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Clinical Advances and Future Perspectives in Vascular Surgery

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

Deadline for manuscript submissions: 20 January 2025 | Viewed by 7338

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Dr. George N. Kouvelos

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Guest Editor

Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
Interests: endovascular; aortic aneurysm; thoracoabdominal aneurysm; complex aneurysm carotid stenosis; angioplasty; stenting
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Dr. Konstantinos Spanos

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Guest Editor

Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
Interests: aortic aneurysm; thoracoabdominal aneurysm; aortic dissection; atheromatosis; complex aneurysm; aortic biology; endovascular treatment; peripheral aneurysm
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Dr. Petroula N. Nana

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Guest Editor

Aortic Center, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Gif-sur-Yvette, France
Interests: endovascular; aortic aneurysm; carotid disease; angioplasty
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Special Issue Information

Dear Colleagues,

Vascular disease is a common cause of death and disability in the growing elderly population, and demand for vascular procedures is increasing worldwide. Over the last two decades, endovascular treatment options for vascular pathologies have been increasingly improved and established. Vascular surgery has progressed over time thanks to the development of new endovascular technologies. Following the use of these technologies, 90% of the aortic pathology, 70% of peripheral arterial disease cases, and 40–50% of carotid stenoses can already be treated with endovascular techniques. Despite the significant therapeutic shift towards endovascular techniques, there will always be a need for hybrid (open/endovascular) repairs in 5–10% of vascular lesions.

This Special Issue aims to provide an update of research on new clinical data and perspectives on the whole area of vascular disease management, including perceptions of new technologies and novel devices. Accordingly, this Special Issue will try to provide a forum for high-quality original research and review articles to showcase the most recent clinical advances and future perspectives in vascular surgery.

Dr. George N. Kouvelos
Dr. Konstantinos Spanos
Dr. Petroula N. Nana
Guest Editors

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Keywords

vascular surgery
endovascular surgery
aortic surgery
peripheral arterial disease
carotid artery disease
EVAR
vascular access
aneurysm
complex aneurysm

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Published Papers (6 papers)

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Research

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15 pages, 3242 KiB

Open AccessArticle

Effect of Ultraviolet Radiation on the Enzymolytic and Biomechanical Profiles of Abdominal Aortic Adventitia Tissue

by Emil-Marian Arbănaşi, Eliza Russu, Eliza-Mihaela Arbănaşi, Constantin Claudiu Ciucanu, Adrian Vasile Mureșan, Shuko Suzuki and Traian V. Chirilă

J. Clin. Med. 2024, 13(2), 633; https://doi.org/10.3390/jcm13020633 - 22 Jan 2024

Cited by 5 | Viewed by 1262

Abstract

Background: The abdominal aortic aneurysm (AAA) is defined as an increase in aortic diameter by more than 50% and is associated with a high risk of rupture and mortality without treatment. The aim of this study is to analyze the role of aortic adventitial collagen photocrosslinking by UV-A irradiation on the biomechanical profile of the aortic wall. Methods: This experimental study is structured in two parts: the first part includes in vitro uniaxial biomechanical evaluation of porcine adventitial tissue subjected to either short-term elastolysis or long-term collagenolysis in an attempt to duplicate two extreme situations as putative stages of aneurysmal degeneration. In the second part, we included biaxial biomechanical evaluation of in vitro human abdominal aortic adventitia and human AAA adventitia specimens. Biomechanical profiles were examined for porcine and human aortic tissue before and after irradiation with UV-A light (365 nm wavelength). Results: On the porcine aortic sample, the enhancing effect of irradiation was evident both on the tissue subjected to elastolysis, which had a high collagen-to-elastin ratio, and on the tissue subjected to prolonged collagenolysis despite being considerably depleted in collagen. Further, the effect of irradiation was conclusively demonstrated in the human adventitia samples, where significant post-irradiation increases in Cauchy stress (longitudinal axis: p = 0.001, circumferential axis: p = 0.004) and Young’s modulus (longitudinal axis: p = 0.03, circumferential axis: p = 0.004) were recorded. Moreover, we have a stronger increase in the strengthening of the AAA adventitia samples following the exposure to UV-A irradiation (p = 0.007) and a statistically significant but not very important increase (p = 0.021) regarding the stiffness in the circumferential axis. Conclusions: The favorable effect of UV irradiation on the strength and stiffness of degraded aortic adventitia in experimental situations mimicking early and later stages of aneurysmal degeneration is essential for the development and potential success of procedures to prevent aneurysmal ruptures. The experiments on human normal and aneurysmal adventitial tissue confirmed the validity and potential success of a procedure based on exposure to UV-A radiation. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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12 pages, 455 KiB

Open AccessArticle

The Diagnostic Value of Trace Metal Concentrations in Hair in Carotid Artery Disease

by Anna Olasińska-Wiśniewska, Tomasz Urbanowicz, Anetta Hanć, Jolanta Tomczak, Beata Begier-Krasińska, Andrzej Tykarski, Krzysztof J. Filipiak, Patrycja Rzesoś, Marek Jemielity and Zbigniew Krasiński

J. Clin. Med. 2023, 12(21), 6794; https://doi.org/10.3390/jcm12216794 - 27 Oct 2023

Cited by 2 | Viewed by 1280

Abstract

Several studies showed the role of trace elements in the increase in human susceptibility to cardiovascular diseases. Carotid artery stenosis is a leading cause of ischemic neurological events. We aimed to analyze the potential role of trace elements in hair as biomarkers of atherosclerotic carotid artery disease. Materials and Methods: Fifty-seven (n = 31 (54%) men and n = 26 (46%) women) individuals with a mean age of 67.7 ± 7.7 years who were white, European, non-Hispanic, and non-Latino were diagnosed and treated in hypertensiology/internal medicine and surgical departments over three consecutive months. Of these patients, forty were diagnosed with advanced carotid artery disease, and seventeen comprised a group of healthy controls. Inflammatory and oncological diseases were exclusion criteria. Hair samples were collected, and 14 trace elements were analyzed. Clinical and laboratory data were compared and revealed differences in the co-existence of diabetes (p = 0.036) and smoking history (p = 0.041). In the multivariable analysis, zinc, chrome, and copper revealed predictive value for the occurrence of carotid artery disease, and their combined receiver operating curve showed area under the curve of 0.935, with a sensitivity of 95% and a specificity of 82.4%. Conclusion: Our report shows the significance of trace elements analyses in patients with advanced carotid artery disease. We revealed that zinc, copper, and chrome concentrations are of particular importance in differentiating atherosclerotic disease and may serve as biomarkers of carotid atherosclerosis. Hair samples represent an easily obtained and beneficial biomatrix for the assessment of biomarkers. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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10 pages, 523 KiB

Open AccessArticle

Sex-Comparative Outcomes of the T-Branch Device for the Treatment of Complex Aortic Aneurysms

by Petroula Nana, Katarzyna Jama, Tilo Kölbel, Konstantinos Spanos, Giuseppe Panuccio, Tomasz Jakimowicz and Fiona Rohlffs

J. Clin. Med. 2023, 12(18), 5811; https://doi.org/10.3390/jcm12185811 - 7 Sep 2023

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Abstract

Introduction: Females are at increased risk of mortality compared to males after complex endovascular aortic repair. This study aims to examine sex-related peri-operative and follow-up outcomes in patients managed with the t-Branch device. Methods: A two-center retrospective analysis of patients managed with the off-the-shelf t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) between 1 January 2014 and 30 September 2020 was performed. Primary outcomes were sex-comparative 30-day mortality, major adverse events (MAEs) and spinal cord ischemia (SCI). Results: A total of 542 patients were included; 28.0% were females. Urgent repair and type I–III thoracoabdominal aneurysms were more common among females (52.6% vs. 34%, p = 0.01, and 57.1% vs. 35.8%, p = 0.004). Technical success was similar (97.4% vs. 96.9%, p = 0.755), as well as early mortality (16.2% in females vs. 10.8% in males; p = 0.084). SCI rates were similar between groups (13.6% vs. 9.2% p = 0.183). MAEs were more common in females; 33.7% vs. 21.4% (p = 0.022). Multivariate analysis did not identify sex as an independent predictor of adverse events. The 12-month survival rate was 75.7% (SE 0.045) for females and 84.1% (SE 0.026) for males (log rank, p = 0.10). Conclusions: Sex was not detected as an independent factor of mortality, MAEs and SCI within patients managed with the t-Branch device. Feasibility was high in both groups. No significant difference was shown in survival during the 12-month follow-up. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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13 pages, 1740 KiB

Open AccessArticle

Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients

by Réka Kaller, Eliza Russu, Emil Marian Arbănași, Adrian Vasile Mureșan, Márk Jakab, Claudiu Constantin Ciucanu, Eliza Mihaela Arbănași, Bogdan Andrei Suciu, Ioan Hosu, Liliana Demian and Emőke Horváth

J. Clin. Med. 2023, 12(13), 4419; https://doi.org/10.3390/jcm12134419 - 30 Jun 2023

Cited by 6 | Viewed by 1683

Abstract

Background: Arteriovenous fistula dysfunction is a widely disputed subject in the scientific literature on end-stage kidney disease (ESKD). The main cause of mortality and morbidity in these patients is the non-maturation or dysfunction of the arteriovenous fistula. Despite the many complications, the native arteriovenous fistula remains the gold standard in the treatment of these patients requiring renal replacement. This study aims to discuss the predictive role of some systemic inflammatory biomarkers (NLR, PLR, SII, IL-6), intimal hyperplasia, and neoangiogenesis (characterized by intimal-media CD31-positive relative surface) in arteriovenous fistula maturation failure. Methods: The present study was designed as an observational, analytical, and prospective study which included patients diagnosed with ESKD with indications of radio-cephalic arteriovenous fistula (RCAVF). Demographic data, comorbidities, preoperative laboratory data and histological/digital morphometry analysis results were processed. The patients included were divided into two groups based on their AVF maturation status at 8 weeks: “Maturation” (Group 1) and “Failed Maturation” (Group 2). Results: There was no difference in the demographic data. In terms of comorbidities, the second group had a greater incidence of heart failure (p = 0.03), diabetes (p = 0.04), peripheral artery disease (p = 0.002), and obesity (p = 0.01). Additionally, regarding the laboratory findings, these patients had higher levels of serum uric acid (p = 0.0005), phosphates (p < 0.0001), and creatinine (p = 0.02), as well as lower levels of total calcium (p = 0.0002), monocytes (p = 0.008), and lymphocytes (p < 0.0001). Moreover, all inflammatory markers (p = 0.001; p < 0.0001; p = 0.006, and p = 0.03) and Ca-P product (p < 0.0001) had higher baseline values in Group 2. Upon immunohistochemical analysis, regarding the density of neoformed vessels, there was a higher incidence of CD31-positive surfaces (p = 0.006) and CD31-positive relative surfaces (p = 0.001); the NLR (r = 0.323; p = 0.03), PLR (r = 0.381; p = 0.04), SII (r = 0.376; p = 0.03), and IL-6 (r = 0.611; p < 0.001) are all significantly correlated with vascular density, as evidenced by CD31. Conclusions: Heart failure, peripheral artery disease, obesity, and diabetes, as well as the systemic inflammatory markers (NLR, PLR, SII, IL-6), intimal hyperplasia, and CD31-positive relative surfaces are predictors of arteriovenous fistula maturation failures. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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14 pages, 697 KiB

Open AccessSystematic Review

The Definition, Diagnosis, and Management of Giant Splenic Artery Aneurysms and Pseudoaneurysms: A Systematic Review

by Valerio Rinaldi, Giulio Illuminati, Roberto Caronna, Giampaolo Prezioso, Piergaspare Palumbo, Paolina Saullo, Vito D’Andrea and Priscilla Nardi

J. Clin. Med. 2024, 13(19), 5793; https://doi.org/10.3390/jcm13195793 - 28 Sep 2024

Viewed by 384

Abstract

Background/Objectives: Giant splenic artery aneurysms (SAAs) and pseudoaneurysms (SAPs) represent rare conditions, characterized by a diameter greater than or equal to 5 cm. The risk of rupture is increased compared to common SAAs and SAPs, necessitating urgent treatments to prevent it. Methods: This systematic review was conducted through a comprehensive search involving the PubMed, Google Scholar, and Scopus databases. A total of 82 patients and 65 articles were included in the analysis. For each patient, we investigated age, sex, symptoms, comorbidities, the presence of a true or a false aneurysm, the dimensional criteria used to define dilations as giant aneurysms or pseudoaneurysms, the dimension of the two greatest diameters, imaging studies, surgical treatment, post-operative length of stay (LOS), and post-operative follow-up. Results: The results revealed a similar incidence in both genders (43 males vs. 39 females) with a median age of 55.79 years. The most frequently described symptom was pain (59.76%). Thirteen cases were false aneurysms and 69 were true aneurysms. The mean greatest diameter was 9.90 cm. The CT scan was the most utilized imaging study (80.49%). Open, endovascular, and hybrid surgery were performed in 47, 26, and 9 patients, respectively, with complication rates of 14.89%, 23.08%, and 22.22% occurring for each treatment. The post-operative LOS was 12.29 days, 2.36 days, and 5 days, respectively. The median follow-up was 17.28 months overall. No recanalization was observed after endovascular procedures during the follow-up period. Conclusions: The dimensional criterion to define SAAs and SAPs as giant was most frequently that at least one diameter was ≥ 5 cm. The CT scan was the most frequently utilized radiological study to diagnose giant SAAs and SAPs. Finally, endovascular procedures, open surgeries, and hybrid treatments presented similar post-operative complication rates. The post-operative LOS was lower for the endovascular group, and the follow-up period did not show aneurysm recanalization in any patients. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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10 pages, 5660 KiB

Open AccessTechnical Note

Radial Artery Deviation and Reimplantation (RADAR) to Accelerate the Maturation of Radial-Cephalic Fistulas for Hemodialysis in Patients with End-Stage Renal Disease

by Tomasz Gołębiowski, Mariusz Kusztal, Andrzej Konieczny, Maciej Gołębiowski, Krzysztof Letachowicz, Dariusz Janczak and Magdalena Krajewska

J. Clin. Med. 2023, 12(20), 6481; https://doi.org/10.3390/jcm12206481 - 12 Oct 2023

Viewed by 1075

Abstract

Background: The most common form of vascular access for hemodialysis is a native arteriovenous fistula, which connects the site of the artery to the end of the vein. The maturation process of the fistula plays a crucial role in the establishment of a functional vascular access. Radial artery stenosis is among the potential causes of maturation failure. In these cases, improving the fistula’s blood flow may be difficult, as traditional surgical reanastomosis and endovascular intervention frequently fail. Radial artery deviation and reimplantation (RADAR) is a novel and effective technique for creating primary fistulas with a high patency rate. The main disadvantage of this procedure is the ligation of the radial artery and the subsequent known consequences. Methods: To accelerate maturation, we used RADAR as a secondary approach in three patients with radial artery stenosis and maturation failure. Results: In all patients after surgery, we observed a significant increase in fistula blood flow. Two patients used fistulas for hemodialysis after surgery. We describe the image diagnosis, procedure, and benefits of this method. Conclusions: The RADAR technique may be successfully used as a secondary access in patients with maturation failure due to RA stenosis to accelerate fistula maturation. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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