Vascular Surgery: Current Challenges and Future Perspectives

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

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 1207

Special Issue Editors


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Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; vascular medicine; surgery; aneurysm; vascular diseases; vascular surgery; cardiac surgery; T lymphocytes; arteries; atherosclerosis

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Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; minimally invasive surgery; laparoscopic surgery; general surgery; colorectal surgery; bariatric surgery; hernia repair; vascular medicine; aneurysm; vascular surgery

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00162 Rome, Italy
Interests: clinical trials; vascular medicine; surgery; aneurysm; vascular diseases; vascular surgery

Special Issue Information

Dear Colleagues,

The evolution of vascular surgery from the 1970s onwards has been entirely aimed at precision surgery with a minimally invasive nature. New techniques have obviously led to new complications and therefore to new challenges. With new techniques and complications, the introduction of endovascular treatments has greatly changed how aortic, peripheral, and carotid illnesses are treated. Despite recent modest innovations, open procedures continue to be an excellent choice in some circumstances.

Future challenges will be in the endovascular revascularization of leg vessels and in neoangiogenic therapy, in the safety of carotid surgery and in the innovation of prosthetic materials.

Long-term follow-up is required to assess aortic remodeling and the decline in the incidence of aortic events following endovascular procedures used to treat acute and chronic aortic dissection. The intricate recanalization and thrombectomy procedures required for endovascular therapy of acute and chronic mesenteric ischemia require technical expertise and specialized equipment.

The potential clinical advantages of these cutting-edge techniques must still be determined and contrasted with the open surgical strategy. Future decision-making will be aided by artificial intelligence, but the viewpoints solicited should be relevant to imaging and radioprotection employing electromagnetic guidance.

In this Special Issue, researchers are invited to discuss contemporary issues in handling various conditions, such as clinical advances in endovascular and vascular surgery, aortic dissection, carotid artery disease, and peripheral arterial disease, just to mention a few.

Prof. Dr. Bruno Salvati
Dr. Lidia Castagneto Gissey
Prof. Dr. Rita Mele
Guest Editors

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Keywords

  • vascular surgery
  • endovascular surgery
  • peripheral arterial disease
  • carotid stenosis
  • aortic dissection
  • mesenteric ischemia
  • restenosis
  • vessel preparation
  • hostile neck
  • artificial intelligence
  • endoleaks

Published Papers (1 paper)

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Research

12 pages, 250 KiB  
Article
Elective Endovascular Aneurysm Repair (EVAR) for the Treatment of Infrarenal Abdominal Aortic Aneurysms of 5.0–5.5 cm: Differences between Men and Women
by Ombretta Martinelli, Simone Cuozzo, Francesca Miceli, Roberto Gattuso, Vito D’Andrea, Paolo Sapienza and Maria Irene Bellini
J. Clin. Med. 2023, 12(13), 4364; https://doi.org/10.3390/jcm12134364 - 28 Jun 2023
Viewed by 955
Abstract
Background: There is significant debate regarding the existence of sex-related differences in the presentation, treatment, and outcomes of men versus women affected by abdominal aortic aneurysm (AAA). The purpose of this study is to compare endovascular aneurysm repair (EVAR) of infrarenal AAAs with [...] Read more.
Background: There is significant debate regarding the existence of sex-related differences in the presentation, treatment, and outcomes of men versus women affected by abdominal aortic aneurysm (AAA). The purpose of this study is to compare endovascular aneurysm repair (EVAR) of infrarenal AAAs with the current sex-neutral 5.0–5.5 cm-diameter threshold for intervention between the two sexes. Methods: Retrospective review of consecutive cases from a single teaching institution over a period of five years of patients who had undergone elective EVAR for AAAs between 5.0 and 5.5 cm in diameter. Outcomes of interest were compared according to sex. Results: Ninety-four patients were included in the analysis, with a higher prevalence of men (53%). Females were older at the time of repair, 78 ± 5.1 years, versus 71.7 ± 7 years (p < 0.01), and had higher incidence of underlying comorbidities, namely, arrhythmia, chronic kidney disease, and previous carotid revascularization. Women had higher incidence of immediate systemic complications (p = 0.021), post-operative AMI (p = 0.001), arrhythmia (p = 0.006), pulmonary oedema (p < 0.001), and persistent renal dysfunction (p = 0.029). Multivariate analysis for post-operative factors associated to mortality and adjusted for sex confirmed that AMI (p = 0.015), arrhythmia (p = 0.049), pulmonary oedema (p = 0.015), persistent renal dysfunction (p < 0.001), cerebral ischemia (p < 0.001), arterial embolism of lower limbs (p < 0.001), and deep-vein thrombosis of lower limbs (p < 0.001) were associated to higher EVAR-related mortality; a higher incidence of post-operative AMI (p = 0.014), pulmonary edema (p = 0.034), and arterial embolism of lower limbs (p = 0.046) were associated to higher 30-days mortality. In females there was also a higher rate of suprarenal fixation (p = 0.026), insertion outside the instruction for use (p = 0.035), and a more hostile neck anatomy with different proximal aortic diameter (p < 0.001) and angle (p = 0.003). Conclusions: A similar threshold of size of AAA for elective surgery for both males and females might not be appropriate for surgical intervention, as females tend to have worse outcomes. Further population-based studies are needed to guide on sex-related differences and intervention on AAA. Full article
(This article belongs to the Special Issue Vascular Surgery: Current Challenges and Future Perspectives)
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