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Open and Endovascular Management of Complex Aortic Aneurysms

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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: closed (20 April 2023) | Viewed by 16027

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Special Issue Editor

Prof. Dr. Jean-Baptiste Ricco

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Guest Editor

Department of Clinical Research, University Hospital of Poitiers, Poitiers, France
Interests: vascular surgery; vascular medicine; biostatistics

Special Issue Information

Dear Colleagues,

Aortic disease is the direct cause of close to 10000 deaths annually in the United States. The goal of aortic aneurysm repair is to prevent the high morbidity and mortality associated with aneurysm rupture.

The decision to treat an AAA is based on the associated risk of treatment, the risk of aneurysm rupture, the patient’s life expectancy, and patient preference. However, the paradigm of open surgical repair (OSR) changed after the introduction of endovascular repair (EVAR). Since then, the use of endovascular techniques in the treatment of aortic aneurysms has expanded dramatically, and EVAR is now the primary treatment for AAA.

While OSR remains an integral part of a comprehensive aortic aneurysm treatment program, rates of open AAA repair have declined dramatically in the endovascular era. Therefore, fewer surgeons and centers have a high-volume open aneurysm practice and the relationship between open AAA repair outcomes and surgeon/center volume is dramatic, particularly for complex AAA, which should be performed by experienced surgeons at high-volume centers.

With this in mind, we have reviewed in this Special Issue the management of complex AAAs, comprising juxtarenal AAAs and suprarenal AAAs, which represent around 15% of AAAs requiring treatment which cannot be repaired with standard EVAR because of the lack of an infrarenal neck. Two techniques (FEVAR and chimney/snorkel EVAR) have been developed to extend the proximal seal zone, allowing for endovascular repair in these patients. This is followed by the management of (1) descending thoracic aneurysms by OSR and by TEVAR, as well as (2) thoracoabdominal and (3) aortic arch aneurysm repair both by OSR and by innovative endovascular techniques.

We believe that this Special Issue will be of interest to readers of the Journal of Clinical Medicine. Endovascular aortic aneurysm repair is now being used in the entire aorta and has allowed definite repair in patients unsuitable for OSR. It has also introduced its own set of complications and challenges.

Prof. Dr. Jean-Baptiste Ricco
Guest Editor

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Keywords

aortic aneurysm
abdominal aortic
aneurysm thoracic aortic aneurysm
juxtarenal aortic aneurysm
endovascular abdominal aortic aneurysm repair (EVAR)
endovascular thoracic aortic aneurysm repair (TEVAR)
endovascular aortic arch aneurysm repair
artificial intelligence
robot-assisted aortic aneurysm repair

Published Papers (13 papers)

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Research

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12 pages, 1089 KiB

Open AccessArticle

Predictors of 30-Day Postoperative Outcome after Elective Endovascular Abdominal Aortic Aneurysm Repair: A Tertiary Referral Center Experience

by Maria P. Ntalouka, Petroula Nana, Alexandros Brotis, Athanasios Chatzis, Maria Mermiri, Konstantinos Stamoulis, Metaxia Bareka, Athanasios Giannoukas, Miltiadis Matsagkas and Eleni Arnaoutoglou

J. Clin. Med. 2023, 12(18), 6004; https://doi.org/10.3390/jcm12186004 - 16 Sep 2023

Cited by 1 | Viewed by 776

Abstract

Background: We evaluated the 30-day postoperative outcome after elective endovascular aneurysm repair (EVAR) and the possible predictors for the 30-day postoperative outcome. Materials: Demographics, medical history, laboratory values, intensive care unit (ICU) admission and 30-day complications classified as major (major adverse cardiovascular events (MACEs), acute kidney injury (AKI) and death of any cause) and minor (postimplantation syndrome (PIS), postoperative delirium (POD), urinary tract infection (UTI) and technical graft failure) were documented (March 2016 to February 2019). Results: We included 322 patients. The majority were managed under general anesthesia (83%) with femoral cutdown (98.1%). Overall, 121 (37.5%) complications, mostly minor (n = 103, 31.9%), were recorded. In total, 11 patients (3.4%) developed MACEs, 5 (1.6%) experienced AKI and 2 (0.6%) died in the ICU. Moreover, 77 patients (23.9%) suffered from PIS, 11 from POD, 11 from UTI and 4 from technical graft failure. The multivariate logistic regression analysis revealed that aneurysm diameter (p = 0.01) and past smoking (p = 0.003) were predictors for complications. PAD was an independent predictor of MACEs (p = 0.003), preoperative neutrophil to lymphocyte ratio (NLR) of AKI (p = 0.003) and past smoking of PIS (p = 0.008), respectively. Conclusions: Our study showed that the 30-day morbidity after EVAR exceeded 35%. However, the majority of complications were minor, and the associated mortality was low. Aneurysm diameter and past smoking were independent predictors for postoperative outcome. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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10 pages, 1281 KiB

Open AccessArticle

by Denise Michelle Danielle Özdemir-van Brunschot, David Holzhey and Spiridon Botsios

J. Clin. Med. 2023, 12(15), 4929; https://doi.org/10.3390/jcm12154929 - 27 Jul 2023

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Abstract

Introduction: Studies comparing male and female patients with abdominal aortic aneurysms have shown that female patients are generally older and more often experience postoperative complications after endovascular and open repair. There are also indications that female patients have more extensive neck pathologies and that they more often have postoperative complications related to proximal neck pathology. Material and methods: This retrospective study describes all consecutive female patients who underwent EVAR between 1 January 2012 and 31 December 2021. Propensity-score matching was used to obtain a matched control male cohort. Propensity scores were generated with the following anatomic parameters: infrarenal and suprarenal angulation, proximal and distal neck diameter and neck length. 1 Female patient was matched with 3 male patients. Results: A total of 160 patients were included, namely 120 male patients and 40 female patients. Due to matching, there were no significant differences regarding infrarenal and suprarenal angulation and proximal and distal neck diameter and length. All-cause and aneurysm-related mortality were comparable (p = 0.19 and p = 0.98). The necessity of neck-related secondary procedures was significantly higher in female patients (p = 0.02). In the multivariate analysis, the female sex was a significant predictor of endoleak type IA within 30 days. However, there was no significant association between intraoperative endoleak type IA and endoleak type IA at the end of follow-up. Conclusions: This study suggests that there was a higher initial incidence of endoleak type IA in female patients, despite thematched preoperative anatomic parameter. Due to the relatively low number of included female patients, conclusions should be drawn carefully. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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9 pages, 3965 KiB

Open AccessArticle

Mechanical Comparison between Fenestrated Endograft and Physician-Made Fenestrations

by Jérémie Jayet, Jennifer Canonge, Frédéric Heim, Marc Coggia, Nabil Chakfé and Raphaël Coscas

J. Clin. Med. 2023, 12(15), 4911; https://doi.org/10.3390/jcm12154911 - 26 Jul 2023

Cited by 2 | Viewed by 1286

Abstract

Introduction: A fenestrated endograft (FE) is the first-line endovascular option for juxta and pararenal abdominal aortic aneurysms. A physician-modified stent-graft (PMSG) and laser in situ fenestration (LISF) have emerged to circumvent manufacturing delays, anatomic standards, and the procedure’s cost raised by FE. The objective was to compare different fenestrations from a mechanical point of view. Methods: In total, five Zenith Cook fenestrations (Cook Medical, Bloomington, IN, USA) and five Anaconda fenestrations (Terumo Company, Inchinnan, Scotland, UK) were included in this study. Laser ISF and PMSG were created on a Cook TX2 polyethylene terephthalate (PET) cover material (Cook Medical, Bloomington, IN, USA). In total, five LISFs and fifty-five PMSG were created. All fenestrations included reached an 8 mm diameter. Radial extension tests were then performed to identify differences in the mechanical behavior between the fenestration designs. The branch pull-out force was measured to test the stability of assembling with a calibrated 8 mm branch. Fatigue tests were performed on the devices to assess the long-term outcomes of the endograft with an oversized 9 mm branch. Results: The results revealed that at over 2 mm of oversizing, the highest average radial strength was 33.4 ± 6.9 N for the Zenith Cook fenestration. The radial strength was higher with the custom-made fenestrations, including both Zenith Cook and Anaconda fenestrations (9.5 ± 4.7 N and 4.49 ± 0.28 N). The comparison between LISF and double loop PMSG highlighted a higher strength value compared with LISF (3.96 N ± 1.86 vs. 2.7 N ± 0.82; p= 0.018). The diameter of the fenestrations varied between 8 and 9 mm. As the pin caliber inserted in the fenestration was 9 mm, one could consider that all fenestrations underwent an “elastic recoil” after cycling. The largest elastic recoil was observed in the non-reinforced/OC fenestrations (40%). A 10% elastic recoil was observed with LISF. Conclusion: In terms of mechanical behavior, the custom-made fenestration produced the highest results in terms of radial and branch pull-out strength. Both PMSG and LISF could be improved with the standardization of the fenestration creation protocol. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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14 pages, 2307 KiB

Open AccessArticle

Identification of Perioperative Procedural and Hemodynamic Risk Factors for Developing Colonic Ischemia after Ruptured Infrarenal Abdominal Aortic Aneurysm Surgery: A Single-Centre Retrospective Cohort Study

by Safwan Omran, Larissa Schawe, Frank Konietschke, Stefan Angermair, Benjamin Weixler, Sascha Treskatsch, Andreas Greiner and Christian Berger

J. Clin. Med. 2023, 12(12), 4159; https://doi.org/10.3390/jcm12124159 - 20 Jun 2023

Cited by 1 | Viewed by 1070

Abstract

(1) Background: This retrospective study evaluated perioperative and intensive care unit (ICU) variables to predict colonic ischemia (CI) after infrarenal ruptured abdominal aortic aneurysm (RAAA) surgery. (2) Materials and Methods: We retrospectively analyzed the data of the patients treated for infrarenal RAAA from January 2011 to December 2020 in our hospital. (3) Results: A total of 135 (82% male) patients were admitted to ICU after treatment of infrarenal RAAA. The median age of all patients was 75 years (IQR 68–81 years). Of those, 24 (18%) patients developed CI, including 22 (92%) cases within the first three postoperative days. CI was found more often after open repair compared to endovascular treatment (22% vs. 5%, p = 0.021). Laboratory findings in the first seven PODs revealed statistically significant differences between CI and non-CI patients for serum lactate, minimum pH, serum bicarbonate, and platelet count. Norepinephrine (NE) was used in 92 (68%) patients during ICU stay. The highest daily dose of norepinephrine was administered to CI patients at POD1. Multivariable analysis revealed that NE > 64 µg/kg (RD 0.40, 95% CI: 0.25–0.55, p < 0.001), operating time ≥ 200 min (RD 0.18, 95% CI: 0.05–0.31, p = 0.042), and pH < 7.3 (RD 0.21, 95% CI: 0.07–0.35, p = 0.019), significantly predicted the development of CI. A total of 23 (17%) patients died during the hospital stay, including 8 (33%) patients from the CI group and 15 (7%) from the non-CI group (p = 0.032). (4) Conclusions: CI after RAAA is a sever complication occurring most frequently within the first 3 postoperative days. Our study identified many surrogate markers associated with colonic ischemia after aortic RAAA, including norepinephrine dose > 64 µg/kg, operating time ≥ 200 min, and PH < 7.3. Future studies are needed to support these results. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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13 pages, 6754 KiB

Open AccessArticle

Outcomes following Management of Complex Thoracoabdominal Aneurysm by an Open Approach

by Roberto Chiesa, Enrico Rinaldi, Andrea Kahlberg, Sarah Tinaglia, Annarita Santoro, Giovanni Colacchio and Germano Melissano

J. Clin. Med. 2023, 12(9), 3193; https://doi.org/10.3390/jcm12093193 - 29 Apr 2023

Cited by 4 | Viewed by 1084

Abstract

Background: In the last decade, advances in surgical techniques, and the introduction of adjuncts for organ protection, have modified the approach for thoracoabdominal aortic aneurysm (TAAA) surgical repair. The aim of this study is to determine whether the contemporary approach influenced the outcomes. Methods: From 1989 to 2022, patients who had received elective open surgical repair (OSR) for TAAA at our institution were retrospectively analyzed. This series has been divided in two groups: Group 1 (1989–2009), and Group 2 (2010–2022). Patients included in Group 1 were those treated with a selective use of adjuncts, and Group 2 included patients treated with the systematic use of adjuncts. Results: A total of 1107 patients were treated (Group 1: 455; Group 2: 652). The surgical management was significantly different between the two groups. The in-hospital mortality was significantly different between the two groups (Group 1: 13.4%, Group 2: 8.1%; p 0.004), as was the rate of permanent spinal cord ischemia (Group 1: 11.9%, Group 2: 7.8%; p 0.023). Renal and respiratory failure were reduced in Group 2, but not significantly. Conclusions: The use of the adjuncts enabled the achievement of improvement in mortality and SCI prevention in TAAA OSR. Although a refined surgical technique, mortality and morbidity are still noteworthy in this complex aortic field. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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13 pages, 2898 KiB

Open AccessArticle

Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years

by Alizée Porto, Virgile Omnes, Michel A. Bartoli, Ron Azogui, Noémie Resseguier, Mariangela De Masi, Laurence Bal, Laura Imbert, Nicolas Jaussaud, Pierre Morera, Alexis Jacquier, Pierre-Antoine Barral, Vlad Gariboldi and Marine Gaudry

J. Clin. Med. 2023, 12(6), 2363; https://doi.org/10.3390/jcm12062363 - 18 Mar 2023

Cited by 2 | Viewed by 1563

Abstract

Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1–66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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12 pages, 4078 KiB

Open AccessArticle

Clinical Evaluation of Non-Contrast-Enhanced Radial Quiescent-Interval Slice-Selective (QISS) Magnetic Resonance Angiography in Comparison to Contrast-Enhanced Computed Tomography Angiography for the Evaluation of Endoleaks after Abdominal Endovascular Aneurysm Repair

by Karim Mostafa, Julian Pfarr, Patrick Langguth, Jost Philipp Schäfer, Jens Trentmann, Ioannis Koktzoglou, Robert R. Edelman, Fernando Bueno Neves, Joachim Graessner, Marcus Both, Olav Jansen and Mona Salehi Ravesh

J. Clin. Med. 2022, 11(21), 6551; https://doi.org/10.3390/jcm11216551 - 4 Nov 2022

Cited by 2 | Viewed by 1217

Abstract

Purpose. Contrast-enhanced (CE) angiographic techniques, such as computed tomographic angiography (CE-CTA), are most commonly used for follow-up imaging after endovascular aneurysm repair. In this study, CE-CTA and non-CE QISS-MRA were compared for the first time for assessing endoleaks and aneurysms at follow-up after abdominal EVAR. Methods. Our study included 20 patients (17 male, median age 79.8 years) who underwent radial QISS-MRA and CE-CTA after EVAR at their first follow-up examination. Two interventional radiologists evaluated datasets from both techniques in each patient concerning presence of endoleaks, types of endoleaks, aneurysm diameter, and image quality. Interobserver and intermodal agreement were assessed with Cohen’s Kappa. Results. Image quality was rated as excellent or good for both modalities by both observers. Ferromagnetic embolization materials cause hyperdense artifacts in CE-CTA causing aneurysm sac diameter measurements to be inaccurate by up to 1 cm. Type 2 endoleaks with low-flow characteristics in CE-CTA were overlooked compared to radial QISS-MRA. Compared to CE-CTA, all endoleaks after abdominal EVAR were detected and classified correctly on QISS-MRA. The interobserver agreement between CE-CTA and QISS-MRA was almost perfect, except for type 2 endoleaks, where agreement was substantial. Intermodal aneurysm diameter correlate “very strongly” for both observers. Conclusions. Radial QISS-MRA is a contrast agent free technique for diagnosing and monitoring all types of endoleaks and aneurysms in patients after abdominal EVAR. It provides information about specific clinical questions concerning aneurysm diameter and presence and types of endoleaks without radiation exposure and the side effects associated with iodine-based contrast agents. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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Review

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16 pages, 1657 KiB

Open AccessReview

Risk Factors for Spinal Cord Injury during Endovascular Repair of Thoracoabdominal Aneurysm: Review of the Literature and Proposal of a Prognostic Score

by Laurent Brisard, Salma El Batti, Ottavia Borghese and Blandine Maurel

J. Clin. Med. 2023, 12(24), 7520; https://doi.org/10.3390/jcm12247520 - 5 Dec 2023

Cited by 1 | Viewed by 934

Abstract

Despite recent improvements, spinal cord ischemia remains the most feared and dramatic complication following extensive aortic repair. Although endovascular procedures are associated with a lower risk compared with open procedures, this risk is still significant and must be considered. A combined medical and surgical approach may help to optimize the tolerance of the spinal cord to ischemia. The aim of this review is to describe the underlying mechanism involved in spinal cord injury during extensive endovascular aortic repair, to describe the different techniques used to improve spinal cord tolerance to ischemia—including the prophylactic or curative use of spinal drainage—and to propose our algorithm for spinal cord protection and the rational use of spinal drainage. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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14 pages, 300 KiB

Open AccessReview

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

by Frédéric Cochennec, Thibault Couture and Laurent Chiche

J. Clin. Med. 2023, 12(23), 7207; https://doi.org/10.3390/jcm12237207 - 21 Nov 2023

Viewed by 736

Abstract

The optimal surgical treatment for extended thoracoabdominal aortic aneurysms (TAAAs) is still a matter of debate. The historical treatment is open repair (OR), but over the past fifteen years, endovascular strategies have gained widespread acceptance. Although several endovascular techniques have been described for the treatment of TAAAs, fenestrated and branched stent grafts (F/BEVARs) are the most frequently used and best documented. They have become the first-line treatment for both high- and moderate-risk surgical patients in most vascular centers. However, no randomized study comparing OR and F/BEVAR has been published, and decision-making is mainly based on the physician’s preference and/or hospital expertise. The objective of this manuscript is to provide an overview of current comparative data for OR and F/BEVAR. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

16 pages, 1821 KiB

Open AccessReview

Hybrid Treatment of Complex Diseases of the Aortic Arch and Descending Thoracic Aorta by Frozen Elephant Trunk Technique

by Jean Porterie, Aurélien Hostalrich, François Dagenais, Bertrand Marcheix, Xavier Chaufour and Jean-Baptiste Ricco

J. Clin. Med. 2023, 12(17), 5693; https://doi.org/10.3390/jcm12175693 - 1 Sep 2023

Cited by 2 | Viewed by 992

Abstract

The surgical management of acute and chronic complex diseases involving the aortic arch and the descending thoracic aorta remains challenging. Hybrid procedures associating total open arch replacement and stent-grafting of the proximal descending aorta were developed to allow a potential single-stage treatment, promote remodeling of the downstream aorta, and facilitate a potential second-stage thoracic endovascular aortic repair by providing an ideal landing zone. While these approaches initially used various homemade combinations of available conventional prostheses and stent-grafts, the so-called frozen elephant trunk technique emerged with the development of several custom-made hybrid prostheses. The aim of this study was to review the contemporary outcomes of this technique in the management of complex aortic diseases, with a special focus on procedural planning, organ protection and monitoring, refinements in surgical techniques, and long-term follow-up. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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12 pages, 305 KiB

Open AccessReview

Benefits of Prehabilitation before Complex Aortic Surgery

by Thomas Mesnard, Maxime Dubosq, Louis Pruvot, Richard Azzaoui, Benjamin O. Patterson and Jonathan Sobocinski

J. Clin. Med. 2023, 12(11), 3691; https://doi.org/10.3390/jcm12113691 - 26 May 2023

Cited by 1 | Viewed by 1431

Abstract

The purpose of this narrative review was to detail and discuss the underlying principles and benefits of preoperative interventions addressing risk factors for perioperative adverse events in open aortic surgery (OAS). The term “complex aortic disease” encompasses juxta/pararenal aortic and thoraco-abdominal aneurysms, chronic aortic dissection and occlusive aorto-iliac pathology. Although endovascular surgery has been increasingly favored, OAS remains a durable option, but by necessity involves extensive surgical approaches and aortic cross-clamping and requires a trained multidisciplinary team. The physiological stress of OAS in a fragile and comorbid patient group mandates thoughtful preoperative risk assessment and the implementation of measures dedicated to improving outcomes. Cardiac and pulmonary complications are one of the most frequent adverse events following major OAS and their incidences are correlated to the patient’s functional status and previous comorbidities. Prehabilitation should be considered in patients with risk factors for pulmonary complications including advanced age, previous chronic obstructive pulmonary disease, and congestive heart failure with the aid of pulmonary function tests. It should also be combined with other measures to improve postoperative course and be included in the more general concept of enhanced recovery after surgery (ERAS). Although the current level of evidence regarding the effectiveness of ERAS in the setting of OAS remains low, an increasing body of literature has promoted its implementation in other specialties. Consequently, vascular teams should commit to improving the current evidence through studies to make ERAS the standard of care for OAS. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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16 pages, 2101 KiB

Open AccessReview

Patient-Specific Numerical Simulations of Endovascular Procedures in Complex Aortic Pathologies: Review and Clinical Perspectives

by Lucie Derycke, Stephane Avril and Antoine Millon

J. Clin. Med. 2023, 12(3), 766; https://doi.org/10.3390/jcm12030766 - 18 Jan 2023

Cited by 3 | Viewed by 2272

Abstract

The endovascular technique is used in the first line treatment in many complex aortic pathologies. Its clinical outcome is mostly determined by the appropriate selection of a stent-graft for a specific patient and the operator’s experience. New tools are still needed to assist practitioners with decision making before and during procedures. For this purpose, numerical simulation enables the digital reproduction of an endovascular intervention with various degrees of accuracy. In this review, we introduce the basic principles and discuss the current literature regarding the use of numerical simulation for endovascular management of complex aortic diseases. Further, we give the future direction of everyday clinical applications, showing that numerical simulation is about to revolutionize how we plan and carry out endovascular interventions. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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Other

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14 pages, 1660 KiB

Open AccessSystematic Review

Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies

by Thomas Le Houérou, Petroula Nana, Mathieu Pernot, Julien Guihaire, Antoine Gaudin, Erol Lerisson, Alessandro Costanzo, Dominique Fabre and Stephan Haulon

J. Clin. Med. 2023, 12(7), 2496; https://doi.org/10.3390/jcm12072496 - 25 Mar 2023

Cited by 5 | Viewed by 1339

Abstract

Background: In situ laser-fenestrated thoracic aortic endovascular repair (FTEVAR) has emerged as a valuable alternative for aortic arch management. This review assessed the early and follow-up outcomes of in situ laser-FTEVAR in aortic arch pathologies. Methods: The PRISMA statement was followed. The English literature was searched, via Ovid, until 15 October 2022. Observational studies, published after 2000, reporting on early and follow-up outcomes for the in situ laser-FTEVAR were eligible. The Newcastle–Ottawa Scale was used to assess the risk of bias. Primary outcomes were the technical success, stroke, and mortality at 30-days, and the secondary were the mortality and reintervention during follow-up. Results: Six retrospective studies from 591 and 247 patients were included. Fifty-nine (23.9%) patients were managed for aortic arch aneurysms and 146 (59.1%) for dissections; 22.6% of them for type A. Technical success was at 98% (range 90–100%). Eight patients died (3.2%) and 11 cases presented any type of stroke (4.5%) during the 30-day follow-up. The mean follow-up was 15 months (1–40 months). Ten deaths were reported (4.2%); one was aortic-related (10%). Thirteen re-interventions (6.0%) were performed. Conclusions: In situ laser-FTEVAR for aortic arch repair may be performed with high technical success and low 30-day and midterm follow-up mortality, stroke, and re-intervention rates when applied in well selected patients and performed by experienced teams. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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