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Challenges in Abdominal Aortic Aneurysm
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Challenges in Abdominal Aortic Aneurysm

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

Deadline for manuscript submissions: 25 July 2024 | Viewed by 4763

Special Issue Editors

Prof. Dr. Natzi Sakalihasan

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Guest Editor
Department of Cardiovascular and Thoracic Surgery, Surgical Research Center (GIGA-Cardiovascular Science Unit), University Hospital of Liège, Liège, Belgium
Interests: rupture and natural history of abdominal aortic aneurysms; functional imaging of aortic diseases; rare aortic diseases; biomechanical analysis of aortic diseases; endoleaks; cancer
Dr. Lucia Musumeci

E-Mail Website
Guest Editor
Department of Cardiology and Cardiovascular Surgery, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
Interests: genetics in aortic diseases; abdominal aortic aneurysms; thoracic aortic aneurysms; dissections

Special Issue Information

Dear Colleagues,

An abdominal aortic aneurysm (AAA) is a chronic inflammatory, multifactorial disease, more prevalent in men >65 years. AAA risk factors include smoking, male sex and positive family history, and AAAs are most common in men of >65 years of age. Infrarenal AAAs are the most frequently observed type, and less common types involve renal arteries (pararenal AAAs) and infrarenal segments closely approaching renal arteries, without involving them (juxtarenal AAAs). These types of AAAs, together with suprarenal AAAs, pose particular technical challenges in endovascular repair due to their complex anatomy.

Other challenges are related to the management of AAA patients with concomitant diseases. Cancer is one of these comorbidities, and in retrospective studies, the concomitant presence of an AAA and cancer has been estimated to be 4%-38%.

AAAs are typically asymptomatic until rupture, an event with a 65-85% mortality rate. The most recognized predictor of rupture is size, but a significant number of smaller aneurysms also rupture.

The present Special Issue aims to highlight challenges in AAAs; therefore, we invite authors to propose articles related to the choice of strategy for the prevention of aneurysm rupture; methods for the identification of aneurysms carrying a high risk of rupture even though they have a diameter below the surgical threshold; or studies focused on methods for the prediction of AAA patients’ outcomes or for the identification of patients at risk of endoleaks.

Prof. Dr. Natzi Sakalihasan
Dr. Lucia Musumeci
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

  • rupture of abdominal aortic aneurysms
  • EVAR
  • FEVAR
  • BEVAR
  • biomechanical analysis
  • endoleaks
  • cancer

Published Papers (6 papers)

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Research

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11 pages, 888 KiB  
Article
Association between PET/CT Scan Findings, Treatment, and Cancer Incidence in a Cohort of AAA Patients
by Natzi Sakalihasan, Samuel Bruls, Roland Hustinx, Vincent Tchana-Sato, Sarah Sakalihasan, Rebecka Hultgren, Nicos Labropoulos, Alain Colige, Rodolphe Durieux, Pierre Drion, Adelin Albert, Jean-Olivier Defraigne and Lucia Musumeci
J. Clin. Med. 2024, 13(6), 1569; https://doi.org/10.3390/jcm13061569 - 09 Mar 2024
Viewed by 551
Abstract
Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on [...] Read more.
Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on serial FDG-PET/CT scan examinations to identify, among AAA patients, those at risk of cancer. Methods: Between 2006 and 2011 we recruited 149 AAA patients, free of cancer at baseline, and followed them until the end of 2021. All patients underwent an FDG-PET/CT scan at inclusion and possibly more scans during follow-up. At each medical imaging examination, the aneurysmal FDG uptake was recorded. Patients were stratified based on their aortic wall PET status (negative/positive). Any occurrence of cancer was reported. A Cox regression analysis and competing-risk modeling were applied to the data. Results: The proportion of AAA patients who developed cancer was 31.5% (mean time to diagnosis was 5.7 ± 3.4 years) and the death rate was 59%. A difference in cancer incidence between PET+ and PET− patients was detected (46.8% vs. 27.3%; HR = 1.96, 95%CI: 1.07–3.57, p = 0.028). Moreover, AAA patients undergoing surgical treatment had a lower risk of cancer than unoperated patients (28% vs. 50%; HR = 0.41, 95%CI: 0.21–0.80, p = 0.009). Conclusions: In AAA patients, diagnostic imaging with an FDG-PET/CT scan can help identify those patients at a higher risk of developing cancer. Moreover, the higher cancer risk in non-surgically treated patients calls for further analysis of associations between aneurysm growth and malignant disease. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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11 pages, 968 KiB  
Article
Diagnostic Utility of a Combined MPO/D-Dimer Score to Distinguish Abdominal Aortic Aneurysm from Peripheral Artery Disease
by Branislav Zagrapan, Johannes Klopf, Nihan Dide Celem, Annika Brandau, Patrick Rossi, Yulia Gordeeva, Alexandra Regina Szewczyk, Linda Liu, Diana Ahmadi-Fazel, Sina Najarnia, Lukas Fuchs, Hubert Hayden, Christian Loewe, Wolf Eilenberg, Christoph Neumayer and Christine Brostjan
J. Clin. Med. 2023, 12(24), 7558; https://doi.org/10.3390/jcm12247558 - 07 Dec 2023
Viewed by 763
Abstract
Abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD) share pathophysiological mechanisms including the activation of the fibrinolytic and innate immune system, which explains the analysis of D-dimer and myeloperoxidase (MPO) in both conditions. This study evaluates the diagnostic marker potential of both [...] Read more.
Abdominal aortic aneurysm (AAA) and peripheral artery disease (PAD) share pathophysiological mechanisms including the activation of the fibrinolytic and innate immune system, which explains the analysis of D-dimer and myeloperoxidase (MPO) in both conditions. This study evaluates the diagnostic marker potential of both variables separately and as a combined MPO/D-dimer score for identifying patients with AAA versus healthy individuals or patients with PAD. Plasma levels of MPO and D-dimer were increased in PAD and AAA compared to healthy controls (median for MPO: 13.63 ng/mL [AAA] vs. 11.74 ng/mL [PAD] vs. 9.16 ng/mL [healthy], D-dimer: 1.27 μg/mL [AAA] vs. 0.58 μg/mL [PAD] vs. 0.38 μg/mL [healthy]). The combined MPO/D-dimer score (median 1.26 [AAA] vs. −0.19 [PAD] vs. −0.93 [healthy]) showed an improved performance in distinguishing AAA from PAD when analysed using the receiver operating characteristic curve (area under the curve) for AAA against the pooled data of healthy controls + PAD: 0.728 [MPO], 0.749 [D-dimer], 0.801 [score]. Diagnostic sensitivity and specificity ranged at 82.9% and 70.2% (for score cut-off = 0). These findings were confirmed for a separate collective of AAA patients with 35% simultaneous PAD. Thus, evaluating MPO together with D-dimer in a simple score may be useful for diagnostic detection and the distinction of AAA from athero-occlusive diseases like PAD. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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12 pages, 588 KiB  
Article
Influence of Patient Anatomy on Intraoperative Radiation Exposure and Operation Time during Standard EVAR
by Wojciech Derwich, Alexandru Barb, Thomas Vogl, Kyriakos Oikonomou and Daphne Gray
J. Clin. Med. 2023, 12(18), 5851; https://doi.org/10.3390/jcm12185851 - 08 Sep 2023
Viewed by 792
Abstract
Endovascular aortic repair (EVAR) is the primary treatment for abdominal aortic aneurysms (AAAs). To optimise patient safety during the standard EVAR procedure, we aimed to investigate the influence of patient anatomy on intraoperative radiation exposure and surgical time. This retrospective study comprised 90 [...] Read more.
Endovascular aortic repair (EVAR) is the primary treatment for abdominal aortic aneurysms (AAAs). To optimise patient safety during the standard EVAR procedure, we aimed to investigate the influence of patient anatomy on intraoperative radiation exposure and surgical time. This retrospective study comprised 90 patients (mean age 73.4 ± 8.2 years; 92.2% male) with an infrarenal aortic aneurysm who underwent a standard EVAR procedure. The relationships between dose area product, operating time, and anatomical conditions were investigated in preoperative computed tomography angiography using open-source software. Logistic regression analysis indicated that only body mass index (BMI) had predictive value for radiation exposure. The accuracy of the model was 98.67%, with an area under the curve of 0.72. The duration of surgery was significantly correlated with an increased BMI (odds ratio (OR) = 1.183; p < 0.05), the tortuosity of AAAs (OR = 1.124; p < 0.05), and the left common iliac artery (OR = 1.028; p < 0.05). Thus, BMI impacts the prediction of intraoperative radiation exposure more significantly than the anatomical characteristics of the infrarenal aorta and iliac arteries, and the duration of surgery significantly correlates with both BMI and the tortuosity of the infrarenal aorta and iliac arteries. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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12 pages, 14469 KiB  
Article
The Incidence of IgG4-Related and Inflammatory Abdominal Aortic Aneurysm Is Rare in a 101 Patient Cohort
by Maja Carina Nackenhorst, Marvin Kapalla, Simon Weidle, Felix Kirchhoff, David Zschäpitz, Sabine Sieber, Christian Reeps, Hans-Henning Eckstein, Heike Schneider, Markus Thaler, Philipp Moog, Albert Busch and Nadja Sachs
J. Clin. Med. 2023, 12(12), 4029; https://doi.org/10.3390/jcm12124029 - 13 Jun 2023
Viewed by 968
Abstract
Abdominal aortic aneurysms (AAA) are the most frequent aortic dilation, with considerable morbidity and mortality. Inflammatory (infl) and IgG4-positive AAAs represent specific subtypes of unclear incidence and clinical significance. Here, histologic and serologic analyses with retrospective clinical data acquisition are investigated via detailed [...] Read more.
Abdominal aortic aneurysms (AAA) are the most frequent aortic dilation, with considerable morbidity and mortality. Inflammatory (infl) and IgG4-positive AAAs represent specific subtypes of unclear incidence and clinical significance. Here, histologic and serologic analyses with retrospective clinical data acquisition are investigated via detailed histology, including morphologic (HE, EvG: inflammatory subtype, angiogenesis, and fibrosis) and immunhistochemic analyses (IgG and IgG4). In addition, complement factors C3/C4 and immunoglobulins IgG, IgG2, IgG4 and IgE were measured in serum samples and clinical data uses patients’ metrics, as well as through semi-automated morphometric analysis (diameter, volume, angulation and vessel tortuosity). A total of 101 eligible patients showed five (5%) IgG4 positive (all scored 1) and seven (7%) inflammatory AAAs. An increased degree of inflammation was seen in IgG4 positive and inflAAA, respectively. However, serologic analysis revealed no increased levels of IgG or IgG4. The operative procedure time was not different for those cases and the short-term clinical outcomes were equal for the entire AAA cohort. Overall, the incidence of inflammatory and IgG4-positive AAA samples seems very low based on histologic and serum analyses. Both entities must be considered distinct disease phenotypes. Short-term operative outcomes were not different for both sub-cohorts. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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Review

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13 pages, 2497 KiB  
Review
The Challenge of Treating Abdominal Aortic Aneurysms with Hostile Neck Anatomy: An Overview
by Alex Houser, Camilo Martinez and Apostolos Tassiopoulos
J. Clin. Med. 2024, 13(5), 1460; https://doi.org/10.3390/jcm13051460 - 02 Mar 2024
Viewed by 682
Abstract
Hostile aortic neck anatomy challenges the outcomes of endovascular abdominal aortic aneurysm repair (EVAR). Besides reverting to open surgical repair (OSR), thoughtful endograft selection and a number of advanced endovascular techniques have been suggested as potential solutions for preventing proximal seal zone complications, [...] Read more.
Hostile aortic neck anatomy challenges the outcomes of endovascular abdominal aortic aneurysm repair (EVAR). Besides reverting to open surgical repair (OSR), thoughtful endograft selection and a number of advanced endovascular techniques have been suggested as potential solutions for preventing proximal seal zone complications, improving EVAR durability, and preventing aneurysm-related death. Each technique is associated with advantages and limitations and there has not been a credible direct comparison amongst them in the form of a well-designed prospective trial. The not infrequent presence of multiple hostile anatomic characteristics further complicates decision making and challenges the surgeon’s skills. This paper serves as an overview of hostile neck anatomy and its implications on EVAR. We provide a concise literature review with the purpose of outlining the treatment modalities and outcomes in this patient population. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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11 pages, 563 KiB  
Review
The Role of Aortic Volume in the Natural History of Abdominal Aortic Aneurysms and Post-Endovascular Aortic Aneurysm Repair Surveillance
by George Kouvelos, George Volakakis, Konstantinos Dakis, Konstantinos Spanos and Athanasios Giannoukas
J. Clin. Med. 2024, 13(1), 193; https://doi.org/10.3390/jcm13010193 - 29 Dec 2023
Viewed by 521
Abstract
There has been a debate about whether maximum diameter can be solely used to assess the natural history of abdominal aortic aneurysm. The aim of the present review is to collect all the available evidence on the role of abdominal aortic aneurysm (AAA) [...] Read more.
There has been a debate about whether maximum diameter can be solely used to assess the natural history of abdominal aortic aneurysm. The aim of the present review is to collect all the available evidence on the role of abdominal aortic aneurysm (AAA) volume in the natural history of AAAs, including small untreated AAAs and AAAs treated by EVAR. The current literature appears to reinforce the role of volume as a supplementary measure for evaluating the natural history of AAA, in both intact AAAs and after EVAR. The clinical impact of AAA volume measurements remains unclear. Several studies show that volumetric analysis can assess changes in AAAs and predict successful endoluminal exclusion after EVAR more accurately than diameter. However, most studies lack strict standardized measurement criteria and well-defined outcome definitions. It remains unclear whether volumetry could replace diameter assessment in defining the risk of rupture of AAAs and identifying clinically relevant sac growth. Full article
(This article belongs to the Special Issue Challenges in Abdominal Aortic Aneurysm)
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