez-Alonso, Luis Felipe Riera del Moral, Salvador Sanchez Coll, Melchor Alvarez-Mon, Miguel A. Ortega and Fernando Ruiz Grande
J. Clin. Med. 2022, 11(8), 2195; https://doi.org/10.3390/jcm11082195 - 14 Apr 2022
Cited by 4 | Viewed by 1343
Abstract
Objectives: To determine the degree of long-term health-related quality of life (HRQoL) of patients undergoing surgery for abdominal aortic aneurysm (AAA) and to analyze the results according to the type of treatment, namely, open abdominal repair (OAR) or endoprosthesis (EVAR). Patients and Methods: [...] Read more.
Objectives: To determine the degree of long-term health-related quality of life (HRQoL) of patients undergoing surgery for abdominal aortic aneurysm (AAA) and to analyze the results according to the type of treatment, namely, open abdominal repair (OAR) or endoprosthesis (EVAR). Patients and Methods: This was a prospective cross-sectional observational study. Patients receiving intervention for AAA between January 2013 and December 2020 were included. The Spanish version of the SF-36 questionnaire was used. A single survey was performed on all patients, and the time elapsed since the intervention was recorded. Results: On all health scales and in the two groups of patients, the highest scores were recorded at six months postoperatively. At that time, the EVAR and OAR groups had similar values. Between 13 and 16 months postoperatively, EVAR patients presented a transient but significant decrease in their scores for physical function (p = 0.016), vitality (p = 0.035) and social function (p = 0.041). From that moment, there were progressive decreases in the scores of the two groups of patients on all the scales of the SF-36 questionnaire, although this trend was less pronounced in the OAR group. At 60 months after the intervention, the latter group showed significantly higher values than EVAR for physical function (p = 0.01), vitality (p = 0.032) and mental health (p = 0.029). Additionally, at 60 months after the intervention, the Sum of the psychological component (MCS) and Sum of the physical component (PCS) scores were significantly higher in the OAR group (p = 0.040 and p = 0.039, respectively). Conclusions: In the short term, patients treated for AAA by EVAR or OAR showed similar results on the SF-36 questionnaire. In the long term, patients treated by EVAR had lower scores on the physical function, vitality and mental health scales. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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14 pages, 4923 KiB  
Article
Neuronal Pre- and Postconditioning via Toll-like Receptor 3 Agonist or Extracorporeal Shock Wave Therapy as New Treatment Strategies for Spinal Cord Ischemia: An In Vitro Study
by Daniela Lobenwein, Rosalie Huber, Lars Kerbler, Alexandra Gratl, Sabine Wipper, Can Gollmann-Tepeköylü and Johannes Holfeld
J. Clin. Med. 2022, 11(8), 2115; https://doi.org/10.3390/jcm11082115 - 11 Apr 2022
Cited by 2 | Viewed by 1896
Abstract
Spinal cord ischemia (SCI) is a devastating and unpredictable complication of thoracoabdominal aortic repair. Postischemic Toll-like receptor 3 (TLR3) activation through either direct agonists or shock wave therapy (SWT) has been previously shown to ameliorate damage in SCI models. Whether the same applies [...] Read more.
Spinal cord ischemia (SCI) is a devastating and unpredictable complication of thoracoabdominal aortic repair. Postischemic Toll-like receptor 3 (TLR3) activation through either direct agonists or shock wave therapy (SWT) has been previously shown to ameliorate damage in SCI models. Whether the same applies for pre- or postconditioning remains unclear. In a model of cultured SHSY-5Y cells, preconditioning with either poly(I:C), a TLR3 agonist, or SWT was performed before induction of hypoxia, whereas postconditioning treatment was performed after termination of hypoxia. We measured cytokine expression via RT-PCR and utilized Western blot analysis for the analysis of signaling and apoptosis. TLR3 activation via poly(I:C) significantly reduced apoptotic markers in both pre- and postconditioning, the former yielding more favorable results through an additional suppression of TLR4 and its downstream signaling. On the contrary, SWT showed slightly more favorable effects in the setting of postconditioning with significantly reduced markers of apoptosis. Pre- and post-ischemic direct TLR3 activation as well as post-ischemic SWT can decrease apoptosis and proinflammatory cytokine expression significantly in vitro and might therefore pose possible new treatment strategies for ischemic spinal cord injury. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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14 pages, 2811 KiB  
Article
A Statistical Shape Model of the Morphological Variation of the Infrarenal Abdominal Aortic Aneurysm Neck
by Willemina A. van Veldhuizen, Richte C. L. Schuurmann, Frank F. A. IJpma, Rogier H. J. Kropman, George A. Antoniou, Jelmer M. Wolterink and Jean-Paul P. M. de Vries
J. Clin. Med. 2022, 11(6), 1687; https://doi.org/10.3390/jcm11061687 - 18 Mar 2022
Cited by 5 | Viewed by 2009
Abstract
Hostile aortic neck characteristics, such as short length and large diameter, have been associated with type Ia endoleaks and reintervention after endovascular aneurysm repair (EVAR). However, such characteristics partially describe the complex aortic neck morphology. A more comprehensive quantitative description of 3D neck [...] Read more.
Hostile aortic neck characteristics, such as short length and large diameter, have been associated with type Ia endoleaks and reintervention after endovascular aneurysm repair (EVAR). However, such characteristics partially describe the complex aortic neck morphology. A more comprehensive quantitative description of 3D neck shape might lead to new insights into the relationship between aortic neck morphology and EVAR outcomes in individual patients. This study identifies the 3D morphological shape components that describe the infrarenal aortic neck through a statistical shape model (SSM). Pre-EVAR CT scans of 97 patients were used to develop the SSM. Parameterization of the morphology was based on the center lumen line reconstruction, a triangular surface mesh of the aortic lumen, 3D coordinates of the renal arteries, and the distal end of the aortic neck. A principal component analysis of the parametrization of the aortic neck coordinates was used as input for the SSM. The SSM consisted of 96 principal components (PCs) that each described a unique shape feature. The first five PCs represented 95% of the total morphological variation in the dataset. The SSM is an objective model that provides a quantitative description of the neck morphology of an individual patient. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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12 pages, 864 KiB  
Article
Predictors of Abdominal Aortic Aneurysm Shrinkage after Endovascular Repair
by Rianne E. van Rijswijk, Erik Groot Jebbink, Suzanne Holewijn, Nicky Stoop, Steven M. van Sterkenburg and Michel M. P. J. Reijnen
J. Clin. Med. 2022, 11(5), 1394; https://doi.org/10.3390/jcm11051394 - 3 Mar 2022
Cited by 7 | Viewed by 2149
Abstract
Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this [...] Read more.
Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this study, a range of parameters was investigated to identify their use in differentiating patients that will develop a shrinking AAA from those with a stable AAA one-year after EVAR. Hundred-seventy-four patients (67 shrinking AAA, 107 stable AAA) who underwent elective, infrarenal EVAR were enrolled between 2011–2018. Long-term survival was significantly better in patients with a shrinking AAA, compared to those with a stable AAA (p = 0.038). Larger preoperative maximum AAA diameter was associated with an increased likelihood of developing AAA shrinkage one-year after EVAR—whereas older age and larger preoperative infrarenal β angle were associated with a reduced likelihood of AAA shrinkage. However, this multivariate logistic regression model was only able to correctly identify 66.7% of patients with AAA shrinkage from the total cohort. This is not sufficient for implementation in clinical care, and therefore future research is recommended to dive deeper into AAA anatomy, and explore potential predictors using artificial intelligence and radiomics. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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10 pages, 1075 KiB  
Article
Supra- and Infra-Renal Aortic Neck Diameter Increase after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm
by Claire van der Riet, Richte C. L. Schuurmann, Angelos Karelis, Mehmet A. Suludere, Meike J. van Harten, Björn Sonesson, Nuno V. Dias, Jean-Paul P. M. de Vries and Martijn L. Dijkstra
J. Clin. Med. 2022, 11(5), 1203; https://doi.org/10.3390/jcm11051203 - 23 Feb 2022
Cited by 3 | Viewed by 1617
Abstract
Hypovolemia-induced hypotension may lead to an aortic diameter decrease in patients with a ruptured abdominal aortic aneurysm (rAAA). This study investigates the changes in supra- and infra-renal aortic neck diameters before and after endovascular aortic aneurysm repair (EVAR) for rAAA and the possible [...] Read more.
Hypovolemia-induced hypotension may lead to an aortic diameter decrease in patients with a ruptured abdominal aortic aneurysm (rAAA). This study investigates the changes in supra- and infra-renal aortic neck diameters before and after endovascular aortic aneurysm repair (EVAR) for rAAA and the possible association with endograft apposition. A retrospective cohort study was conducted including 74 patients treated between 2010 and 2019 in two large European vascular centers. Outer-to-outer wall diameters were measured at +40, +10, 0, −10, and −20 mm relative to the lowest renal artery baseline on the last pre- and first post-EVAR computed tomography angiography (CTA) scan in a vascular workstation. Endograft apposition was determined on the first post-EVAR CTA scan. The post-operative diameter was significantly (p < 0.001) larger than the preoperative diameter at all aortic levels. The aortic diameter at +40 mm (supra-renal) and −10 mm (infra-renal) increased by 6.2 ± 7.3% and 12.6 ± 9.8%, respectively. The aortic diameter at +40 mm increased significantly more in patients with low preoperative systolic blood pressure (<90 mmHg; p = 0.005). A shorter apposition length was associated with a higher aortic diameter increase (R = −0.255; p = 0.032). Hypovolemic-induced hypotension results in a significant decrease in the aortic diameter in patients with an rAAA, which should be taken into account when oversizing the endograft. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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13 pages, 752 KiB  
Article
Preoperative Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Mean Platelet Volume as Predictors of 1-Year Mortality in Patients Undergoing an Open Repair of Abdominal Aortic Aneurysms: A Retrospective Study
by Da Eun Ko, Hei Jin Yoon, Sang Beom Nam, Suk Won Song, Gisong Lee and Sung Yeon Ham
J. Clin. Med. 2021, 10(22), 5410; https://doi.org/10.3390/jcm10225410 - 19 Nov 2021
Cited by 4 | Viewed by 1467
Abstract
Objectives: To investigate if preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), or mean platelet volume (MPV) could be used to predict 1-year mortality in patients undergoing open abdominal aortic aneurysm (AAA) repair. Methods: We retrospectively reviewed 382 patients who [...] Read more.
Objectives: To investigate if preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), or mean platelet volume (MPV) could be used to predict 1-year mortality in patients undergoing open abdominal aortic aneurysm (AAA) repair. Methods: We retrospectively reviewed 382 patients who underwent open AAA repair between January 2008 and July 2019. We divided the patients into two groups based on 1-year mortality and compared the preoperative NLR, PLR, and MPV. The patients were then classified into tertiles based on their preoperative NLR (first tertile: <2.41 (n = 111); second tertile: 2.41 ≤ NLR ≤ 6.07 (n = 111); and third tertile: >6.07 (n = 112)). We compared the incidence of mortality and morbidity across the aforementioned tertiles. We performed a stepwise logistic regression analysis to evaluate the predictors for mortality. An additional subgroup analysis was performed by dividing the cases into non-ruptured and ruptured cases. Results: The preoperative NLR was significantly higher in the non-survivor group than in the survivor group (10.53 ± 7.60 vs. 5.76 ± 6.44, respectively, p = 0.003). The PLR and MPV were similar between the groups (145.35 ± 91.11 vs. 154.20 ± 113.19, p = 0.626, 9.38 ± 1.20 vs. 9.11 ± 1.39, p = 0.267, respectively). The incidence of 1-year mortality was 2.7%, 9.0%, and 14.3% in the first, second, and third NLR tertiles, respectively (p = 0.009). Higher NLR (odds ratio 1.085, 95% confidence interval 1.016–1.159, p = 0.015) and ruptured AAA (odds ratio 2.706, 95% confidence interval 1.097–6.673, p = 0.031) were the independent predictors of 1-year mortality in all patients. Moreover, the preoperative NLR was significantly higher in the ruptured AAA than in the non-ruptured AAA group (11.17 ± 7.90 vs. 4.10 ± 4.75, p < 0.001). In subgroup analysis, preoperative NLR (odds ratio 1.144, 95% confidence interval 1.031–1.271, p = 0.012) and PLR (odds ratio 0.986, 95% confidence interval 16 0.975–0.998, p = 0.017) was an independent predictor for 1-year mortality in ruptured cases. Conclusions: We demonstrated an independent relationship between the preoperative NLR and 1-year mortality in patients undergoing open AAA repair, besides PLR and MPV. Furthermore, the NLR and PLR had predictive power for 1-year mortality in ruptured cases. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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