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Complications in Vascular Surgery: Current Updates and Perspectives
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Complications in Vascular Surgery: Current Updates and Perspectives

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Personalized Therapy in Clinical Medicine".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 4560

Special Issue Editor

Dr. Yamume Tshomba

E-Mail Website
Guest Editor
Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli I.R.C.C.S., Università Cattolica del Sacro Cuore, 00168 Roma, Italy
Interests: aortic aneurysm; thoraco-abdominal aortic aneurysm; aortic dissection; arch disease; stent graft; hybrid repair; open aortic repair

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue entitled “Complications in Vascular Surgery: Current Updates and Perspectives”.

Complications in patients undergoing vascular surgery (including bleeding, stroke, infections, technical failure, etc.) have a significant clinical impact on the outcomes of vascular surgery patients and represent a burden to national health care systems, potentially leading to prolonged lengths of stay, discharge to a non-home facility, unplanned re-admissions, and an increased overall morbidity and mortality. 

The existing literature on this subject is widespread but disorganized and does not fully explore the individual risk factors and the personalized and multidisciplinary strategies and interventions that should be designed to mitigate these factors.

Therefore, the different papers included in this Special Issue will detail the potentially modifiable procedure- and patient-related conditions that endanger the achievement of optimal outcomes in vascular surgery, with the aim of implementing an increased overall quality of care in this subpopulation.

Thank you in advance for your contributions relating to this interesting subject.

Dr. Yamume Tshomba
Guest Editor

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 Personalized Medicine is an international peer-reviewed open access monthly 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

  • endoleak
  • visceral ischaemia
  • lower limb ischaemia
  • graft infection
  • aneurysm shrinkage
  • sac growing
  • transient ischemic attack
  • stroke
  • deep vein thrombosis
  • vascular injuries
  • embolization

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Published Papers (4 papers)

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Review

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16 pages, 1199 KB  
Review
Carotid Restenosis: Incidence, Pathophysiology and Therapeutic Options
by Claudio Bianchini Massoni, Laura Pauletti and Antonio Freyrie
J. Pers. Med. 2026, 16(2), 91; https://doi.org/10.3390/jpm16020091 - 4 Feb 2026
Viewed by 1169
Abstract
Restenosis after carotid endarterectomy and carotid artery stenting remains the main complication after both surgical and endovascular treatment of carotid stenosis, with a 2-year restenosis rate of 6–12%. Complex inflammation processes are the cause of early (<2 years) and late (>2 years) restenosis [...] Read more.
Restenosis after carotid endarterectomy and carotid artery stenting remains the main complication after both surgical and endovascular treatment of carotid stenosis, with a 2-year restenosis rate of 6–12%. Complex inflammation processes are the cause of early (<2 years) and late (>2 years) restenosis and principal systemic risk factors are female gender, hypertension, diabetes, dyslipidemia, and smoking. Non-procedural treatment includes lifestyle modifications and best medical therapy. The procedural treatment, considered mostly for symptomatic patients, includes different open and endovascular techniques. The management should be personalized according to patient and plaque characteristics. Full article
(This article belongs to the Special Issue Complications in Vascular Surgery: Current Updates and Perspectives)
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17 pages, 469 KB  
Review
Neurological Complications After Thoracic Endovascular Repair (TEVAR): A Narrative Review of the Incidence, Mechanisms and Strategies for Prevention and Management
by Francesca Miceli, Marta Ascione, Rocco Cangiano, Antonio Marzano, Alessia Di Girolamo, Giovanni Gagliardo, Luca di Marzo and Wassim Mansour
J. Pers. Med. 2026, 16(2), 77; https://doi.org/10.3390/jpm16020077 - 1 Feb 2026
Cited by 2 | Viewed by 1287
Abstract
Background: Thoracic endovascular aortic repair (TEVAR) has evolved the management of descending thoracic aortic disease, but neurological complications—particularly spinal cord ischemia (SCI), stroke, and postoperative delirium—remain among the most feared adverse events, adversely affecting survival, quality of life, and functional independence. Objectives [...] Read more.
Background: Thoracic endovascular aortic repair (TEVAR) has evolved the management of descending thoracic aortic disease, but neurological complications—particularly spinal cord ischemia (SCI), stroke, and postoperative delirium—remain among the most feared adverse events, adversely affecting survival, quality of life, and functional independence. Objectives: The aim of this study was to provide a contemporary narrative synthesis (2000–2025) of the incidence, mechanisms, risk factors, prevention, and management of neurological complications after TEVAR, emphasizing how current evidence supports individualized and risk-adapted strategies for prevention and management. Methods: A narrative, non-systematic search (PubMed/MEDLINE, Scopus, Cochrane Library; 2000–2025) was conducted using terms related to TEVAR, SCI, cerebrovascular events, delirium, and cognitive dysfunction. Priority was given to large registries, cohort studies, and systematic reviews in adult TEVAR populations. Results: Perioperative stroke occurs in ~2–6% of TEVAR cases, with higher rates in arch/zone 0–2 procedures and when the left subclavian artery (LSA) is covered without revascularization. SCI incidence ranges from ~2–9%, influenced by aortic extent and urgency; Vascular Quality Initiative data report SCI in 3.7% of procedures, with markedly reduced 1-year survival. Major SCI risk factors include extensive thoracic coverage, prior aortic repair, vertebral or hypogastric occlusion, emergency presentation, low perioperative mean arterial pressure, anemia, and chronic kidney disease. Postoperative delirium occurs in ~13% of TEVAR-treated type B dissections and correlates with longer hospitalization and early complications. Emerging nomograms for SCI and delirium enable individualized risk stratification. Conclusions: Neurological complications after TEVAR remain clinically significant. Contemporary evidence supports personalized prevention—selective cerebrospinal fluid (CSF) drainage, LSA revascularization, staging, neuromonitoring, and tailored hemodynamic targets—guided by anatomical complexity, comorbidities, collateral network integrity, and prior aortic history. Further research should refine prediction tools, standardize definitions, and evaluate individualized neuroprotective bundles. Full article
(This article belongs to the Special Issue Complications in Vascular Surgery: Current Updates and Perspectives)
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18 pages, 2833 KB  
Review
Management of Acute Infrainguinal Graft Occlusion: Surgical and Endovascular Approaches in Contemporary Practice
by Edoardo Pasqui, Leonardo Pasquetti, Greta Ferraro, Bruno Gargiulo, Cecilia Molino, Elisa Lazzeri, Giuseppe Galzerano and Gianmarco de Donato
J. Pers. Med. 2025, 15(12), 568; https://doi.org/10.3390/jpm15120568 - 28 Nov 2025
Cited by 1 | Viewed by 1139
Abstract
Background: Acute infrainguinal bypass graft occlusion is a critical vascular emergency that threatens limb viability and challenges both surgical and endovascular management. Despite progress in revascularization strategies, outcomes remain suboptimal, and consensus on the optimal treatment approach is lacking. Methods: This [...] Read more.
Background: Acute infrainguinal bypass graft occlusion is a critical vascular emergency that threatens limb viability and challenges both surgical and endovascular management. Despite progress in revascularization strategies, outcomes remain suboptimal, and consensus on the optimal treatment approach is lacking. Methods: This narrative review summarizes current evidence on the epidemiology, etiology, diagnosis, and treatment of acute infrainguinal graft occlusion. Particular attention is given to the evolving role of catheter-directed thrombolysis and mechanical thrombectomy, as well as to prevention strategies based on structured surveillance and medical optimization. Results: Infrainguinal bypass failure is influenced by technical, anatomical, and systemic factors, with distinct mechanisms affecting vein and prosthetic grafts. While surgical thrombectomy remains a viable option in selected cases, endovascular techniques have gained prominence due to their minimally invasive nature and promising short-term outcomes. Prevention of occlusion through duplex surveillance and best medical therapy is crucial to preserving graft patency and reducing major amputation risk. Conclusions: Management of acute graft occlusion requires timely diagnosis and a tailored, multidisciplinary approach. Although endovascular therapies have expanded treatment options, further prospective studies are needed to define optimal strategies and improve long-term outcomes in this high-risk population. Full article
(This article belongs to the Special Issue Complications in Vascular Surgery: Current Updates and Perspectives)
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Other

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14 pages, 889 KB  
Systematic Review
Tailored Interventional Approaches to the Management of True and False Aneurysms Affecting Aberrant Visceral Arteries Are Associated with Enhanced Clinical Outcomes
by Ottavia Borghese, Arisa Ibrahimi, Antonio Luparelli, Giulia Piermarini and Yamume Tshomba
J. Pers. Med. 2026, 16(3), 165; https://doi.org/10.3390/jpm16030165 - 16 Mar 2026
Viewed by 501
Abstract
Background: Anatomical variations in visceral arteries are not so uncommon (up to 20% of cases in general population), with splenic and hepatic artery anomalies being the most frequently reported. Aberrant arteries may be affected with aneurysmal lesions that are rare but potentially fatal [...] Read more.
Background: Anatomical variations in visceral arteries are not so uncommon (up to 20% of cases in general population), with splenic and hepatic artery anomalies being the most frequently reported. Aberrant arteries may be affected with aneurysmal lesions that are rare but potentially fatal conditions. In their treatment, a comprehensive understanding and knowledge of the underlining anatomical variation are pivotal to prevent potential ischemic complications for the end organ. Methods: A comprehensive literature search on the PubMed, Cochrane and Scopus databases was done using the terms: “anomalous visceral artery aneurysm”, “Aberrant visceral arteries”, and “anomalous origin visceral vessels”. Eligible studies published from inception to 30 June 2024 were identified. Only those that had included the adopted treatment strategies (open, endovascular or hybrid repair) and the related outcomes (mortality, bleeding, end-organ ischemia, lesions of the surrounding organ, need for reintervention) were analyzed to evaluate the safety and efficacy of each approach. A narrative analysis of the indications informing the selection of each interventional treatment, based on individual procedural risks, was also presented. Results: A total of 30 publications describing 36 patients (mean age 48.9 ± 12.8 years, range 22–73 years) with aneurysms involving aberrant visceral arteries were included. Most patients were female (25/36, 69.4%). True aneurysms predominated (with a mean size of 30.5 ± 11.5 mm, range 6–60 mm), being reported in 33/36 (91.7%) patients. Most lesions involved a splenic artery arising from the superior mesenteric artery (27/36, 75.0%). Overall, 26/36 (72.2%) patients were symptomatic upon presentation, most commonly with abdominal or epigastric pain, often associated with nausea or vomiting, back pain or shortness of breath. All patients underwent preoperative Computed angiotomography or subtraction angiography to define the operative strategy. Most cases were managed electively (31/36, 86.1%), but 11.1% (4/36) of cases required urgent intervention (in one case the urgency status was not specified). Overall, 19/36 (52.8%) patients underwent purely endovascular repair, 15/36 (41.7%) were treated with open surgery, and 2/36 (5.6%) had hybrid procedures combining endovascular coiling with laparoscopic splenic artery ligation. Indication for treatment was based on vessel tortuosity, landing zones, and the presence of side branches supplying end organs. Early outcomes were favorable regardless of treatment strategies. A single organ-related complication was reported (1/36, 2.8%) following open/endovascular repair, consisting of mild pancreatitis, which resolved with conservative management. No perioperative or aneurysm-related deaths were reported in any of the included cases. No recurrent aneurysms or late aneurysm-related complications were described during the reported follow-up intervals (mean ≈ 10.5 months, range 1.5–42 months). Conclusions: Aneurysms arising from aberrant visceral arteries present unique challenges because their origin, course, and collateral networks deviate from standard anatomy. Patient selection and detailed anatomic mapping preoperatively are decisive as inadequate imaging or failure to recognize an aberrant origin can lead to the incomplete exclusion or inadvertent sacrifice of critical branches. Understanding the anatomy of visceral arteries and their variations is paramount in clinical practice, particularly when planning interventions for minimizing procedural risks, optimizing outcomes, and preventing potential complications. Contemporary practice favors endovascular repair due to lower perioperative morbidity, but success depends on vessel tortuosity, landing zones, and the presence of important side branches that supply end organs. Full article
(This article belongs to the Special Issue Complications in Vascular Surgery: Current Updates and Perspectives)
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