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Aortic Pathologies: Aneurysm, Atherosclerosis and More

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

Deadline for manuscript submissions: 30 May 2025 | Viewed by 3709

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Special Issue Editors

Dr. Alexander Gombert

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Guest Editor

European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
Interests: cardiovascular physiology; atherosclerosis; vascular medicine; vascular surgery; aortic diseases

Dr. Panagiotis Doukas

E-Mail Website
Guest Editor Assistant

Special Issue Information

Dear Colleagues,

We are happy to introduce our Special Issue “Aortic Pathologies: Aneurysm, Atherosclerosis and More”.

Many well-known and experienced vascular surgeons from across the world have contributed their original manuscripts to this Special Issue, addressing relevant, contemporary, and popular problems associated with aortic pathologies in the fields of thoracoabdominal (TAAA) aortic aneurysm, abdominal aortic aneurysm (AAA) and other pathologies, such as the rare case of coral reef aorta (CRA), severe and clinically relevant atherosclerosis of the juxta- and infrarenal aorta. In this Special Issue, the reader will obtain new insights regarding the outcomes of open TAAA repair, focusing on pre-operative cardiovascular fitness, the clinical value of biomarkers assessing postoperative organ failure after open TAAA repair, and the outcome of the operative and conservative treatment of coral reef aorta, among many more topics. We hope that our collection of manuscripts will inform daily practice and may help with treating patients suffering from aortic pathologies.

Dr. Alexander Gombert
Guest Editor

Dr. Panagiotis Doukas
Guest Editor Assistant

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Keywords

aorta
aortic aneurysm
thoracoabdominal aortic aneurysm
fenestrated endovascular aortic repair (FEVAR)
branched endovascular aortic repair (BEVAR)
spinal cord ischemia
coral reef aorta
surgery
endovascular aortic surgery

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Published Papers (4 papers)

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Research

12 pages, 2819 KiB

Open AccessArticle

Direct Innominate Artery Cannulation for Thoracic Aortic Surgery

by Corrado Cavozza, Rossella Scarongella, Giulia Policastro, Giulia Maj, Antonella Cassinari, Serena Penpa, Antonio Maconi and Andrea Audo

J. Clin. Med. 2025, 14(8), 2684; https://doi.org/10.3390/jcm14082684 - 14 Apr 2025

Viewed by 417

Abstract

Objectives: Direct innominate artery cannulation is a viable and effective alternative for arterial inflow during thoracic aorta surgery, applicable in elective and emergent cases. This technique ensures reliable circulatory control. Methods: A single-center retrospective study of 208 cases that underwent thoracic aortic surgery between January 2010 and December 2021 was performed. The primary outcomes were in-hospital and remote mortality and the secondary outcomes were adverse neurologic events. Results: The median age of the patients was 69 years. The male gender accounted for 63.9% of the cases. The most represented surgical interventions consisted of hemiarch replacement in 105 cases (50.5%) and ascending aorta and aortic valve replacement (wheat procedure) in 71 cases (34.1%). The operative mortality rate was 5.3%, with six cases attributed to aortic-type dissection. The overall remote mortality rate at five years was 7.7. Postoperatively, 70 patients experienced alterations in the level of consciousness, with 12 of these cases belonging to the dissection group. Six patients with permanent neurologic symptoms had a positive computed tomography scan. Of the eleven patients with negative brain computed tomography scans, nine experienced temporary neurological deficits, while two suffered from permanent neurological damage. Conclusions: Direct innominate artery cannulation represents a safe and effective method for providing arterial inflow during cardiopulmonary bypass, offering an outstanding alternative to traditional sites for both planned and urgent surgical interventions. Full article

(This article belongs to the Special Issue Aortic Pathologies: Aneurysm, Atherosclerosis and More)

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10 pages, 401 KiB

Open AccessArticle

Outcome Following Open Repair of Hereditary and Non-Hereditary Thoracoabdominal Aortic Aneurysm in Patients Under 60 Years Old—A Multicenter Study

by Jelle Frankort, Siebe Frankort, Panagiotis Doukas, Christian Uhl, Michael J. Jacobs, Barend M. E. Mees and Alexander Gombert

J. Clin. Med. 2025, 14(7), 2513; https://doi.org/10.3390/jcm14072513 - 7 Apr 2025

Viewed by 335

Abstract

Objective: This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. Methods: We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000–2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan–Meier curve to assess survival, and logistic regression to identify predictors. Results: Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], p = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, p < 0.001) with lower BMI (24.1 vs. 28.4 kg/m², p < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), p < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), p < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), p < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], p < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), p < 0.001). Pulmonary complications (67.0% vs. 61.1%, p = 0.32), acute kidney injury (25.5% vs. 22.8%, p = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, p = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. Conclusions: Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status. Full article

(This article belongs to the Special Issue Aortic Pathologies: Aneurysm, Atherosclerosis and More)

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11 pages, 807 KiB

Open AccessCommunication

Fibrinogen-to-Albumin Ratio as Predictor of Mortality in Acute Aortic Syndromes

by Alexandra Julia Lipa, Patrick Andreikovits, Marco Stoeckl, Hans Domanovits, Christian Schoergenhofer, Michael Schwameis and Juergen Grafeneder

J. Clin. Med. 2025, 14(5), 1669; https://doi.org/10.3390/jcm14051669 - 1 Mar 2025

Viewed by 595

Abstract

Background: Acute aortic syndrome (AAS) is a life-threatening condition characterized by a high mortality, yet reliable prognostic biomarkers are still lacking. The fibrinogen-to-albumin ratio (FAR) has recently gained attention in cardiovascular research but has not been explored in the context of AAS. This study assessed the association between the FAR and 30-day mortality in AAS patients who presented to the emergency department. Methods: We included all AAS patients aged 18 years and older who presented to the emergency department between 2013 and 2021. The outcome measured was 30-day all-cause mortality. Cox regression analysis assessed the relationship between the FAR and the outcome. Results: A total of 171 patients (mean age 67, SD 13.7; 33% female) were included, with 68 (40%) dying within 30 days of admission. Non-survivors had a significantly lower FAR (mean 8.9, SD 4.97) than survivors (mean 10.8, SD 5.44, p = 0.02). FAR was significantly associated with 30-day mortality (crude HR 0.935, 95% CI 0.88–0.99, p = 0.02). This association remained significant after adjusting for age, sex, cardiopulmonary resuscitation, catecholamine administration, bleeding on admission, and type of AAS (adjusted HR 0.92, 95% CI 0.87–0.98, p = 0.01). Conclusions: FAR was independently associated with 30-day mortality in AAS patients who presented to the emergency department. Given its simplicity and cost-effectiveness, it could be a valuable biomarker, especially in resource-limited settings, to improve risk assessment and optimize resource allocation in AAS. Full article

(This article belongs to the Special Issue Aortic Pathologies: Aneurysm, Atherosclerosis and More)

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11 pages, 1964 KiB

Open AccessArticle

The Frozen Elephant Trunk Procedure—8 Years of Experience from Poland

by Marian Burysz, Grzegorz Horosin, Wojciech Olejek, Mariusz Kowalewski, Krzysztof Bartuś, Artur Słomka, Radosław Litwinowicz and Jakub Batko

J. Clin. Med. 2024, 13(21), 6544; https://doi.org/10.3390/jcm13216544 - 31 Oct 2024

Cited by 2 | Viewed by 1968

Abstract

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53–66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience. Full article

(This article belongs to the Special Issue Aortic Pathologies: Aneurysm, Atherosclerosis and More)

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