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Clinical Advances in Aortic Disease and Revascularization

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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: 30 June 2025 | Viewed by 5782

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Dr. Andrej Udelnow

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Department of Endovascular and Vascular Surgery, Brandenburg Medical School Theodor Fontane, Brandenburg University Hospital, Brandenburg an der Havel, Germany
Interests: probabilistic programming; neural networks; intravascular ultrasound; quality of life

Special Issue Information

Dear Colleagues,

Although the management of aortic diseases (AD) has undergone evolutionary and fundamental changes in recent decades due to the establishment of more or less complex endovascular procedures and has become much safer and less invasive, many issues remain and new problems have emerged. There is still limited evidence regarding the differential indications for the (non-operative, endovascular or open-surgical) treatment of aneurysms, penetrating ulcers, dissections, etc. Demographic changes have led to much older patients with a range of comorbidities, often with limited operability, and new questions, such as those of the patient’s quality of life vs. overall survival, have arisen. Major randomized controlled trials investigating the outcomes of endovascular vs. non-operative vs. open-surgical treatment no longer fully reflect the realities of today, and new, more real-world-focusing approaches are needed, including registry data, artificial intelligence, Bayes statistics or other prediction models enabling clinicians to judge with empathy and intuition, supported by patient-individual prognosis. Moreover, new contrast media and radiation-sparing technology, such as intravascular ultrasound, image fusion and virtual reality, will rapidly bring about new perspectives for the treatment of difficult anatomies. Last but not least, the molecular base of ADs will fundamentally change our point of view, since the course of AD has to be associated with a specific etiology rather than with the morphology (i.e., diameter) alone.

Dr. Andrej Udelnow
Guest Editor

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Keywords

aortic disease
aortic aneurysm
endovascular aortic repair
atherosclerosis
aortic dissections
overall survival
quality of life
intravascular ultrasound

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Published Papers (6 papers)

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Research

11 pages, 251 KiB

Open AccessArticle

Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ): Validation in Polish Patients with Aortic Stenosis

by Natalia Świątoniowska-Lonc, Krzysztof Ściborski, Rima Styra, Claudia M. Lüske, Kinga Węgrzynowska-Teodorczyk, Derk Frank, Peter Bramlage, Waldemar Banasiak and Adrian Doroszko

J. Clin. Med. 2025, 14(7), 2502; https://doi.org/10.3390/jcm14072502 - 7 Apr 2025

Viewed by 315

Abstract

Background/Objectives: Quality of life (QoL) is recognized as a clinically significant outcome measure among patients with aortic stenosis (AS). However, there is no validated, AS-specific questionnaire available in Poland for assessing the QoL in AS patients. The aim of the study was to determine the psychometric properties of the Polish version of the Toronto Aortic Stenosis Quality of Life Questionnaire (the TASQ). Methods: The study involved 113 patients with severe AS (including 59 women), aged 74 to 82 years [mean age 77 years], hospitalized at the department of cardiology in 2024. The standardized questionnaires were used to assess the level of QoL, the TASQ, and the Minnesota Living with Heart Failure Questionnaire (the MLHFQ). Results: The mean QoL level assessed by the TASQ was 60.72 ± 22.82. The Cronbach’s alpha for the entire TASQ was 0.919, for the emotional impact subscale 0.873, and for the physical limitation subscale 0.861. Satisfactory values of fit measures were obtained for a five-factor structure (RMSEA < 0.01; CFI > 0.99). The loadings of each item were statistically significant (p < 0.001). The MLHFQ score correlated significantly (p < 0.001) and positively (r > 0) with the score on the scales of physical symptoms (r = 0.479), physical limitations (r = 0.662), social limitations (r = 0.597), emotional impact (r = 0.638), and overall QoL (r = 0.712). Conclusions: Patients with severe AS exhibit low QoL. The TASQ has very good psychometric properties and can be used to assess the QoL in the population of Polish patients with AS. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

16 pages, 4871 KiB

Open AccessArticle

From Planning to Practice: Impact of Achieved Proximal Sealing Zone in Endovascular Aneurysm Repair (EVAR)

by Giulio Accarino, Angelo Silverio, Michele Bellino, Sergio Furgiuele, Mario Fimiani, Mattia Sica, Francesco De Vuono, Giovanni Fornino, Davide Turchino, Giancarlo Accarino, Raffaele Serra, Gennaro Galasso, Carmine Vecchione and Umberto Marcello Bracale

J. Clin. Med. 2025, 14(4), 1309; https://doi.org/10.3390/jcm14041309 - 16 Feb 2025

Cited by 1 | Viewed by 412

Abstract

Background: Endovascular aneurysm repair (EVAR) is the preferred treatment for abdominal aortic aneurysms (AAAs). This study evaluated the differences between the anticipated and actual achieved proximal sealing zones for standard EVAR endografts and their potential implications in a real-world AAA population. Methods: Data from 275 consecutive EVAR patients treated with the Endurant endograft (Medtronic, Minneapolis, MN, USA) between 2009 and 2022 were retrospectively analyzed. The proximal sealing zone was calculated preoperatively (target anticipated sealing zone, TASZ) and postoperatively (real achieved sealing zone, RASZ) from computed tomography angiography (CTA) images. These metrics were evaluated by assuming that they had a truncated cone shape, calculating the cone’s lateral surface by measuring the proximal and distal centerline areas and the distance between the planes. The primary outcome was the occurrence of type 1A endoleak at the longest available follow-up. Results: RASZ was significantly smaller and shorter than TASZ (p = 0.001), with an average area reduction of 24.5 mm² and a median length reduction of 3 mm. Area and cranial length loss were present even when correcting for graft positioning imperfections. In the Cox proportional hazard regression model, TASZ and RASZ lengths were both independently associated with a lower risk of type 1A endoleak (HR: 0.88, 95% CI 0.80–0.96 and HR: 0.92, 95% CI 0.86–0.99, respectively). A Kaplan–Meier analysis confirmed that patients with RASZ > 5.5 mm had a survival free from endoleak higher than patients with RASZ ≤ 5.5 mm. Conclusions: In this real-world AAA population, the achieved proximal sealing zone was significantly shorter and smaller than planned, regardless of optimal endograft placement. The early calculation of RASZ, i.e., the PSZ achieved via CTA, is critical for risk stratification and follow-up. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

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13 pages, 5456 KiB

Open AccessArticle

ALTURA™ Stent Graft Shortening and Its Implications After EVAR

by Artis Knapsis, Melik-Murathan Seker, Markus Udo Wagenhäuser, Julian-Dario Rembe, Janis Savlovskis, Hubert Schelzig, Dainis Krievins and Alexander Oberhuber

J. Clin. Med. 2025, 14(4), 1157; https://doi.org/10.3390/jcm14041157 - 11 Feb 2025

Viewed by 696

Abstract

Objectives: The ALTURA™ stent graft system is designed for the treatment of abdominal aortic and/or aorto-iliac aneurysms. This study evaluates the performance of the ALTURA™ stent graft, focusing on AAA diameter, landing zones, stent graft length, and migration following endovascular aortic repair (EVAR). Methods: This is a retrospective analysis of computed tomography (CT) images focuses on patients with infrarenal abdominal aortic aneurysm (AAA) treated with the ALTURA™ stent graft system (Lombard, Ltd., Didcot, UK) at Pauls Stradins Clinical University Hospital in Riga, Latvia, and University Hospital Düsseldorf in Düsseldorf, Germany. The study population consisted of patients with asymptomatic AAAs who underwent elective treatment between January 2014 and June 2017. Follow-up CT scans were performed at one month, six months, one, two, and three years after implantation. Changes in stent graft length, aneurysm sac diameter, and the proximal and distal sealing zones were evaluated. Results: A retrospective analysis was conducted on computed tomography (CT) images from 40 patients (mean age 70.4 ± 8.5 years, 34 males, 6 females) who were treated with the ALTURA™ stent graft system for infrarenal abdominal aortic aneurysms (mean aneurysm diameter 5.6 ± 1.0 cm). The mean follow-up duration was 24.2 ± 10.6 months, with CT scans completed for all patients at one month and for 80% at one year. The mean total shortening of the stent graft one year after EVAR was 4 ± 3 mm (p < 0.001), 7 ± 5 mm after two years (p < 0.001), and 9 ± 6 mm after three years (p < 0.001). The iliac extensions shortened by 4 ± 3 mm after one year (p < 0.001), 6 ± 4 mm after two years (p < 0.001), and 8 ± 4 mm after three years (p < 0.001). Significant shortening was observed in the iliac extension, while changes in the aortic stent graft were not statistically significant. The reduction in the distal sealing zone and upward migration of the stent graft were 3 ± 3 mm after one year (p < 0.001), 5 ± 5 mm after two years (p < 0.001), and 7 ± 7 mm after three years (p < 0.001). Over the follow-up period, significant stent graft shortening and loss of the distal sealing zone were observed. However, these changes remained within a clinically acceptable range and did not lead to type I endoleak. Aneurysm sac shrinkage greater than 10 mm one year after treatment was observed in 25% of patients (p < 0.001). No aneurysm ruptures or AAA-related deaths were reported. Conclusions: Significant shortening of ALTURA™ stent graft, migration, and sealing zone reduction were observed without clinical impact after three years. However, in patients with short distal sealing zones, these changes could increase the risk of type Ib endoleak. Longer follow-up is needed to assess long-term durability. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

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13 pages, 929 KiB

Open AccessArticle

A Decade-Long Retrospective Study of Factors Influencing Survival in Ruptured Abdominal Aortic Aneurysm

by Günay Kalender, Thomas Weissmann and Ugur Dinç

J. Clin. Med. 2024, 13(21), 6431; https://doi.org/10.3390/jcm13216431 - 27 Oct 2024

Viewed by 1260

Abstract

Background: Ruptured abdominal aortic aneurysm (rAAA) carries a high mortality risk, requiring rapid diagnosis and intervention. This study assesses various clinical factors influencing rAAA management outcomes in alignment with evolving guidelines from 2011 to 2024. Methods: A retrospective analysis of 62 rAAA patients treated at Vivantes Clinic, Berlin, from July 2014 to May 2024 was conducted. Data were obtained from medical records, focusing on vital parameters at admission and during treatment. Both numerical and categorical variables were analyzed to identify survival determinants. Results: The overall survival rate was 55%. Significant differences in systolic and diastolic blood pressures during surgery were noted between survivors and non-survivors, with lower pressures observed in non-survivors at critical surgical stages. Other vital signs showed no significant variations. Survival was significantly associated with gender, fluid therapy, and aneurysm location. Conclusions: Effective blood pressure management during surgery is crucial for improving survival in rAAA cases. This study emphasizes adherence to current clinical guidelines and highlights the need for ongoing research to fill existing knowledge gaps. Further investigations are essential to enhance patient care and outcomes in rAAA. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

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16 pages, 1752 KiB

Open AccessArticle

Custom-Made Device (CMD) for the Repair of Thoraco-Abdominal Aneurysm (TAA): Mid-Long Term Outcomes from a Single Southeast Asian Centre Experience in Singapore

by Nick Zhi Peng Ng, Jolyn Hui Qing Pang, Charyl Jia Qi Yap, Victor Tar Toong Chao, Kiang Hiong Tay and Tze Tec Chong

J. Clin. Med. 2024, 13(20), 6145; https://doi.org/10.3390/jcm13206145 - 15 Oct 2024

Cited by 1 | Viewed by 1226

Abstract

Introduction: Given the high risk of peri-operative morbidity and mortality associated with open repair, endovascular repair for thoraco-abdominal aneurysms is increasingly performed. This study aims to describe mid to long-term results for patients who were treated with COOK Custom-Made Endograft Device at a single Southeast Asian tertiary centre. Methods: Mid to long-term results of patients treated from 2012 to 2022 were retrospectively reviewed. Indications for treatment were aortic diameter > 5.5 cm, enlargement > 5 mm in 6 months or high-risk morphology. Clinical, operative, early to late complications and reintervention details were captured. The endpoints were technical success, primary patency and primary assisted patency. Results: Electronic medical records of 29 consecutive patients (64.4 ± 1.6 years old; 26/29 males 89.6%) were reviewed. 24/29 (83%) were hypertensive, and 20/29 (69%) were smokers. The mean diameter was 5.5 cm, and the majority were treated for Crawford type IV (19/29, 65.5%). Endograft deployment was 100%. Catheterisation of fenestration was successful in 109/116 (94%). 30-day mortality and morbidity were observed in 12/29 (41%), for which access site complications were most common. No significant haemorrhage or graft explant was recorded. The mean follow-up period was 32.4 months (range 1–108 months). Primary patency was 92.9% (95% CI: 83.8–100.0) at 6 months and decreased to 77.7% (95% CI: 63.4–95.2) at 24 months. Sac shrinkage or stability was noted in 17/29 (58.6%). Re-intervention was performed in 9/29 (31%) for limb occlusion (2/9, 22.2%), renal artery stent occlusion (1/9, 11.1%) and endoleaks (6/9, 66.6%). Assisted patency was maintained at 100% for 12 months before decreasing to 66.7% (95% CI: 37.9–100.0) at 24 months. Conclusions: The study reports the first mid-long-term result in this region, though limited by the sample size. Re-intervention at 30% suggests that disease and procedures remain challenging, emphasising the need to assimilate lessons and experience at high-volume centres. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

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11 pages, 1277 KiB

Open AccessArticle

Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair

by Yuhan Qi, Chengxin Weng, Ding Yuan, Tiehao Wang, Yukui Ma, Yi Yang, Jichun Zhao and Bin Huang

J. Clin. Med. 2023, 12(23), 7500; https://doi.org/10.3390/jcm12237500 - 4 Dec 2023

Cited by 1 | Viewed by 1293

Abstract

Consideration for oversizing the proximal stent graft is suggested in endovascular aortic repair. However, a special recommendation for the proximal oversizing ratio (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA) is ambiguous. This study aims to evaluate the effect of different degrees of the proximal oversizing ratio (OSR) on risk of type IA endoleak (TIAEL) in hemodynamically stable and unstable patients with rAAA undergoing emergency endovascular aortic repair (EVAR). Our study included 134 rAAA patients undergoing emergent EVAR, and we did not observe a significant association between hemodynamic instability and risk of T1AEL (HR 3.89, 95%CI 0.40–37.75, p = 0.24). All three T1AELs in the hemodynamically unstable subgroup were observed in patients with OSR ≤ 30%, but no significant difference was found regarding T1AEL between patients with OSR > 30% and OSR ≤ 30% (0.00% vs. 11.11%, p = 0.19). As for hemodynamically stable patients, OSR > 20% was associated with a significantly decreased risk of T1AEL (HR 0.03, 95%CI 0.01–0.53, p = 0.016). In conclusion, a proximal OSR > 20% is associated with a decreased risk of T1AEL in hemodynamically stable patients, while an OSR > 30% did not add an additional advantage of lowering the risk of T1AEL in hemodynamically unstable patients. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization)

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