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Clinical Advances in Aortic Aneurysm
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Clinical Advances in Aortic Aneurysm

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 December 2024 | Viewed by 2219

Special Issue Editor

Dr. Ciro Ferrer

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Guest Editor
Vascular Surgery Unit, San Giovanni—Addolorata Hospital, Roma, Italy
Interests: abdominal aortic aneurysm; thoraco-abdominal aortic aneurysm; aortic arch aneurysm; aortic dissection; iliac aneurysm; connective tissue disorder; aortitis

Special Issue Information

Dear Colleagues,

The last two decades have brought many remarkable advances in endovascular aneurysm repair. Considerable advancements have been made in the minimally invasive management of aortic aneurysm, from the total percutaneous approach to novel low-profile and incredibly conformable stent grafts, passing through the development of dedicated software for vessel analysis, fusion technique imaging, and, lastly, the application of artificial intelligence. Through continued innovation from industry as well as the creativity of many physicians, we have today a huge armamentarium of devices, including a variety of custom-designed or off-the-shelf solutions to cope with complex aortic diseases, such as arch or thoraco-abdominal aneurysms and dissections. This technological evolution has made sure that more and more patients with a complex aortic pathology can today be managed with ease and a degree of invasiveness which were previously unthinkable. This Special Issue aims to provide a comprehensive review of the latest endovascular solutions for the treatment of complex aortic disease. It will also focus on the prevention of major complications in the arch and thoraco-abdominal field as well as the intra- and post-operative management of patients. It will also cover some rare conditions, such as aortitis and genetically triggered aortic disease.

Dr. Ciro Ferrer
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thoraco-abdominal aortic aneurysm
  • aortic arch aneurysm
  • aortic dissection
  • connective tissue disease
  • aortitis

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Published Papers (2 papers)

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Research

12 pages, 1947 KiB  
Article
Early and Mid-Term Results of Endovascular Aneurysm Repair with the Cordis Incraft Ultra-Low Profile Endograft: A High-Volume Center Experience
by Luigi Baccani, Gianbattista Parlani, Giacomo Isernia, Massimo Lenti, Andrea Maria Terpin and Gioele Simonte
J. Clin. Med. 2024, 13(18), 5413; https://doi.org/10.3390/jcm13185413 - 12 Sep 2024
Viewed by 934
Abstract
Background/Objectives: In recent years, manufacturers have developed new low-profile stent grafts to allow endovascular treatment of abdominal aortic aneurysms (AAA) in patients with small access vessels. We evaluated the early and mid-term outcomes of the Incraft (Cordis Corp, Bridgewater, NJ, USA) ultra-low [...] Read more.
Background/Objectives: In recent years, manufacturers have developed new low-profile stent grafts to allow endovascular treatment of abdominal aortic aneurysms (AAA) in patients with small access vessels. We evaluated the early and mid-term outcomes of the Incraft (Cordis Corp, Bridgewater, NJ, USA) ultra-low profile endograft implantation in a high-volume single center. Methods: Between 2014 and 2023, 133 consecutive endovascular aneurysm repair (EVAR) procedures performed using the Incraft endograft were recorded in a prospective database. Indications included infrarenal aortic aneurysms, common iliac aneurysms, and infrarenal penetrating aortic ulcers. Mid-term results were analyzed using the Kaplan–Meier method. Results: During the study period, 133 patients were treated with the Cordis Incraft endograft, in both elective and urgent settings. The Incraft graft was the first choice for patients with hostile iliac accesses, a feature characterizing at least one side in 90.2% of the patients in the study cohort. The immediate technical success rate was 78.2%. The intraoperative endoleak rate was 51.9% (20.3% type 1 A, 0.8% type 1 B, and 30.8% type 2 endoleak). Within 30 days, technical and clinical success rates were both 99.3%; all type 1A and 1B endoleaks were resolved at the 30-day follow-up CT-angiogram. After a mean follow-up of 35.4 months, the actuarial freedom from the re-intervention rate was 96.0%, 91.1%, and 84.0% at 1, 3, and 5 years, respectively. The iliac leg patency rate was 97.1%, 94.1%, and 93.1% at 1, 3, and 5 years, respectively. No statistically significant differences were observed between hostile and non-hostile access groups, nor between the groups with grade 1, grade 2, and grade 3 access hostility. Conclusions: The ultra-low profile Cordis Incraft endograft represents a valid option for the endovascular treatment of AAA in patients with hostile iliac accesses. The procedure can be performed with high rates of technical and clinical success at 30 days and the rates of iliac branch occlusion observed during the follow-up period appear acceptable in patients with poor aorto-iliac outflow. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Aneurysm)
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13 pages, 13248 KiB  
Article
Urgent or Emergent Endovascular Aortic Repair of Infective Aortitis
by Bernardo Orellana Davila, Carlotta Mancusi, Carlo Coscarella, Claudio Spataro, Paolo Carfagna, Arnaldo Ippoliti, Rocco Giudice and Ciro Ferrer
J. Clin. Med. 2024, 13(16), 4669; https://doi.org/10.3390/jcm13164669 - 9 Aug 2024
Viewed by 853
Abstract
Background: Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by [...] Read more.
Background: Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by open surgery, with subsequent lack of information about the endovascular repair. The aim of the present study is to report the results of our experience with the urgent or emergent endovascular repair of infective aortitis with acute presentation. Methods: All consecutive urgent or emergent endovascular repairs, performed between January 2019 and January 2024 for the treatment of infective aortitis, were included. The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. Results: A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. The endovascular techniques performed were as follows: four thoracic-EVAR (TEVAR), three off-the-shelf branched-EVAR (BEVAR), one Chimney-EVAR (Ch-EVAR), six EVAR with bifurcated graft, and one EVAR with straight tube graft. Technical success was achieved in 100% of the patients. Two patients (13%) died within 30 days after the index procedure. No case of early aortic-related mortality was registered. During a mean follow-up of 31.6 ± 23.1 months (range 1–71), no further death or major adverse event was registered among the remaining 13 alive patients. Re-interventions were performed in three cases (20%). Aneurysm’s shrinkage > 5 mm or stability was noted in 10 of the 13 patients who survived the early period after repair. Conclusions: Despite the relative reluctance to use an endograft in an infected area, in our experience the endovascular approach resulted to be feasible, safe, and effective in the treatment of infective aortitis with acute presentation, with acceptable peri-operative and mid-term follow-up outcomes. Further studies are needed to confirm our results. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Aneurysm)
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