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Special Issue "Open and Endovascular Management of Complex Aortic Aneurysms"

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

Deadline for manuscript submissions: 20 April 2023 | Viewed by 1533

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Special Issue Editor

Prof. Dr. Jean-Baptiste Ricco

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Guest Editor

Department of Clinical Research, University Hospital of Poitiers, Poitiers, France
Interests: vascular surgery; vascular medicine; biostatistics

Special Issue Information

Dear Colleagues,

Aortic disease is the direct cause of close to 10000 deaths annually in the United States. The goal of aortic aneurysm repair is to prevent the high morbidity and mortality associated with aneurysm rupture.

The decision to treat an AAA is based on the associated risk of treatment, the risk of aneurysm rupture, the patient’s life expectancy, and patient preference. However, the paradigm of open surgical repair (OSR) changed after the introduction of endovascular repair (EVAR). Since then, the use of endovascular techniques in the treatment of aortic aneurysms has expanded dramatically, and EVAR is now the primary treatment for AAA.

While OSR remains an integral part of a comprehensive aortic aneurysm treatment program, rates of open AAA repair have declined dramatically in the endovascular era. Therefore, fewer surgeons and centers have a high-volume open aneurysm practice and the relationship between open AAA repair outcomes and surgeon/center volume is dramatic, particularly for complex AAA, which should be performed by experienced surgeons at high-volume centers.

With this in mind, we have reviewed in this Special Issue the management of complex AAAs, comprising juxtarenal AAAs and suprarenal AAAs, which represent around 15% of AAAs requiring treatment which cannot be repaired with standard EVAR because of the lack of an infrarenal neck. Two techniques (FEVAR and chimney/snorkel EVAR) have been developed to extend the proximal seal zone, allowing for endovascular repair in these patients. This is followed by the management of (1) descending thoracic aneurysms by OSR and by TEVAR, as well as (2) thoracoabdominal and (3) aortic arch aneurysm repair both by OSR and by innovative endovascular techniques.

We believe that this Special Issue will be of interest to readers of the Journal of Clinical Medicine. Endovascular aortic aneurysm repair is now being used in the entire aorta and has allowed definite repair in patients unsuitable for OSR. It has also introduced its own set of complications and challenges.

Prof. Dr. Jean-Baptiste Ricco
Guest Editor

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Keywords

aortic aneurysm
abdominal aortic
aneurysm thoracic aortic aneurysm
juxtarenal aortic aneurysm
endovascular abdominal aortic aneurysm repair (EVAR)
endovascular thoracic aortic aneurysm repair (TEVAR)
endovascular aortic arch aneurysm repair
artificial intelligence
robot-assisted aortic aneurysm repair

Published Papers (3 papers)

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Research

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Open AccessArticle

Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years

Pierre-Antoine Barral

Vlad Gariboldi

and

Marine Gaudry

J. Clin. Med. 2023, 12(6), 2363; https://doi.org/10.3390/jcm12062363 - 18 Mar 2023

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Abstract

Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1–66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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Review

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Open AccessReview

Patient-Specific Numerical Simulations of Endovascular Procedures in Complex Aortic Pathologies: Review and Clinical Perspectives

Lucie Derycke

Stephane Avril

and

Antoine Millon

J. Clin. Med. 2023, 12(3), 766; https://doi.org/10.3390/jcm12030766 - 18 Jan 2023

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Abstract

The endovascular technique is used in the first line treatment in many complex aortic pathologies. Its clinical outcome is mostly determined by the appropriate selection of a stent-graft for a specific patient and the operator’s experience. New tools are still needed to assist practitioners with decision making before and during procedures. For this purpose, numerical simulation enables the digital reproduction of an endovascular intervention with various degrees of accuracy. In this review, we introduce the basic principles and discuss the current literature regarding the use of numerical simulation for endovascular management of complex aortic diseases. Further, we give the future direction of everyday clinical applications, showing that numerical simulation is about to revolutionize how we plan and carry out endovascular interventions. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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Other

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Open AccessSystematic Review

Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies

and

J. Clin. Med. 2023, 12(7), 2496; https://doi.org/10.3390/jcm12072496 - 25 Mar 2023

Viewed by 190

Abstract

Background: In situ laser-fenestrated thoracic aortic endovascular repair (FTEVAR) has emerged as a valuable alternative for aortic arch management. This review assessed the early and follow-up outcomes of in situ laser-FTEVAR in aortic arch pathologies. Methods: The PRISMA statement was followed. The English literature was searched, via Ovid, until 15 October 2022. Observational studies, published after 2000, reporting on early and follow-up outcomes for the in situ laser-FTEVAR were eligible. The Newcastle–Ottawa Scale was used to assess the risk of bias. Primary outcomes were the technical success, stroke, and mortality at 30-days, and the secondary were the mortality and reintervention during follow-up. Results: Six retrospective studies from 591 and 247 patients were included. Fifty-nine (23.9%) patients were managed for aortic arch aneurysms and 146 (59.1%) for dissections; 22.6% of them for type A. Technical success was at 98% (range 90–100%). Eight patients died (3.2%) and 11 cases presented any type of stroke (4.5%) during the 30-day follow-up. The mean follow-up was 15 months (1–40 months). Ten deaths were reported (4.2%); one was aortic-related (10%). Thirteen re-interventions (6.0%) were performed. Conclusions: In situ laser-FTEVAR for aortic arch repair may be performed with high technical success and low 30-day and midterm follow-up mortality, stroke, and re-intervention rates when applied in well selected patients and performed by experienced teams. Full article

(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)

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Special Issue "Open and Endovascular Management of Complex Aortic Aneurysms"

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