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Clinical Updates on the Aortic Aneurysm and Aortic Dissection

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

Deadline for manuscript submissions: 28 August 2024 | Viewed by 5962

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Special Issue Editors

Dr. Benedikt Reutersberg

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Guest Editor

Department of Vascular Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
Interests: fenestrated and branched aortic repair; physician modified stent-graft; open aortic surgery

Dr. Matthias Trenner

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Guest Editor

1. Vascular Medicine, St. Josef's Hospital, 65189 Wiesbaden, Germany
2. Vascular Surgery, TUM School of Medicine, Technical University of Munich, 81675 Munich, Germany
Interests: vascular surgery; endovascular surgery; aortic diseases; aneurysm; vascular diseases

Special Issue Information

Dear Colleagues,

Aortic aneurysm and aortic dissection are potentially life-threatening conditions that require urgent attention. In recent years, a substantial amount of research has been conducted, evidenced by over 18,094 papers that have been published and indexed by the Web of Science since 2019.

Despite advances in diagnosis and treatment, there are significant treatment gaps that need to be addressed to save lives.

One major gap is the early detection and diagnosis of aortic aneurysms, as they often present no symptoms until a catastrophic event occurs. Increased awareness and effective screening programs are crucial to identify at-risk individuals. With falling incidence in the Western world, cost–benefit analyses or more targeted screening methods are becoming increasingly important.

Similarly, there is a need for timely recognition and diagnosis of aortic dissections, as symptoms can be easily mistaken for other conditions. Medical professionals must be equipped with the necessary knowledge and tools for prompt identification.

Bridging these gaps requires optimizing treatment strategies, refining surgical approaches, and developing novel therapies.

Comprehensive long-term management strategies are also essential for individuals who have survived aortic dissections. Standardized guidelines and protocols for post-dissection care, including regular imaging studies and medication management, are vital for optimal outcomes.

This Special Issue aims to address these gaps, gives updates on current clinical research developments and invites articles on screening methods, treatment gaps, and innovative approaches to diagnosis.

Let us collaborate and together take a step towards overcoming the treatment gap for aortic aneurysms and aortic dissection.

Sincerely,

Dr. Benedikt Reutersberg
Dr. Matthias Trenner
Guest Editors

Manuscript Submission Information

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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

aortic dissections
aortic aneurysms
endovascular aortic repair
open surgery
screening
atherosclerosis
aortic arch
tevar
bevar
fevar
complex endovascular aortic repair

Published Papers (8 papers)

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Research

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14 pages, 2145 KiB

Open AccessArticle

Hospital Incidence and Treatment Outcomes of Patients with Aneurysms and Dissections of the Iliac Artery in Switzerland—A Secondary Analysis of Swiss DRG Statistics Data

by Roland Bozalka, Anna-Leonie Menges, Alexander Zimmermann and Lorenz Meuli

J. Clin. Med. 2024, 13(8), 2267; https://doi.org/10.3390/jcm13082267 - 14 Apr 2024

Viewed by 271

Abstract

Background/Objectives: Aneurysms and dissections of the iliac artery (ADIAs) are significant vascular conditions often associated with aortic pathologies. Despite their importance, reports on isolated iliac artery pathologies are rare. This study aimed to investigate the epidemiology of ADIA in Switzerland including treatment incidence and hospital outcomes. Methods: A retrospective analysis of diagnosis-related group (DRG) statistics from 2011 to 2018 in Switzerland was conducted, identifying all cases of ADIA while excluding those with concomitant treatment of aortic pathologies. Age-standardized incidence rates and treatment outcomes were assessed, with multivariable logistic regression performed to identify factors associated with hospital mortality. Results: From 2011 to 2018, 1037 ADIA cases were hospitalized in Switzerland. Incidence rates for elective treatment were significantly higher in men than women, increasing in men from 1.5 to 2.4 cases per 100,000 men (p = 0.007), while remaining stable in women at around 0.2 cases per 100,000 women. Acute treatment incidence rates were lower but still higher in men, at 0.9 cases per 100,000 men and 0.2 cases per 100,000 women. Crude hospital mortality rates were lower for endovascular repair than open surgical repair in both elective (0.8% vs. 3.1%, p = 0.023) and emergency treatment (6.7% vs. 18.4%, p = 0.045). Multivariable analysis showed that endovascular repair was associated with significantly reduced hospital mortality compared to open repair (OR 0.27, 95%-CI: 0.10 to 0.66, p = 0.006). Conclusions: This nationwide study of iliac artery pathologies shows that the treatment incidence was about 10 times higher in men than in women for elective procedures, but only about five times higher for emergency treatment. Endovascular procedures were associated with significantly lower hospital mortality than open procedures, while hospital mortality rates were comparable for men and women. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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12 pages, 1440 KiB

Open AccessFeature PaperArticle

Long-Term Health-Related Quality of Life following Acute Type A Aortic Dissection with a Focus on Male–Female Differences: A Cross Sectional Study

by Frederike Meccanici, Carlijn G. E. Thijssen, Arjen L. Gökalp, Annemijn W. Bom, Guillaume S. C. Geuzebroek, Joost F. ter Woorst, Roland R. J. van Kimmenade, Marco C. Post, Johanna J. M. Takkenberg and Jolien W. Roos-Hesselink

J. Clin. Med. 2024, 13(8), 2265; https://doi.org/10.3390/jcm13082265 - 13 Apr 2024

Viewed by 437

Abstract

Objectives: Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, of which the long-term impact on health-related quality of life (HRQoL) and male–female-specific insights remain inadequately clarified. Methods: Consecutive adult ATAAD patients who underwent surgery were retrospectively included between 2007 and 2017 in four referral centers in the Netherlands, and baseline data were collected. The 36-Item Short-Form (SF-36) Health Survey was sent to all survivors between 2019 and 2021 and compared to validated SF-36 scores of the Dutch general population stratified by age group and sex. Results: In total, 324/555 surviving patients returned the SF-36 questionnaire (response rate 58%), of which 40.0% were female; the median follow-up was 6.5 years (range: 1.7–13.9, IQR: 4.0–9.4) after surgery for ATAAD. In comparison to the general population, ATAAD patients scored significantly lower on 6/8 SF-36 subdomains and higher on bodily pain. Differences in HRQoL domains compared to the sex-matched data were largely comparable between sexes, apart from bodily pain. In the age-matched subgroups impaired HRQoL was most pronounced in younger patients aged 41–60 (5/8 impaired domains). Female ATAAD patients scored significantly worse on 5/8 SF-36 subdomains and the physical component summary (PCS) scores than male patients. Age at ATAAD, female sex, hypertension, COPD, and prior thoracic aortic aneurysm were associated with worse PCS scores. Conclusions: Long-term HRQoL was impaired in both male and female ATAAD patients when compared to the general population. Further studies on the nature of this impairment and on interventions to improve HRQoL after ATAAD are clearly warranted, with special attention to females and younger patients. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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11 pages, 1073 KiB

Open AccessArticle

Factors Associated with Early Mortality in Acute Type A Aortic Dissection—A Single-Centre Experience

by Panagiotis Doukas, Nicola Dalibor, András Keszei, Jelle Frankort, Julia Krabbe, Rachad Zayat, Michael J. Jacobs, Alexander Gombert, Payam Akhyari and Arash Mehdiani

J. Clin. Med. 2024, 13(4), 1023; https://doi.org/10.3390/jcm13041023 - 10 Feb 2024

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Abstract

Background: Acute aortic dissection type A (AADA) is a surgical emergency with relevant mortality and morbidity despite improvements in current management protocols. Identifying patients at risk of a fatal outcome and controlling the factors associated with mortality remain of paramount importance. Methods: In this retrospective observational study, we reviewed the medical records of 117 patients with AADA, who were referred to our centre and operated on between 2005 and 2021. Preoperative, intraoperative, and postoperative variables were analysed and tested for their correlation with in-hospital mortality. Results: The overall survival rate was 83%. Preoperatively, factors associated with mortality were age (p = 0.02), chronic hypertension (p = 0.02), any grade of aortic valve stenosis in the patient’s medical history (p = 0.03), atrial fibrillation (p = 0.04), and oral anticoagulation (p = 0.04). Non-survivors had significantly longer operative times (p = 0.002). During the postoperative phase, mortality was strongly associated with acute kidney injury (AKI) (p < 0.001), acute heart failure (p < 0.001), stroke (p = 0.02), focal neurological deficits (p = 0.02), and sepsis (p = 0.001). In the multivariate regression analysis, the onset of postoperative focal neurological deficits was the best predictor of a fatal outcome after adjusting for ARDS (odds ratio: 5.8, 95%-CI: 1.2–41.7, p = 0.04). Conclusions: In this retrospective analysis, atrial fibrillation, oral anticoagulation, hypertension, and age were significantly correlated with mortality. Postoperatively, acute kidney injury, acute heart failure, sepsis, and focal neurological deficits were correlated with in-hospital mortality, and focal neurological deficit has been identified as a significant predictor of fatal outcomes. Early detection and interdisciplinary management of at-risk patients remain crucial throughout the postoperative phase. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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12 pages, 964 KiB

Open AccessArticle

Relative Thrombus Burden Ratio Reveals Overproportioned Intraluminal Thrombus Growth—Potential Implications for Abdominal Aortic Aneurysm

by Joscha Mulorz, Agnesa Mazrekaj, Justus Sehl, Amir Arnautovic, Waseem Garabet, Kim-Jürgen Krott, Hubert Schelzig, Margitta Elvers and Markus Udo Wagenhäuser

J. Clin. Med. 2024, 13(4), 962; https://doi.org/10.3390/jcm13040962 - 08 Feb 2024

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Abstract

Background: An intraluminal, non-occlusive thrombus (ILT) is a common feature in an abdominal aortic aneurysm (AAA). This study investigated the relative progression of ILT vs. AAA volume using a novel parameter, the so-called thrombus burden ratio (TBR), in non-treated AAAs. Parameters potentially associated with TBR progression were analyzed and TBR progression in large vs. small and fast- vs. slow-growing AAAs was assessed. Methods: This retrospective, single-center study analyzed sequential contrast-enhanced computed tomography angiography (CTA) scans between 2009 and 2018 from patients with an AAA before surgical treatment. Patients’ medical data and CTA scans were analyzed at two given time points. The TBR was calculated as a ratio of ILT and AAA volume, and relative TBR progression was calculated by normalization for time between sequential CTA scans. Spearman’s correlation was applied to identify morphologic parameters correlating with TBR progression, and multivariate linear regression analysis was used to evaluate the association of clinical and morphological parameters with TBR progression. Results: A total of 35 patients were included. The mean time between CT scans was 16 ± 15.9 months. AAA volume progression was 12 ± 3% and ILT volume progression was 36 ± 13%, resulting in a TBR progression of 11 ± 4%, suggesting overproportioned ILT growth. TBR progression was 0.8 ± 0.8% per month. Spearman’s correlation verified ILT growth as the most relevant parameter contributing to TBR progression (R = 0.51). Relative TBR progression did not differ significantly in large vs. small and fast- vs. slow-growing AAAs. In the multivariate regression analysis, none of the studied factors were associated with TBR progression. Conclusion: TBR increases during AAA development, indicating an overproportioned ILT vs. AAA volume growth. The TBR may serve as a useful parameter, as it incorporates the ILT volume growth relative to the AAA volume, therefore combining two important parameters that are usually reported separately. Yet, the clinical relevance in helping to identify potential corresponding risk factors and the evaluation of patients at risk needs to be further validated in a larger study cohort. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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16 pages, 1705 KiB

Open AccessArticle

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

by Ilaria Puttini, Marvin Kapalla, Anja Braune, Enrico Michler, Joselyn Kröger, Brigitta Lutz, Natzi Sakhalihasan, Matthias Trenner, Gabor Biro, Wolfgang Weber, Thomas Rössel, Christian Reeps, Hans-Henning Eckstein, Steffen Wolk, Christoph Knappich, Susan Notohamiprodjo and Albert Busch

J. Clin. Med. 2024, 13(1), 269; https://doi.org/10.3390/jcm13010269 - 03 Jan 2024

Viewed by 654

Abstract

Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUV_TLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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11 pages, 474 KiB

Open AccessArticle

Preoperative Imaging Signs of Cerebral Malperfusion in Acute Type A Aortic Dissection: Influence on Outcomes and Prognostic Implications—A 20-Year Experience

by Mohammed Al-Tawil, Mohamed Salem, Christine Friedrich, Shirin Diraz, Alexandra Broll, Najma Rezahie, Jan Schoettler, Nora de Silva, Thomas Puehler, Jochen Cremer and Assad Haneya

J. Clin. Med. 2023, 12(20), 6659; https://doi.org/10.3390/jcm12206659 - 20 Oct 2023

Viewed by 693

Abstract

Background: Acute type A aortic dissection (ATAAD) continues to be a subject of active research due to its high mortality rates and associated complications. Cerebral malperfusion in ATAAD can have a devastating impact on patients’ neurological function and overall quality of life. We aimed to explore the risk profile and prognosis in ATAAD patients presenting with preoperative imaging signs of cerebral malperfusion (PSCM). Methods: We obtained patient data from our Aortic Dissection Registry, which included 480 consecutive ATAAD cases who underwent surgical repair between 2001 and 2021. Primary endpoint outcomes included the in-hospital and 30-day mortality, postoperative new neurological deficit, mechanical ventilation hours, and intensive care unit (ICU) length of stay. Results: Of the total cohort, 82 patients (17.1%) had PSCM. Both groups had similar distributions in terms of age, sex, and body mass index. The patients in the PSCM group presented with a higher logistic EuroSCORE (47, IQR [31, 64] vs. 24, IQR [15, 39]; p < 0.001) and a higher portion of patients with a previous cardiac surgery (7.3% vs. 2.0%; p = 0.020). Intraoperatively, the bypass, cardioplegia, and aortic cross-clamp times were similar between both groups. However, the patients in the PSCM group received significantly more intraoperative packed red blood cells, fresh frozen plasma, and platelets transfusions (p < 0.05). Following the surgery, the patients who presented with PSCM had markedly longer ventilation hours (108.5 h, IQR [44, 277] vs. 43 h, IQR [16, 158], p < 0.001) and a significantly longer ICU length of stay (7 days, IQR [4, 13] vs. 5 days, IQR [2, 11]; p = 0.013). Additionally, the patients with PSCM had significantly higher rates of postoperative new neurological deficits (35.4% vs. 19.4%; p = 0.002). In the Cox regression analysis, PSCM was associated with significantly poorer long-term survival (hazard ratio (HR) 1.75, 95%CI [1.20–2.53], p = 0.003). Surprisingly, hypertension was shown as a protective factor against long-term mortality (HR: 0.59, 95%CI [0.43–0.82], p = 0.001). Conclusion: PSCM in ATAAD patients is linked to worse postoperative outcomes and poorer long-term survival, emphasizing the need for early recognition and tailored management. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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12 pages, 2089 KiB

Open AccessArticle

Paracolic Gutter Routing: A Novel Retroperitoneal Extra-Anatomical Repair for Infected Aorto-Iliac Axis

by Hazem El Beyrouti, Mohamed Omar, Cristi-Teodor Calimanescu, Hendrik Treede and Nancy Halloum

J. Clin. Med. 2023, 12(17), 5765; https://doi.org/10.3390/jcm12175765 - 04 Sep 2023

Viewed by 1316

Abstract

Objective: We describe and analyze outcomes of a novel extra-anatomical paracolic gutter routing technique for surgical repair of aorto-iliac infections. Methods: A double-center, observational, cohort study of all consecutive patients with aorto-iliac infections treated using extra-anatomical paracolic gutter technique. Between May 2015 and December 2022, six patients with aorto-iliac infections were treated with the paracolic gutter routing technique. Cases were identified retrospectively in an institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. Results: Aorto-bifemoral vascular reconstructions were performed using this technique in six patients. During mean follow-up of 52 ± 44 months, there was one case of graft thrombosis (17%) with subsequent successful thrombectomy. Primary and secondary graft patency rates were 83% and 100%, respectively. There was one mortality (17%) due to candida sepsis. All graft prostheses were patent at last follow-up. Conclusions: The paracolic gutter technique is a useful technique in patients with extensive aorto-iliac infections, arteriovenous and iliac-ureteric fistulas, or at a high risk of vascular graft infection and is associated with favorable reinfection and patency rates. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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Review

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16 pages, 503 KiB

Open AccessReview

Acute Aortic Syndromes from Diagnosis to Treatment—A Comprehensive Review

by Cosmin M. Banceu, Diana M. Banceu, David S. Kauvar, Adrian Popentiu, Vladimir Voth, Markus Liebrich, Marius Halic Neamtu, Marvin Oprean, Daiana Cristutiu, Marius Harpa, Klara Brinzaniuc and Horatiu Suciu

J. Clin. Med. 2024, 13(5), 1231; https://doi.org/10.3390/jcm13051231 - 21 Feb 2024

Viewed by 876

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This work aims to provide a comprehensive description of the characteristics of a group of acute aortic diseases that are all potentially life-threatening and are collectively referred to as acute aortic syndromes (AASs). There have been recent developments in the care and diagnostic plan for AAS. A substantial clinical index of suspicion is required to identify AASs before irreversible fatal consequences arise because of their indefinite symptoms and physical indicators. A methodical approach to the diagnosis of AAS is addressed. Timely and suitable therapy should be started immediately after diagnosis. Improving clinical outcomes requires centralising patients with AAS in high-volume centres with high-volume surgeons. Consequently, the management of these patients benefits from the increased use of aortic centres, multidisciplinary teams and an “aorta code”. Each acute aortic entity requires a different patient treatment strategy; these are outlined below. Finally, numerous preventive strategies for AAS are discussed. The keys to good results are early diagnosis, understanding the natural history of these disorders and, where necessary, prompt surgical intervention. It is important to keep in mind that chest pain does not necessarily correspond with coronary heart disease and to be alert to the possible existence of aortic diseases because once antiplatelet drugs are administered, a blocked coagulation system can complicate aortic surgery and affect prognosis. The management of AAS in “aortic centres” improves long-term outcomes and decreases mortality rates. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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