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Abdominal Aortic Aneurysm: Clinical Updates and Perspectives
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Abdominal Aortic Aneurysm: Clinical Updates and Perspectives

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 July 2022) | Viewed by 17044

Special Issue Editors

Dr. George N. Kouvelos

E-Mail Website
Guest Editor
Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
Interests: endovascular; aortic aneurysm; thoracoabdominal aneurysm; complex aneurysm carotid stenosis; angioplasty; stenting
Special Issues, Collections and Topics in MDPI journals
Dr. Konstantinos Spanos

E-Mail Website
Guest Editor
Department of Vascular Surgery, University of Thessaly, 41334 Larissa, Greece
Interests: aortic aneurysm; thoracoabdominal aneurysm; aortic dissection; atheromatosis; complex aneurysm; aortic biology; endovascular treatment; peripheral aneurysm
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Abdominal aortic aneurysm (AAA) is an important disease causing high morbidity and mortality rates worldwide. There has been continuous research during the past decade to investigate the pathophysiology, i.e., factors that may influence the natural progression of the disease as well as several clinical aspects of AAA treatment. Endovascular aneurysm repair (EVAR) has revolutionised AAA treatment in recent decades, offering excellent early and good mid-term outcomes, although durability in the long term still remains doubtful.

This Special Issue aims to provide an update of research on new clinical data and perspectives on the whole area of AAA management, including perceptions of new technologies and novel devices. Accordingly, this Special Issue will try to provide a forum for high-quality original research and review articles to showcase the most recent advances in AAA management and treatment.

Prof. George N. Kouvelos
Dr. Konstantinos Spanos
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

  • abdominal aortic aneurysm
  • management
  • endovascular repair
  • EVAR
  • abdominal aorta

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Related Special Issue

Published Papers (6 papers)

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Research

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9 pages, 1270 KiB  
Article
Condition “Vasa Vasorum” in Patients with Thoracic Aortic Aneurysm
by Petr V. Chumachenko, Alexandra G. Ivanova, Mariam Bagheri Ekta, Andrey V. Omelchenko, Vasily N. Sukhorukov, Alexander M. Markin, Yuliya V. Markina and Anton Y. Postnov
J. Clin. Med. 2023, 12(10), 3578; https://doi.org/10.3390/jcm12103578 - 20 May 2023
Cited by 3 | Viewed by 2010
Abstract
It is known that vasa vasorum contributes substantially to the blood supply and nutrition of one-third of the wall of the ascending thoracic aorta. Therefore, we focused on studying the relationship between inflammatory cells and vasa vasorum vessels in patients with aortic aneurysm. [...] Read more.
It is known that vasa vasorum contributes substantially to the blood supply and nutrition of one-third of the wall of the ascending thoracic aorta. Therefore, we focused on studying the relationship between inflammatory cells and vasa vasorum vessels in patients with aortic aneurysm. The material for the study was biopsies of thoracic aortic aneurysms taken from patients during an aneurysmectomy (34 men, 14 women, aged 33 to 79 years). The biopsies belonged to patients with non-hereditary thoracic aortic aneurysm. An immunohistochemical study was carried out using antibodies to antigens of T cells (CD3, CD4, CD8); macrophages (CD68); B cells (CD20); endothelium (CD31, CD34, von Willebrand factor (vWF)); and smooth muscle cells (alpha actin). Samples without inflammatory infiltrates contained less vasa vasorum in the tunica adventitia than samples with inflammatory infiltrates, and this difference was statistically significant p < 0.05. T cell infiltrates in the adventitia of aortic aneurysms were found in 28 of 48 patients. In the vessels of the vasa vasorum, surrounded by inflammatory infiltrates, T cells that adhered to the endothelium were found. The same cells were also localized in the subendothelial area. The number of adherent T cells in patients with inflammatory infiltrates in the aortic wall dominated the number of these cells in patients without inflammation of the aortic wall. This difference was statistically significant, p < 0.0006. Hypertrophy and sclerosis of the arteries of the vasa vasorum system, the narrowing of their lumen, and, as a result, impaired blood supply to the aortic wall, were found in 34 patients with hypertension. In 18 patients (both in patients with hypertension and in patients without hypertension), T cells that adhered to the vasa vasorum endothelium were found. In nine cases, massive infiltrates of T cells and macrophages were found, which surrounded and squeezed the vasa vasorum, preventing blood circulation. In six patients, parietal and obturating blood clots were found in the vasa vasorum vessels, which disrupted the normal blood supply to the aortic wall. We believe that this indicates the importance of the state of the vessels of the vasa vasorum in the development of an aortic aneurysm. In addition, pathological changes in these vessels may not always play a primary role, but always a very important role, in the pathogenesis of this disease. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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15 pages, 1216 KiB  
Article
Outcomes of Directional Branches of the T-Branch Off-the-Shelf Multi-Branched Stent-Graft
by Konstantinos Spanos, Tomasz Jakimowicz, Petroula Nana, Christian-Alexander Behrendt, Giuseppe Panuccio, George Kouvelos, Katarzyna Jama, Ahmed Eleshra, Fiona Rohlffs and Tilo Kölbel
J. Clin. Med. 2022, 11(21), 6513; https://doi.org/10.3390/jcm11216513 - 2 Nov 2022
Cited by 10 | Viewed by 2242
Abstract
Background: A controversy on bridging covered stent (BCS) choice, between self-expanding (SECS) and balloon-expandable (BECS) stents, still exists in branched endovascular repair. This study aimed to determine the primary target vessel (TV) patency in patients treated with the t-Branch device and identify factors [...] Read more.
Background: A controversy on bridging covered stent (BCS) choice, between self-expanding (SECS) and balloon-expandable (BECS) stents, still exists in branched endovascular repair. This study aimed to determine the primary target vessel (TV) patency in patients treated with the t-Branch device and identify factors impairing the outcomes. Methods: A retrospective study was undertaken, including patients treated with the t-Branch (Cook Medical, Bloomington, IN, USA) between 2014 and 2019 (early 2014–2016; late 2017–2019). The endpoint was the primary patency (CT: celiac trunk, SMA, superior mesenteric artery, RRA: right renal artery, LRA: left renal artery) during the follow-up. Any branch instability event was assessed. The factors affecting the patency were determined using multivariable regression models and Kaplan–Meier analyses. Results: In total, 2018 TVs were analyzed; 1542 SECSs and 476 BECSs. The CT patency was 99.8% (SE 0.2%) at the 1st month, with no other event. The SMA patency was 97.8% (SE 1) at the 12th month. The RRA patency was 96.7% (SE 2) at the 24th month. The LRA patency was 99% (SE 0.4) at the 6th month. Relining was the only factor independently associated with the SMA patency (OR 8.27; 95% CI 1.4–4.9; p = 0.02). The freedom from instability was 62% (SE 4.3%) and 45% (SE 5.4%) at the 24th month and 36th month. No significant difference was identified between the BECSs and SECSs in the early or late experience. Conclusion: BCS for the t-Branch branches performed with a good primary patency during the short-term follow-up. The type of BCS did not influence the patency. Relining might be protective for SMA patency. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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12 pages, 1581 KiB  
Article
Infrarenal Remains Infrarenal—EVAR Suitability of Small AAA Is Rarely Compromised despite Morphological Changes during Surveillance
by Corinna Becker, Tanja Bülow, Alexander Gombert, Johannes Kalder and Paula Rosalie Keschenau
J. Clin. Med. 2022, 11(18), 5319; https://doi.org/10.3390/jcm11185319 - 9 Sep 2022
Viewed by 3156
Abstract
The aim was to analyze small abdominal aortic aneurysm (AAA) morphology during surveillance with regard to standard endovascular aortic repair (EVAR) suitability. This retrospective single-center study included all patients (n = 52, 48 male, 70 ± 8 years) with asymptomatic AAA ≤ 5.4 [...] Read more.
The aim was to analyze small abdominal aortic aneurysm (AAA) morphology during surveillance with regard to standard endovascular aortic repair (EVAR) suitability. This retrospective single-center study included all patients (n = 52, 48 male, 70 ± 8 years) with asymptomatic AAA ≤ 5.4 cm undergoing ≥2 computed tomography angiography(CTA)/magnetic resonance imaging (MRI) studies (interval: ≥6 months) between 2010 and 2018. Aneurysm diameter, neck quality (shape, length, angulation, thrombus/calcification), aneurysm thrombus, and distal landing zone diameters were compared between first and last CTA/MRI. Resulting treatment plan changes were determined. Neck shortening occurred in 25 AAA (mean rate: 2.0 ± 4.2 mm/year). Neck thrombus, present in 31 patients initially, increased in 16. Average AAA diameters were 47.7 ± 9.3 mm and 56.3 ± 11.6 mm on first and last CTA/MRI, mean aneurysm growth rate was 4.2 mm/year. Aneurysm thrombus was present in 46 patients primarily, increasing in 32. Neck thrombus growth and neck length change, aneurysm thrombus amount and aneurysm growth and aneurysm growth and neck angulation were significantly correlated. A total of 46 (88%) patients underwent open (12/46) or endovascular (34/46) surgery. The planned procedure changed from EVAR to fenestrated EVAR in two patients and from double to triple fenestrated EVAR in one. Thus, standard EVAR suitability was predominantly maintained as the threshold diameter for surgery was reached despite morphological changes. Consecutively, a possibly different pathogenesis of infra- versus suprarenal AAA merits further investigation. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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15 pages, 1941 KiB  
Article
Postoperative Outcomes and Reinterventions Following Fenestrated/Branched Endovascular Aortic Repair in Post-Dissection and Complex Degenerative Abdominal and Thoraco-Abdominal Aortic Aneurysms
by Bright Benfor, Julia Högl, Ryan Gouveia e Melo, Jan Stana, Carlota Fernandez Prendes, Maximilian Pichlmaier, Barbara Rantner and Nikolaos Tsilimparis
J. Clin. Med. 2022, 11(16), 4768; https://doi.org/10.3390/jcm11164768 - 16 Aug 2022
Cited by 11 | Viewed by 2064
Abstract
Background: The outcome of FBEVAR in post-dissection thoracoabdominal aortic aneurysms has not been well established in the literature. The aim of this study was to compare midterm outcomes following FBEVAR in post-dissection aneurysms to degenerative aneurysms. (2) Methods: This was a retrospective review [...] Read more.
Background: The outcome of FBEVAR in post-dissection thoracoabdominal aortic aneurysms has not been well established in the literature. The aim of this study was to compare midterm outcomes following FBEVAR in post-dissection aneurysms to degenerative aneurysms. (2) Methods: This was a retrospective review of all patients undergoing FBEVAR in a single center between 2017 and 2020. The baseline characteristics, intraoperative details, and postoperative outcomes of patients with post-dissection aneurysms were compared to those with degenerative outcomes. The primary end point was unplanned reinterventions. Cox regression analysis was performed to identify the determinants of worse outcomes. Results: A total of 137 subjects with a mean age of 70 ± 10 years were included in the study, out of which 30 presented post-dissection aneurysms (22%). Custom-made devices were employed in 119 patients, off-the-shelf devices in 13 and physician-modified endografts in 5, with incorporation in 505 target vessels. The technical success rate was comparable in both groups (97% vs. 98%, p = 0.21). However, the one-year freedom from unplanned reintervention was lower in the post-dissection group (67% vs. 89%, p = 0.011). Conclusion: FBEVAR in post-dissection aneurysms is associated with a favorable technical success rate, but reintervention rates remain high. Long procedural duration and the use of adjunctive techniques are associated with increased risk of reinterventions. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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Review

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11 pages, 2710 KiB  
Review
Endovascular Abdominal Aortic Aneurysm Repair: Overview of Current Guidance, Strategies, and New Technologies, Perspectives from the United Kingdom
by Robert Bakewell, Miltiadis Krokidis and Andrew Winterbottom
J. Clin. Med. 2022, 11(18), 5415; https://doi.org/10.3390/jcm11185415 - 15 Sep 2022
Cited by 7 | Viewed by 3985
Abstract
Endovascular aortic aneurysm repair has changed the management of patients affected by this condition, offering a minimally invasive solution with satisfactory outcomes. Constant evolution of this technology has expanded the use of endovascular devices to more complex cases. The purpose of this review [...] Read more.
Endovascular aortic aneurysm repair has changed the management of patients affected by this condition, offering a minimally invasive solution with satisfactory outcomes. Constant evolution of this technology has expanded the use of endovascular devices to more complex cases. The purpose of this review article is to describe the current strategies, guidance, and technologies in this field, with a particular focus on practices in the United Kingdom. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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Other

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16 pages, 3222 KiB  
Systematic Review
Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis
by Natalia Niklas, Michalina Malec, Piotr Gutowski, Arkadiusz Kazimierczak and Paweł Rynio
J. Clin. Med. 2022, 11(18), 5491; https://doi.org/10.3390/jcm11185491 - 19 Sep 2022
Cited by 5 | Viewed by 2384
Abstract
Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis [...] Read more.
Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis following PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were used to identify studies that investigated the effect of IMA embolization on the occurrence of type II endoleaks and secondary interventions in a group of patients with abdominal aortic aneurysm who underwent EVAR compared with results after EVAR procedure without embolization. A random effects meta-analysis was performed. Of 3510 studies, 6 studies involving 659 patients were included. Meta-analysis of all studies showed that the rate of secondary interventions was smaller in patients with IMA embolization (OR, 0.17; SE, 0.45; 95% CI, 0.07 to 0.41; p < 0.01; I2 = 0%). The occurrence of type II endoleaks was also smaller in the embolization group (OR, 0.37; SE, 0.21; 95% CI, 0.25 to 0.57; p < 0.01; I2 = 16.20%). This meta-analysis suggests that IMA embolization correlates with lower rates of type II endoleaks and secondary interventions. Full article
(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)
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