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Special Issue "Clinical Advances and Future Perspectives in Vascular Surgery"

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Dear Colleagues,

Vascular disease is a common cause of death and disability in the growing elderly population, and demand for vascular procedures is increasing worldwide. Over the last two decades, endovascular treatment options for vascular pathologies have been increasingly improved and established. Vascular surgery has progressed over time thanks to the development of new endovascular technologies. Following the use of these technologies, 90% of the aortic pathology, 70% of peripheral arterial disease cases, and 40–50% of carotid stenoses can already be treated with endovascular techniques. Despite the significant therapeutic shift towards endovascular techniques, there will always be a need for hybrid (open/endovascular) repairs in 5–10% of vascular lesions.

This Special Issue aims to provide an update of research on new clinical data and perspectives on the whole area of vascular disease management, including perceptions of new technologies and novel devices. Accordingly, this Special Issue will try to provide a forum for high-quality original research and review articles to showcase the most recent clinical advances and future perspectives in vascular surgery.

Dr. George N. Kouvelos
Dr. Konstantinos Spanos
Dr. Petroula N. Nana
Guest Editors

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Keywords

vascular surgery
endovascular surgery
aortic surgery
peripheral arterial disease
carotid artery disease
EVAR
vascular access
aneurysm
complex aneurysm

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Research

Open AccessArticle

Sex-Comparative Outcomes of the T-Branch Device for the Treatment of Complex Aortic Aneurysms

and

J. Clin. Med. 2023, 12(18), 5811; https://doi.org/10.3390/jcm12185811 - 07 Sep 2023

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Abstract

Introduction: Females are at increased risk of mortality compared to males after complex endovascular aortic repair. This study aims to examine sex-related peri-operative and follow-up outcomes in patients managed with the t-Branch device. Methods: A two-center retrospective analysis of patients managed with the off-the-shelf t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) between 1 January 2014 and 30 September 2020 was performed. Primary outcomes were sex-comparative 30-day mortality, major adverse events (MAEs) and spinal cord ischemia (SCI). Results: A total of 542 patients were included; 28.0% were females. Urgent repair and type I–III thoracoabdominal aneurysms were more common among females (52.6% vs. 34%, p = 0.01, and 57.1% vs. 35.8%, p = 0.004). Technical success was similar (97.4% vs. 96.9%, p = 0.755), as well as early mortality (16.2% in females vs. 10.8% in males; p = 0.084). SCI rates were similar between groups (13.6% vs. 9.2% p = 0.183). MAEs were more common in females; 33.7% vs. 21.4% (p = 0.022). Multivariate analysis did not identify sex as an independent predictor of adverse events. The 12-month survival rate was 75.7% (SE 0.045) for females and 84.1% (SE 0.026) for males (log rank, p = 0.10). Conclusions: Sex was not detected as an independent factor of mortality, MAEs and SCI within patients managed with the t-Branch device. Feasibility was high in both groups. No significant difference was shown in survival during the 12-month follow-up. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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Open AccessArticle

Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients

Réka Kaller

Eliza Russu

Emil Marian Arbănași

Adrian Vasile Mureșan

Márk Jakab

Claudiu Constantin Ciucanu

Eliza Mihaela Arbănași

and

J. Clin. Med. 2023, 12(13), 4419; https://doi.org/10.3390/jcm12134419 - 30 Jun 2023

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Abstract

Background: Arteriovenous fistula dysfunction is a widely disputed subject in the scientific literature on end-stage kidney disease (ESKD). The main cause of mortality and morbidity in these patients is the non-maturation or dysfunction of the arteriovenous fistula. Despite the many complications, the native arteriovenous fistula remains the gold standard in the treatment of these patients requiring renal replacement. This study aims to discuss the predictive role of some systemic inflammatory biomarkers (NLR, PLR, SII, IL-6), intimal hyperplasia, and neoangiogenesis (characterized by intimal-media CD31-positive relative surface) in arteriovenous fistula maturation failure. Methods: The present study was designed as an observational, analytical, and prospective study which included patients diagnosed with ESKD with indications of radio-cephalic arteriovenous fistula (RCAVF). Demographic data, comorbidities, preoperative laboratory data and histological/digital morphometry analysis results were processed. The patients included were divided into two groups based on their AVF maturation status at 8 weeks: “Maturation” (Group 1) and “Failed Maturation” (Group 2). Results: There was no difference in the demographic data. In terms of comorbidities, the second group had a greater incidence of heart failure (p = 0.03), diabetes (p = 0.04), peripheral artery disease (p = 0.002), and obesity (p = 0.01). Additionally, regarding the laboratory findings, these patients had higher levels of serum uric acid (p = 0.0005), phosphates (p < 0.0001), and creatinine (p = 0.02), as well as lower levels of total calcium (p = 0.0002), monocytes (p = 0.008), and lymphocytes (p < 0.0001). Moreover, all inflammatory markers (p = 0.001; p < 0.0001; p = 0.006, and p = 0.03) and Ca-P product (p < 0.0001) had higher baseline values in Group 2. Upon immunohistochemical analysis, regarding the density of neoformed vessels, there was a higher incidence of CD31-positive surfaces (p = 0.006) and CD31-positive relative surfaces (p = 0.001); the NLR (r = 0.323; p = 0.03), PLR (r = 0.381; p = 0.04), SII (r = 0.376; p = 0.03), and IL-6 (r = 0.611; p < 0.001) are all significantly correlated with vascular density, as evidenced by CD31. Conclusions: Heart failure, peripheral artery disease, obesity, and diabetes, as well as the systemic inflammatory markers (NLR, PLR, SII, IL-6), intimal hyperplasia, and CD31-positive relative surfaces are predictors of arteriovenous fistula maturation failures. Full article

(This article belongs to the Special Issue Clinical Advances and Future Perspectives in Vascular Surgery)

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Special Issue "Clinical Advances and Future Perspectives in Vascular Surgery"

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