Advances in Endovascular Aortic Aneurysm Repair

Endovascular aortic repair (EVAR) has evolved as the preferred method for treating abdominal aortic aneurysms (AAA). However, variations in anatomical structures, such as the proximal neck, iliac axes, and access vessels, still pose significant challenges that affect the feasibility and reduce the durability of the results. These anatomical constraints are particularly pronounced in women, who exhibit more complex anatomies and face a higher risk of procedural failure and complications when undergoing EVAR.

The most common and important anatomic reason for patients being excluded from EVAR are, in decreasing order of frequency:
o Short and angulated proximal necks
o Tortuous and calcified iliac arteries
o Narrow external iliac arteries or severely diseased common femoral arteries.

Over the past decades, technological advances in endograft design have sought to address these challenges by accommodating increasingly difficult anatomies. Some of the last generation endografts are now capable to adapt to proximal necks as short as 7mm and have ultra-low profile delivery systems to navigate severely diseased iliac axes with minimal impact. However, the clinical value of such new devices in minimizing early and late complications in AAA with hostile anatomy are still poorly studied.

This Research Topic aims to explore and validate the clinical benefits of the latest endografts and novel techniques that enhance the outcomes of EVAR, especially in AAA involving hostile aorto-iliac anatomy. We also aim to investigate the alleged weaknesses of such innovations, especially in terms of durability of the new endografts, which could be responsible for modular disconnections, fractures and type III, IV and V endoleaks.

We welcome contributions focusing on both clinical outcomes and pre-clinical evaluations:
o Comparative and non-comparative clinical studies of low-profile endografts with long-term data
o Systematic reviews and meta-analyses evaluating the performance of innovative endografts
o Research on the hemodynamic impacts of endografts post-implantation
o Studies on new EVAR techniques like intravascular lithotripsy and in-situ fenestrations
o Evaluations of endografts in challenging iliac anatomies

Article types suitable for submission include full research articles, reviews, and larger case series (over 10 patients). Priority will be given to comparative and non-comparative clinical evaluation of low-profile endografts with long-term results, systematic reviews and meta-analysis, over smaller experience and pre-clinical studies. The Editors are particularly interested in assessing the outcomes of ultra-low profile endografts in the setting of hostile iliac anatomy.

Keywords: Endovascular Aortic Repair (EVAR), Abdominal Aortic Aneurysm (AAA), Hostile Aorto-Iliac Anatomy, Endograft Design, Women's Health in Vascular Surgery, Proximal Neck Challenges

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.