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van Veldhuizen WA, de Vries JPPM, Tuinstra A, Zuidema R, IJpma FFA, Wolterink JM, Schuurmann RCL. Machine Learning Based Prediction of Post-operative Infrarenal Endograft Apposition for Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00567-7. [PMID: 38972630 DOI: 10.1016/j.ejvs.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/09/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Challenging infrarenal aortic neck characteristics have been associated with an increased risk of type Ia endoleak after endovascular aneurysm repair (EVAR). Short apposition (< 10 mm circumferential shortest apposition length [SAL]) on the first post-operative computed tomography angiography (CTA) has been associated with type Ia endoleak. Therefore, this study aimed to develop a model to predict post-operative SAL in patients with an abdominal aortic aneurysm based on the pre-operative shape. METHODS A statistical shape model was developed to obtain principal component scores. The dataset comprised patients treated by standard EVAR without complications (n = 93) enriched with patients with a late type Ia endoleak (n = 54). The infrarenal SAL was obtained from the first post-operative CTA and subsequently binarised (< 10 mm and ≥ 10 mm). The principal component scores that were statistically different between the SAL groups were used as input for five classification models, and evaluated by means of leave one out cross validation. Area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity were determined for each classification model. RESULTS Of the 147 patients, 24 patients had an infrarenal SAL < 10 mm and 123 patients had a SAL ≥ 10 mm. The gradient boosting model resulted in the highest AUC of 0.77. Using this model, 114 patients (77.6%) were correctly classified; sensitivity (< 10 mm apposition was correctly predicted) and specificity (≥ 10 mm apposition was correctly predicted) were 0.70 and 0.79 based on a threshold of 0.21, respectively. CONCLUSION A model was developed to predict which patients undergoing EVAR will achieve sufficient graft apposition (≥ 10 mm) in the infrarenal aortic neck based on a statistical shape model of pre-operative CTA data. This model can help vascular specialists during the planning phase to accurately identify patients who are unlikely to achieve sufficient apposition after standard EVAR.
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Affiliation(s)
- Willemina A van Veldhuizen
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Annemarij Tuinstra
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Roy Zuidema
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, Division of Trauma Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands; Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Sirignano P, Piffaretti G, Ceruti S, Orso M, Picozzi M, Ricci G, Sirignano A, Taurino M. Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:273-279. [PMID: 38319647 DOI: 10.23736/s0021-9509.23.12906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Società Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS A questionnaire consisting of 26 statements was developed, validated by an 18-member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when ≥70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS Two-hundred-forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first-round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital, Rome, Italy -
- Department of General and Specialistic Surgery, Sapienza University, Rome, Italy -
| | - Gabriele Piffaretti
- Vascular Surgery, ASST Settelaghi University Teaching Hospital, Varese, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Silvia Ceruti
- Research Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Massimiliano Orso
- Istituto Zooprofilattico Sperimentale dell'Umbria e delle Marche "Togo Rosati", Perugia, Italy
| | - Mario Picozzi
- Research Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Giovanna Ricci
- School of Civil Law, University of Camerino, Camerino, Macerata, Italy
| | - Ascanio Sirignano
- School of Civil Law, University of Camerino, Camerino, Macerata, Italy
| | - Maurizio Taurino
- Vascular and Endovascular Surgery Unit, Sant'Andrea Hospital, Rome, Italy
- Department of Molecular and Clinical Medicine, Sapienza University, Rome, Italy
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van Veldhuizen WA, Schuurmann RCL, Zuidema R, Geraedts ACM, IJpma FFA, Kropman RHJ, Antoniou GA, van Sambeek MRHM, Balm R, Wolterink JM, de Vries JPPM. A Statistical Shape Model of Infrarenal Aortic Necks in Patients With and Without Late Type Ia Endoleak After Endovascular Aneurysm Repair. J Endovasc Ther 2023:15266028221149913. [PMID: 36647185 DOI: 10.1177/15266028221149913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Hostile aortic neck characteristics, including short length, severe suprarenal and infrarenal angulation, conicity, and large diameter, have been associated with increased risk for type Ia endoleak (T1aEL) after endovascular aneurysm repair (EVAR). This study investigates the mid-term discriminative ability of a statistical shape model (SSM) of the infrarenal aortic neck morphology compared with or in combination with conventional measurements in patients who developed T1aEL post-EVAR. MATERIALS AND METHODS The dataset composed of EVAR patients who developed a T1aEL during follow-up and a control group without T1aEL. Principal component (PC) analysis was performed using a parametrization to create an SSM. Three logistic regression models were created. To discriminate between patients with and without T1aEL, sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were calculated. RESULTS In total, 126 patients (84% male) were included. Median follow-up time in T1aEl group and control group was 52 (31, 78.5) and 51 (40, 62.5) months, respectively. Median follow-up time was not statistically different between the groups (p=0.72). A statistically significant difference between the median PC scores of the T1aEL and control groups was found for the first, eighth, and ninth PC. Sensitivity, specificity, and AUC values for the SSM-based versus the conventional measurements-based logistic regression models were 79%, 70%, and 0.82 versus 74%, 73%, and 0.85, respectively. The model of the SSM and conventional measurements combined resulted in sensitivity, specificity, and AUC of 81%, 81%, and 0.92. CONCLUSION An SSM of the infrarenal aortic neck determines its 3-dimensional geometry. The SSM is a potential valuable tool for risk stratification and T1aEL prediction in EVAR. The SSM complements the conventional measurements of the individual preoperative infrarenal aortic neck geometry by increasing the predictive value for late type Ia endoleak after standard EVAR. CLINICAL IMPACT A statistical shape model (SSM) determines the 3-dimensional geometry of the infrarenal aortic neck. The SSM complements the conventional measurements of the individual pre-operative infrarenal aortic neck geometry by increasing the predictive value for late type Ia endoleaks post-EVAR. The SSM is a potential valuable tool for risk stratification and late T1aEL prediction in EVAR and it is a first step toward implementation of a treatment planning support tool in daily clinical practice.
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Affiliation(s)
- Willemina A van Veldhuizen
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Multi-Modality Medical Imaging (M3I) Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Roy Zuidema
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna C M Geraedts
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank F A IJpma
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Rogier H J Kropman
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | | | - Ron Balm
- Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
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Cuozzo S, Martinelli O, Brizzi V, Miceli F, Flora F, Sbarigia E, Gattuso R. Early Experience with Ovation Alto Stent-Graft. Ann Vasc Surg 2022; 88:346-353. [PMID: 36058461 DOI: 10.1016/j.avsg.2022.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Alto is the latest generation of the Ovation stent-graft platform for endovascular aneurysm repair (EVAR). Its ultra-low profile and its proximal sealing zone close to the lowest renal artery (≥7 mm), increase standard EVAR eligibility. We report early clinical and technical outcomes with the Alto stent-graft in our University Hospital Center, after CE Mark approval in August 2020. METHODS Seven patients (all male, mean age 76,1±6.2 years) underwent EVAR with Ovation Alto stent-graft between June 2021 and February 2022. All the EVAR procedures were performed by a team of vascular surgeons experienced on EVAR with previous generation of Ovation platform. Follow-up consisted of duplex ultrasounds examination (DUS) at 1, 3 and 6 months and of a 1-month control computed tomography angiography (CTA). Patients treated gave consent to participate in this case series and publication. A descriptive analysis of variables was performed. SPSS (Version 25; SPSS Inc, Chicago, IL, USA) and Excel (Microsoft Corporation, Redmond, WA, USA) were used for statistical analysis. RESULTS Most of patients had a fusiform AAA (n = 5; 71,4%). The median maximal transversal aortic diameter (DT) was 5,06 cm (range, 3,98 - 6,99). Due to hostile aortic neck anatomy, on-label EVAR was considered feasible only with Ovation Alto stent-graft. Narrow iliac arteries (<6 mm) were also present in 2 cases. All procedures were performed according to the instruction for use (IFU) of the device. Technical success was achieved in all cases. No type IA/IB/III endoleak occurred at completion angiography. No distal migration (>10 mm), but two distal displacements (≥ 2 mm) were observed at control CTA. During follow-up, DUS and CTA showed no type I/III endoleak, no stent-graft migration (>10 mm), and no proximal aortic neck variations (p=ns). 3 patients (42.8%) are under strict surveillance because of low-flow type II endoleak not associated with sac variations. CONCLUSION Our early experience shows promising technical and clinical success with Alto stent-graft. The proximal relocation of the proximal sealing rings and the ultra-low profile delivery system allow on-label EVAR in a wider range of aortic anatomies. Notwithstanding, further studies, metanalysis and prospective registries are mandatory to evaluate mid and long-term efficacy and safety of this latest Ovation platform.
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Affiliation(s)
- Simone Cuozzo
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy.
| | - Ombretta Martinelli
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Vincenzo Brizzi
- Vascular Surgery Department, CHU de Bordeaux, Bordeaux - France
| | - Francesca Miceli
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Federico Flora
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Enrico Sbarigia
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
| | - Roberto Gattuso
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I - "La Sapienza" University of Rome, Rome - Italy
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Is Evar Feasible in Challenging Aortic Neck Anatomies? A Technical Review and Ethical Discussion. J Clin Med 2022; 11:jcm11154460. [PMID: 35956076 PMCID: PMC9369586 DOI: 10.3390/jcm11154460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/12/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Endovascular aneurysm repair (EVAR) has become an accepted alternative to open repair (OR) for the treatment of abdominal aortic aneurysm (AAA) despite “hostile” anatomies that may reduce its effectiveness. Guidelines suggest refraining from EVAR in such circumstances, but in clinical practice, up to 44% of EVAR procedures are performed using stent grafts outside their instruction for use (IFU), with acceptable outcomes. Starting from this “inconsistency” between clinical practice and guidelines, the aim of this contribution is to report the technical results of the use of EVAR in challenging anatomies as well as the ethical aspects to identify the criteria by which the “best interest” of the patient can be set. Materials and Methods: A literature review on currently available evidence on standard EVAR using commercially available endografts in patients with hostile aortic neck anatomies was conducted. Medline using the PubMed interface and The Cochrane Library databases were searched from 1 January 2000 to 6 May 2021, considering the following outcomes: technical success; need for additional procedures; conversion to OR; reintervention; migration; the presence of type I endoleaks; AAA-related mortality rate. Results: A total of 52 publications were selected by the investigators for a detailed review. All studies were either prospective or retrospective observational studies reporting the immediate, 30-day, and/or follow-up outcomes of standard EVAR procedures in patients with challenging neck anatomies. No randomized trials were identified. Fourteen different endo-grafts systems were used in the selected studies. A total of 45 studies reported a technical success rate ranging from 93 to 100%, and 42 the need for additional procedures (mean value of 9.04%). Results at 30 days: the incidence rate of type Ia endoleak was reported by 37 studies with a mean value of 2.65%; 31 studies reported a null migration rate and 32 a null conversion rate to OR; in 31 of the 35 studies that reported AAA-related mortality, the incidence was null. Mid-term follow-up: the incidence rate of type Ia endoleak was reported by 48 studies with a mean value of 6.65%; 30 studies reported a null migration rate, 33 a null conversion rate to OR, and 28 of the 45 studies reported that the AAA-related mortality incidence was null. Conclusions: Based on the present analysis, EVAR appears to be a safe and effective procedure—and therefore recommendable—even in the presence of hostile anatomies, in patients deemed unfit for OR. However, in order to identify and pursue the patient’s best interest, particular attention must be paid to the management of the patient’s informed consent process, which—in addition to being an essential ethical-legal requirement to legitimize the medical act—ensures that clinical data can be integrated with the patient’s personal preferences and background, beyond the therapeutic potential of the proposed procedures and what is generically stated in the guidelines.
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A Statistical Shape Model of the Morphological Variation of the Infrarenal Abdominal Aortic Aneurysm Neck. J Clin Med 2022; 11:jcm11061687. [PMID: 35330011 PMCID: PMC8948978 DOI: 10.3390/jcm11061687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Hostile aortic neck characteristics, such as short length and large diameter, have been associated with type Ia endoleaks and reintervention after endovascular aneurysm repair (EVAR). However, such characteristics partially describe the complex aortic neck morphology. A more comprehensive quantitative description of 3D neck shape might lead to new insights into the relationship between aortic neck morphology and EVAR outcomes in individual patients. This study identifies the 3D morphological shape components that describe the infrarenal aortic neck through a statistical shape model (SSM). Pre-EVAR CT scans of 97 patients were used to develop the SSM. Parameterization of the morphology was based on the center lumen line reconstruction, a triangular surface mesh of the aortic lumen, 3D coordinates of the renal arteries, and the distal end of the aortic neck. A principal component analysis of the parametrization of the aortic neck coordinates was used as input for the SSM. The SSM consisted of 96 principal components (PCs) that each described a unique shape feature. The first five PCs represented 95% of the total morphological variation in the dataset. The SSM is an objective model that provides a quantitative description of the neck morphology of an individual patient.
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Schoretsanitis N, Georgakarakos E, Argyriou C, Lazarides M, Ktenidis K, Papanas N, Deftereos S, Georgiadis GS. The Incraft stent graft for the treatment of abdominal aortic aneurysms: an iliac-friendly device with an effective conventional proximal sealing mechanism. Expert Rev Med Devices 2021; 19:37-41. [PMID: 34937480 DOI: 10.1080/17434440.2022.2020096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The Incraft aortic stent graft (Cordis, Bridgewater, NJ, USA) is a trimodular endovascular stent graft with a conventional suprarenal active fixation specifically designed to overcome the anatomic limitation of small, stenotic, and tortuous iliac vessels. AREAS COVERED The present article provides a complete description of the Incraft stent graft, its clinical performance, its technical characteristics as well as a comparison with other competitive endografts. EXPERT OPINION The Incraft stent graft is an EVAR ultra low-profile device initially designed for overcoming the limitation of the hostile iliac anatomy. Recently, the device is being increasingly used in real-world conditions and not only in complex iliac anatomies with good mid-term results. Whether it remains a useful EVAR toolbox or will become a workhorse endograft is yet to be determined.
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Affiliation(s)
- Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltos Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Kiriakos Ktenidis
- Vascular Surgery Unit, 1st Propaedeutic Surgical Department, Ahepa University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Savas Deftereos
- Radiology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Marone EM, Freyrie A, Ruotolo C, Michelagnoli S, Antonello M, Speziale F, Veroux P, Gargiulo M, Gaggiano A. Expert Opinion on Hostile Neck Definition in Endovascular Treatment of Abdominal Aortic Aneurysms (a Delphi Consensus). Ann Vasc Surg 2020; 62:173-182. [DOI: 10.1016/j.avsg.2019.05.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 01/23/2023]
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Georgakarakos E, Ioannidis G, Koutsoumpelis A, Papatheodorou N, Argyriou C, Spanos K, Giannoukas AD, Georgiadis GS. Τhe AFX unibody bifurcated unibody aortic endograft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2019; 17:5-15. [DOI: 10.1080/17434440.2020.1704254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios Ioannidis
- Department of Radiotherapy, University Hospital of Larissa, Larissa, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Christos Argyriou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D. Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Georgakarakos E, Argyriou C, Georgiadis GS, Lazarides MK. Pulse Wave Analysis after Treatment of Abdominal Aortic Aneurysms with the Ovation Device. Ann Vasc Surg 2017; 40:146-153. [DOI: 10.1016/j.avsg.2016.07.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 07/06/2016] [Indexed: 11/24/2022]
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Georgakarakos E, Souftas V. Commentary: Shortening of the Sealing Zone With the Ovation Endograft. J Endovasc Ther 2017; 24:198-200. [PMID: 28058987 DOI: 10.1177/1526602816685972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Vasileios Souftas
- 2 Interventional Radiology Unit, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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