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Dorn A, Dorweiler B, Ahmad W, Mylonas S, Becker I, Majd P. Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort. J Clin Med 2023; 12:4411. [PMID: 37445445 PMCID: PMC10343002 DOI: 10.3390/jcm12134411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.
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Affiliation(s)
- Anna Dorn
- Vascular Surgery Department, Protestant Hospital, 51465 Bergisch Gladbach, Germany;
| | - Bernhard Dorweiler
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Wael Ahmad
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Spyridon Mylonas
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Payman Majd
- Vascular Surgery Department, Protestant Hospital, 51465 Bergisch Gladbach, Germany;
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Ahmad W, Brunkwall J, Bunck AC, Dorweiler B, Mylonas S. Favorable Remodeling After TEVAR in Uncomplicated Acute and Subacute Type B Aortic Dissection in Comparison to Conservative Treatment: A Midterm Analysis. J Endovasc Ther 2023:15266028231158971. [PMID: 36891635 DOI: 10.1177/15266028231158971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the midterm and long-term outcomes of patients who underwent thoracic endovascular aortic repair (TEVAR) procedure to treat an uncomplicated acute and subacute type B aortic dissection (uATBAD) with high risk for subsequent aortic complications compared with the group of patients who received a conservative treatment protocol during the same period. MATERIALS AND METHODS Between 2008 and 2019, 35 patients who had TEVAR due to uATBAD and those with conservative procedure (n=18) were included in a retrospective analysis and follow-up study. The primary endpoints were false lumen thrombosis/perfusion, true lumen diameter, and aortic dilatation. The aortic-related mortality, reintervention, and long-term survival were the secondary endpoints. RESULTS In the study period, 53 patients (22 females) with a mean age of 61.1±13 years were included. No 30-day and in-hospital mortality was recorded. Permanent neurological deficits occurred in 2 patients (5.7%). In the TEVAR group (n=35) and in a median follow-up period of 34 months, a significant reduction of maximum aortic and false lumen diameter as well as a significant increase of true lumen diameter were detected (p<0.001 each). Complete false lumen thrombosis increased from 6% preoperatively to 60% at follow-up. The median difference in aortic, false lumen, and true lumen diameter was -5 mm (interquartile range [IQR]=-28 to 8 mm), -11 mm (IQR=-53 to 10 mm), and 7 mm (IQR=-13 to 17 mm), respectively. In 3 patients (8.6%), a reintervention was needed. Two patients (1 aortic-related) died during follow-up. The estimated survival according to Kaplan-Meyer analysis was 94.1% after 3 years and 87.5% after 5 years. Similar to the TEVAR group, no 30-day or in-hospital mortality was recorded in the conservative group. During follow-up, 2 patients died and 5 patients underwent conversion-TEVAR (28%). In a median follow-up period of 26 months (range=150), a significant increase of maximum aortic diameter (p=0.006) and a tendency to augmentation of the false lumen (p=0.06) were noted. No significant reduction of the true lumen was seen. CONCLUSIONS Thoracic endovascular aortic repair in patients at high risk of subsequent aortic complications in uncomplicated acute and subacute type B aortic dissection is safe and is associated with favorable midterm outcomes regarding aortic remodeling. CLINICAL IMPACT In a retrospective, single center analysis of prospectively collected data with follow-up, we compared 35 patients with high-risk features who recieved TEVAR in acute and sub-acute uncomplicated type B aortic dissection to a control-group (n=18). The TEVAR group showed a significant positive remoduling (reduction of max. aortic and false lumen diameter and increase of true lumen diameter (p<0.001 each)) during follow-up with an estimated survival of 94.1% after 3 years and 87.5% after 5 years.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Department of Radiology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Li Y, Rother U, Rosenberg Y, Hinterseher I, Uhl C, Mylonas S, Grambow E, Gombert A, Busch A, Bresler A, Öz T, Görtz H, Pfister K, Dovzhanskiy D, Trenner M, Behrendt CA. A prospective survey study on the education and awareness about walking exercise amongst inpatients with symptomatic peripheral arterial disease in Germany. VASA 2023. [PMID: 36734257 DOI: 10.1024/0301-1526/a001057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: To determine the adherence to supervised exercise training and underlying reasons for non-adherence amongst patients with inpatient treatment of symptomatic lower extremity peripheral arterial disease (PAD). Patients: This was a prospective questionnaire-based survey study of all consecutively treated inpatients with treatment for either intermittent claudication or chronic limb-threatening ischaemia (CLTI) surveyed at sixteen participating centres in Germany. Results: A total of 235 patients (median age 70 years) were included, thereof 29.4% females and 34.6% with CLTI. The median time from first PAD diagnosis was 4 years (IQR: 1-8). Only 11.4% have previously participated in any walking exercise programme before the index treatment, thereby 10.0% in the IC subgroup and 12.0% with CLTI. Amongst all patients, 35.6% responded they were appropriately informed about the necessity and benefits of walking exercise programmes by their hospital physicians (25.8% by general practitioners), and 65.3% agreed that adherence to supervised exercise may improve their pain-free walking distance. A total of 24.5% responded they had access to necessary information concerning local walking exercise programmes. Amongst 127 free text comments on the reasons for non-adherence to supervised exercise training, 64% of the comments contained lack of information or consent on such measures. Conclusions: Less than 12% of the patients enrolled in the current study have ever participated in a walking exercise programme during their life course. Although all practice guidelines contain corresponding class I recommendations, especially for patients suffering from IC, most patients responded that they were not appropriately informed about the necessity of exercise training along with the fact that 65% agreed that exercise may increase the pain-free walking distance. Taken all together, these results emphasise that we miss an important opportunity in the patient-physician communication. Efforts should be made to improve acceptance and application of structured walking-exercise for patients with PAD.
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Affiliation(s)
- Yi Li
- University Medical Center Erlangen, Germany.,German Institute for Vascular Research, Berlin, Germany
| | - Ulrich Rother
- University Medical Center Erlangen, Germany.,German Institute for Vascular Research, Berlin, Germany
| | - Yvonne Rosenberg
- German Institute for Vascular Research, Berlin, Germany.,Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany
| | - Irene Hinterseher
- Berlin Institute of Health, Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Christian Uhl
- German Institute for Vascular Research, Berlin, Germany.,Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Medical Faculty, University of Cologne, Germany
| | - Eberhard Grambow
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, Germany
| | - Alexander Gombert
- European Vascular Center Aachen Maastricht, Department of Vascular Surgery University Hospital RWTH Aachen, Germany
| | - Albert Busch
- Division of Vascular and Endovascular Surgery Department for Visceral-, Thoracic and Vascular Surgery Medical Faculty Carl Gustav Carus and University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Germany
| | - Ayko Bresler
- Department of Vascular and Endovascular Surgery, Goethe University Hospital Frankfurt/Main, Germany
| | - Tugce Öz
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, Munich, Germany
| | - Hartmut Görtz
- German Institute for Vascular Research, Berlin, Germany.,Department of Vascular and Endovascular Surgery, Bonifatiushospital Lingen, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Germany
| | - Dmitriy Dovzhanskiy
- German Institute for Vascular Research, Berlin, Germany.,Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.,Department of Vascular and Endovascular Surgery, Clinic Bergstrasse of University Hospital Heidelberg, Heppenheim, Germany
| | - Matthias Trenner
- Department of Vascular Medicine, St. Josefs Hospital, Wiesbaden, Germany
| | - Christian-Alexander Behrendt
- German Institute for Vascular Research, Berlin, Germany.,Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, Hamburg, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Alushi K, Hinterseher I, Peters F, Rother U, Bischoff MS, Mylonas S, Grambow E, Gombert A, Busch A, Gray D, Konstantinou N, Stavroulakis K, Horn M, Görtz H, Uhl C, Federrath H, Trute HH, Kreutzburg T, Behrendt CA. Distribution of Mobile Health Applications amongst Patients with Symptomatic Peripheral Arterial Disease in Germany: A Cross-Sectional Survey Study. J Clin Med 2022; 11:jcm11030498. [PMID: 35159950 PMCID: PMC8836389 DOI: 10.3390/jcm11030498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Broadly available digital and mobile health applications (also known as mHealth) have recently gained increasing attention by the vascular community, but very little is known about the dissemination and acceptance of such technologies in certain target populations. The current study aimed to determine the user behaviour and acceptance of such digital technologies amongst patients with peripheral arterial disease (PAD). Methods: A cross-sectional survey of consecutively treated inpatients at 12 university institutions, as well as one non-university institution, was conducted. All admitted patients with symptomatic PAD were surveyed for 30 consecutive days within a flexible timeframe between 1 July and 30 September 2021. The factors associated with smartphone use were estimated via backward selection within a logistic regression model with clustered standard errors. Results: A total of 326 patients participated (response rate 96.3%), thereof 102 (34.0%) were treated for intermittent claudication (IC, 29.2% women, 70 years in median) and 198 were treated for chronic limb-threatening ischaemia (CLTI, 29.5% women, 70 years in median). Amongst all of the patients, 46.6% stated that they had not changed their lifestyle and health behaviour since the index diagnosis (four years in median), and 33.1% responded that they were not aware of the reasons for all of their medication orders. Amongst all those surveyed, 66.8% owned a smartphone (IC: 70.6%, CLTI: 64.1%), thereof 27.9% needed regular user support. While 42.5% used smartphone apps, only 15.0% used mobile health applications, and 19.0% owned wearables. One out of five patients agreed that such technologies could help to improve their healthy lifestyle. Only higher age was inversely associated with smartphone possession. Conclusions: The current survey showed that smartphones are prevalent amongst patients with peripheral arterial disease, but only a small proportion used mobile health applications and a considerable number of patients needed regular user support. Almost half of the patients did not change their lifestyle and one third were not aware of the reasons for their medication orders, emphasising room for improvement. These findings can further help to guide future projects using such applications to identify those target populations that are reachable with digital interventions.
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Affiliation(s)
- Kastriot Alushi
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Irene Hinterseher
- Berlin Institute of Health, Vascular Surgery Clinic, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany;
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Frederik Peters
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Ulrich Rother
- Department of Vascular Surgery, University Medical Center Erlangen, 91054 Erlangen, Germany;
| | - Moritz S. Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.S.B.); (C.U.)
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany;
| | - Eberhard Grambow
- Department of General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Alexander Gombert
- European Vascular Center Aachen Maastricht, Department of Vascular Surgery University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Albert Busch
- Division of Vascular and Endovascular Surgery, Department of Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, 01307 Dresden, Germany;
| | - Daphne Gray
- Department of Vascular and Endovascular Surgery, Goethe University Hospital, 60590 Frankfurt, Germany;
| | - Nikolaos Konstantinou
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, 80539 Munich, Germany; (N.K.); (K.S.)
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, Ludwig Maximilians University Hospital, 80539 Munich, Germany; (N.K.); (K.S.)
| | - Marco Horn
- Division of Vascular and Endovascular Surgery, Department of Surgery, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;
| | - Hartmut Görtz
- Department of Vascular and Endovascular Surgery, Bonifatius Hospital Lingen, 49808 Lingen, Germany;
| | - Christian Uhl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany; (M.S.B.); (C.U.)
| | - Hannes Federrath
- Working Group Security in Distributed Systems at University of Hamburg, Department of Computer Science, University of Hamburg, 22527 Hamburg, Germany;
| | | | - Thea Kreutzburg
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
| | - Christian-Alexander Behrendt
- Research Group GermanVasc, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany; (K.A.); (F.P.); (T.K.)
- Correspondence:
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Mylonas S, Behrens A, Dorweiler B. [Pro Endo: No Need for Open Any More... Surveillance is All Important]. Zentralbl Chir 2021; 146:464-469. [PMID: 34666361 DOI: 10.1055/a-1618-6913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Since its first report in 1991, endovascular aneurysm repair (EVAR) has become an established and preferred treatment modality for many patients. Several randomised controlled trials comparing EVAR and open repair have shown an early survival benefit, lower perioperative morbidity and shorter hospital stay with EVAR. As a result, EVAR has become the most common method of elective repair of BAAs in most vascular centres. Despite its widespread use, there are still subgroups of the patient population for whom the benefit of EVAR has not been clearly demonstrated. The most frequently discussed subgroup in this context is the patient with few risk factors - due to concerns about the durability and need of reinterventions. EVAR can provide durability and long-term survival similar to open repair in these younger patients, as long as the aneurysm anatomy and instructions for use are followed. The evidence on the effects of follow-up on patient survival is currently controversial. With increasing knowledge about the behavior of endoprostheses and factors that influence the complications of the endograft, changes in follow-up protocols have been made. A more patient-specific follow-up strategy and less compliance with a rigorous follow up scheme are required.
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Affiliation(s)
- Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
| | - Amelie Behrens
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
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Dorweiler B, Mylonas S, Salem O. [Debate on Infrarenal AAA in Young and Fit Patients ('Fit for Open Repair'): Open Repair is Safe and Long-term Results are Better]. Zentralbl Chir 2021; 146:458-463. [PMID: 34666358 DOI: 10.1055/a-1611-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endovascular aortic repair, initially developed for patients at prohibitively high risk for an open repair, has undergone significant technical evolution and refinement and has emerged as the preferred treatment option for patients with an infrarenal aortic aneurysm. However, analysis of long-term data of the randomised studies revealed inferior results with regards to survival and freedom-from-reintervention after eight years. Open aortic repair has been performed for more than seven decades and especially for the younger patients with few comorbidities, results are excellent. Potential drawbacks of open repair like incisional hernias, erectile dysfunction and quality of life can either be effectively prevented (mesh reinforcement) or actually failed to show a significant difference compared to open repair in recent studies. Therefore, meticulous assessment of patient comorbidites using validated parameters is the key element for decision-making and parameters such as young age, low comorbidity profile, large aneurysm and presence of atopic renal arteries or a dominant inferior mesenteric artery should prompt a recommendation of open repair.
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Affiliation(s)
- Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Koln, Deutschland
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Koln, Deutschland
| | - Oroa Salem
- Department of Vascular and Endovascular Surgery, Uniklinik Köln, Köln, Deutschland
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Jungi S, Mylonas S, Ante M, Ahmad W, Meisenbacher K, Brunkwall J, Böckler D. Outcome after acute und subacute TEVAR in uncomplicated type B aortic dissection. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
In the past years, a paradigm shift from best medical therapy to early thoracic endovascular aortic repair (TEVAR) has been observed in the treatment of uncomplicated type B aortic dissection (uTBAD). We aimed to analyze outcomes after TEVAR in the acute and subacute phase of uTBAD, focusing on aortic remodeling.
Methods
Retrospective analysis of consecutive patients who underwent TEVAR for acute or subacute uTBAD in two tertiary referral centers from 2008 – 2017. Two assessors per center reviewed computed tomography scans of each patient at presentation, at one year and at the last follow-up using post-processing software.
Results
Forty-nine patients were treated with TEVAR for uTBAD. The indication for TEVAR was the presence of multiple morphologic predictors of adverse aortic outcome. The most common predictors were a false lumen diameter of > = 22mm in 76% of patients, a primary entry tear of > = 10mm in 69% and a total aortic diameter of > = 40mm in 67%. There were no in-hospital deaths and no deaths at 1 year. The median follow-up was 40.6 months. Three-year cumulative survival was 94 % (46/49). Fourteen secondary interventions were performed in 10 patients (20 %) after a median of 4.2 months. TEVAR lead to remodeling of the descending thoracic aorta with a median reduction of the total aortic diameter of 4.5 mm within one year and stable diameters after three years. The median maximum false lumen diameter diminished from 26 mm to 15 mm in one year (at 3 years: 14.8 mm).
Conclusion
In this cohort of selected patients with uTBAD and multiple morphologic predictors of worse aortic outcome, elective acute or subacute TEVAR was associated with a low mortality and positive aortic remodeling in the mid-term follow-up.
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Affiliation(s)
- S Jungi
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - S Mylonas
- Clinic and Polyclinic for Vascular Surgery, Vascular and Endovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - M Ante
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - W Ahmad
- Clinic and Polyclinic for Vascular Surgery, Vascular and Endovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - K Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J Brunkwall
- Clinic and Polyclinic for Vascular Surgery, Vascular and Endovascular Surgery, University Hospital Cologne, Cologne, Germany
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Ahmad W, Liakopoulos OJ, Mylonas S, Wegner M, Brunkwall J, Dorweiler B. Long-Term Outcomes after Thoracic Endovascular Aortic Repair Using Chimney Grafts for Aortic Arch Pathologies: 10 Years of Single-Center Experience. Ann Vasc Surg 2020; 72:400-408. [PMID: 32927039 DOI: 10.1016/j.avsg.2020.08.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study reports the early- and long-term outcomes of the thoracic endovascular aortic repair using the Chimney-Graft technique (ChTEVAR) for the treatment of aortic arch pathologies. METHODS From January 2010 to December 2019, patients who underwent aortic ChTEVAR technique in our institution were included. Early, mid, and long-term outcomes in this group of patients were evaluated. Patient follow-up data were obtained by imaging follow-up that are routinely performed after 3-6 months following initial surgery and then at yearly intervals. RESULTS Aortic arch repair with a ChTEVAR was performed in 54 patients. The 30-day mortality was 18.5% (n = 10). All-cause 30-day mortality was higher in the subgroup of patients operated urgently (33% vs. 14%) without a significant difference (P = 0.141). Permanent neurological deficit (PND) was observed in 15% (8/54 patients); stroke in 11% (6/54), and paraplegia 4% (2/54). During follow-up the primary and primary-assisted chimney-graft patency was 96.8% and 97.8%, respectively. The multivariate analysis identified the age >70 years and the aortic diameter as independent risk factors for elevated mortality during the follow-up (P = 0.015 and 0.001, respectively). The PND was an independent predictor for 30-day mortality (P = 0.014, hazard ratio 13.5, 95% confidence interval 1.7-106.6). CONCLUSIONS The ChTEVAR has noninferior results to other open and endovascular aortic arch repair methods with an acceptable long-term survival especially in elective procedures.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany.
| | - Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Moritz Wegner
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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Czerny M, Eggebrecht H, Rousseau H, Mouroz PR, Janosi RA, Lescan M, Schlensak C, Böckler D, Ante M, Weijde EV, Heijmen R, Eckstein HH, Reutersberg B, Trimarchi S, Schmidli J, Wyss T, Frey R, Makaloski V, Brunkwall J, Mylonas S, Szeberin Z, Klocker J, Gottardi R, Schusterova I, Morlock J, Berger T, Beyersdorf F, Rylski B. Distal Stent Graft-Induced New Entry After TEVAR or FET: Insights Into a New Disease From EuREC. Ann Thorac Surg 2020; 110:1494-1500. [PMID: 32283085 DOI: 10.1016/j.athoracsur.2020.02.079] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The study sought to learn about incidence and reasons for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair (TEVAR) or after frozen elephant trunk (FET) implantation, and develop prevention algorithms. METHODS In an analysis of an international multicenter registry (EuREC [European Registry of Endovascular Aortic Repair Complications] registry), we found 69 dSINE patients of 1430 (4.8%) TEVAR patients with type B aortic dissection and 6 dSINE patients of 100 (6%) patients after the FET procedure for aortic dissection with secondary morphological comparison. RESULTS The underlying aortic pathology was acute type B aortic dissection in 33 (44%) patients, subacute or chronic type B aortic dissection in 34 (45%) patients, acute type A aortic dissection in 3 patients and remaining dissection after type A repair in 3 (8%) patients, and acute type B intramural hematoma in 2 (3%) patients. dSINE occurred in 4.4% of patients in the acute setting and in 4.9% of patients in the subacute or chronic setting after TEVAR. After the FET procedure, dSINE occurred in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. The interval between TEVAR or FET and the diagnosis of dSINE was 489 ± 681 days. Follow-up after dSINE was 1340 ± 1151 days, and 4 (5%) patients developed recurrence of dSINE. Morphological analysis between patients after TEVAR with and without dSINE showed a smaller true lumen diameter, a more accentuated oval true lumen morphology, and a higher degree of stent graft oversizing in patients who developed dSINE. CONCLUSIONS dSINE after TEVAR or FET is not rare and occurs with similar incidence after acute and chronic aortic dissection (early and late). Avoiding oversizing in the acute and chronic settings as well as carefully selecting patients for TEVAR in postdissection aneurysmal formation will aid in reducing the incidence of dSINE to a minimum.
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Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany.
| | | | - Herve Rousseau
- Department of Radiology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Paul Revel Mouroz
- Department of Radiology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Rolf-Alexander Janosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany
| | - Mario Lescan
- Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Cardiothoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Dittmar Böckler
- Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Marius Ante
- Department of Vascular Surgery, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Emma Vdr Weijde
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Germany
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Germany
| | - Hans Henning Eckstein
- Munich Aortic Centre, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich Germany
| | - Benedikt Reutersberg
- Munich Aortic Centre, Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich Germany
| | - Santi Trimarchi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Romina Frey
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Zoltan Szeberin
- Department of Vascular Surgery, Semmelweis University, Budapest, Hungary
| | - Josef Klocker
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Gottardi
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | | | - Julia Morlock
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, Bad Krozingen, Germany
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Brunkwall JS, Vaquero-Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Calavia AR, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective Study of the Iliac Branch Device E-liac in Patients with Common Iliac Artery Aneurysms: 12 Month Results. Eur J Vasc Endovasc Surg 2019; 58:831-838. [DOI: 10.1016/j.ejvs.2019.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
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Ahmad W, Buse C, Kröger JR, Mylonas S, Majd P, Brunkwall S, Maintz D, Brunkwall JS. A Shorter Aortic Arch Sealing Ring (< 10 mm) Distal to the Most Distal Chimney Seems to Be an Additional Important Factor Contributing to a Gutter Endoleak in Aortic Arch TEVAR. Ann Vasc Surg 2019; 61:116-123. [PMID: 31394247 DOI: 10.1016/j.avsg.2019.05.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of the present study was to define the possible anatomical and technical parameter that might predict the occurrence of gutter endoleak or type Ia endoleak (EL Ia) in patients treated with the chimney graft (CG) technique for the brachiocephalic trunk (BCT) and left common carotid artery (LCCA) due to aortic arch pathologies. METHODS We reviewed our institutional endovascular aortic database of patients, who between 2010 and 2018 had undergone thoracic endovascular aortic repair (TEVAR) with chimney graft technique (ChTEVAR) as a debranching method of the supraaortic arteries. RESULTS ChTEVAR was performed in 45 patients of whom a chimney in both the LCCA and the BCT was used in 32 patients, only in the LCCA in twelve patients, and only in the BCT in one patient. Eight patients (17.8%) had an EL Ia (based on postoperative computed tomography angiography). No late EL Ia was detected during the follow-up period. All patients with a postoperative EL Ia received 2 CGs with one each for the BCT, and LCCA had either no or a sealing ring distal to the most distal chimney of less than 10 mm versus patients with a longer sealing zone (P = 0.043). Patients with an endoleak did not differ from those without endoleak with respect to stent-graft oversizing, the diameter of the proximal and distal landing zones, or the aortic diameter directly proximal to the pathology. CONCLUSIONS A sealing ring distal to the most distal chimney of more than 10 mm seems to be associated with a reduced risk of an EL Ia. The relatively few patients and the single-center nature require larger studies to verify the present results.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany.
| | - Christian Buse
- Faculty of Medicine, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jan Robert Kröger
- Department of Radiology, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Payman Majd
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Silke Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - David Maintz
- Chairman, Department of Radiology, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jan Sigge Brunkwall
- Chairman, Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
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Galas N, Becker I, Ficon T, Sakrauski M, Reichert R, Ahmad W, Mylonas S, Brunkwall J, Majd P. Prescription rate of anti-atherosclerotic drugs in German nursing homes and its impact on outcome. VASA 2018; 48:158-166. [PMID: 30376415 DOI: 10.1024/0301-1526/a000754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) is one of the major manifestations of general atherosclerosis and strongly associated with increased cardiovascular morbidity and mortality. Because only few epidemiologic studies are available concerning the prevalence of PAD in inhabitants ≥ 80 years of age, we screened inhabitants of nursing care homes in Germany for PAD and cardiovascular diseases and to assess the one year mortality. PATIENTS AND METHODS We conducted a prospective cohort study, screening inhabitants of 42 nursing homes for PAD. Demographic data, comorbidities, cardiovascular risk factors and daily medication were collected. PAD was defined as ankle-brachial index < 0.9. During a follow up period of one year, cardio- and cerebrovascular events and mortality were recorded, as well as the rate of falls and major amputation. RESULTS 1,329 probands (391 men, 938 women) > 60 years were eligible for further analysis. The mean age was 84.1 years (range 61-107 years) and the prevalence of PAD was 31.5 % . Media sclerosis was found in up to 17 %, and an existing diagnosis of PAD (in case of pathological ABI) and undertreatment was common. Probands with PAD were less likely to be treated according to guideline recommendations (antiplatelet therapy, beta blockers, statins) than probands with coronary artery disease (CAD). The overall one-year mortality was 19.8 % (n = 236), significantly higher than for a gender and age matched German population (p < 0.001). CONCLUSIONS The current study shows a high prevalence of PAD in German nursing care homes. The one year mortality was not significantly different between probands with PAD and those with severe PAD (defined as an ABI of ≤ 0.5), whereas a media sclerosis was associated with an increased risk in probands with CAD in comparison to those without. Use of anti-diabetic agents and aspirin in monotherapy was associated with a reduced one-year mortality risk.
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Affiliation(s)
- Noemi Galas
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Ingrid Becker
- 2 Institute for statistics and epidemiology, Mathematician University of Cologne, Cologne, Germany
| | | | | | | | - Wael Ahmad
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.,3 University of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Payman Majd
- 1 Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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13
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Ante M, Mylonas S, Skrypnik D, Bischoff MS, Rengier F, Brunkwall J, Böckler D. Prevalence of the Computed Tomographic Morphological DISSECT Predictors in Uncomplicated Stanford Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 56:525-533. [DOI: 10.1016/j.ejvs.2018.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
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14
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Brunkwall J, Vaquero Puerta C, Heckenkamp J, Egaña Barrenechea JM, Szopinski P, Mertikian G, Seifert S, Rümenapf G, Buz S, Assadian A, Majd P, Mylonas S, Revilla Calavia A, Theis T, de Blas Bravo M, Pleban E, Schupp J, Esche M, Kocaer C, Hirsch K, Oberhuber A, Schäfer JP. Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results. Vascular 2018; 26:647-656. [PMID: 30037302 DOI: 10.1177/1708538118789510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. METHODS A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. RESULTS Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53-90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. CONCLUSIONS The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.
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Affiliation(s)
- Jan Brunkwall
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Joerg Heckenkamp
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | | | - Piotr Szopinski
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Gerard Mertikian
- 6 Department of Interventional Radiology, Hietzing Hospital, Vienna, Austria
| | - Sven Seifert
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Gerhard Rümenapf
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | - Semih Buz
- 9 Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Payman Majd
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | - Spyridon Mylonas
- 1 Clinic of Vascular and Endovascular Surgery, University Clinic of Cologne, Cologne, Germany
| | | | - Thorsten Theis
- 3 Department of Vascular and Endovascular Surgery, Marienhospital, Osnabrück, Germany
| | - Mariano de Blas Bravo
- 4 Department of Vascular Surgery, Donostia University Hospital, San Sebastián, Spain
| | - Eliza Pleban
- 5 Clinic of Vascular Surgery, Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Jasper Schupp
- 11 Department of Radiology, University of Kiel, Kiel, Germany
| | - Mirko Esche
- 7 Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Germany
| | - Cetin Kocaer
- 8 Department of Vascular Surgery, Diakonissen Speyer-Mannheim Hospital, Speyer, Germany
| | | | - Alexander Oberhuber
- 12 Department of Vascular and Endovascular Surgery, University of Düsseldorf, Germany
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Abstract
Vascular malformations are congenital vascular anomalies with normal endothelial turnover, which can affect the whole vessel tree (arterial, capillary or lymphatic) both as isolated defects or as part of a syndrome. Developmental errors during embryogenesis, such as abnormal signaling processes that control the apoptosis, maturation and growth of vascular cells, lead to the persistence of vascular plexus cells with some degree of differentiation. Vascular malformations are usually present at birth, although symptoms or complications may be manifested later. Since the overwhelming majority are symptomatic, treatment is indicated which is often aimed only at improving the symptoms by controlling the size.
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Affiliation(s)
- S Mylonas
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - S Brunkwall
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - J Brunkwall
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Mylonas S, Brunkwall S, Brunkwall J. [Vascular anomalies. Part I: vascular tumors]. Chirurg 2017; 89:245-254. [PMID: 29189879 DOI: 10.1007/s00104-017-0557-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vascular anomalies represent a spectrum of structural disorders and inborn errors of vascular morphogenesis, which may affect the entire arterial and venous vascular tree. They are divided into two major categories: tumors, which exhibit endothelial hyperplasia and malformations, which have normal endothelial turnover unless disturbed. Depending on their nature and complexity they can range from a simple "birthmark" to life-threatening entities. The relatively low incidence (4-10%) of vascular anomalies among the general population combined with the fact that their management often falls within the purview of several different medical and surgical specialties, has traditionally resulted in insufficient expertise in the management of these conditions. Therefore, accurate identification, a uniform nomenclature and a multidisciplinary approach are paramount for correct management.
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Affiliation(s)
- S Mylonas
- Klinik und Poliklinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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17
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Shahverdyan R, Mylonas S, Gawenda M, Brunkwall J. Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches. Vascular 2017; 26:175-182. [DOI: 10.1177/1708538117723200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0–56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan–Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.
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Affiliation(s)
- Robert Shahverdyan
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Spyridon Mylonas
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Michael Gawenda
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Jan Brunkwall
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
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18
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Kotsis T, Mylonas S, Katsenis K, Arapoglou V, Dimakakos P. Abdominal Aortic Aneurysm With Ectopic Renal Artery Origins: A Case Report. Vasc Endovascular Surg 2016; 41:463-6. [DOI: 10.1177/1538574407303179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The coexistense of an abdominal aortic aneurysm with ectopic main renal vasculature complicates aortic surgery and mandates a focused imaging evaluation and a carefully planned operation to minimize renal ischemia. We present the case of a 75-year-old man with an abdominal aortic aneurysm and a right kidney with two ectopic main renal arteries, one originating from the aneurysmal distal aorta and the other from the right common iliac artery; the patient underwent a surgical repair and followed an uneventful course with no deterioration of renal function. The preoperative and intraoperative details are reported, along with a review of the literature.
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Affiliation(s)
- T. Kotsis
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece,
| | - S. Mylonas
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece
| | - K. Katsenis
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece
| | - V. Arapoglou
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece
| | - P. Dimakakos
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece
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Majd P, Mylonas S, Gawenda M, Brunkwall J. External Validation of Risk Stratification Models Predicting the Immediate Mortality After Open Repair of Ruptured AAA. World J Surg 2016; 40:1771-7. [PMID: 26913734 DOI: 10.1007/s00268-016-3461-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preoperative risk stratification of the immediate postoperative death after surgery may be helpful for the decision-making for patients with ruptured AAAs (rAAs). The purpose of this study was to apply and validate the Glasgow aneurysm score (GAS) and the Hardman Index (HI) in predicting 30-day/in-hospital mortality in open surgical repair (OSR) and endovascular repair (rEVAR) of rAAAs. METHODS We conducted a retrospective review of a prospectively created database including all patients with a rAAA referred to our Institution between August 1998 and December 2014. Primary outcome was 30-day/in-hospital mortality. Multivariate logistic regression analysis was used to identify independent risk factors. The receiver-operator characteristic curve was used to determine the value of the HI and GAS in predicting 30-day/in-hospital death. RESULTS A total of 150 patients (130 patients received OSR, 20 patients rEVAR) were included in our analysis. The 30-day/in-hospital mortality was 34.0 % for the entire cohort: 36.15 % for OSR group and 20.0 % for rEVAR group (p 0.210). A multivariate analysis in the OSR group evidenced that unconsciousness was a statistically significant [adjusted odds ratio (OR) 8.00] predictor of 30-day/in-hospital mortality. The mean GAS was 86.9 ± 16.1 for the OSR group and 88.1 ± 11.2 for the rEVAR group (p 0.773). The AUC for GAS was 0.805 among OSR patients and 0.975 among rEVAR patients. The mean HI in the OSR group was 1.11 ± 1.0 and the AUC for HI was 0.82. CONCLUSIONS Surgical repair of rAAAs is still associated with a considerable mortality rate. We confirmed the great discriminative ability of GAS in patients with rAAAs treated with OSR. With regard to HI, this scoring system could accurately predict early mortality after OSR in our cohort but failed to identify patients at highest risk for postoperative mortality.
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Affiliation(s)
- Payman Majd
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Michael Gawenda
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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Kotsis T, Louizos LA, Mylonas S, Pappas E, Despoina K, Plemenou Matrona F. Rapid diameter expansion of aortic aneurysm after human immunodeficiency virus infection. VASA 2015; 44:387-90. [PMID: 26317259 DOI: 10.1024/0301-1526/a000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brunkwall S, Ahmad W, Mylonas S, Sharkawy M, Wippermann J, Brunkwall J. The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR. J Endovasc Ther 2015; 22:934-7. [PMID: 26394811 DOI: 10.1177/1526602815607441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment. CASE REPORT A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak. CONCLUSION A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.
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Affiliation(s)
- Silke Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Mohamed Sharkawy
- Department of Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo, Egypt
| | - Jens Wippermann
- Department of Cardiovascular Surgery, University of Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
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Kotsis T, Pappas E, Sarmas G, Basilopoulou S, Hatzioannou A, Theodoraki K, Mylonas S, Speggos K. Carotid endarterectomy in a young symptomatic patient with B-thalassemia major. Ann Vasc Surg 2015; 29:838.e1-5. [PMID: 25681635 DOI: 10.1016/j.avsg.2014.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/09/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
β-Thalassemia major promotes atherosclerotic process, although the debating literature concerning the lipidic profile of young patients; it is well accepted that there is early vascular destruction in these homozygous patients either as a direct consequence of the genetic disorder per se or because of the repeated transfusions and the iron overload. Despite the potential of the disease for local brain thrombotic events, accelerated atheromatosis can lead to early thromboembolic events. We present an interesting case of a 36-year-old man with unilateral embolic infarcts (repeated transient ischemic attacks) originated from a near occlusion right carotid stenosis with additional peripheral thrombus. The patient underwent a successful carotid endarterectomy with primary arterial closure with uneventful postoperative course, confirmed by a clear postoperative angiography; he remains asymptomatic 18 months later. To the best of our knowledge, this is the first case of a young symptomatic patient with β-thalassemia major who underwent carotid repair.
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Affiliation(s)
- Thomas Kotsis
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece.
| | - Evangelos Pappas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
| | - Georgios Sarmas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
| | | | - Achilles Hatzioannou
- 1st Laboratory of Radiology, Aretaieion Hospital, Medical School, University of Athens, Greece
| | - Kassiani Theodoraki
- 1st Clinic of Anaesthesiology, Aretaieion Hospital, Medical School, University of Athens, Greece
| | - Spyridon Mylonas
- Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital Medical School, University of Athens, Greece
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Moulakakis KG, Dalainas I, Kakisis J, Mylonas S, Liapis CD. Endovascular Treatment versus Open Repair for Abdominal Aortic Aneurysms: The Influence of Fitness in Decision Making. Int J Angiol 2014; 22:9-12. [PMID: 24436578 DOI: 10.1055/s-0033-1333868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm repair and endovascular aneurysm repair (EVAR). The decision making depends on the balance of risks and benefits. The treating physician must take into account the patient's life expectancy, the patient's fitness, the anatomic suitability that makes endovascular repair possible, and finally the patient's preference. The patient's fitness is an important variable predicting the outcome of AAA surgical reconstruction. The hypothesis is that the impact of risk factors upon perioperative mortality might differ between patients undergoing open repair and endovascular repair. The purpose of this review article is to investigate whether fitter patients with a large AAA benefit more from having endovascular rather than open repair. According to the available data, there is emerging evidence that patients at high medical risk for open repair may benefit from EVAR while in low risk patients with suitable anatomy for EVAR, both techniques have similar effects. There is rising evidence that a patient with ruptured AAA would benefit more from an endovascular procedure if eligible, and thus fitness in such emergencies is not the first priority but anatomical suitability for EVAR.
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Affiliation(s)
| | - Ilias Dalainas
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - Spyridon Mylonas
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
| | - Christos D Liapis
- Department of Vascular Surgery, "Attikon" University Hospital, Athens, Greece
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Raptis A, Antonopoulos C, Kakisis J, Blann A, Kavalieratos G, Mantas G, Mylonas S, Markatis F, Papasideris C, Liapis C. C0410: Hemostatic Derangements in Patients Undergoing Open and Endovascular Repair of Abdominal Aortic Aneurysms. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50365-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kouzelis A, Kravvas A, Mylonas S, Giannikas D, Panagopoulos A. Double axis cephalocondylic fixation of stable and unstable intertrochanteric fractures: early results in 60 cases with the veronail system. Open Orthop J 2014; 8:60-8. [PMID: 24851139 PMCID: PMC4026756 DOI: 10.2174/1874325001408010060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 04/01/2014] [Accepted: 04/06/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This prospective case-series, without control group, study presents our early experience in the treatment of both stable and unstable peri-trochanteric fractures with a new cephalocondylic implant; the Veronail system. MATERIALS & METHODS Enrolment in our study was from January 2008 through September 2009, with follow-up until October 2011 (at least 1 year). During this period 65 consecutively patients with a fracture in the trochanteric region of the femur (31.A1, A2 and A3 according to AO classification) were surgically managed and prospectively followed up for at least one year. Average age was 78 years old (range 42 to 93) with 40 female and 25 male patients. All patients were surgically treated using the Veronail system. Demographic and nursery data such as pre-existing illness, previous ambulatory status, type of anaesthesia, duration of surgery, volume of blood loss, transfusions, length of hospital stay, time to union and overall complications were systematically recorded and analysed. RESULTS Mean follow up was 17 months (range, 12 to 23 months). Radiological evaluation was performed at 1, 3, 6 and 12 months postoperatively, as well as at the last follow up visit. Clinical outcome was assessed using the parameters of Harris Hip score. Solid union was achieved in 57/60 patients (95%) at a mean time of 12.5 weeks. Two fractures did not progress to union. There were 3 superficial infections and 1 deep infection; all were successfully managed with appropriate antibiotic treatment. The Harris hip score at the last follow up visit was excellent or good in 46 (77%) of the patients. CONCLUSIONS In the face of the good clinical and radiological results we consider the Veronail system to be of particular interest and perfectly adapted in primary surgery for both elderly and young patients.
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Affiliation(s)
- Alpha Kouzelis
- Orthopaedic Department, University Hospital of Patras, GR, Papanikolaou str 26504 Rio, Patras, Greece
| | - A Kravvas
- Orthopaedic Department, University Hospital of Patras, GR, Papanikolaou str 26504 Rio, Patras, Greece
| | - S Mylonas
- Orthopaedic Department, University Hospital of Patras, GR, Papanikolaou str 26504 Rio, Patras, Greece
| | - D Giannikas
- Orthopaedic Department, University Hospital of Patras, GR, Papanikolaou str 26504 Rio, Patras, Greece
| | - A Panagopoulos
- Orthopaedic Department, University Hospital of Patras, GR, Papanikolaou str 26504 Rio, Patras, Greece
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Kotsis T, Moulakakis KG, Mylonas S, Andrikopoulos V. Vascular manifestations of Behcet's disease: report of a case and review of the literature. Phlebology 2011; 26:249-53. [PMID: 21478143 DOI: 10.1258/phleb.2010.010024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Adamantiades-Behçet's disease (ABD) is a relapsing vasculitis of unknown aetiology and variable clinical manifestations. The syndrome can be presented in a myriad of ways and can involve nearly every organ. Although vascular involvement is not included among the ABD diagnostic criteria, it is a unique clinical manifestation in adults with a potentially devastating outcome. We report an ABD case, presenting with a thrombotic occlusion of the inferior vena cava. The authors review the recent literature, emphasizing the spectrum of vascular manifestations accompanying Behçet's disease.
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Affiliation(s)
- T Kotsis
- Department of Vascular Surgery, 'Red Cross' General Hospital, Andrea Papandreou 132 Street, Glyfada, Athens 16561, Greece
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Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther 2011; 17:694-702. [PMID: 21142475 DOI: 10.1583/1545-1550-17.6.694] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To review the incidence, causes, and mortality rates of early and late conversion to open surgery after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS A systematic search of the English-language literature from 2002 to 2009 was performed by interrogation of the PubMed, MEDLINE, and EMBASE databases. Studies were included if they: (1) had >100 patients treated with EVAR and (2) provided adequate data to calculate incidence and associated mortality rates. The search yielded 13 articles with sufficient data to analyze early conversion (12,236 patients, 178 conversions) and 15 articles with available data for late conversion (14,298 patients, 279 conversions). RESULTS The rate of early conversion among the 13 articles reviewed ranged from 0.8% to 5.9%; more recent studies carried lower rates of early conversion. Mortality rates of early conversion varied between 0% and 28.5%. Overall, there were 178 (1.5%) early conversions among the 12,236 AAAs treated with EVAR, with an average mortality of 12.4%. The rates of late conversion ranged from 0.4% to 22%. Of the 14,289 AAA patients undergoing endovascular repair, 279 (1.9%) required late conversion; the mortality rate was 10%. CONCLUSION Though the incidence is gradually declining, secondary interventions persist as the Achilles' heel of EVAR. A lifelong follow-up strategy for AAA patients treated with EVAR is essential for early detection and treatment of complications of the procedure. Vascular surgeons should be familiar with the complex open conversion procedures.
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Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
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Moulakakis K, Mylonas S, Avgerinos E, Kotsis T, Liapis C. An Update of the Role of Endovascular Repair in Blunt Carotid Artery Trauma. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moulakakis KG, Mylonas S, Avgerinos E, Kotsis T, Liapis CD. An update of the role of endovascular repair in blunt carotid artery trauma. Eur J Vasc Endovasc Surg 2010; 40:312-9. [PMID: 20573526 DOI: 10.1016/j.ejvs.2010.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 05/11/2010] [Indexed: 12/26/2022]
Abstract
Blunt carotid injury (BCAI) is an increasingly recognised entity in trauma patients. Without a prompt diagnosis and a proper treatment, they can result in devastating consequences with cerebral ischaemia rate of 40-80% and mortality rate of 25-60%. Several applied screening protocols and continuously improving diagnostic modalities have been developed to identify patients with BCAI. The appropriate treatment of BCAI still remains controversial and strictly individualised. Besides anti-thrombotic/anticoagulation therapy and surgical intervention, continuously evolving endovascular techniques emerge as an additional treatment option for patients with BCAI. We provide an update on blunt carotid trauma, emphasising the role of endovascular approaches.
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Affiliation(s)
- K G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
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Kotsis T, Kontis J, Mylonas S, Kottis G. Simultaneous open abdominal aortic aneurysm repair and typical right hepatectomy due to hydatid liver disease: a case report. Acta Chir Belg 2009; 109:260-1. [PMID: 19499697 DOI: 10.1080/00015458.2009.11680421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dimakakos EP, Katsenis K, Kalemikerakis J, Arkadopoulos N, Mylonas S, Arapoglou V, Tsiganis T, Kotis T. Infected Venous Leg Ulcers: Management With Silver-releasing Foam Dressing . Wounds 2009; 21:4-8. [PMID: 25904580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this work was to study the safety and effectiveness of silver foam dressing (Contreet® Ag, Coloplast, Humlebaek, Denmark) in promoting the healing of infected venous ulcers over 9 weeks of treatment. Forty-two patients with infected venous ulcers were included and randomized into two groups. Group A had 21 patients (12 women and 9 men, mean age 61.2 years) who were treated with the silver foam for 9 weeks. Group B also had 21 patients (14 women and 7 men, mean age 58.7 years) who were treated with a nonadhesive foam (Biatain®, Coloplast, Humlebaek, Denmark) for 9 weeks. In both groups, ulcer size and depth, intensity of pain, wound exudation, bacterial load, side effects of both materials, and ulcer healing were documented and compared. There was no significant difference at the initial assessment in both groups regarding ulcer size, ulcer depth, grade of exudation, pain intensity, or bacterial load. However, group A ulcers had a significantly greater healing (P = 0.02) compared to group B. Pain intensity was significantly less in group A patients at several time points. After 9 weeks of treatment, the silver foam dressing was found to be a safe material that promotes rapid healing of venous ulcers and relieves pain. .
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Kotsis T, Mylonas S, Katsenis K, Arapoglou V, Dimakakos P. External iliac venous aneurysm treated with tangential aneurysmatectomy and lateral venorrhaphy: a case report and review of the literature. Vasc Endovascular Surg 2008; 42:615-9. [PMID: 18662910 DOI: 10.1177/1538574408320171] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Venous aneurysms of the femoro-iliac axis are uncommon abnormalities of the vascular system with a potentially life-threatening course; they can be associated with the disastrous events of thromboembolism or rupture. Therefore, a focused imaging evaluation and prophylactic treatment is essential. The appropriate surgical approach is, however, dictated by the morphological parameters and the extent of the aneurysm. We present an external iliac venous aneurysm in a 31-year-old woman that was revealed incidentally and treated successfully by tangential aneurysmectomy and lateral venorrhaphy. The choice of surgical technique is discussed along with a review of the literature on venous aneurysms.
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Affiliation(s)
- Thomas Kotsis
- Vascular Unit, 2nd Clinic of Surgery, University of Athens, Aretaieion Hospital, Athens, Greece.
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Mylonas S, Valavanidis A, Dimitropoulos K, Polissiou M, Tsiftsoglou AS, Vizirianakis IS. Synthesis, molecular structure determination, and antitumor activity of platinum(II) and palladium(II) complexes of 2-substituted benzimidazole. J Inorg Biochem 1988; 34:265-75. [PMID: 3253411 DOI: 10.1016/0162-0134(88)83004-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The complexes of 2-aminomethyl benzimidazole, 2-(beta-aminoethyl)benzimidazole, and 2-(alpha-aminoethy-l)benzimidazole with Pt(II) and Pd(II) have been prepared. The molecular structure of the free ligands and their complexes were studied by IR and 1H NMR. It was concluded that the substituted benzimidazole derivatives behave as bidentate ligands, being bound to the metal atoms via the nitrogen of the -N = group and the amino group of the side chain of the benzimidazole ring. The metal complexes were tested for antineoplastic activity both in cultures of neoplastic cells (MEL-745, K-562, Colon 205, IMP-32, SK-N-SH) and in vivo in rodents bearing L-1210 leukemia. The antiproliferative activity of these agents was compared to that of cis-platin.
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Affiliation(s)
- S Mylonas
- Department of Chemistry, University of Athens, Greece
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