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Medicina
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Current Perspectives and Future Directions in Vascular Surgery
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Current Perspectives and Future Directions in Vascular Surgery

A Special Issue of Medicina (ISSN 1648-9144) belonging to the section "Surgery".

Deadline for manuscript submissions: 31 March 2027 | Viewed by 2415

Editors

Dr. Alfonso Ielasi

E-Mail Website
Guest Editor
IRCCS Galeazzi St Ambrogio Hospital, Via Cristina Belgioioso 173, 20157 Milan, Italy
Interests: aortic valve stenosis; heart-valve; transcatheter aortic valve implantation; vascular complications; TAVI; aortic regurgitation; peripheral arterial disease
Special Issues, Collections and Topics in MDPI journals
Dr. Luca Galassi

E-Mail Website
Guest Editor Assistant
Department of Cardiovascular Science, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
Interests: limb salvage; diabetic foot care; endovascular interventions; peripheral arterial disease; angioplasty; stenting; bypass surgery; critical limb ischemia; vascular surgery outcomes; aortic biomechanics

Special Issue Information

Dear Colleagues,

Vascular surgery is evolving rapidly, driven by continuous innovation, refined imaging technologies, and the widespread adoption of endovascular and hybrid techniques. Over the past decades, the field has expanded its boundaries, from complex aortic reconstruction to distal limb salvage, achieving remarkable progress in patient safety, procedural precision, and recovery. These advances have reshaped traditional paradigms, yet they also bring new challenges related to durability, reintervention, and equitable access to advanced care.

The aim of this Special Issue, “Current Perspectives and Future Directions in Vascular Surgery”, is to provide a comprehensive overview of recent developments and to highlight future directions that will shape the next generation of vascular care. Topics of interest include innovations in endovascular and open surgery, hybrid approaches, imaging and navigation technologies, perioperative optimization, outcome durability, and the integration of artificial intelligence and personalized medicine.

We invite original research articles, reviews, and expert perspectives that explore cutting-edge techniques, novel devices, and multidisciplinary strategies for improving vascular outcomes. By bringing together diverse expertise, this Special Issue seeks to foster collaboration, stimulate discussion, and inspire innovation across the global vascular community.

Dr. Alfonso Ielasi
Guest Editor

Dr. Luca Galassi
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-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina 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 2200 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

  • vascular surgery
  • endovascular repair
  • hybrid techniques
  • aortic disease
  • peripheral arterial disease
  • surgical innovation
  • precision medicine

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Published Papers (3 papers)

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Research

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13 pages, 914 KB  
Article
Left Ventricular Longitudinal Strain Is Associated with Ascending Aortic Diameters in Healthy Adults—A Detailed Single-Center Retrospective Analysis from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study
by Attila Nemes, Nóra Ambrus and Csaba Lengyel
Medicina 2026, 62(8), 1522; https://doi.org/10.3390/medicina62081522 - 7 Aug 2026
Viewed by 292
Abstract
Background and Objectives: A more precise understanding of ventriculo–arterial coupling is essential, particularly regarding quantitative and qualitative associations can be demonstrated between the aorta and the left ventricle (LV), which is considered the engine of the central circulation. The aim of the [...] Read more.
Background and Objectives: A more precise understanding of ventriculo–arterial coupling is essential, particularly regarding quantitative and qualitative associations can be demonstrated between the aorta and the left ventricle (LV), which is considered the engine of the central circulation. The aim of the present study was to investigate the associations between three-dimensional speckle-tracking echocardiography (3DSTE) derived unidimensional LV strains and end-systolic and end-diastolic ascending aortic diameters measured by M-mode echocardiography (MME). Additionally, the outcomes were analyzed after stratifying the parameters into below-average, average, and above-average. Materials and Methods: The present retrospective cohort study consisted of 162 healthy adult volunteers enrolled between 2011 and 2017, of which 93 participants (mean age: 30.6 ± 10.0 years; 54 males) were eligible for simultaneous 3DSTE-derived LV strain assessment and MME-based aortic dimension measurement. In all individuals, MME, two-dimensional Doppler echocardiography and 3DSTE were performed. Results: An increase in end-diastolic ascending aortic diameter (AAD) was associated with an increase in end-systolic AAD, and vice versa. At the maximum end-diastolic AAD, the basal, global, and mean segmental LV longitudinal strain (LS) values reached their lowest. When end-systolic AAD reached its maximum, both global and mean segmental LV-LS dropped to their minimum. The highest end-diastolic and end-systolic AADs were detectable in the presence of the lowest global LV-LS. With larger end-diastolic and end-systolic AADs, a trend toward higher LV radial strain was present. Conclusions: Even in the absence of cardiovascular pathology, a finely tuned interaction can be observed between regional LV deformation, especially with LV-LS and the size of the ascending aorta in healthy individuals. Full article
(This article belongs to the Special Issue Current Perspectives and Future Directions in Vascular Surgery)
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Review

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23 pages, 2926 KB  
Review
Plaque Prolapse in Carotid Artery Stenting: Mechanisms, Imaging and Device-Based Prevention
by Luca Galassi, Leonardo Pasquetti, Federica Facchinetti, Rebecca Magugliani, Elena Goldoni, Edoardo Pasqui, Giovanni Nano and Gianmarco de Donato
Medicina 2026, 62(7), 1235; https://doi.org/10.3390/medicina62071235 - 26 Jun 2026
Viewed by 592
Abstract
Carotid artery stenting (CAS) is an established revascularization option for patients with carotid disease at high surgical risk. Periprocedural cerebral embolization remains a clinical concern, and plaque prolapse, the extrusion of atherosclerotic material through the stent struts into the lumen, has emerged as [...] Read more.
Carotid artery stenting (CAS) is an established revascularization option for patients with carotid disease at high surgical risk. Periprocedural cerebral embolization remains a clinical concern, and plaque prolapse, the extrusion of atherosclerotic material through the stent struts into the lumen, has emerged as an actionable mechanism directly linked to embolic events and adverse neurological outcomes. This narrative review provides a structured, practice-oriented framework addressing one specific question: how can plaque prolapse be prevented during CAS? Drawing on prospective registries, comparative cohort studies and intravascular imaging analyses based on optical coherence tomography (OCT) and intravascular ultrasound (IVUS), we discuss the main determinants of prolapse risk, plaque morphology, procedural variables and device selection, converging on dual-layer micromesh stent (DLMS) technology as the most advanced device-based solution available. Pooled clinical data indicate a 30-day stroke rate of approximately 1.4% when DLMSs are used in combination with embolic protection, and OCT studies confirm reduced prolapse compared with single-layer stents. Prevention requires an integrated strategy combining lesion-specific characterisation, optimised technique and tailored device selection, while standardised imaging definitions and adequately powered randomised trials with hard clinical endpoints remain research priorities. Full article
(This article belongs to the Special Issue Current Perspectives and Future Directions in Vascular Surgery)
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Other

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5 pages, 195 KB  
Opinion
Are Coronary Calcium-Modifying Techniques Levelling the Playfield?
by Georgiana Pintea Bentea and Pierre-Emmanuel Massart
Medicina 2026, 62(4), 782; https://doi.org/10.3390/medicina62040782 - 17 Apr 2026
Viewed by 719
Abstract
Patients with heavily calcified coronary arteries represent a challenge in percutaneous coronary intervention (PCI), as severe calcification impairs device delivery and limits optimal stent expansion, leading to higher risks of stent thrombosis, restenosis, and adverse clinical outcomes. Approximately 20% of patients undergoing PCI [...] Read more.
Patients with heavily calcified coronary arteries represent a challenge in percutaneous coronary intervention (PCI), as severe calcification impairs device delivery and limits optimal stent expansion, leading to higher risks of stent thrombosis, restenosis, and adverse clinical outcomes. Approximately 20% of patients undergoing PCI exhibit severe coronary calcification, which independently predicts incomplete revascularization, increased mortality, and higher rates of major adverse cardiovascular events over mid-term follow-up. Recent advances have focused on improving the assessment and management of calcified lesions. Intracoronary imaging modalities, including intravascular ultrasound and optical coherence tomography, allow precise detection and characterization of calcium burden, overcoming the limitations of angiography. These tools play a pivotal role in guiding procedural strategy, enabling tailored selection of calcium-modifying techniques based on lesion morphology, and optimizing stent deployment. Technological innovations have significantly expanded therapeutic options. While non-compliant balloon angioplasty alone is often insufficient, adjunctive devices such as cutting and scoring balloons improve plaque modification in focal disease. Atherectomy techniques, including rotational and orbital systems, are effective for more complex lesions but require technical expertise and carry procedural risks. Intravascular lithotripsy has emerged as a promising, less aggressive modality capable of fracturing deep calcium, while excimer laser atherectomy offers an alternative for resistant lesions. Despite these advances, current evidence supporting calcium-modifying strategies is largely based on procedural outcomes rather than definitive improvements in long-term clinical endpoints. Meta-analyses and randomized trials have not demonstrated clear superiority of any single technique, and most studies remain underpowered. Intriguingly, recent data suggest that outcomes in treated calcified lesions may approximate those of non-calcified disease, raising the hypothesis that these technologies could mitigate the adverse impact of calcification. However, this remains unproven, highlighting the urgent need for adequately powered randomized trials to determine their true clinical benefit. Full article
(This article belongs to the Special Issue Current Perspectives and Future Directions in Vascular Surgery)
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