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Open Questions in Aortic Disease: New Problems, New Insights
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Open Questions in Aortic Disease: New Problems, New Insights

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

Deadline for manuscript submissions: closed (20 November 2024) | Viewed by 4369

Special Issue Editors

Dr. Daniele Bissacco

E-Mail Website
Guest Editor
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Interests: vascular surgery; vascular medicine; endovascular surgery; aortic repair; aortic stent
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Maurizio Domanin

E-Mail Website
Guest Editor
1. Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Interests: vascular surgery; vascular medicine; endovascular surgery; aortic disease
Prof. Dr. Santi Trimarchi

E-Mail Website
Guest Editor
1. Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
Interests: vascular surgery; vascular medicine; endovascular surgery; aortic disease

Special Issue Information

Dear Colleagues,

Aortic disease encompasses a wide range of clinical and anatomical conditions, including aneurysm and dissection, that can have acute or chronic manifestations. Over the years, significant advancements have been made in the treatment of these pathological conditions. The introduction of endovascular surgery and its subsequent advancements have greatly enhanced patient management and treatment outcomes. However, vascular specialists now face increasingly complex pathologies that necessitate innovative approaches and state-of-the-art technologies. In this evolving landscape, it has become crucial to gather insights from global experiences in the treatment of aortic disease to ensure that optimal treatment decisions are made based on individual patient and aortic characteristics. Therefore, we cordially invite vascular experts to contribute to this Special Issue by providing original articles, case series, technical experiences, and reviews on novel treatments in the field of aortic disease. By sharing your expertise and experiences, we aim to foster a comprehensive understanding of the latest advancements in aortic disease management. We encourage submissions that explore cutting-edge technologies and present innovative approaches, ultimately striving to improve patient outcomes. We look forward to receiving your valuable contributions to this Special Issue, which will undoubtedly contribute to our collective knowledge and ultimately benefit patients worldwide.

Dr. Daniele Bissacco
Prof. Dr. Maurizio Domanin
Prof. Dr. Santi Trimarchi
Guest Editors

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

  • vascular surgery
  • aortic disease
  • aortic aneurysm
  • aortic dissection
  • endovascular aortic repair
  • open aortic repair

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Published Papers (4 papers)

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Research

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9 pages, 783 KiB  
Article
Contemporary Single-Center Experience of Complete Aortic Arch Replacement Employing the Frozen Elephant Trunk Technique in Patients with Extensive Aortic Disease
by Armin-Kai Schoeberl, Florian Huber, Bruno Schachner, Valentina Preinfalk and Andreas Zierer
J. Clin. Med. 2024, 13(22), 6640; https://doi.org/10.3390/jcm13226640 - 5 Nov 2024
Viewed by 610
Abstract
Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic [...] Read more.
Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161–205), 89 (70–113), and 45 (38–54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30–439) days. The median follow-up time was 25 (8–52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure. Full article
(This article belongs to the Special Issue Open Questions in Aortic Disease: New Problems, New Insights)
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14 pages, 1730 KiB  
Article
Prognostic Impact of Pulmonary Diseases in 952 Patients with Thoracic and/or Abdominal Aortic Aneurysm
by Yoichi Kobayashi, Takashi Ishiguro, Naho Kagiyama, Makoto Sumi and Noboru Takayanagi
J. Clin. Med. 2024, 13(20), 6247; https://doi.org/10.3390/jcm13206247 - 19 Oct 2024
Viewed by 820
Abstract
Background/Objectives: Pulmonary diseases are common in patients with thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Although high prevalences of chronic obstructive pulmonary disease and lung cancer (LC) are known, the prevalence of these and other pulmonary diseases regarding their relation to [...] Read more.
Background/Objectives: Pulmonary diseases are common in patients with thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). Although high prevalences of chronic obstructive pulmonary disease and lung cancer (LC) are known, the prevalence of these and other pulmonary diseases regarding their relation to the outcome of TAA and/or AAA are not determined. Methods: Pulmonary diseases present at aortic aneurysm (AA) diagnosis and follow-up periods and cause of death of 952 patients with TAA, AAA, or TAA + AAA (including thoracoabdominal AA) treated at our institution in Japan were retrospectively analyzed. Cox regression analysis was used to investigate potential risk factors of mortality. Results: The mean patient age was 72.4 years, and the median follow-up was 4.92 years. At diagnosis, 528 (55.5%) patients had pulmonary diseases, including emphysema without interstitial lung disease (ILD) or LC, LC, idiopathic pulmonary fibrosis (IPF) without LC, non-IPF ILD without LC, and interstitial lung abnormalities (ILAs) without LC in 250, 85, 65, 15, and 58 patients, respectively. During follow-up, LC and acute exacerbation (AE) of IPF developed in 50 and 12 patients, respectively. In 213 patients who died, there were 45 (21.1%) aortic disease-related deaths. Other causes of death included LC (27.7%), cardiovascular events (9.4%), pneumonia (5.6%), and interstitial lung disease (4.7%). In a multivariate Cox regression hazard model, age; larger maximum aneurysm diameter; and coexisting LC, IPF, or concomitant cancer were associated with poor prognosis. Conclusions: In patients with AA, not only age and aneurysm diameter but also coexisting LC and IPF were prognostic factors for mortality. Full article
(This article belongs to the Special Issue Open Questions in Aortic Disease: New Problems, New Insights)
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10 pages, 509 KiB  
Article
Intraoperative Predictors and Proposal for a Novel Prognostic Risk Score for In-Hospital Mortality after Open Repair of Ruptured Abdominal Aortic Aneurysms (SPARTAN Score)
by Raffaella Berchiolli, Nicola Troisi, Giulia Bertagna, Mario D’Oria, Luca Mezzetto, Vittorio Malquori, Valerio Artini, Duilio Motta, Lorenzo Grosso, Beatrice Grando, Giovanni Badalamenti, Cristiano Calvagna, Davide Mastrorilli, Gian Franco Veraldi, Daniele Adami and Sandro Lepidi
J. Clin. Med. 2024, 13(5), 1384; https://doi.org/10.3390/jcm13051384 - 28 Feb 2024
Viewed by 859
Abstract
(1) Background: Several mortality risk scores have been developed to predict mortality in ruptured abdominal aortic aneurysms (rAAAs), but none focused on intraoperative factors. The aim of this study is to identify intraoperative variables affecting in-hospital mortality after open repair and develop a [...] Read more.
(1) Background: Several mortality risk scores have been developed to predict mortality in ruptured abdominal aortic aneurysms (rAAAs), but none focused on intraoperative factors. The aim of this study is to identify intraoperative variables affecting in-hospital mortality after open repair and develop a novel prognostic risk score. (2) Methods: The analysis of a retrospectively maintained dataset identified patients who underwent open repair for rAAA from January 2007 to October 2023 in three Italian tertiary referral centers. Multinomial logistic regression was used to calculate the association between intraoperative variables and perioperative mortality. Independent intraoperative factors were used to create a prognostic score. (3) Results: In total, 316 patients with a mean age of 77.3 (SD ± 8.5) were included. In-hospital mortality rate was 30.7%. Hemoperitoneum (p < 0.001), suprarenal clamping (p = 0.001), and operation times of >240 min (p = 0.008) were negative predictors of perioperative mortality, while the patency of at least one hypogastric artery had a protective role (p = 0.008). Numerical values were assigned to each variable based on the respective odds ratio to create a risk stratification for in-hospital mortality. (4) Conclusions: rAAA represents a major cause of mortality. Intraoperative variables are essential to estimate patients’ risk in surgically treated patients. A prognostic risk score based on these factors alone may be useful to predict in-hospital mortality after open repair. Full article
(This article belongs to the Special Issue Open Questions in Aortic Disease: New Problems, New Insights)
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Review

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18 pages, 1249 KiB  
Review
Discussing on the Aortic Coverage in Type B Aortic Dissection Treatment: A Comprehensive Scoping Review
by Daniele Bissacco, Jasper F. de Kort, Anna Ramella, Sara Allievi, Paolo Bellotti, Renato Casana, Maurizio Domanin, Francesco Migliavacca and Santi Trimarchi
J. Clin. Med. 2024, 13(13), 3897; https://doi.org/10.3390/jcm13133897 - 2 Jul 2024
Cited by 1 | Viewed by 1514
Abstract
Objective: The objective of this study is to investigate and address the question surrounding the determination of the optimal endograft length of coverage during TEVAR for type B aortic dissection (TBAD), with a particular emphasis on the distal landing zone (DLZ). Data sources: [...] Read more.
Objective: The objective of this study is to investigate and address the question surrounding the determination of the optimal endograft length of coverage during TEVAR for type B aortic dissection (TBAD), with a particular emphasis on the distal landing zone (DLZ). Data sources: MEDLINE, Scopus, and Web of Science databases were used. Methods: The PRISMA-ScR statement was followed. Results: Several variables can contribute to the length of coverage during TEVAR in TBAD patient. Baseline patient’s characteristics, TBAD-related features, the type of endoprosthesis, and postoperative graft behaviour may contribute to the choice of coverage. Conclusions: No robust data have been published regarding the optimal length of TEVAR. Therefore, reporting the percentage of covered aorta and improving computational studies should be valorised to improve postoperative outcomes. Full article
(This article belongs to the Special Issue Open Questions in Aortic Disease: New Problems, New Insights)
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