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Clinical Advances in the Management of Abdominal and Thoracoabdominal Aortic Aneurysms

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

Deadline for manuscript submissions: 25 May 2026 | Viewed by 1124

Special Issue Editor

Dr. Daniela Mazzaccaro

E-Mail Website
Guest Editor
Operative Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy
Interests: carotid pathology; aortic aneurysms; dissection; atherosclerosis; peripheral artery disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The use of endovascular techniques has become increasingly widespread for the management of abdominal and thoracoabdominal aortic aneurysms (AAAs and TAAAs), leading to a paradigm shift away from open surgical repair, which remains, however, the gold standard treatment for young and fit patients.

One of the crucial aspects of this issue includes the development of patient-specific fenestrated and branched endografts (F/BEVAR), which increase the feasibility and success of treating more complex aortic anatomies that were previously only treatable with open surgery.

These technical innovations have been made possible thanks to advances in the imaging modality, development of 3D printing for pre-operative planning, and new biomaterials for improved device durability and security. Personalized medicine approaches, utilizing biomechanical data and AI, are also emerging to improve risk prediction and treatment tailoring.

The aim of this Special Issue is to provide an updated insight into the most recent advances in the management of this complex pathology.

Dr. Daniela Mazzaccaro
Guest Editor

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Keywords

  • abdominal aneurysm
  • thoraco-abdominal
  • computed-tomography angiography
  • branched endograft
  • branched endovascular aortic repair
  • fenestrated endograft
  • open surgery
  • 3-D printing

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Published Papers (3 papers)

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Research

13 pages, 633 KB  
Article
Mid-Term Clinical Outcomes of the Low-Profile Ankura™ Stent Graft System for Endovascular Aneurysm Repair
by Fatma Akca Ozsar, Bekir Bogachan Akkaya, Mehmet Cahit Saricaoglu, Onur Buyukcakir, Evren Ozcinar, Hakki Zafer Iscan and Levent Yazicioglu
J. Clin. Med. 2026, 15(9), 3231; https://doi.org/10.3390/jcm15093231 - 23 Apr 2026
Viewed by 116
Abstract
Background: To evaluate the real-world safety and mid-term clinical performance of the Ankura™ AAA Stent Graft System in patients undergoing endovascular aneurysm repair (EVAR). Materials and Methods: This prospective, multicenter PMCF study analyzed 100 patients with abdominal aortic aneurysms (AAAs). Patients were monitored [...] Read more.
Background: To evaluate the real-world safety and mid-term clinical performance of the Ankura™ AAA Stent Graft System in patients undergoing endovascular aneurysm repair (EVAR). Materials and Methods: This prospective, multicenter PMCF study analyzed 100 patients with abdominal aortic aneurysms (AAAs). Patients were monitored for a mean duration of 2.26 years. Primary endpoints included 30-day major adverse events and 24-month treatment success. Statistical evaluation of risk factors for reintervention was performed using univariate logistic regression. Results: The study cohort was predominantly male (97%), with a mean age of 72.01 years. Hypertension (90%) and smoking (89%) were the most prevalent comorbidities. Regarding the primary endpoints, the 30-day MAE rate was 2%. During the overall follow-up (mean 2.26 years), the primary patency rate was 97%, demonstrating high structural integrity and sustained patency. However, the overall freedom from reintervention rate was 74%, corresponding to a 26% reintervention requirement and a 27% incidence of endoleak. Reinterventions were almost exclusively driven by these post-procedural morphological complications; specifically, 26 of the 27 patients with endoleaks required a secondary procedure. No preoperative clinical or anatomical parameters were identified as significant independent predictors of reintervention in the univariate analysis (p > 0.05). The overall mortality rate was 12%, with 0% aneurysm-related mortality. Conclusions: Mid-term success and reintervention after EVAR with the Ankura™ system are primarily driven by postoperative morphological complications, such as endoleaks, rather than baseline patient risk profiles. These findings underscore the critical importance of rigorous, lifelong radiological surveillance regardless of preoperative anatomical challenges. Full article
(This article belongs to the Special Issue Clinical Advances in the Management of Abdominal and Thoracoabdominal Aortic Aneurysms)
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8 pages, 1281 KB  
Article
Experience of Alternative Technique for Branch Cannulation in Branched Endovascular Aneurysm Repair
by Daniela Mazzaccaro, Paolo C. Righini, Fabiana Fancoli, Alfredo Modafferi, Giovanni Malacrida, Marina Galligani and Giovanni Nano
J. Clin. Med. 2026, 15(7), 2497; https://doi.org/10.3390/jcm15072497 - 24 Mar 2026
Viewed by 254
Abstract
Background/Objectives: To describe our experience of using an alternative technique for retrograde branch graft cannulation during Branched EndoVascular Aortic Repair (B-EVAR) of complex abdominal and thoraco-abdominal aortic aneurysm (TAAA) with branched endografts. Methods: Data from patients who underwent B-EVAR for TAAA/complex [...] Read more.
Background/Objectives: To describe our experience of using an alternative technique for retrograde branch graft cannulation during Branched EndoVascular Aortic Repair (B-EVAR) of complex abdominal and thoraco-abdominal aortic aneurysm (TAAA) with branched endografts. Methods: Data from patients who underwent B-EVAR for TAAA/complex abdominal aneurysms and in whom the cannulation of a branch was performed through a retrograde approach with our technique were retrospectively collected and analyzed. The technique consists of the placement of two 4F Ber catheters in both femoral arteries, which are advanced in parallel with the main graft before its deployment and left in the aneurysmal sac. These catheters are then used as a bailout for the retrograde cannulation of one or more branches of the endograft. Results: The technique was employed in 4 patients (1 female, 1 urgent) treated from 2018 onward, allowing the successful catheterization of 4 challenging branches that could not be catheterized using other approaches. The patients’ mean age was 80.7 + 2.2 years. No intraoperative nor postoperative complications linked to the technique occurred. Conclusions: The placement of two catheters from both femoral arteries inside the aneurysmal sac before graft deployment can be safe and useful for bailout retrograde cannulation of any branch of the endograft, when other techniques fail. Full article
(This article belongs to the Special Issue Clinical Advances in the Management of Abdominal and Thoracoabdominal Aortic Aneurysms)
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18 pages, 2200 KB  
Article
Impact of Endovascular Aortic Repair on Aortic Stiffness: Preliminary Results from a Prospective In Vivo Study Following EVAR
by Paolo Bellotti, Emma-Lena Maris, Jasper F. de Kort, Daniele Bissacco, Silvia Romagnoli, Maurizio Domanin, Chiara Grignaffini, Paolo Salvi, Gianfranco Parati, Valentina Mazzi, Karol Calo, Bianca Griffo, Diego Gallo, Umberto Morbiducci, Constantijn E. V. B. Hazenberg, Joost A. van Herwaarden and Santi Trimarchi
J. Clin. Med. 2026, 15(4), 1532; https://doi.org/10.3390/jcm15041532 - 15 Feb 2026
Viewed by 492
Abstract
Background: Aortic stiffness (AoS) is an established predictor of cardiovascular morbidity and mortality. Endovascular aneurysm repair (EVAR) introduces a rigid stent-graft into the aorta, potentially increasing AoS and impairing subendocardial perfusion. This prospective study aimed to evaluate changes in AoS and myocardial [...] Read more.
Background: Aortic stiffness (AoS) is an established predictor of cardiovascular morbidity and mortality. Endovascular aneurysm repair (EVAR) introduces a rigid stent-graft into the aorta, potentially increasing AoS and impairing subendocardial perfusion. This prospective study aimed to evaluate changes in AoS and myocardial perfusion following EVAR, measured by carotid-to-femoral pulse wave velocity (cf-PWV) and the Subendocardial Viability Ratio (SEVR), and examined the influence of graft length on post-operative cf-PWV and SEVR. Methods: From October 2023 to April 2025, 38 patients undergoing elective EVAR were prospectively enrolled. Cf-PWV and the SEVR were measured <72 h preoperatively and 7 days postoperatively using the PulsePen® device. Descriptive statistics were used to summarize baseline characteristics. Data were assessed for normality with the Shapiro–Wilk test; non-normally distributed variables were analysed using the Wilcoxon signed-rank test and presented as median [interquartile range, IQR], while normally distributed variables were analysed using paired t-tests and presented as mean ± standard deviation (SD). Linear regression was applied to evaluate associations between graft length and postoperative changes in cf-PWV and SEVR. Results: Cf-PWV increased significantly after EVAR, with a median within-patient change of 1.0 m/s [IQR 3.1] (p < 0.001), corresponding to a 10.6% increase. The SEVR decreased significantly by 15.1% (p = 0.006). Graft length correlated positively with cf-PWV change, with a 0.2% increase in cf-PWV per millimetre of graft length (r = 0.41; p = 0.029), but not with SEVR (r = 0.058, p = 0.763). Conclusions: EVAR was associated with increased AoS and reduced subendocardial perfusion, with greater stiffness changes observed in patients receiving longer grafts. These preliminary findings highlight important haemodynamic consequences of EVAR and may inform patient selection, postoperative management, and the development of future stent-graft designs to mitigate long-term cardiovascular risk. Full article
(This article belongs to the Special Issue Clinical Advances in the Management of Abdominal and Thoracoabdominal Aortic Aneurysms)
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