Mechanism, Diagnosis, and Treatment of Aortic Diseases

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (24 February 2023) | Viewed by 16661

Special Issue Editor

Heart and Vascular Center, Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary
Interests: interventional radiology; vascular interventions; peripheral artery disease; aortic disease; MR research; ultrasound
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Many diseases can occur in the aorta. Examples of such diseases are aneurysms, dissections, stenoses/occlusions, and aortitis. Each disease has its own pathomechanism, predisposing factors, clinical and radiological characteristics, and therapeutic approaches. Computed tomography (CT) angiography, magnetic resonance angiography, ultrasound, and, in special cases, positron emission tomography (PET) and PET-CT play a key role in establishing diagnosis and assessing therapeutic efficacy. Due to the complexity of aortic diseases, the optimal therapy, which may be pharmacological, endovascular, open surgery, or a combination thereof, is usually decided by a multidisciplinary team.

As a result of intensive experimental and clinical research, much has been revealed in recent years about the pathomechanism of and predisposing factors for aortic diseases, but many questions remain unanswered. Significant progress has also been made in diagnostic methods and drug therapies, as well as in invasive (mainly endovascular) devices. Our goal is to provide a comprehensive picture of the results of genetic, immunological, vascular, radiological, and surgical research related to the pathomechanism, diagnosis, and therapy of aortic diseases.

Dr. Edit Dósa
Guest Editor

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Keywords

  • aorta
  • aortic disease
  • aortic aneurysm
  • aortic dissection
  • penetrating aortic ulcer
  • aortic stenosis
  • arteritis
  • pathomechanism
  • diagnosis
  • pharmacological therapy
  • invasive therapy
  • endovascular therapy
  • open surgery

Published Papers (9 papers)

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Research

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8 pages, 1562 KiB  
Communication
The Association of Novel Single-Nucleotide Variants in the Collagen Matrix-Encoding Gene PRDM5 with Aortic Aneurysmal Disease
by Peyton Moore, Adam Wolf and Mohanakrishnan Sathyamoorthy
Life 2023, 13(8), 1649; https://doi.org/10.3390/life13081649 - 28 Jul 2023
Viewed by 855
Abstract
Thoracic aortic aneurysms are clinical conditions that are associated with severe clinical endpoints including dissection and rupture, potentially leading to sudden death. Contrary to their abdominal counterparts, thoracic aortic aneurysms are well-recognized to have a genetic basis underlying their development. Among all patients [...] Read more.
Thoracic aortic aneurysms are clinical conditions that are associated with severe clinical endpoints including dissection and rupture, potentially leading to sudden death. Contrary to their abdominal counterparts, thoracic aortic aneurysms are well-recognized to have a genetic basis underlying their development. Among all patients with aneurysmal disease who underwent clinical genetic screening in our program (N = 145), two patients were found to have variants of uncertain significance (VUS) in the PRDM5 gene. This gene is responsible for multiple regulatory functions in extracellular matrix development, and this is the first report, to our knowledge, to associate this gene with aortopathy. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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14 pages, 18665 KiB  
Article
Endovascular Aneurysm Sac Embolization for Treatment of Ruptured Aneurysms in the Aortoiliac Segment Using N-Butyl-Cyanoacrylate
by Karim Mostafa, Marie Schierenbeck, Jens Trentmann, Hannes Gottschalk, Julian Andersson, Julian Pfarr, Malte Sieren, Olav Jansen and Philipp J. Schäfer
Life 2023, 13(4), 919; https://doi.org/10.3390/life13040919 - 31 Mar 2023
Viewed by 1039
Abstract
Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization [...] Read more.
Background Aneurysmal rupture in the aortoiliac segment is a severe, life-threatening condition. Nowadays, in addition to surgical treatment, the implantation of a covered stent graft constitutes a feasible, minimally invasive treatment option. A novel approach is the add-on of transarterial aneurysm sac embolization with N-butyl-cyanoacrylate (NBCA). Here, we report our experience of performing this add-on embolization procedure after endovascular aneurysm repair for complex ruptured aneurysms of the aortoiliac segment. Material and Methods We describe six patients (mean age of 75.2 years; all male) with ruptured aneurysms in the visceral aortic and aortoiliac segment in whom a high-volume transarterial aneurysm sac embolization was performed as an add-on therapy to the implantation of an aortic prosthesis. The aim of this add-on intervention was to achieve the definite embolization of the aneurysmal rupture site and to ensure the best possible aneurysmal sealing. We report the feasibility, technical success, and considerations of using NBCA as well as clinical and follow-up imaging results, given their availability. Results Technical success was achieved in all cases. Clinical success was achieved in four cases. No periprocedural complications or reinterventions were reported. The mean full procedure time was 107.8 min. The mean radiation dose was 12,966.1 cGy/cm2. A mean amount of 10.7 mL of NBCA mixed with lipiodol in a 1:3 to 1:5 ratio was used for all patients. Available follow-up imaging up to 36 months after the procedure showed no aneurysm progression or endoleaks. In two patients, the NBCA cast had almost fully dissolved over the course of follow-up. Conclusions Our study underscores the notion that aneurysm sac embolization using high volumes of NBCA with ethiodized oil as an embolic agent is a feasible and add-on treatment option for optimizing the exclusion of the aneurysm from patients with ruptured aneurysms in the aortoiliac segment. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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11 pages, 825 KiB  
Article
Complications in Patients with Chronic Type B Aortic Dissection (cTBAD)—A Long-Term Analysis
by Darya Mohajeri, Christos Rammos, Konstantinos Tsagakis, Thomas Schlosser, Arjang Ruhparwar, Tienush Rassaf, Rolf Alexander Jánosi and Julia Lortz
Life 2023, 13(3), 851; https://doi.org/10.3390/life13030851 - 22 Mar 2023
Viewed by 1292
Abstract
Chronic type B aortic dissection (cTBAD) is a rare but challenging condition that requires individual treatment strategies. Especially the long-term therapy impacts prognosis. In this single-center retrospective study, we evaluated patients with cTBAD in our vascular outpatient clinic over 10 years. Follow-up consultations [...] Read more.
Chronic type B aortic dissection (cTBAD) is a rare but challenging condition that requires individual treatment strategies. Especially the long-term therapy impacts prognosis. In this single-center retrospective study, we evaluated patients with cTBAD in our vascular outpatient clinic over 10 years. Follow-up consultations included contrast-enhanced, electrocardiogram-triggered, high-resolution CT angiography (CTA) covering the entire aorta. Evaluated characteristics went beyond demographic characteristics combining the treatment approach and the timing and occurrence of potential complications. We analyzed 133 patients in total (n = 92, 69.2% male) with cTBAD with a mean follow-up of 67.7 months. Most of them underwent invasive treatment (n = 102, 76.7%), the majority received thoracic endovascular aortic repair (TEVAR) (n = 82, 61.7%). A total of 80 patients (60.2%) had major complications, whereas over a third was free of complications even after 5 years. Most common complications were progress of dissection and endoleaks, aneurysms of true (TL) and false lumen (FL) were more common in the later time periods. The treatment of cTBAD in terms of timing, therapy approach, and complications is still challenging for the entire aortic team. Nevertheless, the early recognition of complications permits promising treatment options and highlights the importance of frequent follow-up examinations especially within the first years. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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10 pages, 855 KiB  
Article
Clampless In-Situ Immobilized Branching (CLIMB) to Reconstruct the Internal Iliac Artery
by Takuro Shirasu, Atsushi Akai, Manabu Motoki and Masaaki Kato
Life 2022, 12(11), 1928; https://doi.org/10.3390/life12111928 - 18 Nov 2022
Viewed by 1035
Abstract
Background: Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. [...] Read more.
Background: Surgical reconstruction of the internal iliac artery (IIA) or its branches is sometimes demanding because of difficulty in distal clamping and suturing in the narrow pelvic space. Here we present a hybrid technique of ClampLess In-situ imMobilized Branching (CLIMB) to reconstruct IIA. Methods: in the CLIMB technique, an 8 mm artificial graft is sutured onto the surface of the common iliac artery (CIA) without clamping. Following puncture of the CIA wall, stent grafts are bridged from IIA to the graft. Finally, the graft is sutured to the ipsilateral external iliac artery (EIA). Concomitant endovascular aneurysm repair or IIA branch embolization can also be performed. We applied this technique to the patients unsuited for other IIA reconstruction. Results: eleven patients underwent the current technique. All but one patient underwent contralateral IIA interruption. Seven patients had a history of aorto-iliac repair before the index surgery. Iliac extender, internal iliac component, Viabahn VBX or Fluency covered stent were used for bridging the graft. Simultaneous IIA branch embolization was performed in 2 patients. Distal landing zones were IIA in 7 grafts, superior gluteal artery in 4 grafts and inferior gluteal artery (IGA) in 1 graft. Technical success was achieved in all cases. No patient complained of buttock claudication or other ischemic symptoms on the treatment side. During a mean follow-up period of 38 months, 11 out of 12 grafts were patent without any related endoleak. One IGA graft occluded at 56 months after surgery. Conclusions: the CLIMB technique is a viable alternative to preserve IIA with an acceptable mid-term durability. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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12 pages, 11095 KiB  
Article
Long Term Results of Reduction Ascending Aortoplasty
by Cinzia Trumello, Ilaria Giambuzzi, Marta Bargagna, Kevin Tavana, Arturo Bisogno, Guido Ascione, Mariachiara Calabrese, Alessandro Castiglioni, Ottavio Alfieri and Michele De Bonis
Life 2022, 12(10), 1526; https://doi.org/10.3390/life12101526 - 30 Sep 2022
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Abstract
The aim of this retrospective study is to show medium-long-term results in terms of cardiac death and aortic events in patients undergoing reduction ascending aortoplasty between 1997 and 2009 in our hospital. The Fine and Grey model for competing risk analysis was performed [...] Read more.
The aim of this retrospective study is to show medium-long-term results in terms of cardiac death and aortic events in patients undergoing reduction ascending aortoplasty between 1997 and 2009 in our hospital. The Fine and Grey model for competing risk analysis was performed for time to cardiac death, with non-cardiac death as the competing risk, and time to recurrence of both re-dilation (aortic diameter > 45 mm) and re-operation with overall death as the competing risk. Paired t-test was used to evaluate the change in aortic diameter from the post-operative values to follow-up. The population included 142 patients. The mean pre-operative aortic diameter and the diameter at follow-up were respectively 46.5 ± 5.11 mm vs. 41.4 ± 5.55 mm (p-value < 0.001). At a mean follow-up of 11.6 ± 4.15 years, 11 patients (7.7%) required re-operation on the ascending aorta. At 16 years, the CIF of aortic-related events was 29.4 ± 7.2%; the freedom from cardiac death was 89.2 ± 3.7%. Ten patients (7%) died from cardiac causes but no one was aortic-related. The Fine and Grey analysis did not identify any significant predictors. This procedure is safe but might be justified only in high-risk patients or in those with advanced age/short life expectancy. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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10 pages, 1162 KiB  
Article
Midterm Results of Iliac Branch Devices in a Newly Established Aortic Center
by Sarolta Borzsák, András Süvegh, András Szentiványi, Daniele Mariastefano Fontanini, Milán Vecsey-Nagy, Péter Banga, Péter Sótonyi, Zoltán Szeberin and Csaba Csobay-Novák
Life 2022, 12(8), 1154; https://doi.org/10.3390/life12081154 - 29 Jul 2022
Cited by 1 | Viewed by 1459
Abstract
The first-line treatment of common iliac artery aneurysms is endovascular repair. International guidelines recommend the preservation of the internal iliac artery, which is best achieved by the implantation of an iliac bifurcation device (IBD). Our aim was to evaluate the initial midterm results [...] Read more.
The first-line treatment of common iliac artery aneurysms is endovascular repair. International guidelines recommend the preservation of the internal iliac artery, which is best achieved by the implantation of an iliac bifurcation device (IBD). Our aim was to evaluate the initial midterm results of IBDs in the leading vascular center of Hungary. In this single-center retrospective study, relevant clinical data and the results of the imaging examinations were collected and analyzed in all patients who underwent IBD implantation between December 2010 and July 2021. Thirty-five patients (31 males, mean age: 67.9 ± 8.5 years) underwent endovascular treatment with 37 IBD implantations. Technical success was achieved in 88.2% of the patients, with no perioperative mortality or open surgical conversion. One patient was lost during follow-up. Internal iliac artery occlusion was detected in three (8.8%) patients, and reintervention was performed in five (14.7%) patients. Primary patency of the internal iliac branch was 97.1% at 1 month, 93% at 2 months, and 89.0% at 5 years. The average follow-up time was 20.1 ± 26.2 months, during which two (5.9%) deaths occurred. Our initial experience with iliac branch devices was associated with a low complication rate and a favorable outcome, which confirms the midterm success of this intervention. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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9 pages, 555 KiB  
Article
Complex Aortic Interventions Can Be Safely Introduced to the Clinical Practice by Physicians Skilled in Basic Endovascular Techniques
by Sarolta Borzsák, András Szentiványi, András Süvegh, Daniele Mariastefano Fontanini, Milán Vecsey-Nagy, Péter Banga, Zoltán Szeberin, Péter Sótonyi and Csaba Csobay-Novák
Life 2022, 12(6), 902; https://doi.org/10.3390/life12060902 - 16 Jun 2022
Cited by 1 | Viewed by 1862
Abstract
Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched [...] Read more.
Our purpose was to evaluate the risk associated with the learning curve of starting a complex aortic programme in an Eastern European country. A retrospective study was conducted involving the initial 20 patients (16 males, mean age: 65 ± 11 years) undergoing fenestrated/branched endovascular aortic repair in a single centre. Demographic, anatomical, procedural, and postoperative variables were collected. Our elective patient cohort consisted of 9 pararenal aneurysms (45%) and 11 thoracoabdominal aortic aneurysms (55%), with the latter including 4 chronic dissection cases (20%). A total of 71 branch vessels were incorporated (3.5 ± 0.9 per patient). The per vessel technical success rate was 100%. In-hospital mortality was 5% (1/20). At an average follow-up of 14 ± 22 months, the primary clinical success rate was 45% (9/20) and the secondary clinical success was achieved in 75% of cases (15/20). All-cause mortality at 14 months was 20% (4/20; aortic related: 1/20, 5%). Four bridging stent occlusions were found (5.6%). Mortality and reintervention rates were comparable to the initial results of high-volume centres, while the complexity of our cases and the per vessel technical success rate was comparable to the values reported as late experience. The morbidity of the learning curve could be decreased if operators are skilled in basic endovascular procedures. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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Review

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15 pages, 1218 KiB  
Review
Current Understanding of Aortic Dissection
by Xun Yuan, Andreas Mitsis and Christoph A. Nienaber
Life 2022, 12(10), 1606; https://doi.org/10.3390/life12101606 - 14 Oct 2022
Cited by 11 | Viewed by 4789
Abstract
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within [...] Read more.
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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18 pages, 333 KiB  
Review
Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene
by Panteleimon E. Papakonstantinou, Dimitra Benia, Dimitrios Polyzos, Konstantinos Papakonstantinou, Filippos-Paschalis Rorris, Fotios Toulgaridis, Konstantinos Manousiadis, Sotirios Xydonas and Antonios Sideris
Life 2022, 12(10), 1511; https://doi.org/10.3390/life12101511 - 28 Sep 2022
Cited by 2 | Viewed by 2176
Abstract
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, [...] Read more.
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD. Full article
(This article belongs to the Special Issue Mechanism, Diagnosis, and Treatment of Aortic Diseases)
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