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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: 31 July 2025 | Viewed by 8300

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Special Issue Editor

Dr. Luca Bertoglio

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Guest Editor

Division of Vascular Surgery, Department of Clinical and Experimental Sciences, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
Interests: vascular surgery; vascular medicine; stents; aortic diseases; vascular diseases; medical and biomedical image processing; angiography; atherosclerosis

Special Issue Information

Dear Colleagues,

Vascular and endovascular medicine are specialized fields of medicine that focus on the diagnosis, treatment, and management of diseases affecting the blood vessels. Endovascular treatments such as angioplasty, stenting, and embolization have revolutionized the treatment of vascular diseases, reducing the need for open surgery and improving patient recovery times. Recent clinical advances in vascular imaging technologies, such as CT angiography and magnetic resonance imaging (MRI), have improved the accuracy of diagnosis, allowing for earlier detection and treatment of vascular disease. However, these advances have also brought challenges, include the development of better preventative measures and more effective treatments for vascular diseases such as arterial aneurysms, peripheral artery disease, and venous thromboembolism.

In conclusion, while recent clinical advances in vascular and endovascular medicine have greatly improved patient outcomes, they have also introduced new challenges that will require ongoing attention from the medical community. Addressing these challenges will require continued innovation, research, and collaboration among practitioners in these fields. We look forward to your enthusiastic participation in this Special Issue that will promote scientific communication of our knowledge with the ultimate goal of positively influencing treatment and care for our patients.

Dr. Luca Bertoglio
Guest Editor

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Keywords

vascular and endovascular medicine
minimally invasive cardiovascular surgery
vascular diseases
endovascular technologies
endovascular surgery
aortic dissection

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Published Papers (7 papers)

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Research

11 pages, 398 KiB

Open AccessArticle

Early and Mid-Term Outcomes of Isolated Type 2 Endoleak Refractory to an Embolization Procedure

by Francesca Miceli, Ada Dajci, Alessia Di Girolamo, Piergiorgio Nardis, Marta Ascione, Rocco Cangiano, Roberto Gattuso, Antonio Sterpetti, Luca di Marzo and Wassim Mansour

J. Clin. Med. 2025, 14(2), 502; https://doi.org/10.3390/jcm14020502 - 14 Jan 2025

Viewed by 662

Abstract

Introduction: A type 2 endoleak (EL2) remains the most prevalent complication of endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA). Methods: We conducted a retrospective, single-center analysis, including patients who underwent embolization for an isolated EL2 after EVAR. The study population was stratified into two groups: Group A, consisting of patients whose EL2 resolved after the first embolization procedure, and Group B, consisting of those with refractory EL2 (rEL2). The indication for EL2 treatment was aneurysmal sac growth amounting to >10 mm from the index EVAR. The indications for endograft explantation were the absence of high comorbidities and persisting aneurysmal sac expansion. Those with high comorbidities were subjected to another endovascular procedure or a conservative approach, the latter being preferred. The primary endpoint was EL2 resolution. The secondary endpoints were mid-term outcomes in terms of aneurysmal sac shrinkage, stability and expansion rates, and aneurysm-related complications. Results: Among 57 patients, 19 patients (33.3%) showed signs of EL2 after the first embolization, whereas 38 (66.6%) presented rEL2. Of these, 14 (36.8%) presented significant aneurysmal sac expansion: 8 patients underwent a secondary embolization, while an open conversion was performed in the remaining 6 patients (42.8%), 4 of whom, in an elective setting, showed a complete resolution of EL2, while 2 patients treated in an urgent setting died from a ruptured aneurysm. Among the patients treated with a secondary embolization, only 2 patients presented EL2 resolution, while the other 6 patients (75%) showed rEL2. Out of the 38 patients with rEL2, 24 patients did not undergo further interventions; of these, 11 (45.8%) presented sac expansion, and 16% developed type IA EL. Conclusions: A strict follow-up and possibly a more aggressive treatment should be considered in an elective setting for patients with rEL2. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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12 pages, 479 KiB

Open AccessArticle

Stent-Induced Inflammation: A Comparative Cross-Sectional Study of Post-Implantation Syndrome in Venous and Arterial Procedures

by Nur Dikmen, Evren Ozcinar, Ali Ihsan Hasde, Ahmet Kayan, Nadir Polat, Ali Ardakani, Ezel Kadiroğlu Yuruyen and Zeynep Eyileten

J. Clin. Med. 2024, 13(19), 5937; https://doi.org/10.3390/jcm13195937 - 5 Oct 2024

Viewed by 1061

Abstract

Background: Postimplantation syndrome (PIS) is a known inflammatory response following endovascular stent placement, yet comparative data between venous and arterial stenting remains limited. This study seeks to evaluate the incidence, characteristics, and clinical implications of PIS across these two distinct vascular territories. Methods: We retrospectively analyzed 191 patients who underwent either venous (n = 36) or arterial (n = 155) stent placement. Data collection encompassed demographic profiles, perioperative laboratory findings, and clinical outcomes. The primary endpoint was the incidence of PIS, defined as the presence of fever (≥38 °C), leukocytosis, and elevated C-reactive protein (CRP) within 30 days postprocedure. Secondary outcomes included length of hospital and ICU stay, incidence of endoleaks, reintervention rates, and 30-day mortality. Comparative statistical analyses were conducted to assess differences between the venous and arterial stent groups. Results: PIS was observed more frequently in arterial stent patients, as evidenced by significantly elevated postoperative white blood cell counts at 24 and 48 h (p = 0.046 and p = 0.014, respectively), along with borderline CRP increases (p = 0.052). Fever occurrence peaked at 72 and 96 h postprocedure, predominantly in the arterial cohort. Furthermore, patients with arterial stents had significantly longer hospital stays (5.59 ± 0.46 days vs. 3.42 ± 0.36 days; p = 0.0018) and a higher rate of 30-day endoleaks (7.1% vs. 0%; p = 0.005). Despite similar mortality and major adverse cardiac event (MACE) rates between groups, arterial stent patients exhibited a greater need for reintervention. While PIS was less common among venous stent recipients, its potential impact on postoperative recovery warrants careful monitoring. Conclusions: Arterial stenting is associated with a higher incidence of PIS and a more pronounced systemic inflammatory response, contributing to longer hospitalization and increased postoperative complications. Although venous stent patients experience PIS less frequently, its occurrence should not be overlooked, as it may influence overall recovery and clinical outcomes. Recognition and management of PIS in both venous and arterial stent patients are critical to improving patient care and optimizing procedural success. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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13 pages, 1561 KiB

Open AccessArticle

Association of Centre Quality Certification with Characteristics of Patients, Management, and Outcomes Following Carotid Endarterectomy or Carotid Artery Stenting

by Stefan Saicic, Christoph Knappich, Michael Kallmayer, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Julian Böhm, Sofie Lückerath, Hans-Henning Eckstein and Andreas Kuehnl

J. Clin. Med. 2024, 13(15), 4407; https://doi.org/10.3390/jcm13154407 - 28 Jul 2024

Viewed by 971

Abstract

Background: The aim of this study was to analyze the association between center quality certifications and patients’ characteristics, clinical management, and outcomes after carotid revascularization. Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the Bavarian subset of the nationwide German statutory quality assurance carotid database. Hospitals were classified as to whether a certified vascular center (cVC) or a certified stroke unit (cSU) was present on-site or not. The primary outcome event was any stroke or death until discharge from the hospital. Results: In total, 31,793 cases were included between 2012 and 2018. The primary outcome rate in asymptomatic patients treated by CEA ranged from 0.7% to 1.5%, with the highest rate in hospitals with cVC but without cSU. The multivariable regression analysis revealed a significantly lower primary outcome rate in centers with cSU in asymptomatic patients (aOR 0.69; 95% CI 0.56–0.86; p < 0.001). In symptomatic patients needing emergency treatment, the on-site availability of a cSU was associated with a significantly lower primary outcome rate (aOR 0.56; 95% CI 0.40–0.80; p < 0.001), whereas the presence of a cVC was associated with higher risk (aOR 3.07; 95% CI 1.65–5.72). Conclusions: This study provides evidence of statistically significant better results in some sub-cohorts in certified centers. In centers with cSU, the risk of any stroke or death was significantly lower in asymptomatic patients receiving CEA or symptomatic patients treated by emergency CEA. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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12 pages, 1201 KiB

Open AccessArticle

Determinants of Pre- and Post-Procedural Neurological Assessment, and Outcome of Carotid Endarterectomy or Stenting

by Michael Kallmayer, Christoph Knappich, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Hans-Henning Eckstein and Andreas Kuehnl

J. Clin. Med. 2024, 13(14), 4177; https://doi.org/10.3390/jcm13144177 - 17 Jul 2024

Viewed by 1070

Abstract

Background: The German–Austrian guideline on the treatment of carotid stenosis recommends specialist neurological assessment (NA) before and after carotid endarterectomy (CEA) or carotid artery stenting (CAS). This study analyzes the determinants of NA and the association of NA with the perioperative rate of stroke or death. Materials and Methods: This study is a pre-planned sub-study of the ISAR-IQ project, which analyzes data from the nationwide German statutory quality assurance carotid database. Patients were classified as asymptomatic (group A), elective symptomatic (group B), and others (group C: emergency (C1), simultaneous operation (C2), and other indications (C3)). The primary outcome event (POE) of this study was any in-hospital stroke or death. Adjusted odds ratios for pre- and post-NA and the POE were calculated using multivariable regression analyses. Results: We analyzed 228,133 patients (54% asymptomatic, 68% male, mean age 72 years) undergoing CEA or CAS between 2012 and 2018. Age and sex were not associated with the likelihood of pre-NA or post-NA. The multivariable regression analysis showed an inverse association between pre-NA and POE (adjusted odds ratio (aOR) 0.47; 95% CI 0.44–0.51, p < 0.001), and a direct association of post-NA and POE (aOR 4.39; 95% CI 4.04–4.78, p < 0.001). Conclusions: Pre- and postinterventional specialist NA is strongly associated with the risk of any in-hospital stroke or death after CEA or CAS in Germany. A relevant confounding by indication or reversed causation cannot be ruled out. Nevertheless, to improve the quality assurance of treatment, the NA recommended in the guideline should be carried out consistently. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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11 pages, 1037 KiB

Open AccessArticle

The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease

by Andreas L. H. Gerken, Martin Sigl, Elisa Israel, Christel Weiß, Christoph Reißfelder and Kay Schwenke

J. Clin. Med. 2024, 13(13), 3991; https://doi.org/10.3390/jcm13133991 - 8 Jul 2024

Viewed by 1342

Abstract

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle–brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO₂), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO₂ in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO₂, rHb, and the ABI did not. Conclusions: Elevated leg SO₂ was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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12 pages, 516 KiB

Open AccessArticle

Sex-Specific Analysis of Mid-Term Outcomes of Atherectomy-Assisted Endovascular Treatment in Severe Peripheral Arterial Disease

by Konstantinos Avranas, Apostolos G. Pitoulias, Gergana T. Taneva, Efthymios Beropoulis and Konstantinos P. Donas

J. Clin. Med. 2024, 13(11), 3235; https://doi.org/10.3390/jcm13113235 - 30 May 2024

Viewed by 1105

Abstract

Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are no published mid-term outcomes evaluating the performance of atherectomy differentiated by sex. This study aims to evaluate sex-specific outcomes and prognostic factors affecting the results of atherectomy-assisted endovascular treatment in severe PAD. Methods: A retrospective analysis was conducted at a single centre in Germany, initiated by physicians and not sponsored by industry, on patients presenting with Rutherford categories ranging from III to V and featuring de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries. The intervention involved rotational atherectomy-assisted angioplasty utilising the Jetstream (Boston, US^®) device. The point of interest of this study was postinterventional clinical improvement as well as mid-term outcomes, including primary patency, over a targeted 2-year follow-up period. Statistical analysis utilised Cox regression (survival analysis) to calculate hazard ratios according to sex category. Comparative survival analysis was performed using the log-rank test and visually represented through Kaplan–Meier curves. Risk factors associated with absence of clinical improvement were examined across both sex groups utilising the chi-square or Fisher exact test, as appropriate. Results: A total of 98 patients (103 limbs) were initially included, with >75% having moderate-to-severe lesion calcification (>50%). A total of 84 patients (97 limbs, 62 male and 35 female) proceeded to a 2-year follow-up (mean 16.4 months for males and 16.1 for females) after a successful index procedure. Age distribution, Rutherford class, diabetes, chronic kidney disease (CKD), target vessel, lesion type, and length were balanced among both groups. Similar primary patency rates, of 89% among female and 91% among male limbs, were observed (p = 0.471). Female patients exhibited a lower rate of clinical improvement based on the Rutherford scale in comparison to males (80.6% vs. 94.5%, p = 0.048). CDK was the only significant prognostic factor across pooled data (odds ratio for CKD: 15.15, p < 0.001). Conclusions: Rotational atherectomy showed comparably high rates of mid-term primary patency, with low rates of bailout stent placement. These findings highlight the beneficial use of atherectomy in female patients who are per se at risk for higher rates of complications during and after endovascular interventions. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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15 pages, 2161 KiB

Open AccessArticle

Analysis of Target Vessel Instability in Fenestrated Endovascular Repair (f-EVAR) in Thoraco-Abdominal Aortic Pathologies

by Daniel Becker, Laura Sikman, Ahmed Ali, Selim Mosbahi, Carlota F. Prendes, Jan Stana and Nikolaos Tsilimparis

J. Clin. Med. 2024, 13(10), 2898; https://doi.org/10.3390/jcm13102898 - 14 May 2024

Cited by 3 | Viewed by 1254

Abstract

Objective: The aim of this study was to evaluate the influence of target vessel anatomy and post-stenting geometry on the outcome of fenestrated endovascular aortic repair (f-EVAR). Methods: A retrospective review of data from a single center was conducted, including all consecutive fenestrated endovascular aortic repairs (f-EVARs) performed between September 2018 and December 2023 for thoraco-abdominal aortic aneurysms (TAAAs) and complex abdominal aortic aneurysms (cAAAs). The analysis focused on the correlation of target vessel instability to target vessel anatomy and geometry after stenting. The primary endpoint was the cumulative incidence of target vessel instability. Secondary endpoints were the 30-day and follow-up re-interventions. Results: A total of 136 patients underwent f-EVAR with 481 stented target vessels. A total of ten target vessel instabilities occurred including three in visceral and seven instabilities in renal vessels. The cumulative incidence of target vessel instability with death as the competing risk was 1.4%, 1.8% and 3.4% at 1, 2 and 3 years, respectively. In renal target vessels (260/481), a diameter ≤ 4 mm (OR 1.21, 95% CI 1.035–1.274, p = 0.009) and an aortic protrusion ≥ 5.75 mm (OR 8.21, 95% CI 3.150–12-23, p = 0.027) was associated with an increased target vessel instability. In visceral target vessels (221/481), instability was significantly associated with a preoperative tortuosity index ≥ 1.25 (HR 15.19, CI 95% 2.50–17.47, p = 0.045) and an oversizing ratio of ≥1.25 (HR 7.739, CI % 4.756–12.878, p = 0.049). Conclusions: f-EVAR showed favorable mid-term results concerning target vessel instability in the current cohort. A diameter of ≤4 mm and an aortic protrusion of ≥5.75 mm in the renal target vessels as well as a preoperative tortuosity index and an oversizing of the bridging stent of ≥1.25 in the visceral target vessels should be avoided. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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