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State of the Art in Management of Aortic Aneurysm in Vascular Surgery

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 (30 December 2025) | Viewed by 3675

Special Issue Editors

Dr. Rana O. Afifi

E-Mail Website
Guest Editor
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
Interests: vascular surgery; endovascular surgery; aortic dissection; aortic repair
Dr. Eanas Yassa

E-Mail Website
Guest Editor Assistant
Vascular Surgery Department, Corewell Health, Michigan State University, 142 Campau Ave NW, Grand Rapids, MI 49503, USA
Interests: vascular surgery; aortic disease; aortic dissection; aortic repair

Special Issue Information

Dear Colleagues,

Managing vascular aneurysms throughout history is a testament to curiosity, humility, tenacity, and innovation within medicine. Early Egyptian documentation, as far back as 1550 B.C, notes “tumors of the arteries” that are uncurable without “magic”. Tenacious early surgeons, such as Dr. Vorhees in 1952, attempted packing, ligation, wrapping, and eventually interposition grafting. This led us to modern open aneurysm repair and focusing on developing better artificial conduits. The 20th century brought about further innovations with the advent of endovascular aortic aneurysm repair. Again, humility forced early innovators to focus on improving fixation, durability, profile, and, now, disease extent. Incorporating branch vessels through customizable physician-modified and commercially made branched and fenestrated devices has allowed for a whole new range of patients to undergo aneurysm repair with lower morbidity and mortality. Advancements, including 3D imaging, on-table overlay, fusion capabilities, and progressive hybrid devices, continue to leverage the vascular surgeon’s commitment to quality, safety, innovation, and collaboration in the name of patient care.  This Special Issue aims to provide a comprehensive overview of the advances in diagnosing and managing aortic aneurysms. Therefore, researchers are encouraged to submit original articles or reviews to this Special Issue.

Dr. Rana O. Afifi
Guest Editor

Dr. Eanas Yassa
Guest Editor Assistant

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 250 words) can be sent to the Editorial Office for assessment.

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

  • aortic dissection
  • complex aortic surgery
  • endovascular aortic repair
  • aortic imaging
  • aortic aneurysm

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Published Papers (5 papers)

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Research

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9 pages, 1008 KB  
Article
A Decade of the GSTT Aortic Infection Programme: A Description of a Clinical Management Algorithm by a Multidisciplinary Team
by Thomas Richards, Carolyn Hemsley, Nicholas Price and Morad Sallam
J. Clin. Med. 2026, 15(5), 1754; https://doi.org/10.3390/jcm15051754 - 25 Feb 2026
Viewed by 450
Abstract
Background/Objectives: The management of mycotic aortic aneurysm and aortic graft infection is complex, and the pathology is rare. Over the past decade, we have developed a high-volume multidisciplinary service and comprehensive management algorithm. We intend to report on our experience and management [...] Read more.
Background/Objectives: The management of mycotic aortic aneurysm and aortic graft infection is complex, and the pathology is rare. Over the past decade, we have developed a high-volume multidisciplinary service and comprehensive management algorithm. We intend to report on our experience and management strategy. Methods: We have examined the different aspects of the service, how it was developed, the standardisation of management, and its impact on consistent decision-making. Discussion: Low-volume, high-complexity pathologies are challenging and infrequently reported in the literature. The growth of our service and experience has improved outcomes and allowed for timely and consistent decision-making. We believe a central, multidisciplinary, standardised approach allows for prospective data collection and analysis. Although mycotic aortic aneurysm and aortic graft infection are discrete pathologies, our management algorithm and dedicated aortic infection service provides a comprehensive management strategy for both conditions. Conclusions: A comprehensive management algorithm has not previously been described by a tertiary centre. We have demonstrated that a unique multidisciplinary clinical approach and dedicated specialist service following a standardised management algorithm delivers superior patient outcomes. Whilst our basic management algorithm has remained largely intact over the years, we anticipate change in the future based upon emerging high-quality evidence and our own experience. Full article
(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)
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11 pages, 1126 KB  
Article
Factors Affecting Post-EVAR Imaging Surveillance: An Opportunity for Improvement
by Daniel Gage, Drayson B. Campbell, Michael R. Go, Xiaoyi Teng and Kristine Orion
J. Clin. Med. 2026, 15(1), 39; https://doi.org/10.3390/jcm15010039 - 20 Dec 2025
Viewed by 463
Abstract
Background/Objectives: Appropriate imaging surveillance, established by the Society of Vascular Surgery (SVS), following endovascular aorta repair (EVAR) is critical for patient monitoring. We hypothesized that adherence to follow-up decreases over time, and therefore, the ability to detect endoleaks after EVAR also decreases. [...] Read more.
Background/Objectives: Appropriate imaging surveillance, established by the Society of Vascular Surgery (SVS), following endovascular aorta repair (EVAR) is critical for patient monitoring. We hypothesized that adherence to follow-up decreases over time, and therefore, the ability to detect endoleaks after EVAR also decreases. Methods: A retrospective cohort study of patients who underwent EVAR from 2014 to 2022 at our institution was completed. Patients were stratified by adherence to SVS guidelines for up to five years postoperatively. Demographics, detection of an endoleak > 30 days postoperatively, distance from our facility, and Area Deprivation Index (ADI) were collected. Comparisons of baseline comorbidities between groups and multivariate logistic regressions were performed using R studio. Results: 395 patients underwent an index EVAR at our institution from 2014–2022. 174 (44%) of patients adhered to all imaging recommendations, with an average loss to follow-up of 9.7% per year. 61 (15.4%) patients had a detected type II endoleak during the study period. Multivariable analysis identified residence > 50 miles from our institution as an independent risk factor for nonadherence (OR 1.76, p = 0.018) when controlling for age, sex, race, and ADI quartile. Conclusions: Adherence to surveillance guidelines gradually decreases after EVAR, but type II endoleak detection continues to occur years following the operation. While residence greater than 50 miles away was associated with nonadherence, patients’ ADI was not. Our results identify an opportunity for providers who may see patients more frequently to assist in reminding and arranging imaging follow-up for patients following their procedure. Full article
(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)
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10 pages, 1265 KB  
Article
Hybrid Repair of Thoraco-Abdominal Aortic Disease with Complex Renal and Hypogastric Anatomy
by Fabrizio Minelli, Simona Sica, Francesco Sposato, Antonino Marzullo, Laura Rascio, Ottavia Borghese, Giovanni Tinelli and Yamume Tshomba
J. Clin. Med. 2025, 14(21), 7525; https://doi.org/10.3390/jcm14217525 - 23 Oct 2025
Viewed by 711
Abstract
Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and [...] Read more.
Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and effectiveness of a hybrid approach in high-risk patients with TAA disease and complex renal and hypogastric anatomy. Methods: This was a retrospective single-center study, including all consecutive patients with TAAA and TAAD with complex renal and/or hypogastric artery anatomy treated with a hybrid approach between 2020 and 2024 in a high-volume aortic center. Primary endpoint was technical success. Secondary endpoints were early complications, overall and aortic-related mortality, aortic-related reintervention, the incidence of endoleaks, and the target vessel (TV) patency and TV instability at 30-day and during follow-up. Results: During the study period, a total of 92 patients with TAAA or TAAD were treated at our institution. Five high-risk patients (5.4%) with complex renal/hypogastric artery anatomy underwent open renal debranching and hypogastric revascularization followed by staged endovascular repair with custom-made double fenestrated/branched device. Technical success was achieved in all cases with no intra-operative mortality. No spinal cord ischemia or 30-day mortality occurred. Target vessel patency at 30 days was 90%. At a median follow-up of 38 months (IQR 26–49 months), there were no cases of aortic-related death. Conclusions: Hybrid repair is a feasible and effective option for managing complex TAAA and TAAD in high-risk patients. Larger studies with longer follow-up are needed to better define the clinical role of this approach. Full article
(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)
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Review

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19 pages, 1052 KB  
Review
Automatic Segmentation of Intraluminal Thrombus in Abdominal Aortic Aneurysms Based on CT Images: A Comprehensive Review of Deep Learning-Based Methods
by Jia Guo, Fabien Lareyre, Sébastien Goffart, Andrea Chierici, Hervé Delingette and Juliette Raffort
J. Clin. Med. 2025, 14(23), 8497; https://doi.org/10.3390/jcm14238497 - 30 Nov 2025
Cited by 2 | Viewed by 1094
Abstract
Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through [...] Read more.
Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through searches of PUBMED and Web of Science up to September 2025. Only English-language studies applying DL-based networks for ILT segmentation in patients with AAA on computed tomography angiography were included. After screening 664 articles, 22 met the eligibility criteria and were included. The reported methodological frameworks and segmentation performance metrics were extracted for comparison and analysis. Results: Among the studies included, the reported Dice similarity coefficients ranged from 0.81 to 0.93 for 2D networks and from 0.804 to 0.9868 for 3D networks. Notably, 2D Multiview fusion models outperform other 2D approaches, while 3D U-Net remains a strong baseline. Methods using preoperative images demonstrated great applicability for surgical planning, while postoperative segmentation faced challenges related to imaging artifacts caused by stent. Conclusions: This review provides a comprehensive overview of recent DL-based ILT segmentation methods for AAA patients on CTA, offering perspectives for applications in advanced preoperative planning and postoperative surveillance. Despite the promising results, the lack of standardized datasets limits model development and external validation. Future research should address these limitations by focusing on multicenter standardized datasets and seamless integration into clinical workflows. Full article
(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)
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Other

Jump to: Research, Review

17 pages, 667 KB  
Protocol
Post-Traumatic Stress Disorder After Acute Cardiovascular Events: Protocol of a Systematic Review and Meta-Analysis
by Harleen K. Sandhu, Michael P. Van Wie, Mary B. Short and Charles C. Miller III
J. Clin. Med. 2026, 15(8), 2962; https://doi.org/10.3390/jcm15082962 - 14 Apr 2026
Viewed by 386
Abstract
Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening [...] Read more.
Background: An aortic disease diagnosis can be perceived by patients as a stressful and often life-altering event. In addition, an acute event, such as aortic rupture or dissection—and the surgical intervention that will be required to address it—can be viewed as potentially life-threatening and traumatic. Serious health conditions, including stroke and acute coronary syndromes, have been described in the literature to correlate with trauma-like symptoms. Post-traumatic stress disorder (PTSD) is well described in connection with external traumatic events, such as war, assault and similarly catastrophic events. A key element of this type of PTSD is that its occurrence arises secondary to an external traumatizer. However, recent work has suggested that internal events—such as a catastrophic medical event (e.g., acute cardiovascular event and/or surgery)—can trigger PTSD symptoms. An important question is whether medical event-initiated PTSD can (or should) be treated similarly to traditionally defined PTSD, when the triggering threat may persist rather than having been confined to a past event. This systematic review will summarize the literature on the occurrence of PTSD as a consequence of an acute cardiovascular event and attempt to identify effective treatments using meta-analysis, if the literature quantity and quality support it. Methods: The search strategy will include publicly available electronic databases, including MEDLINE via PubMed and OVID, EMBASE via Elsevier, Cumulative Index for Nursing and Allied Health Literature (CINAHL) via EBSCOhost, SCOPUS, PsychInfo, and the Cochrane Library, to identify publications that report the development and/or treatment of PTSD as a consequence of an acute cardiovascular event, which include cardiac arrest, acute coronary syndromes, and acute aortic syndromes. Identification of publications, article classification, methodological review/quality assessment, and data extraction will be performed by two trained experts in cardiovascular epidemiology, with the resolution of disagreements carried out by a third independent reviewer. The review conduct and meta-analysis will follow PRISMA and MOOSE guidelines. Data will be aggregated using random effects models when quantitative data are reliable and heterogeneity is reasonable. If a quantitative synthesis is not possible due to data quality, a narrative synthesis will be conducted. Statistical heterogeneity will be assessed by I2 statistics. The quality of evidence will be assessed using the GRADE criteria. Ethics and Dissemination: This study did not require an institutional review board or human subjects protection committee approval given the nature of the study design. The results will be published in a peer-reviewed journal, along with recommendations for future research. Full article
(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)
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