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Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications

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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: 20 July 2026 | Viewed by 1719

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Special Issue Editors

Dr. Petroula N. Nana

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Guest Editor

Department of Vascular Medicine, German Aortic Center, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
Interests: aortic aneurysm; aortic dissection; genetic aortic disease; acute aortic syndromes; endovascular repair; complications
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Tilo Kölbel

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Guest Editor

Dr. José Ignacio F. Torrealba

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Special Issue Information

Dear Colleagues,

Endovascular aortic repair is a field of continuous evolution, with new devices and techniques constantly im-proving the technical success and clinical outcomes of patients with diseases affecting the entire aorta, including iliac bifurcations. Custom-made and off-the-shelf solutions have increased the availability of endograft configurations, providing a more individualized approach, while the widespread use of surgeon-modified endografts mirrors the development of endovascular materials and techniques. At the same time, newer open and hybrid solutions provide a reliable treatment choice in healthy patients. However, the expansion of the targeted population and inclusion of increasingly demanding cases may affect aortic repair outcomes, leading to complications that may affect early- and long-term survival, making the prevention of complications a significant step in improving aortic repair performance. In addition, the nature and extent of the disease and patients’ baseline features seem to also play a significant role, setting higher demands in daily practice in terms of diagnosis, planning, and decision making.

This Special Issue is a chance to share the available experience and expertise on current practices in aortic disease management.

Dr. Petroula N. Nana
Prof. Dr. Tilo Kölbel
Dr. José Ignacio F. Torrealba
Guest Editors

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Keywords

aortic aneurysm
aortic dissection
genetic aortic disease
acute aortic syndromes
endovascular repair
complica-tions
outcomes

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Published Papers (4 papers)

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Research

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12 pages, 301 KB

Open AccessFeature PaperArticle

Local Anesthesia for Complex F/BEVAR in a High-Risk Cohort: A Single-Center Feasibility Study

by Natasha Hasemaki, Ihza Fachriza, Jan Stana, Alexia-Vasiliki Amvrazi, David Khangholi, Tugce Öz, Nikolaos Konstantinou and Nikolaos Tsilimparis

J. Clin. Med. 2026, 15(9), 3257; https://doi.org/10.3390/jcm15093257 - 24 Apr 2026

Abstract

Background/Objectives: Fenestrated and branched endovascular aortic repair (F/BEVAR) is increasingly used for the treatment of complex aortic aneurysms, and is traditionally performed under general anesthesia (GA). Data on the use of local anesthesia (LA) for F/BEVAR remain limited. This study aimed to report early outcomes of F/BEVAR performed under LA versus GA, with a focus on feasibility and perioperative complications in a high-risk patient population. Methods: This single-center retrospective analysis included patients undergoing F/BEVAR under LA or GA. Primary outcomes were in-hospital mortality and in-hospital complications. Secondary outcomes included early reintervention, intensive care unit and hospital length of stay, blood transfusion requirements, and technical success. Results: A total of 359 patients were included, of whom 25 (7.0%) were treated under LA and 334 (93.0%) under GA. Conversion from LA to GA occurred in 6 patients (24%). Patients in the LA group represented a higher-risk cohort, with advanced age, higher ASA class, larger aneurysm diameters, and a greater proportion of emergency and ruptured repairs. Technical success was high, and procedural metrics were within expected ranges. In-hospital mortality was numerically higher in the LA group (12.0% vs. 2.9%, p = 0.05). Overall, in-hospital complications were more frequent in the LA group (68.0% vs. 41.3%, p = 0.009), including a higher rate of spinal cord ischemia (24.0% vs. 8.5%, p = 0.02). Blood transfusion requirements were also greater in patients treated under LA (p = 0.004), while blood loss, ICU stay, and hospital length of stay were comparable. Early reintervention occurred more frequently in the LA group (31.8% vs. 10.4%, p = 0.009). Conclusions: LA appears feasible in selected high-risk patients undergoing complex F/BEVAR. However, given substantial baseline differences between groups, no conclusions can be drawn regarding comparative safety or efficacy relative to GA. These findings should be considered preliminary. Full article

(This article belongs to the Special Issue Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications)

16 pages, 942 KB

Open AccessArticle

Pulmonary Risk Stratification in Open Thoracoabdominal Aortic Aneurysm Repair

by Jelle Frankort, Mohammed Al-Falahi, Andras Keszei, Bernhard Hruschka, Quentin Cappel, Christian Uhl and Alexander Gombert

J. Clin. Med. 2026, 15(7), 2623; https://doi.org/10.3390/jcm15072623 - 30 Mar 2026

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Abstract

Background/Objectives: The aim of this study was to assess whether preoperative pulmonary function testing (PFT) is related to postoperative complications after open thoracoabdominal aortic aneurysm (TAAA) repair. Methods: This study was conducted as a retrospective cohort analysis of 205 patients undergoing open TAAA repair (2006–2024) with preoperative spirometry and body plethysmography with at least one value available. Patients were classified by ventilation patterns: obstructive (n = 85, 45.2%), restrictive (n = 26, 14.1%), and hyperinflation (n = 56, 30.3%). Primary endpoints included in-hospital mortality, pulmonary complications (pneumonia, ARDS), and multi-organ outcomes. Associations were analyzed using chi-square and Spearman correlation tests and multivariable linear regression adjusted for age, smoking status, COPD, emergency operation, and time period. Results: Postoperative pulmonary complications occurred in 126 patients (61.5%), including pneumonia (46.8%) and ARDS (15.1%). Reduced vital capacity and FEV₁ expressed as a percentage of the lower limit of normal (%LLN) were related to postoperative pneumonia (p = 0.031 and p = 0.003) and ARDS (p = 0.038). Both obstructive and restrictive ventilation patterns were related to acute kidney injury after surgery (all KDIGO stage) (p = 0.044 and p = 0.043, respectively). Hyperinflation was related to atrial fibrillation (p = 0.039) and stroke (p = 0.034). FEV₁ < 2.0 L was related to increased mortality risk (p = 0.037), and FEV₁ < 1.5 L predicted acute kidney injury (p = 0.017), spinal cord ischemia (p = 0.035), and mortality (p = 0.023). Prolonged mechanical ventilation correlated with reduced preoperative lung function (VC %LLN ρ = −0.288, p = 0.002; FEV₁ %LLN ρ = −0.286, p = 0.001). During median follow-up of 6.35 years, patients in the highest FEV₁ quartile demonstrated substantially reduced long-term mortality (HR 0.27, 95% CI 0.10–0.73, p = 0.01). These associations between lower FEV₁ and VC (expressed as %LLN) with pneumonia, ARDS, in-hospital mortality, and prolonged ventilation remained significant after multivariable analysis. Conclusions: Preoperative pulmonary function assessment may help identify TAAA patients at increased risk of postoperative complications and mortality. Combining percentage-predicted spirometry, ventilation patterns, and hyperinflation markers may support individualized treatment selection, prehabilitation, and perioperative monitoring based on each patient’s specific risk profile. Full article

(This article belongs to the Special Issue Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications)

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13 pages, 1648 KB

Open AccessArticle

Mixed-Reality-Assisted Physician-Modified Stent Grafts: An Experimental Pre-Clinical Feasibility Study Using the Valiant Captivia and Endurant II Stent Graft Systems

by Johannes Hatzl, Jana Ebner, Christian Uhl, Andreas Sebastian Peters, Alexandru Barb, Jonathan Fiering, Alexandra Marquardt and Dittmar Böckler

J. Clin. Med. 2026, 15(4), 1663; https://doi.org/10.3390/jcm15041663 - 23 Feb 2026

Viewed by 539

Abstract

Objectives: Physician-modified endografts (PMEGs) expand endovascular treatment options in urgent or cost-sensitive settings where industry-provided custom-made devices (CMDs) are not available. Current PMEG manufacturing techniques are time-consuming, lack standardization, and often require repeated adjustments to achieve strut-free fenestration positioning. Mixed reality (MxR) may streamline this process by overlaying virtual templates directly onto the physical stent graft guiding fenestration positioning. Methods: We developed a standardized MxR-assisted workflow for four-fenestrated PMEG preparations and compared it to a conventional marking technique. In this experimental set-up, between May 2025 and July 2025, three stent grafts were evaluated (Endurant II^® 28 mm, Valiant Captivia^® 30 mm, and Valiant Captivia^® 32 mm). Five observers performed fenestration marking on 20 grafts per device type (10 per method), resulting in 60 PMEGs and 240 fenestrations. Outcomes included absolute positional error, relative positional error, number of strut-free fenestrations, number of re-attempts to achieve strut-free configuration, time required, and usability assessed via the System Usability Scale (SUS). Results: Across 240 fenestrations, both methods achieved high accuracy. Median absolute errors ranged from 0 to 1.25 mm for the conventional method and 0 to 1.75 mm for MxR. Relative positional errors were similarly small, with no significant differences between methods. MxR achieved higher rates of strut-free fenestration in the 28 mm Endurant II^® device. Re-attempts were fewer with MxR. Median procedure time was significantly reduced for the MxR-assisted workflow in Valiant Captivia 30 mm (5.0 vs. 9.8 min, p = 0.049) and 32 mm (5.6 vs. 8.2 min, p = 0.049) while a trend was observed for Endurant II (7.5 vs. 15.6 min, p = 0.066). SUS scores favored MxR (76.2 vs. 62.6), though not significantly. Conclusions: The MxR-assisted PMEG production workflow seems promising in this pre-clinical, experimental study and warrants continued development and investigation. Full article

(This article belongs to the Special Issue Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications)

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Review

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9 pages, 387 KB

Open AccessReview

Desmosine in Aortic Disease: Biology, Measurement, and Clinical Applications in Aortic Pathologies

by Alexander Gombert, Saurav Ranjan Mohapatra, Jelle M. Frankort, Christian Uhl and Panagiotis Doukas

J. Clin. Med. 2026, 15(7), 2540; https://doi.org/10.3390/jcm15072540 - 26 Mar 2026

Viewed by 336

Abstract

Thoracoabdominal aortic aneurysms (TAAAs) are uncommon and usually silent until rupture, causing a substantial burden to the health care system. Aneurysm growth and rupture prediction is mainly based on aneurysm diameter measurement by imaging modalities, meaning that the biology of aneurysm growth is not part of a potentially more adequate surveillance of aortic aneurysm patients. Alternatives or complementary options for aortic aneurysm surveillance are an ongoing, non-addressed open issue of vascular medicine. The application of different biomarkers has been discussed, yet so far, an adequate candidate for aortic aneurysm surveillance, if it comes to the thoracic or thoracoabdominal aorta, preferably without radiation exposure, has not been named. Elastin breakdown, as a component of aortic wall degeneration primarily driven by matrix metalloproteinases (MMPs), is a core element of aneurysm development. Desmosine is an elastin-specific cross-link increasingly studied as a circulating or urinary biomarker of compromised aortic wall integrity and disease activity. Accordingly, this review investigated whether plasma desmosine (pDES), a highly specific marker of elastin degradation, could be used as a non-invasive biomarker for detecting aortic aneurysms and assessing their risk profile. The existing literature of desmosine in fields of aortic pathologies in the acute and chronic setting will be assessed based on the current literature; furthermore, future perspectives of desmosine as a biomarker of aortic pathologies, such as aortic aneurysm dynamics, will be discussed. Full article

(This article belongs to the Special Issue Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications)

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