Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Vascular Surgery: Current Challenges and New Perspectives

Special Issue Editors
Special Issue Information
Keywords
Published Papers

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

Deadline for manuscript submissions: 30 April 2024 | Viewed by 5544

Share This Special Issue

Special Issue Editors

Dr. François Saucy

E-Mail Website
Guest Editor

1. Service of Vascular Surgery, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
2. Service of Vascular Surgery, Department of Heart and Vessels, University Hospital, 1011 Lausanne, Switzerland
Interests: restenosis; vessel preparation; hostile neck; peripheral arterial disease; drug delivery

Dr. Quentin Pellenc

E-Mail Website
Guest Editor

1. Service of Vascular Surgery, Ensemble Hospitalier de la Côte, 1110 Morges, Switzerland
2. Marfan Syndrome National Referral Center, Bichat University Hospital, 75018 Paris, France
Interests: aortic dissection; false lumen thrombosis; connective tissue disorders; open aortic repair; acute mesenteric ischemia

Special Issue Information

Dear Colleagues,

The development of endovascular approaches has significantly modified the treatment of aortic, peripheral, and carotid diseases with new strategies and complications. Open procedures remain a valuable option in specific situations with recent limited innovations. This Special Issue invites researchers to address current challenges in managing different areas, such as aortic dissection, mesenteric ischemia, and peripheral arterial disease.

The endovascular techniques used in acute and chronic aortic dissection need long-term follow-up to evaluate aortic remodeling and the reduction in the rate of incidence of aortic events. Endovascular management of acute and chronic mesenteric ischemia requires technical skills and dedicated devices to perform complex recanalization and thrombectomy. Vessel preparation and drug-eluting technologies are frequently used in PAD patients. The limitations of paclitaxel when it comes to preventing restenosis and potential side effects has promoted sirolimus-coated balloons and stents, but long-term results are still needed. Nevertheless, the potential clinical benefit of these advanced procedures remains to be defined and compared to the open surgical approach. Artificial intelligence will help decision making in the future, but the perspectives invited should be related to imaging and radioprotection using electromagnetic guidance.

Therefore, the editors will consider original manuscripts, short communications, and reviews relevant to these topics. We look forward to your enthusiastic participation in this Special Issue.

Dr. François Saucy
Dr. Quentin Pellenc
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

aortic dissection
spinal cord ischemia
mesenteric ischemia
restenosis
vessel preparation
hostile neck
artificial intelligence
radioprotection
electromagnetic guidance
endoleaks

Published Papers (7 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Other

11 pages, 225 KiB

Open AccessArticle

Safety and Feasibility of the BYCROSS^® Atherectomy Device for the Treatment of Femoropopliteal Arterial Obstructions: Single-Center Short-Term Outcomes

by Goudje L. van Leeuwen, Reinoud P. H. Bokkers, Job Oldenziel, Richte C. L. Schuurmann, Cornelis G. Vos and Jean-Paul P. M. de Vries

J. Clin. Med. 2024, 13(6), 1809; https://doi.org/10.3390/jcm13061809 - 21 Mar 2024

Viewed by 500

Abstract

Background: Endovascular techniques have gained preference over peripheral arterial bypass surgery due to their minimally invasive nature; however, endovascular treatments often show limited efficacy in arterial segments with a high atherosclerotic load. The use of atherectomy devices enables the removal of calcified plaque material and may promote arterial wall remodeling. This study assessed the technical success, safety, and feasibility of the BYCROSS^® atherectomy device in femoropopliteal lesions. Methods: This single-center, retrospective cohort study analyzed elective patients undergoing BYCROSS^® atherectomy for chronic peripheral arterial disease from March 2022 to May 2023. Patient data, procedural details, and outcomes were retrospectively collected from electronic patient records. The primary performance endpoints of this study were technical success, complications, and patency rates. Primary safety endpoints included 30-day and short-term major adverse limb events (MALEs), major adverse cardiovascular events (MACEs), and mortality rate. Results: The study included 19 patients (median age, 71 years; 63% male) with Fontaine class IIb (26%), III (21%), or IV (53%). The BYCROSS^® atherectomy device was used to treat 22 limbs in the femoropopliteal tract, of which 11 lesions (50%) were occlusions and 11 were stenoses, with a median length of 24 cm (interquartile range: 17–38). Technical success was achieved in all cases: 4.5% required atherectomy only, 50% required additional balloon angioplasties, 41% required balloon angioplasties and stenting, and 4.5% required segments only stenting. Additional treatment of below-the-knee arteries was performed in 12 patients. Procedurally related complications (not limited to the use of the BYCROSS^® device) occurred in 23% of limbs, including distal embolization and laceration. At 30 days, mortality was 5%, the MACE rate was 11%, and the MALE rate was 0%. The observed mortality rate was not directly related to the procedure. Patency (<50% restenosis at duplex ultrasound) was 83% at 30 days. Conclusions: The use of the BYCROSS^® atherectomy device for the treatment of femoropopliteal lesions appears to be safe and feasible, with high technical success and low MALE and MACE rates in a challenging population with long-segment femoropopliteal lesions. Long-term follow-up in larger patient series is needed to confirm these findings and to determine the durability of this technique. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

9 pages, 230 KiB

Open AccessArticle

Hypnosis during Endovascular Abdominal Aortic Aneurysm Repair

by Lucie Derycke, Quentin De Roux, Nicolas Mongardon, Asmaa Khaled, Marie Corniquet, Pascal Desgranges, Joseph Touma and for the SOS Aorte Paris Est Group

J. Clin. Med. 2024, 13(4), 979; https://doi.org/10.3390/jcm13040979 - 08 Feb 2024

Viewed by 581

Abstract

(1) Background: Endovascular abdominal aneurysm repair (EVAR) is associated with a reduction in early morbidity and mortality compared with open repair. Procedures performed under hypnosis might represent an alternative to further reduce the risks related to general anesthesia (GA). This study aimed to assess the feasibility and safety of hypnosis and local anesthesia during EVAR. (2) Methods: All consecutive patients who underwent EVAR or fenestrated/branched EVAR (f/bEVAR) under hypnosis and local anesthesia (n = 28) between 2017 and 2019 were retrospectively studied and matched to control patients who underwent the same interventions under GA. (3) Results: There was neither a significant difference in the length of ICU stay (p = 0.06), nor in the occurrence of endoleaks, reintervention, and 30-day mortality rate (p = 1.00, 0.73, and 0.24, respectively). The hypnosis group had lower use of norepinephrine (maximum dose 0.04 ± 0.1 vs. 1.2 ± 4.0 mg·h⁻¹, p < 0.001), shorter procedure duration (181.2 ± 71.4 vs. 214.3 ± 79.6 h, p = 0.04), and shorter length of stay (5.4 ± 3.2 vs. 8.4 ± 5.9 days, p = 0.002). (4) Conclusions: In this pioneering study, hypnosis during EVAR appears feasible and safe. It is associated with lower intraoperative use of norepinephrine, as well as procedure duration and length of in-hospital stay. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

13 pages, 1723 KiB

Open AccessArticle

Preventing Acute Limb Ischemia during VA-ECMO—In Silico Analysis of Physical Parameters Associated with Lower Limb Perfusion

by Tifanie Brockaert, Inês Ferreira, Anne Laplante, Paul Fogel, David Grimbert and Pierre Mordant

J. Clin. Med. 2023, 12(18), 6049; https://doi.org/10.3390/jcm12186049 - 19 Sep 2023

Viewed by 801

Abstract

Background: Peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation is increasingly used in refractory cardiogenic shock. However, the obstruction of the femoral artery by the return cannula could lead to acute limb ischemia, a frequently encountered situation that is inconstantly prevented by the adjunction of a distal perfusion cannula (DPC). The aim of this study was to investigate the influence of three physical parameters on the perfusion of the cannulated lower limb. Methods: Using patient-specific arterial models and computational fluid dynamic simulations, we studied four diameters of arterial cannula, three diameters of DPC, and two percentages of arterial section limitation. Results: We found that adequate perfusion of the cannulated limb was achieved in only two out of the twenty-one configurations tested, specifically, when the arterial cannula had a diameter of 17 Fr, was considered to limit the section of the artery by 90%, and was associated with an 8 Fr or a 10 Fr DPC. Multivariable analysis revealed that the perfusion of the cannulated lower limb was correlated with the diameter of the DPC, but also with the diameter of the arterial cannula and the percentage of arterial section limitation. Conclusions: In most of the cases simulated here, the current system combining unsized arterial cannula and non-specific DPC was not sufficient to provide adequate perfusion of the cannulated lower limb, urging the need for innovative strategies to efficiently prevent acute limb ischemia during peripheral femoro-femoral veno-arterial extracorporeal membrane oxygenation. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

► Show Figures

Figure 1

14 pages, 1490 KiB

Open AccessArticle

Fenestrated Physician-Modified Endografts for Preservation of Main and Accessory Renal Arteries in Juxtarenal Aortic Aneurysms

by Hon-Lai Chan, Dimitrios D. Papazoglou, Silvan Jungi, Salome Weiss, Daniel Becker, Drosos Kotelis and Vladimir Makaloski

J. Clin. Med. 2023, 12(14), 4708; https://doi.org/10.3390/jcm12144708 - 15 Jul 2023

Viewed by 1099

Abstract

Background: There is a paucity of reporting outcomes of complex aortic aneurysm treatment such as juxtarenal abdominal aortic aneurysms, where additional techniques to preserve renal artery perfusion are required. Methods: Retrospective analysis of consecutive patients who underwent emergent and elective aortic repair with fenestrated PMEGs between March 2019 and January 2023. Endpoints were technical success, reinterventions, secondary reinterventions and target vessel patency. Results: Forty-seven target vessels in 37 patients (23 male, median age 75 years) were targeted, of which 44 were renal arteries (RAs) with a mean diameter of 5.4 ± 1.0 mm. Thirteen were accessory RAs and six had a diameter ≤ 4 mm. Technical success rate was 87% overall; 97% for main and 62% for accessory RAs respectively. Target vessel patency and freedom from secondary reintervention was 100% and 97% at 30 days and 96% and 91% at one year, respectively. There was no 30-day mortality. Conclusion: Fenestrated physician-modified endografts are safe and effective for the treatment of patients with juxtarenal abdominal aortic aneurysms when incorporating main renal arteries. Limited technical success may be expected when targeting accessory renal arteries, especially when small in diameter. Long-term follow-up is needed to confirm durability of PMEGs for renal artery preservation. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

► Show Figures

Graphical abstract

12 pages, 1532 KiB

Open AccessArticle

Diminishing Endograft Apposition during Follow-Up Is an Important Indicator of Late Type 1a Endoleak after Endovascular Aneurysm Repair

by Roy Zuidema, Anna C. M. Geraedts, Willemina A. van Veldhuizen, Sana Mulay, Jean-Paul P. M. de Vries, Richte C. L. Schuurmann, Ron Balm and the ODYSSEUS-T1EL Study Group

J. Clin. Med. 2023, 12(12), 3969; https://doi.org/10.3390/jcm12123969 - 10 Jun 2023

Viewed by 1000

Abstract

Late type 1a endoleaks (T1aELs) after endovascular aneurysm repair (EVAR) are hazardous complications which should be avoided. This study investigated the evolution of the shortest apposition length (SAL) post-EVAR and hypothesised that a declining apposition during follow-up may be an indicator of T1aEL development. Patients with a late T1aEL were selected from a consecutive multicentre database. For each T1aEL patient, the preoperative computed tomography angiography (CTA), first postoperative CTA, and pre-endoleak CTA were analysed. T1aEL patients were matched 1:1 to uncomplicated controls, based on endograft type and follow-up duration. Anatomical characteristics and endograft dimensions, including the post-EVAR SAL, were measured. Included were 28 patients with a late T1aEL and 28 matched controls. The SAL decreased from 11.2 mm (5.6–20.6 mm) to 3.9 mm (0.0–11.4 mm) in the T1aEL group (p = 0.006), whereas an increase in SAL was seen in the control group from 21.3 mm (14.1–25.8 mm) to 25.4 mm (19.0–36.2 mm; p = 0.015). On the pre-endoleak CTA, 18 patients (64%) in the T1aEL group had a SAL < 10 mm, and one (4%) patient in the control group had a SAL < 10 mm on the matched CTAs. Moreover, three mechanisms of decreasing sealing zone were identified, which might be used to determine optimal imaging or reintervention strategies. Diminishing SAL < 10 mm is an indicator for T1aEL during follow-up, it is imperative to include apposition analysis during follow-up. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

► Show Figures

Figure 1

Other

Jump to: Research

11 pages, 6144 KiB

Open AccessSystematic Review

Impact of Frailty and Sarcopenia on Thirty-Day and Long-Term Mortality in Patients Undergoing Elective Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

by François Saucy, Hervé Probst, Johan Hungerbühler, Coralie Maufroy and Jean-Baptiste Ricco

J. Clin. Med. 2024, 13(7), 1935; https://doi.org/10.3390/jcm13071935 - 27 Mar 2024

Viewed by 404

Abstract

Background: The aim of this study was to assess the prognostic role of frailty and sarcopenia on the survival of patients with AAA undergoing elective endovascular repair (EVAR). Methods: A systematic review of the literature was conducted in accordance with Meta-analysis of Observational Studies in Epidemiology (MOOSE). The association of frailty or sarcopenia with 30-day mortality and late survival was expressed as odds ratios (ORs) or hazard ratios (HRs) with a 95% confidence interval (CI). Meta-analysis random effects models were applied. The five-factor modified frailty index (mFI-5) was used as a frailty metric and sarcopenia was determined using computed tomography angiography (CTA) with measurements of the total psoas muscle area. Frailty was defined as patients with mFI-5 ≥ 0.6 and sarcopenia was defined as the total psoas muscle area (TPA) within the lowest tertile. Results: Thirteen observational cohorts reporting a total of 56,756 patient records were eligible for analysis. Patients with frailty (mFI-5 ≥ 0.6) had significantly increased 30-day mortality than those without frailty (random effects method: OR, 4.84, 95% CI 3.34–7.00, p < 0.001). Patients with sarcopenia (lowest TPA tertile) had significantly increased 30-day mortality according to the fixed effects method (OR, 3.30, 95% CI 2.17–5.02, p < 0.001), but not the random effects method (OR, 2.64, 95% CI 0.83–8.39, p = 0.098). Patients with sarcopenia or frailty had a significantly increased hazard ratio (HR) for late mortality than those without frailty or sarcopenia according to the random effects method (HR, 2.39, 95% CI 1.66–3.43, p < 0.001). The heterogeneity of the studies was low (I²: 0.00%, p = 0.86). The relation of frailty to age extracted from four studies demonstrates that the risk of frailty increases with age according to the random effects method (standard mean differences, SMD, 0.52, 95% CI 0.44–0.61, p < 0.001). The heterogeneity of the studies was low (I²: 0.00%, p = 0.64). Conclusions: Patients with sarcopenia or frailty have a significantly increased risk of mortality following elective EVAR. Prospective studies validating the use of frailty and sarcopenia for risk prediction after EVAR are needed before these tools can be used to support decision making. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

► Show Figures

Figure 1

10 pages, 8915 KiB

Open AccessSystematic Review

The Safety and Outcome of Minimally Invasive Staged Segmental Artery Coil Embolization (MIS²ACE) Prior Thoracoabdominal Aortic Aneurysm Repair: A Single-Center Study, Systematic Review, and Meta-Analysis

by Vaiva Dabravolskaite, Eleni Xourgia, Drosos Kotelis and Vladimir Makaloski

J. Clin. Med. 2024, 13(5), 1408; https://doi.org/10.3390/jcm13051408 - 29 Feb 2024

Viewed by 479

Abstract

Background: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS²ACE) is a novel technique of spinal cord preconditioning used to reduce the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. In this study, we report our experience with MIS²ACE, including both degenerative and post-dissection TAAA, while we attempt to systematically summarize relevant data available in the literature. Design: single-center observational study with systematic review of the literature and meta-analysis. Methods: Initial retrospective analysis of 7 patients undergoing MIS²ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data. Results: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS²ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS²ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS²ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS²ACE patients is 1.9% (95% CI −0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions). Conclusions: While the current published data is limited, our study further confirms that MIS²ACE is a technically feasible and safe option for spinal cord preconditioning. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Challenges and New Perspectives)

► Show Figures

Journal Menu

Journal Browser

Vascular Surgery: Current Challenges and New Perspectives

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (7 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI