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Special Issue "Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects"

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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: 15 April 2023 | Viewed by 4155

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Special Issue Editors

Dr. Martin Teraa

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Guest Editor

Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Interests: peripheral artery disease (PAD); aortic pathology; endovascular interventions

Dr. Constantijn E.V.B. Hazenberg

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Guest Editor

Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
Interests: peripheral artery disease (PAD); aortic pathology; endovascular interventions

Special Issue Information

Dear Colleagues,

We are the Guest Editors of a new Special Issue entitled “Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects” to be published in the Journal of Clinical Medicine (JCM, Impact Factor 4.242, ISSN 2077-0383, https://www.mdpi.com/journal/jcm). The treatment of aortic pathologies has changed significantly over the past few decades, fueled by the first endovascular aneurysm repair (EVAR). Gradually, endovascular interventions to treat aortic pathologies have become the first line of treatment in most centers and have been shown to be both safe and effective. Over the years, image guidance, endovascular materials and techniques, and stent grafts have evolved, enabling us to treat a wider range of aneurysms and other aortic diseases. On one hand, endovascular aortic repair opens doors for innovations related to interventional planning, imaging, stent graft development, application of Artificial Intelligence (AI), and patient selection. On the other hand, there are also drawbacks, such as the negative effects of radiation, endoleaks (relevance, detection, and treatment), and cost-effectiveness issues, which evoke new research questions. Endovascular aortic repair has seen and continues to see significant progress, a development which cannot be stopped. This Special Issue will address topics that can keep us in the loop and help us to achieve even faster, more effective, cheaper, and safer repairs.

We would like to invite you to contribute an original research or review article to this Special Issue.

Dr. Martin Teraa
Dr. Constantijn E.V.B. Hazenberg
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.

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Keywords

endovascular aneurysm repair (EVAR)
complex EVAR
aortic pathology
aortic disease
aortic aneurysm
aneurysm
aortic dissection
endovascular intervention

Published Papers (6 papers)

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Editorial

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Open AccessEditorial

The Current Era of Endovascular Aortic Interventions and What the Future Holds

Martin Teraa

and

Constantijn E. V. B. Hazenberg

J. Clin. Med. 2022, 11(19), 5900; https://doi.org/10.3390/jcm11195900 - 06 Oct 2022

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Abstract

Today, more than 30 years after the first endovascular aneurysm repair (EVAR) by Juan Parodi and Julio Palmaz [...] Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

Research

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Open AccessArticle

Incidence and Outcomes of Abdominal Aortic Aneurysm Repair in New Zealand from 2001 to 2021

and

J. Clin. Med. 2023, 12(6), 2331; https://doi.org/10.3390/jcm12062331 - 16 Mar 2023

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Abstract

Purpose: The burden of abdominal aortic aneurysms (AAA) has changed in the last 20 years but is still considered to be a major cause of cardiovascular mortality. The introduction of endovascular aortic repair (EVAR) and improved peri-operative care has resulted in a steady improvement in both outcomes and long-term survival. The objective of this study was to identify the burden of AAA disease by analysing AAA-related hospitalisations and deaths. Methodology: All AAA-related hospitalisations in NZ from January 2001 to December 2021 were identified from the National Minimum Dataset, and mortality data were obtained from the NZ Mortality Collection dataset from January 2001 to December 2018. Data was analysed for patient characteristics including deprivation index, repair methods and 30-day outcomes. Results: From 2001 to 2021, 14,436 patients with an intact AAA were identified with a mean age of 75.1 years (SD 9.7 years), and 4100 (28%) were females. From 2001 to 2018, there were 5000 ruptured AAA with a mean age of 77.8 (SD 9.4), and 1676 (33%) were females. The rate of hospitalisations related to AAA has decreased from 43.7 per 100,000 in 2001 to 15.4 per 100,000 in 2018. There was a higher proportion of rupture AAA in patients living in more deprived areas. The use of EVAR for intact AAA repair has increased from 18.1% in 2001 to 64.3% in 2021. The proportion of octogenarians undergoing intact AAA repair has increased from 16.2% in 2001 to 28.4% in 2021. The 30-day mortality for intact AAA repair has declined from 5.8% in 2001 to 1.7% in 2021; however, it has remained unchanged for ruptured AAA repair at 31.6% across the same period. Conclusions: This study highlights that the incidence of AAA has declined in the last two decades. The mortality has improved for patients who had a planned repair. Understanding the contemporary burden of AAA is paramount to improve access to health, reduce variation in outcomes and promote surgical quality improvement. Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

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Open AccessArticle

Feasibility and Safety of Percutaneous Axillary Artery Access in a Prospective Series of 100 Complex Aortic and Aortoiliac Interventions

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J. Clin. Med. 2023, 12(5), 1959; https://doi.org/10.3390/jcm12051959 - 01 Mar 2023

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Abstract

We aimed to review the feasibility and safe use of the percutaneous axillary artery (AxA, 100 patients) approach for endovascular repair (ER) of thoraco-abdominal aortic aneurysms (TAAA, 90 patients) using fenestrated, branched, and chimney stent grafts and other complex endovascular procedures (10 patients) necessitating AxA access. Percutaneous puncture of the AxA in its third segment was performed using sheaths sized between 6 to 14F. For closing puncture sites greater than 8F, two Perclose ProGlide percutaneous vascular closure devices (PVCDs) (Abbott Vascular, Santa Clara, CA, USA) were deployed in the pre-close technique. The median maximum diameter of the AxA in the third segment was 7.27 mm (range 4.50–10.80). Device success, defined as successful hemostasis by PVCD, was reported in 92 patients (92.0%). As recently reported results in the first 40 patients suggested that adverse events, including vessel stenosis or occlusion, occurred only in cases with a diameter of the AxA < 5 mm, in all subsequent 60 cases AxA access was restricted to a vessel diameter ≥ 5 mm. In this late group, no hemodynamic impairment of the AxA occurred except in six early cases below this diameter threshold, all of which could be repaired by endovascular measures. Overall mortality at 30 days was 8%. In conclusion, percutaneous approach of the AxA in its third segment is feasible and represents a safe alternative access to open access for complex endovascular aorto-iliac procedures. Complications are rare, especially if the maximum diameter of the access vessel (AxA) is ≥5 mm. Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

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Open AccessArticle

Dynamic Morphology of the Ascending Aorta and Its Implications for Proximal Landing in Thoracic Endovascular Aortic Repair

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J. Clin. Med. 2023, 12(1), 70; https://doi.org/10.3390/jcm12010070 - 21 Dec 2022

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Abstract

In this study, we assessed the dynamic segmental anatomy of the entire ascending aorta (AA), enabling the determination of a favorable proximal landing zone and appropriate aortic sizing for the most proximal thoracic endovascular aortic repair (TEVAR). Methods: Patients with a non-operated AA (diameter < 40 mm) underwent electrocardiogram-gated computed tomography angiography (ECG-CTA) of the entire AA in the systolic and diastolic phases. For each plane of each segment, the maximum and minimum diameters in the systole and diastole phases were recorded. The Wilcoxon signed-rank test was used to compare aortic size values. Results: A total of 100 patients were enrolled (53% male; median age 82.1 years; age range 76.8–85.1). Analysis of the dynamic plane dimensions of the AA during the cardiac cycle showed significantly higher systolic values than diastolic values (p < 0.001). Analysis of the proximal AA segment showed greater distal plane values than proximal plane values (p < 0.001), showing a reversed funnel form. At the mid-ascending segment, the dynamic values did not notably differ between the distal plane and the proximal segmental plane, demonstrating a cylindrical form. At the distal segment of the AA, the proximal plane values were larger than the distal segmental plane values (p < 0.001), thus generating a funnel form. Conclusions: The entire AA showed greater systolic than diastolic aortic dimensions throughout the cardiac cycle. The mid-ascending and distal-ascending segments showed favorable forms for TEVAR using a regular cylindrical endograft design. The most proximal segment of the AA showed a pronounced conical form; therefore, a specific endograft design should be considered. Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

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Open AccessArticle

Effectiveness and Minimal-Invasiveness of Zone 0 Landing Thoracic Endovascular Aortic Repair Using Branched Endograft

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J. Clin. Med. 2022, 11(23), 6981; https://doi.org/10.3390/jcm11236981 - 26 Nov 2022

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Abstract

Background: Zone 0 landing thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch diseases has become a topic of interest. This study aimed to verify whether branced TEVAR (bTEVAR) is an effective and a more minimally invasive treatment by comparing the outcomes of bTEVAR and hybrid TEVAR (hTEVAR) in landing zone 0. Methods: This retrospective, single-center, observational cohort study included 54 patients (bTEVAR, n = 25; hTEVAR, n = 29; median age, 78 years; median follow-up period, 5.4 years) from October 2012 to June 2018. The logistic Euro-SCORE was significantly higher in the bTEVAR group than in the hTEVAR group (38% vs. 21%, p < 0.001). Results: There was no significant difference the in-hospital mortality between the bTEVAR and hTEVAR groups (0% vs. 3.4%, p = 1.00). The operative time (220 vs. 279 min, p < 0.001) and length of hospital stay (12 vs. 17 days, p = 0.013) were significantly shorter in the bTEVAR group than in the hTEVAR group. The 7-year free rates of aorta-related deaths (bTEVAR [95.5%] vs. hTEVAR [86.9%], Log-rankp = 0.390) and aortic reintervention (bTEVAR [86.3%] vs. hTEVAR [86.9%], Log-rankp = 0.638) were not significantly different. Conclusions: The early and mid-term outcomes in both groups were satisfactory. bTEVAR might be superior to hTEVAR in that it is less invasive. Therefore, bTEVAR may be considered an effective and a more minimally invasive treatment for high-risk patients. Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

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Review

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Chimney vs. Fenestrated Endovascular vs. Open Repair for Juxta/Pararenal Abdominal Aortic Aneurysms: Systematic Review and Network Meta-Analysis of the Medium-Term Results

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J. Clin. Med. 2022, 11(22), 6779; https://doi.org/10.3390/jcm11226779 - 16 Nov 2022

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Abstract

Introduction: This systematic review with network meta-analysis aimed at comparing the medium-term results of open surgery (OS), fenestrated endovascular repair (FEVAR), and chimney endovascular repair (ChEVAR) in patients with juxta/pararenal abdominal aortic aneurysms (JAAAs/PAAAs). Materials and methods: MEDLINE, SCOPUS, and Web of Science were searched from inception date to 1st July 2022. Any studies comparing the results of two or three treatment strategies (ChEVAR, FEVAR, or OS) on medium-term outcomes in patients with JAAAs/PAAAs were included. Primary outcomes were all-cause mortality, aortic-related reintervention, and aortic-related mortality, while secondary outcomes were visceral stent/bypass occlusion/occlusion, major adverse cardiovascular events (MACEs), new onset renal replacement therapy (RRT), total endoleaks, and type I/III endoleak. Results: FEVAR (OR = 1.53, 95%CrI 1.03–2.11) was associated with higher medium-term all-cause mortality than OS. Sensitivity analysis including only studies that analysed JAAA showed that FEVAR (OR = 1.65, 95%CrI 1.08–2.33) persisted to be associated with higher medium-term mortality than OS. Both FEVAR (OR = 8.32, 95%CrI 3.80–27.16) and ChEVAR (OR = 5.95, 95%CrI 2.23–20.18) were associated with a higher aortic-related reintervention rate than OS. No difference between different treatment options was found in terms of aortic-related mortality. FEVAR (OR = 13.13, 95%CrI 2.70–105.2) and ChEVAR (OR = 16.82, 95%CrI 2.79–176.7) were associated with a higher rate of medium-term visceral branch occlusion/stenosis compared to OS; however, there was no difference found between FEVAR and ChEVAR. Conclusions: An advantage of OS compared to FEVAR and ChEVAR after mid-term follow-up aortic-related intervention and vessel branch/bypass stenosis/occlusion was found. This suggests that younger, low-surgical-risk patients might benefit from open surgery of JAAA/PAAA as a first approach. Full article

(This article belongs to the Special Issue Endovascular Aortic Interventions and Aneurysm Repair: Recent Advances and Future Prospects)

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