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Korosoglou G, Torsello G, Saratzis A, Isernia G, Kontopodis N, González TM, Jacobs K, Van Herzeele I, Zayed H, Stavroulakis K. Editor's Choice - Endovascular Versus Surgical Treatment for All Comer Patients With Prosthetic Bypass Graft Occlusion: The Multicentre ENSUPRO Study. Eur J Vasc Endovasc Surg 2024; 67:786-796. [PMID: 37543355 DOI: 10.1016/j.ejvs.2023.07.054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 06/10/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Bypass surgery plays a key role in complex lower limb lesions. However, there is a lack of evidence regarding the management of symptomatic prosthetic bypass graft (PBG) occlusion. This study aimed to report outcomes following open, hybrid, or endovascular management of patients presenting with symptomatic PBG occlusion. METHODS A multicentre, retrospective cohort study was conducted, including patients presenting with PBG occlusion between January 2014 and December 2021 from 18 centres. It assessed the comparative value of treatment strategies, including (1) recanalisation of native vessels, (2) endovascular treatment of the failed PBG, (3) hybrid treatment, and (4) open surgery. The primary outcome measure was amputation free survival (AFS, time to major amputation and or death), whereas all cause mortality, major amputation, PBG re-occlusion, target lesion revascularisation (TLR), and Rutherford category (RC) improvement during follow up were considered as secondary endpoints. RESULTS Of 260 patients with occluded PBGs, 108 (41.5%) were treated endovascularly (24 [22.2%] by recanalisation of native vessels and 84 [77.7%] by PBG re-opening), 57 (21.9%) underwent hybrid revascularisation, and 58 (22.3%) had surgery. In addition, 27 (10.4%) were treated conservatively and 10 (3.8%) received systemic thrombolysis. With a median follow up of 1.4 (0.6 - 3.0) years, AFS was 95.5%, 76.4%, 45.5%, and 37.1%, respectively in Groups 1 - 4 (p = .007). Older age and non-endovascular treatment (HR 1.05 and 1.70; p < .01 for both) were independent predictors of poor AFS. Endovascular treatment was associated with lower rates of major amputation (p = .04), PBG re-occlusion (p < .001), and TLR (p = .037), and higher RC improvements (p < .001), whereas all cause mortality was comparable between treatment groups (p = .21). CONCLUSION Endovascular treatment is associated with higher rates of AFS and RC improvement and lower rates of PBG re-occlusion and TLR in patients with PBG occlusion.
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Affiliation(s)
| | - Giovanni Torsello
- University Hospital Münster, Institute for Vascular Research, Franziskus Hospital, Münster, Germany
| | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Giacomo Isernia
- Department of Vascular and Endovascular Surgery, University Hospital of Perugia, Perugia, Italy
| | | | | | - Karen Jacobs
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hany Zayed
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kontopodis N, Kehagias E, Chronis C, Nasis N, Tsetis D, Ioannou CV. Technical challenges during emergent endovascular aneurysm repair with the ALTO system. Expert Rev Med Devices 2024; 21:269-275. [PMID: 38571391 DOI: 10.1080/17434440.2024.2339416] [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: 01/05/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Ruptured abdominal aortic aneurysms (AAAs) pose an immediate threat for patient's life and endovascular repair (EVAR) is currently the preferred treatment modality in the presence of suitable anatomy. This is determined based on the requirements of each endograft as described in the instructions for use (IFU). The new ALTO system (Endologix, Irvin, CA, U.S.A.), can accommodate a great range of anatomies such as short necks and/or narrow access, but its unique design requires specific technical modifications during treatment of ruptured AAAs. AREAS COVERED The standard double balloon technique has long been described and it is used to provide circulatory support during EVAR for ruptured AAA. While this technique is straightforward with the use of endografts with a traditional design, this would not be the case if one uses the ALTO system. In that case specific maneuvers would be required to treat AAA patients in an acute setting. EXPERT OPINION The ALTO system although being able to treat AAAs with adverse anatomy, it may not be appropriate during treatment of ruptured AAA patients with profound hemodynamic instability. A careful evaluation of the individual's patient anatomy and hemodynamic condition is mandatory in order to decide the best endograft for each case.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Christos Chronis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Nasis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete, Heraklion, Crete, Greece
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Kontopodis N, Tosounidis T, Kehagias E, Kouraki A, Tzirakis K, Ioannou CV. Concomitant vascular and orthopedic trauma: 10 points to consider. J Clin Orthop Trauma 2024; 51:102407. [PMID: 38681997 PMCID: PMC11053217 DOI: 10.1016/j.jcot.2024.102407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Although vascular injuries complicate only 1-2% of patients with orthopedic trauma, they may be encountered in a much higher rate of around 10 % in injuries around the knee and elbow joints following both fractures and dislocations. In case of vascular involvement, specific diagnostic and therapeutic challenges arise and there is a higher risk for significant morbidity (i.e. limb loss) or mortality. In the absence of randomized data, diagnostic and therapeutic algorithms are not always straightforward and clinical practice may be based on experience and local protocols rather than firm evidence. With this article we intend to review available literature regarding concomitant skeletal and vascular trauma in order to provide concise information and clear guidelines of when to operate with least investigations and when to go for a full spectrum of investigations in the absence of hard clinical signs. Additionally, other aspects concerning the manipulation of these patients are discussed, such as the indications of primary amputation, the potential role of endovascular techniques and the value of the Resuscitative Endovascular Balloon Occlusion of the Aorta. In summary, this scoping review summarizes current practices in the diagnostic and therapeutic management of patients with concomitant orthopedic and vascular injuries, discusses different treatment strategies and gives a practical perspective for implementation on every day practice.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, University of Crete-Medical School, Heraklion, Crete, Greece
| | - Theodoros Tosounidis
- Orthopedic Department, University of Crete-Medical School, Heraklion, Crete, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, University of Crete-Medical School, Heraklion, Crete, Greece
| | | | - Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Christos V. Ioannou
- Vascular Surgery Department, University of Crete-Medical School, Heraklion, Crete, Greece
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Tzirakis K, Kontopodis N, Ioannou CV. A hemodynamic study of blood flow models on various stent graft configurations during aorto-iliac reconstruction. Clin Hemorheol Microcirc 2024:CH232058. [PMID: 38363603 DOI: 10.3233/ch-232058] [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: 02/17/2024]
Abstract
PURPOSE To compare the hemodynamic performance of three (Bottom Up non-ballet, Top-Down non-ballet, Top Down ballet) idealized stent graft configurations used during endovascular repair of abdominal aortic aneurysms, under the influence of various rheological models. METHODS Ten rheological models are assumed and a commercial finite volume solver is employed for the simulation of blood flow under realistic boundary conditions. An appropriate mesh convergence study is performed and five hemodynamic variables are computed: the time average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), endothelial cell activation potential and displacement force (DF) for all three configurations. RESULTS The choice of blood flow model may affect results, but does not constitute a significant determinant on the overall performance of the assumed stent grafts. On the contrary, stent graft geometry has a major effect. Specifically, the Bottom Up non-ballet type is characterized by the least favorable performance presenting the lowest TAWSS and the highest OSI, RRT and ECAP values. On the other hand, the Top Down ballet type presents hemodynamic advantages yielding the highest TAWSS and lowest OSI, RRT and ECAP average values. Furthermore, the ballet type is characterized by the lowest DF, although differences observed are small and their clinical relevance uncertain. CONCLUSIONS The effect of the assumed rheological model on the overall performance of the grafts is not significant. It is thus relatively safe to claim that it is the type of stent graft that determines its overall performance rather than the adopted blood flow model.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
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Kontopodis N, Galanakis N, Ioannou CV, Antoniou GA. Systematic Review and Meta-Analysis of the Effect of Anticoagulation on Outcomes After Endovascular Aneurysm Repair. J Endovasc Ther 2023:15266028231214761. [PMID: 38031419 DOI: 10.1177/15266028231214761] [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: 12/01/2023]
Abstract
PURPOSE Our objective was to investigate whether patients who receive anticoagulation therapy have different outcomes after endovascular aneurysm repair (EVAR) from those who do not. MATERIALS AND METHODS We conducted a systematic review of studies that compared outcomes of EVAR in patients who were on therapeutic anticoagulation vs those who were not. We developed and reported the review in accordance with the PRISMA guidelines with a registered protocol (CRD42022375894). The Ovid interface was used to search Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) up to November 2022. The quality of studies was assessed with the Newcastle-Ottawa Scale (NOS) (maximum score=9), and the evidence was appraised with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The hazard ratio (HR) and 95% confidence interval (CI) was the effect estimate in time-to-event meta-analyses, calculated using the inverse-variance statistical method and random-effects models. RESULTS Sixteen studies qualified for inclusion reporting a total of 35 739 individuals. Anticoagulated patients had a statistically significantly higher hazard of death (HR=1.93, 95% CI=1.03-3.63), endoleak (HR=2.13, 95% CI=1.55-2.93), reintervention (HR=1.79, 95% CI=1.27-2.52), and aneurysm sac expansion (HR=2.72, 95% CI=1.57-4.72) than patients not receiving anticoagulation therapy. The median score on the NOS was 7 (range=4-9). The certainty of evidence was very low for mortality and reintervention and low for endoleak and sac expansion. CONCLUSIONS Anticoagulation is a poor prognostic factor after standard EVAR and should be considered in decision-making, consent processes, and surveillance strategies. CLINICAL IMPACT The number of individuals who take anticoagulation treatment has been rapidly increasing over the recent years. We aimed to investigate the effect of such treatment on outcomes after endovascular aneurysm repair (EVAR). Anticoagulated patients were found to have increased mortality, endoleak, and reintervention rates after EVAR compared to their non-anticoagulated counterparts. Anticoagulation therapy has a prognostic role in EVAR and should be considered in decision making and EVAR surveillance. Anticoagulated patients need to be informed of the higher failure rates of EVAR, and intensified surveillance strategies may need to be implemented in this patient cohort.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - George A Antoniou
- Manchester Vascular Centre, 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
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de Bree E, Michelakis D, Heretis I, Kontopodis N, Spanakis K, Lagoudaki E, Tolia M, Zografakis-Sfakianakis M, Ioannou C, Mavroudis D. Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies. Cancers (Basel) 2023; 15:5469. [PMID: 38001729 PMCID: PMC10670057 DOI: 10.3390/cancers15225469] [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: 10/07/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Retroperitoneal soft tissue sarcoma (RPS) is a rare and heterogenous disease for which surgery is the cornerstone of treatment. However, the local recurrence rate is much higher than in soft tissue sarcoma of the extremities since wide resection is usually unfeasible in RPS due to its large size, indistinct tumour borders, anatomical constraints and the thinness of the overlying peritoneum. Local recurrence is the leading cause of death for low-grade RPS, whereas high-grade tumours are prone to distant metastases. In recent decades, the role of emerging therapeutic strategies, such as more extended surgery and (neo)adjuvant treatments to improve oncological outcome in primary localised RPS, has been extensively investigated. In this review, the recent data on the evolving multidisciplinary management of primary localised RPS are comprehensively discussed. The heterogeneity of RPS, with their different histological subtypes and biological behaviour, renders a standard therapeutic 'one-size-fits-all' approach inappropriate, and treatment should be modified according to histological type and malignancy grade. There is sufficient evidence that frontline extended surgery with compartmental resection including all ipsilateral retroperitoneal fat and liberal en bloc resection of adjacent organs and structures, even if they are not macroscopically involved, increases local tumour control in low-grade sarcoma and liposarcoma, but not in leiomyosarcoma for which complete macroscopic resection seems sufficient. Additionally, preoperative radiotherapy is not indicated for all RPSs, but seems to be beneficial in well-differentiated liposarcoma and grade I/II dedifferentiated liposarcoma, and probably in solitary fibrous tumour. Whether neoadjuvant chemotherapy is of benefit in high-grade RPS remains unclear from retrospective data and is subject of the ongoing randomised STRASS 2 trial, from which the results are eagerly awaited. Personalised, histology-tailored multimodality treatment is promising and will likely further evolve as our understanding of the molecular and genetic characteristics within RPS improves.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Dimosthenis Michelakis
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Ioannis Heretis
- Department of Urology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Nikolaos Kontopodis
- Department of Vascular Surgery, Medical School of Crete University Hospital, 71110 Heraklion, Greece; (N.K.); (C.I.)
| | - Konstantinos Spanakis
- Department of Medical Imaging, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Eleni Lagoudaki
- Department of Pathology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Maria Tolia
- Department of Radiation Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | | | - Christos Ioannou
- Department of Vascular Surgery, Medical School of Crete University Hospital, 71110 Heraklion, Greece; (N.K.); (C.I.)
| | - Dimitrios Mavroudis
- Department of Medical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
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Frankort J, Mees B, Doukas P, Keszei A, Kontopodis N, Antoniou GA, Jacobs MJ, Gombert A. Systematic Review of the Effect of Cerebrospinal Fluid Drainage on Outcomes After Endovascular Descending Thoracic/Thoraco-Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 66:501-512. [PMID: 37182608 DOI: 10.1016/j.ejvs.2023.05.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/07/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE This study aimed to investigate whether prophylactic use of cerebrospinal fluid (CSF) drainage in endovascular descending thoracic aortic aneurysm (DTAA) and thoraco-abdominal aortic aneurysm (TAAA) repair contributes to a lower rate of post-operative spinal cord ischaemia (SCI). DATA SOURCES MEDLINE, Embase, and CINAHL. REVIEW METHODS A literature review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42021245893). Risk of bias was assessed through the Newcastle-Ottawa scale (NOS), and the certainty of evidence was graded using the GRADE approach. A proportion meta-analysis was conducted to calculate the pooled rate and 95% confidence interval (CI) of both early and late onset SCI. Pooled outcome estimates were calculated using the odds ratio (OR) and associated 95% CI. The primary outcome was SCI, both early and lateonset. Secondary outcomes were complications of CSF drainage, length of hospital stay, and peri-operative (30 day or in hospital) mortality rates. RESULTS Twenty-eight observational, retrospective studies were included, reporting 4 814 patients (2 599 patients with and 2 215 without CSF drainage). The NOS showed a moderate risk of bias. The incidence of SCI was similar in patients with CSF drainage (0.05, 95% CI 0.03 ‒ 0.08) and without CSF drainage (0.05, 95% CI 0.00 ‒ 0.14). No significant decrease in SCI was found when using CSF drainage (OR 0.67, 95% CI 0.29 ‒ 1.55, p = .35). The incidence rate of CSF drainage related complication was 0.10 (95% CI 0.04 ‒ 0.19). The 30 day and in hospital mortality rate with CSF drainage was 0.08 (95% CI 0.05 ‒ 0.12). The 30 day and in hospital mortality rate without CSF drainage and comparison with late mortality and length of hospital stay could not be determined due to lack of data. The quality of evidence was considered very low. CONCLUSION Pre-operative CSF drainage placement was not related to a favourable outcome regarding SCI rate in endovascular TAAA and DTAA repair. Due to the low quality of evidence, no clear recommendation on pre-operative use of CSF drainage placement can be made.
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Affiliation(s)
- Jelle Frankort
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany; Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands.
| | - Barend Mees
- Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands
| | - Panagiotis Doukas
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany
| | - Andràs Keszei
- Centre for Translational & Clinical Research Aachen (CTC-A), University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - 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
| | - Michael J Jacobs
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany; Department of Vascular Surgery, European Vascular Centre Maastricht-Aachen, MUMC Maastricht, Maastricht, The Netherlands
| | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Centre Aachen-Maastricht, RWTH Aachen, Aachen, Germany
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Kontopodis N, Tzirakis K, Galanakis N, Ioannou CV. Bilateral Isolated Common and Internal Iliac Artery Aneurysms Treated with Iliac Branch Endoprostheses Using the Gluteal Arteries as Distal Landing Zones. Vasc Specialist Int 2023; 39:20. [PMID: 37475563 DOI: 10.5758/vsi.230048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/25/2023] [Accepted: 07/21/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Kontopodis N, Tzirakis K, Tzartzalou I, Ioannou CV. Comparison of the Haemodynamic Performance of Various Treatment Options for Aorto-Iliac Occlusive Disease. EJVES Vasc Forum 2023; 60:24-27. [PMID: 37547924 PMCID: PMC10403718 DOI: 10.1016/j.ejvsvf.2023.07.001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Several surgical and endovascular techniques are used during the treatment of aorto-iliac occlusive disease. Aortobifemoral bypass (AoBFB) is the standard of care, but other options such as axillobifemoral (AxBFB) bypass, aorto-iliac kissing stents (KS), and covered endovascular reconstruction of aortic bifurcation (CERAB) are also available. This study aimed to perform a computational comparison of these four modalities to investigate their haemodynamic performance. Report Eight patient specific anatomies were analysed, with each of the abovementioned techniques used to treat two anatomies. The CT angiograms were segmented from the renal (or axillary) to common femoral arteries and the 3D geometries were exported. A commercial finite volume solver was implemented for numerical simulations. Outcomes that were assessed were pressure drop (ΔP) between the inlet and the outlet for every configuration and haemodynamic indices of Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT) as markers of a thrombogenic environment. The results indicate that maximum ΔP was observed at peak systole for all models, with values ranging between 12 mmHg and 21 mmHg for the AoBFB, 64 mmHg and 96 mmHg for the AxBFB, 31 mmHg and 46 mmHg for the KS, and 43 mmHg and 46 mmHg for the CERAB configuration. TAWSS, OSI, and RRT varied among different configurations, mostly presenting values well above thrombogenic thresholds. Regarding RRT, the percentage of total surface area presenting such values is 2.5%, 3.2%, 2%, and 4.3% for the AoBFB, AxBFB, KS, and CERAB configurations, respectively. Discussion Computational modelling indicates a favourable haemodynamic performance of AoBFB compared with the other configurations. This leads to a smaller pressure drop and sconsequently a higher pressure in the outlet of the conduit, which is the perfusion pressure of the limb. Notably, lower patency rates of the latter modalities cannot be explained based on haemodynamic indices.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Ifigeneia Tzartzalou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V. Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
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Kontopodis N, Ioannou CV. "We Are Not The Same": Comparison of Three Radiofrequency Thermal Devices Used for Saphenous Vein Ablation. Eur J Vasc Endovasc Surg 2023; 66:102. [PMID: 37087069 DOI: 10.1016/j.ejvs.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, University Hospital of Heraklion, Heraklion, Crete, Greece.
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Kontopodis N, Galanakis N, Ioannou CV. Endovascular Aneurysm Repair Using the ALTO Endograft in a Patient with a Very Tight 10-mm Aortic Bifurcation. Vasc Specialist Int 2023; 39:18. [PMID: 37401415 DOI: 10.5758/vsi.230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Tzirakis K, Kamarianakis Y, Kontopodis N, Ioannou CV. Selection of Bifurcated Grafts' Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance. Bioengineering (Basel) 2023; 10:776. [PMID: 37508803 PMCID: PMC10376214 DOI: 10.3390/bioengineering10070776] [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: 06/01/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
During the vascular surgical reconstruction of aorto-iliac occlusive/aneurysmal disease, bifurcated grafts are used where vascular surgeons intra-operatively select the size and the relative lengths of the parent and daughter portions of the graft. Currently, clinical practice regarding the selection of the most favorable geometric configuration of the graft is an understudied research subject: decisions are solely based on the clinical experience of the operating surgeon. This manuscript aims to evaluate the hemodynamic performance of various diameters, D, of bifurcated aortic grafts and relate those with proximal/distal part length ratios (the angle φ between the limbs is used as a surrogate marker of the main body-to-limb length ratio) in order to provide insights regarding the effects of different geometries on the hemodynamic environment. To this end, a computationally intensive set of simulations is conducted, and the resulting data are analyzed with modern statistical regression tools. A negative curvilinear relationship of TAWSS with both φ and D is recorded. It is shown that the angle between limbs is a more important predictor for the variability of TAWSS, while the graft's diameter is an important determinant for the variability of OSI. Large percentages of the total graft area with TAWSS < 0.4 Pa, which correspond to thrombogenic stimulating environments, are only observed for large values of φ and D > 20 mm. This variable ranges from 10% (for the smallest values of φ and D) to 55% (for the largest φ and D values). Our findings suggest that grafts with the smallest possible angle between the limbs (i.e., smallest parent-to-daughter length ratio) present the most favorable hemodynamic performance, yielding the smallest percentage of total graft area under thrombogenic simulating environments. Similarly, grafts with the smallest acceptable diameter should be preferred for the same reason. Especially, grafts with diameters greater than 20 mm should be avoided, given the abrupt increase in estimated thrombogenic areas.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Crete, Greece
| | - Yiannis Kamarianakis
- Data Science Group, Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, 70013 Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Kontopodis N, Gavalaki A, Galanakis N, Kantzas M, Ioannou C, Geroulakos G, Kakisis J, Antoniou GA. Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young. J Endovasc Ther 2023:15266028231179419. [PMID: 37350089 DOI: 10.1177/15266028231179419] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
PURPOSE The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients. MATERIALS AND METHODS A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models. RESULTS Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low. CONCLUSION Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy. PROTOCOL REGISTRATION PROSPERO, CRD42022325051. CLINICAL IMPACT Uncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Aikaterini Gavalaki
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Michalis Kantzas
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - 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
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Galanakis N, Kontopodis N, Matthaiou N, Tsetis D, Kehagias E. Multimodality Assessment of Nutcracker Syndrome in a Young Patient. Vasc Specialist Int 2023; 39:11. [PMID: 37248776 DOI: 10.5758/vsi.230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolas Matthaiou
- Interventional Radiology Unit, Radiology Clinic, AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Greece
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Kontopodis N, Lasithiotakis K, Kasiolas I, Kafetzakis A, Chrysos E, Ioannou CV. Does the routine skin only closure in ruptured Abdominal Aortic Aneurysm repair safely diminish abdominal compartment syndrome? A hypothesis generating retrospective study. Aorta (Stamford) 2023. [PMID: 37055015 DOI: 10.1055/a-2066-8480] [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] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Abdominal compartment syndrome (ACS) often complicates ruptured abdominal aortic aneurysm (rAAA) repair. We aim to report results with routine skin-only abdominal wound closure after rAAA surgical repair. METHODS Single center, retrospective study including consecutive patients undergoing rAAA surgical repair during 7-years. Skin-only closure was routinely performed and if possible, secondary abdominal closure was performed during the same admission. Demographic information, preoperative hemodynamic condition of patients, perioperative information such as ACS, mortality and rate of abdominal closure and postoperative information were collected. RESULTS During the study period 93 rAAAs were recorded. Ten patients were too frail to undergo repair or refused treatment. Eighty-three patients underwent immediate surgical repair. Mean age was 72.4±10.5 years and the vast majority were male (82:1). Preoperative systolic blood pressure <90mmHg was recorded in 31 patients. Intra-operative mortality was recorded in 9 cases. Overall in-hospital mortality was 34.9% (29/83). Primary fascial closure was performed in 5 patients, while skin-only closure was performed in 69. ACS was recorded in two cases in whom skin sutures were removed and negative pressure wound treatment was applied. Secondary fascial closure was feasible in 30 patients during the same admission. Among 37 patients not undergoing fascial closure, 18 died and 19 survived and were discharged with a planned ventral hernia. Median length of ICU and hospital stay were 5(1-24) and 13(8-35) days, respectively. After a mean follow-up of 21 months, telephone contact was possible with 14/19 patients that left the hospital with an abdominal hernia. Three reported hernia-related complications mandating surgical repair, while in 11 this was well tolerated. CONCLUSION Routine skin-only closure during rAAA surgical repair results in low rates of ACS at the expense of a high rate of patients being discharged with a planned ventral hernia which, however, seems to be well tolerated by the majority of patients.
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Affiliation(s)
| | - Konstantinos Lasithiotakis
- General surgery Department, University of Crete Faculty of Medicine: Panepistemio Kretes Iatrike Schole, Heraklion, Crete, GREECE
| | - Ioannis Kasiolas
- General surgery Department, University General Hospital of Heraklion Medical Service: Panepistemiako Geniko Nosokomeio Erakleiou Iatrike Yperesia, Heraklion, Crete, GREECE
| | - Alexandros Kafetzakis
- Vascular Surgery Department, University General Hospital of Heraklion Medical Service: Panepistemiako Geniko Nosokomeio Erakleiou Iatrike Yperesia, Heraklion, Crete, GREECE
| | - Emmanuel Chrysos
- General surgery Department, University of Crete Faculty of Medicine: Panepistemio Kretes Iatrike Schole, Heraklion, Crete, GREECE
| | - Christos V Ioannou
- Vascular Surgery Department, University of Crete Faculty of Medicine: Panepistemio Kretes Iatrike Schole, Heraklion, Crete, GREECE
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Kontopodis N, Ioannou CV. Endovascular Aneurysm Repair in a Patient with Severe Iliac Tortuosity. Eur J Vasc Endovasc Surg 2023; 65:483. [PMID: 36657707 DOI: 10.1016/j.ejvs.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Greece.
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Greece
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Kontopodis N, Galanakis N, Kiparakis M, Ioannou CV, Kakisis I, Geroulakos G, Antoniou GA. Pre-Emptive Embolization of the Aneurysm Sac or Aortic Side Branches in Endovascular Aneurysm Repair: Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. Ann Vasc Surg 2023; 91:90-107. [PMID: 36494004 DOI: 10.1016/j.avsg.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate outcomes of pre-emptive embolization of the aneurysm sac or aortic side branches in endovascular aneurysm repair (EVAR). METHODS The review was reported as per Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 with a preregistered protocol. Bibliographic sources (MEDLINE, Embase, and CENTRAL) were searched using subject headings and free text terms. Randomized controlled trials comparing EVAR with versus without embolization were included. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) or risk difference (RD) and 95% confidence interval (CI) applying the Mantel-Haenszel method. Continuous outcomes were summarized using mean difference (MD) and 95% CI applying the inverse variance method. The certainty of evidence was appraised with the Grading of Recommendations Assessment, Development, and Evaluation framework. Version 2 of the Cochrane tool was used to assess the risk of bias. Trial sequential analysis assumed alpha = 5% and power = 80%. RESULTS Four randomized controlled trials were included. No significant difference was found in aneurysm-related mortality (RD 0.00, 95% CI -0.03 to 0.03), overall mortality (OR 1.85, 95% CI 0.42-8.13), aneurysm rupture (RD 0.00, 95% CI -0.03 to 0.03), type II endoleak-related reintervention (RD -0.07, 95% CI -0.21 to 0.06), procedure time (MD 20.12, 95% CI -11.54 to 51.77), or fluoroscopy time (MD 11.17, 95% CI -11.22 to 33.56). Patients with pre-emptive embolization had significantly lower odds of type II endoleak (OR 0.45, 95% CI 0.26-0.78) and sac expansion (OR 0.19, 95% CI 0.07-0.52). The risk of bias was high for all outcomes. The certainty of evidence was very low for all outcomes, except for type II endoleak, for which it was low. Trial sequential analysis showed an inconclusive result for overall mortality and type II endoleak-related reintervention but confirmed the advantage of embolization in reducing type II endoleak and sac expansion. CONCLUSIONS Limited, low certainty data suggest pre-emptive embolization confers no clinical benefits in EVAR.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Michalis Kiparakis
- Cardiac Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Ioannis Kakisis
- Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - 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.
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Tzirakis K, Kontopodis N, Kehagias E, Ioannou CV. Effect of Sac Asymmetry, Neck and Iliac Angle on the Hemodynamic Behavior of Idealized Abdominal Aortic Aneurysm Geometries. Ann Vasc Surg 2023:S0890-5096(23)00126-7. [PMID: 36868463 DOI: 10.1016/j.avsg.2023.02.026] [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] [Received: 11/10/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are currently treated based on the universal maximum diameter criterion, but other geometric variables may play a role in the risk of rupture. The hemodynamic environment inside the AAA sac has been shown to interact with several biologic processes which can affect prognosis. AAA geometric configuration has a significant impact in the hemodynamic conditions that develop, which has only been recently realized, with implications for rupture risk estimations. We aim to perform a parametric study to evaluate the effect of aortic neck angulation, angle between the iliac arteries, and sac asymmetry (SA) on the hemodynamic variables of AAAs. METHODS This study uses idealized AAA models and it is parametrized in terms of 3 quantities as follows: the neck angle, φ (°), iliac angle, θ (°), and SA (%), each of which accepts 3 different values, specifically φ = (0°, 30°, 60°), θ = (40°, 60°, 80°), and SA = (S, °SS, °OS), where the SA can either be on the same side with respect to neck (SS) or on the opposite side (OS). Time average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and the velocity profile are calculated for different geometric configurations, while the percentage of the total surface area under thrombogenic conditions, using thresholds previously reported in the literature, is also recorded. RESULTS In case of an angulated neck and a higher angle between iliac arteries, favorable hemodynamic conditions are predicted with higher TAWSS and lower OSI and RRT values. The area under thrombogenic conditions reduces by 16-46% as the neck angle increases from 0° to 60°, depending on the hemodynamic variable under consideration. The effect of iliac angulation is present but less pronounced with 2.5-7.5% change between the lower and the higher angle. The effect of SA seems to be significant for OSI, with a nonsymmetrical configuration being hemodynamically favorable, which in the presence of an angulated neck is more pronounced for the OS outline. CONCLUSIONS Favorable hemodynamic conditions develop inside the sac of idealized AAAs with increasing neck and iliac angles. Regarding the SA parameter, asymmetrical configurations most often appear advantageous. Concerning the velocity profile the triplet (φ, θ, SA) may affect outcomes under certain conditions and thus should be taken into account when parametrizing the geometric characteristics of AAAs.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece.
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece
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Tzirakis K, Kamarianakis Y, Kontopodis N, Ioannou CV. The Effect of Blood Rheology and Inlet Boundary Conditions on Realistic Abdominal Aortic Aneurysms under Pulsatile Flow Conditions. Bioengineering (Basel) 2023; 10:bioengineering10020272. [PMID: 36829766 PMCID: PMC9953019 DOI: 10.3390/bioengineering10020272] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The effects of non-Newtonian rheology and boundary conditions on various pathophysiologies have been studied quite extensively in the literature. The majority of results present qualitative and/or quantitative conclusions that are not thoroughly assessed from a statistical perspective. METHODS The finite volume method was employed for the numerical simulation of seven patient-specific abdominal aortic aneurysms. For each case, five rheological models and three inlet velocity boundary conditions were considered. Outlier- and heteroscedasticity-robust ANOVA tests assessed the simultaneous effect of rheological specifications and boundary conditions on fourteen variables that capture important characteristics of vascular flows. RESULTS The selection of inlet velocity profiles appears as a more critical factor relative to rheological specifications, especially regarding differences in the oscillatory characteristics of computed flows. Response variables that relate to the average tangential force on the wall over the entire cycle do not differ significantly across alternative factor levels, as long as one focuses on non-Newtonian specifications. CONCLUSIONS The two factors, namely blood rheological models and inlet velocity boundary condition, exert additive effects on variables that characterize vascular flows, with negligible interaction effects. Regarding thrombus-prone conditions, the Plug inlet profile offers an advantageous hemodynamic configuration with respect to the other two profiles.
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Affiliation(s)
- Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, 71410 Heraklion, Crete, Greece
- Correspondence:
| | - Yiannis Kamarianakis
- Data Science Group, Institute of Applied and Computational Mathematics, Foundation for Research & Technology-Hellas, 70013 Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Christos V. Ioannou
- Vascular Surgery Department, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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Antoniou GA, Kontopodis N, Rogers SK, Golledge J, Forbes TL, Torella F, Verhagen HJM, Schermerhorn ML. Editor's Choice - Meta-Analysis of Compliance with Endovascular Aneurysm Repair Surveillance: The EVAR Surveillance Paradox. Eur J Vasc Endovasc Surg 2023; 65:244-254. [PMID: 36273676 DOI: 10.1016/j.ejvs.2022.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/30/2022] [Revised: 09/24/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the survival of patients who attended surveillance after endovascular aneurysm repair (EVAR) with those who were non-compliant. DATA SOURCES MEDLINE and Embase were searched using the Ovid interface. REVIEW METHODS A systematic review was conducted complying with the PRISMA guidelines. Eligible studies compared survival in EVAR surveillance compliant patients with non-compliant patients. Non-compliance was defined as failure to attend at least one post-EVAR follow up. The risk of bias was assessed with the Newcastle-Ottawa scale, and the certainty of evidence using the GRADE framework. Primary outcomes were survival and aneurysm related death. Effect measures were the hazard ratio (HR) or odds ratio (OR) and 95% confidence interval (CI) calculated using the inverse variance or Mantel-Haenszel statistical method and random effects models. RESULTS Thirteen cohort studies with a total of 22 762 patients were included. Eight studies were deemed high risk of bias. The pooled proportion of patients who were non-compliant with EVAR surveillance was 43% (95% CI 36 - 51). No statistically significant difference was found in the hazard of all cause mortality (HR 1.04, 95% CI 0.61 - 1.77), aneurysm related mortality (HR 1.80, 95% CI 0.85-3.80), or secondary intervention (HR 0.66, 95% CI 0.31 - 1.41) between patients who had incomplete and complete follow up after EVAR. The odds of aneurysm rupture were lower in non-compliant patients (OR 0.63, 95% CI 0.39 - 1.01). The certainty of evidence was very low for all outcomes. Subgroup analysis for patients who had no surveillance vs. those with complete surveillance showed no significant difference in all cause mortality (HR 1.10, 95% CI 0.43 - 2.80). CONCLUSION Patients who were non-compliant with EVAR surveillance had similar survival to those who were compliant. These findings question the value of intense surveillance in all patients post-EVAR and highlight the need for further research on individualised or risk adjusted surveillance.
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Affiliation(s)
- 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.
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | - Steven K Rogers
- 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
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia; Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Thomas L Forbes
- Division of Vascular Surgery, Peter Munk Cardiac Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Torella
- Liverpool Vascular & Endovascular Service, Liverpool, UK; School of Physical Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Hence J M Verhagen
- Division of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Boston, MA, USA
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Kontopodis N, Pagonidis K, Fakoukaki I, Tzirakis K, Ioannou CV. Images in Vascular Medicine: Internal carotid artery aplasia. Vasc Med 2023; 28:87-88. [PMID: 36588394 DOI: 10.1177/1358863x221144080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Nikolaos Kontopodis
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | | | | | - Christos V Ioannou
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, School of Medicine, University of Crete, Heraklion, Crete, Greece
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22
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Matthaiou N, Galanakis N, Papadakis AE, Kehagias E, Kontopodis N, Charalambous S, Perisinakis K, Maris TG, Ioannou CV, Tsetis D. Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study. J Vasc Interv Radiol 2022; 33:1531-1535. [PMID: 36100065 DOI: 10.1016/j.jvir.2022.09.006] [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] [Received: 01/15/2022] [Revised: 07/07/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022] Open
Abstract
This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes-dual-energy index (DEI) and effective Z (Zeff)-were calculated, ranging from 0.0027 to 0.321 and from 6.89 to 13.02, respectively. Statistical analysis showed a significant correlation between the DEI and Zeff values (P < .001). The interobserver intraclass correlation coefficient was 0.91 for the mean Zeff values and 0.86 for the mean DEI values. This technique could potentially provide useful information regarding the composition of a CTO.
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Affiliation(s)
- Nikolas Matthaiou
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece
| | - Antonios E Papadakis
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece
| | - Konstantinos Perisinakis
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion, Heraklion, Greece; Department of Radiology, University of Crete Medical School, Heraklion, Greece.
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Kontopodis N, Galanakis N, Charalambous S, Matsagkas M, Giannoukas AD, Tsetis D, Ioannou CV, Antoniou GA. Editor's Choice - Endovascular Aneurysm Repair in High Risk Patients: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 64:461-474. [PMID: 35872342 DOI: 10.1016/j.ejvs.2022.07.009] [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: 02/11/2022] [Revised: 06/06/2022] [Accepted: 07/10/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate outcomes of endovascular aneurysm repair (EVAR) in high risk patients. METHODS Bibliographic sources (MEDLINE, EMBASE, CINAHL, and CENTRAL) were searched using combinations of thesaurus and free text terms. The review protocol was registered in PROSPERO (CRD42021287207) and reported according to PRISMA 2020. Pooled estimates were calculated using odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI) applying the Mantel-Haenszel or inverse variance method. EVAR peri-operative mortality in high risk patients over time was examined with mixed effects meta-regression. The GRADE framework was used to rate the certainty of evidence. RESULTS The pooled peri-operative mortality in 18 416 high risk patients who underwent EVAR was 3% (95% CI 2.3 - 4%) and has significantly reduced over time (year of publication p = .003; median study point p = .023). The peri-operative mortality was significantly lower in high risk patients treated with EVAR compared with open repair (OR 0.64; 95% CI 0.45 - 0.92), but no significant difference was found in overall (HR 1.06; 95% CI 0.76 - 1.49) or aneurysm related mortality (HR 0.57; 95% CI 0.21 - 1.55). No significant difference was found in overall mortality between high risk patients treated with EVAR vs. no intervention (HR 0.42; 95% CI 0.14 - 1.26), but the aneurysm related mortality was significantly lower in the former (HR 0.30; 95% CI 0.14 - 0.63). The peri-operative mortality was higher in high risk than normal risk patients treated with EVAR (OR 2.33; 95% CI 1.75 - 3.10), as was the overall mortality (HR 3.50; 95% CI 2.55 - 4.80). The certainty of evidence was very low for EVAR vs. open surgery or no intervention and low for high vs. normal risk patients. CONCLUSION The EVAR peri-operative mortality in high risk patients has improved over time. Even though the aneurysm related mortality of EVAR is lower compared with no intervention, EVAR may confer no overall survival benefit.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Stavros Charalambous
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece; Department of Radiology, Division of Interventional Radiology, Nicosia General Hospital, Nicosia, Cyprus
| | - Miltiadis Matsagkas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Tsetis
- Interventiona Radiology Unit, Medical School, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Department, Medical School, University of Crete, Heraklion, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.
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Lioudaki S, Kontopodis N, Ioannou CV. Mirror Image Incision for Popliteal Aneurysm Repair Tailored to Patient Specific Anatomy. Vasc Specialist Int 2022; 38:25. [PMID: 36176262 PMCID: PMC9523209 DOI: 10.5758/vsi.220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stella Lioudaki
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Christos V. Ioannou
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Ioannou P, Karakonstantis S, Tavlas E, Kontopodis N, Maraki S, Chamilos G, Kofteridis DP. Actinotignum schaalii infection - a case series from a tertiary hospital in Greece. Germs 2022; 12:394-399. [PMID: 37680677 PMCID: PMC10482473 DOI: 10.18683/germs.2022.1343] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 09/09/2023]
Abstract
Introduction Actinotignum schaalii is a small Gram-positive facultative anaerobic coccoid rod that was reclassified in 1997 from the genus Actinomyces and is difficult to culture with usual microbiological techniques, as it is slowly growing. A. schaalii is an emerging human pathogen that is most commonly implicated in urinary tract infections (UTIs), but has also been isolated less frequently from abscesses of various sites (such as the skin, the genitourinary tract, surgical sites or intraabdominal). Methods All cases where A. schaalii was identified during a 6-year period (January 2016 - January 2022) in the University Hospital of Heraklion were reviewed. Results A. schaalii was isolated in 11 cultures from 10 patients. The site of infection was skin and soft tissue in nine out of eleven cultures (81.8%) and the bone was the site of infection in two patients (18.2%). Most cultures were polymicrobial. The median age of patients was 55.5 years (interquartile range 34-63 years), and 80% (n=8) were male. A. schaalii was susceptible to beta-lactams, quinolones and vancomycin, but resistant to clindamycin, erythromycin and metronidazole. Moreover, two cases of diabetic patients diagnosed with polymicrobial diabetic foot osteomyelitis from this organism are presented in detail. Both patients were successfully managed with targeted antimicrobial treatment and prompt surgical management. Conclusions A. schaalii is an emerging pathogen that is likely under-reported due to difficulties in isolation and identification. Herein two cases of diabetic foot osteomyelitis are also presented in detail, successfully managed with targeted antimicrobial therapy and surgical debridement.
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Affiliation(s)
- Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Stamatis Karakonstantis
- MD, MSc, Department of Vascular Diseases, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Emmanuil Tavlas
- MD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Nikolaos Kontopodis
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Sofia Maraki
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - George Chamilos
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
| | - Diamantis P Kofteridis
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, Greece, Stavrakia and Voutes crossroads, Heraklion, Crete, Greece, PC 71110
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27
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Kontopodis N, Tzirakis K, Stylianou F, Vavourakis V, Patou GM, Ioannou CV. Should the Proximal Part of a Bifurcated Aortic Graft be Kept as Short as Possible? A Computational Study Elucidates on Aortic Graft Hemodynamics for Various Main Body Lengths. Ann Vasc Surg 2022; 84:344-353. [PMID: 34954372 DOI: 10.1016/j.avsg.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND It is accepted that surgically placed bifurcated aortic grafts should be shaped as a short proximal main tube with two long distal limbs. We aim to investigate the hemodynamic effect of different main body lengths in bifurcated aortic grafts using 3D computer models. METHODS Five different idealized models are generated to represent an aorto-bifemoral graft. Distance from renal to femoral arteries is set at 25cm and distance between the femoral arteries is set at 14cm. Values of the main body length taken into account to build the idealized models are 3cm, 6cm, 9cm, 12cm and 15cm. Blood flow resistance, Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI) and Relative Residence Time (RRT) are estimated using the constructed 3D models. RESULTS The total resistance decreased monotonically by as far as 40% as the main body length increased. Appropriate hemodynamic simulations show a maximum TAWSS decrease and a corresponding maximum OSI and RRT increase with elongated main body configurations, indicating a hemodynamic benefit of the "Short" main body configuration. Nevertheless, the differences in these later variables are small, affecting a limited portion of the geometries. CONCLUSION A long main body of a bifurcated aortic graft results in significantly reduced total resistance in idealized models designed to represent an aorto-bifemoral surgical graft, while the differences observed in TAWSS, OSI and RRT between models are small.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Medical School, University of Crete, Heraklion, Crete, GREECE.
| | - Konstantinos Tzirakis
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, GREECE
| | - Fotos Stylianou
- Department of Mechanical & Manufacturing Engineering, University of Cyprus, Leukosia, CYPRUS
| | - Vasileios Vavourakis
- Department of Mechanical & Manufacturing Engineering, University of Cyprus, Leukosia, CYPRUS; Department of Medical Physics & Biomedical Engineering, University College of London, London, UK
| | - George M Patou
- Department of Mechanical Engineering, Hellenic Mediterranean University, Heraklion, Crete, GREECE
| | - Christos V Ioannou
- Vascular Surgery Unit, Medical School, University of Crete, Heraklion, Crete, GREECE
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Galanakis N, Maris TG, Kontopodis N, Tsetis K, Kehagias E, Tsetis D. Perfusion imaging techniques in lower extremity peripheral arterial disease. Br J Radiol 2022; 95:20211203. [PMID: 35522774 PMCID: PMC10996332 DOI: 10.1259/bjr.20211203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022] Open
Abstract
Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system. However, they can be also used to evaluate limb perfusion, using appropriate techniques and protocols. This information may be valuable for assessment of the severity of ischemia and detection of hypoperfused areas. Moreover, they can be used for planning of revascularization strategy in patients with severe PAD and evaluation of therapeutic outcome. These techniques may also determine prognosis and amputation risk in patients with PAD. This review gives a basic overview of the perfusion techniques for lower limbs provided by imaging modalities such as ultrasound, CT, MRI, digital subtraction angiography and scintigraphy and their clinical applications for evaluation of PAD and revascularization outcome.
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Affiliation(s)
- Nikolaos Galanakis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and
Vascular Surgery, University Hospital Heraklion, University of Crete
Medical School, Heraklion,
Greece
| | - Konstantinos Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Elias Kehagias
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, University Hospital Heraklion,
University of Crete Medical School,
Heraklion, Greece
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Kontopodis N, Charalambous S, Galanakis N, Lioudaki S, Tzartzalou I, Kehagias E, Tsetis D, Ioannou CV. Late neck related adverse events are rare among patients with wide aortic neck undergoing endovascular aneurysm repair with the Ovation endograft. Ann Vasc Surg 2022; 88:337-345. [DOI: 10.1016/j.avsg.2022.06.095] [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] [Received: 04/18/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022]
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Kontopodis N, Tzartzalou I, Tzouliadakis G, Ioannou CV. Concomitant Treatment of Several Visceral and Renal Artery Pathologies during Open Abdominal Aortic Aneurysm Repair. Vasc Specialist Int 2022; 38:18. [PMID: 35769010 PMCID: PMC9243489 DOI: 10.5758/vsi.220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nikolaos Kontopodis
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Ifigeneia Tzartzalou
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - George Tzouliadakis
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
| | - Christos V. Ioannou
- Department of Vascular Surgery, University of Crete Medical School, Heraklion, Greece
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Kontopodis N, Klontzas M, Tzirakis K, Charalambous S, Marias K, Tsetis D, Karantanas A, Ioannou CV. Prediction of abdominal aortic aneurysm growth by artificial intelligence taking into account clinical, biologic, morphologic, and biomechanical variables. Vascular 2022; 31:409-416. [PMID: 35687809 DOI: 10.1177/17085381221077821] [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: 11/16/2022]
Abstract
OBJECTIVES To develop a prediction model that could risk stratify abdominal aortic aneurysms (AAAs) into high and low growth rate groups, using machine learning algorithms based on variables from different pathophysiological fields. METHODS A cohort of 40 patients with small AAAs (maximum diameter 32-53 mm) who had at least an initial and a follow-up CT scan (median follow-up 12 months, range 3-36 months) were included. 29 input variables from clinical, biological, morphometric, and biomechanical pathophysiological aspects extracted for predictive modeling. Collected data were used to build two supervised machine learning models. A gradient boosting (XGboost) and a support vector machines (SVM) algorithm were trained with 60% and tested with 40% of the data to predict which AAA would achieve a growth rate higher than the median of our study cohort. Receiver operating characteristics (ROC) curves and areas under the curve (AUC) were used for the evaluation of the developed algorithms. RESULTS XGboost achieved the highest AUC in predicting high compared to low AAA growth rate with an AUC of 81.2% (95% CI from 61.1 to 100%). SVM achieved the second highest performance with an AUC of 68.8% (95% CI from 46.5 to 91%). Based on the best performing algorithm, variable importance was estimated. Diameter-diameter ratio (maximum diameter/neck diameter), Tortuosity from Renal arteries to aortic bifurcation, and maximum thickness of the intraluminal thrombus were found to be the most important factors for model predictions. Other factors were also found to play a significant but less important role. CONCLUSIONS A prediction model that can risk stratify AAAs into high and low growth rate groups could be developed by analyzing several factors implicated in the multifactorial pathophysiology of this disease, with the use of machine learning algorithms. Future studies including larger patient cohorts and implementing additional risk markers may aid in the establishment of such methodology during AAA rupture risk estimation.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, 37778University Hospital of Heraklion, Crete, Greece
| | - Michail Klontzas
- Department of Medical Imaging, 37778University Hospital Voutes, Heraklion, Greece.,Department of Radiology, 37778Medical School University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, Institute of Computer Science, 54570Foundation for Research and Technology (FORTH), Heraklion, Greece
| | - Konstantinos Tzirakis
- Biomechanics Laboratory, Department of Mechanical Engineering, 112178Hellenic Mediterranean University, Heraklion, Greece
| | - Stavros Charalambous
- Department of Medical Imaging, 37778University Hospital Voutes, Heraklion, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, 54570Foundation for Research and Technology (FORTH), Heraklion, Greece.,Department of Electrical and Computer Engineering, 112178Hellenic Mediterranean University, Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, 37778University Hospital Voutes, Heraklion, Greece.,Department of Radiology, 37778Medical School University of Crete, Heraklion, Greece
| | - Apostolos Karantanas
- Department of Medical Imaging, 37778University Hospital Voutes, Heraklion, Greece.,Department of Radiology, 37778Medical School University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, Institute of Computer Science, 54570Foundation for Research and Technology (FORTH), Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, 37778University Hospital of Heraklion, Crete, Greece
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Galanakis N, Kontopodis N, Kehagias E, Daskalakis N, Tsetis K, Ioannou CV, Tsetis D. Direct Iliac Vein Stenting in Phlegmasia Cerulea Dolens Caused by May-Thurner Syndrome. Vasc Specialist Int 2021; 37:37. [PMID: 34959225 PMCID: PMC8720580 DOI: 10.5758/vsi.210031] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/19/2021] [Accepted: 12/03/2021] [Indexed: 11/20/2022] Open
Abstract
Phlegmasia cerulea dolens (PCD) is an uncommon but potentially limb-threatening complication of acute deep vein thrombosis. A 56-year-old male presented with PCD. Color Doppler ultrasonography revealed extensive thrombosis of the left superficial and common femoral and external and common iliac veins. After an unsuccessful iliofemoral thrombectomy, contrast-enhanced computed tomography revealed iliofemoral deep vein thrombosis due to May-Thurner syndrome (MTS). After the deployment of an inferior vena cava filter, the thrombotic occlusion was traversed with a guidewire and direct stenting was performed to achieve immediate recanalization. The patient was discharged two days after the procedure, demonstrating significant clinical improvement. MTS is a rare cause of PCD. Direct iliac vein stenting may be a safe and effective alternative treatment for rapid recanalization if percutaneous mechanical thrombectomy devices are unavailable.
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Affiliation(s)
- Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Daskalakis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Konstantinos Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
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Kontopodis N, Galanakis N, Charalambous S, Kehagias E, Tsetis D, Ioannou CV. A Unique Clinical Presentation of Subclavian Steal Syndrome Provoked by Walking in a Patient with a Patent Axillo-Femoral Bypass. Vasc Specialist Int 2021; 37:35. [PMID: 34794124 PMCID: PMC8602899 DOI: 10.5758/vsi.210058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
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Kontopodis N, Galanakis N, Ioannou CV, Tsetis D, Georgiadis GS, Antoniou GA. Meta-Analysis of the Crossed Versus Standard Limb Configuration in Endovascular Aneurysm Repair. Ann Vasc Surg 2021; 80:358-369. [PMID: 34788700 DOI: 10.1016/j.avsg.2021.10.037] [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] [Received: 08/30/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate whether the crossed-limb technique confers better or worse clinical outcomes compared to the standard straight limb configuration in standard endovascular aneurysm repair (EVAR). METHODS We conducted a systematic review to identify studies comparing outcomes of EVAR with the crossed versus standard limb configuration. MEDLINE, EMBASE, CINAHL, and CENTRAL were searched in March 2021 using the Healthcare Databases Advanced Search interface developed by the National Institute for Heath and Care Excellence. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool. Summary estimates were calculated using the odds ratio (OR), risk difference (RD), or mean difference (MD) and 95% confidence interval (CI), applying the Mantel-Haenszel or inverse variance statistical method. Random-effects models were employed. RESULTS Four observational studies qualified for inclusion, reporting a total of 1132 patients. All presented contemporary experiences. Baseline clinical characteristics were largely similar between patients with and without the crossed-limb configuration, but the anatomy tended to be less favourable in patients treated with the crossed-limb technique. No statistically significant difference was found in the primary outcomes: limb occlusion (OR 1.44, 95% CI 0.65 - 3.19), type Ib endoleak (RD 0.01, 95% CI -0.03 - 0.04), type III endoleak (RD 0.01, 95% CI -0.01 - 0.03); or secondary outcomes: perioperative mortality (RD 0.00, 95% CI -0.03 - 0.03), type Ia endoleak (RD 0.00, 95% CI -0.03 - 0.02), type II endoleak (OR 1.38, 95% CI 0.51 - 3.74), procedure duration (MD 18.07 min, 95% CI -1.14-37.29). Inconsistency across studies was low for all outcomes. The studies were judged to be of high quality on the NOS. The main bias identified using the ROBINS-I tool was due to confounding. CONCLUSIONS The crossed-limb technique was not found to confer inferior clinical outcomes in the medium term compared to the standard limb configuration in patients who undergo standard EVAR.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University General Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom.
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Kontopodis N, Charalambous S, Vourakis G, Galanakis N, Mitsias P, Tsetis D, Ioannou CV. Images in Vascular Medicine: Bright light amaurosis - When external carotid artery stenosis matters. Vasc Med 2021; 27:203-204. [PMID: 34693850 DOI: 10.1177/1358863x211048542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Kontopodis
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University Hospital of Heraklion, Crete, Greece
| | - Stavros Charalambous
- Department of Medical Imaging, Interventional Radiology Unit, University Hospital of Heraklion, Crete, Greece
| | - George Vourakis
- Department of Neurology, University Hospital of Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Department of Medical Imaging, Interventional Radiology Unit, University Hospital of Heraklion, Crete, Greece
| | - Panayiotis Mitsias
- Department of Neurology, University Hospital of Heraklion, Crete, Greece.,School of Medicine, University of Crete, Heraklion, Greece.,Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Dimitrios Tsetis
- Department of Medical Imaging, Interventional Radiology Unit, University Hospital of Heraklion, Crete, Greece
| | - Christos V Ioannou
- Department of Cardiothoracic and Vascular Surgery, Vascular Surgery Unit, University Hospital of Heraklion, Crete, Greece
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Lioudaki S, Kontopodis N, Pontikoglou C, Gkalea V, Pappas T, Matsouka C, Papadaki E, Ioannou CV. Multiple Sites of Arterial Thrombosis in A 35-Year Old Patient after ChAdOx1 (AstraZeneca) Vaccination, Requiring Emergent Femoral and Carotid Surgical Thrombectomy. Ann Vasc Surg 2021; 79:438.e1-438.e4. [PMID: 34644642 DOI: 10.1016/j.avsg.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a rare complication following ChAdOx1 (AstraZeneca) vaccination. Venous thrombosis in unusual sites such as splachnic or intracranial thrombosis, is the commonest manifestation. CASE REPORT We report a 35-year-old male patient who presented with acute left leg ischemia and thrombocytopenia 11-days after vaccination requiring emergent thrombectomy. During work-up, a localized thrombus was detected in the left carotid bifurcation mandating carotid thrombectomy. Localized right iliac thrombus causing a non-limiting flow stenosis was treated conservatively. The platelet aggregating capacity of patient's plasma was confirmed in a functional assay, thereby establishing VITT. CONCLUSION To the best of our knowledge this is the first case presenting multiple arterial thromboses requiring surgical treatment after ChAdOx1 vaccination.
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Affiliation(s)
- Stella Lioudaki
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece.
| | | | - Vasiliki Gkalea
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Thomas Pappas
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Charis Matsouka
- Hematology Department, Alexandra General Hospital, Athens, Greece
| | - Eleni Papadaki
- Hematology Department, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Medical School, University of Crete, Heraklion, Crete, Greece
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Kontopodis N, Galanakis N, Akoumianakis E, Ioannou C, Tsetis D, Antoniou G. Systematic Review and Meta-Analysis of the Impact of Institutional and Surgeon Procedure Volume on Outcomes After Ruptured Abdominal Aortic Aneurysm Repair. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.08.034] [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: 11/29/2022]
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Galanakis N, Kontopodis N, Kehagias E, Daskalakis N, Ioannou CV, Tsetis D. Endovascular Recanalization of an Infrarenal Aortoiliac Occlusion Using a Combined Bilateral Subintimal Approach. Vasc Specialist Int 2021; 37:32. [PMID: 34580240 PMCID: PMC8479141 DOI: 10.5758/vsi.210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/29/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Nikolaos Daskalakis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
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Kontopodis N, Galanakis N, Akoumianakis E, Ioannou CV, Tsetis D, Antoniou GA. Editor's Choice - Systematic Review and Meta-Analysis of the Impact of Institutional and Surgeon Procedure Volume on Outcomes After Ruptured Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 62:388-398. [PMID: 34384687 DOI: 10.1016/j.ejvs.2021.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/12/2021] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate whether there is a correlation between institutional or surgeon case volume and outcomes in patients with ruptured abdominal aortic aneurysm (rAAA). DATA SOURCES The Healthcare Database Advanced Search interface developed by the National Institute of Health and Care Excellence was used to search MEDLINE, Embase, CINAHL, and CENTRAL. REVIEW METHODS The systematic review complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with the protocol registered in PROSPERO (CRD42020213121). Prognostic studies were considered comparing outcomes of patients with rAAA undergoing repair in high and low volume institutions or by high and low volume surgeons. Pooled estimates for peri-operative mortality were calculated using the odds ratio (OR) and 95% confidence intervals (CI), applying the Mantel-Haenszel method. Analysis of adjusted outcome estimates was performed with the generic inverse variance method. RESULTS Thirteen studies reporting a total of 120 116 patients were included. Patients treated in low volume centres had a statistically significantly higher peri-operative mortality than those treated in high volume centres (OR 1.39; 95% CI 1.22 - 1.59). Subgroup analysis showed a mortality difference in favour of high volume centres for both endovascular aneurysm repair (EVAR; OR 1.61, 95% CI 1.11 - 2.35) and open repair (OR 1.50, 95% CI 1.25 - 1.81). Adjusted analysis showed a benefit of treatment in high volume centres for open repair (OR 1.68, 95% CI 1.21 - 2.33) but not for EVAR (OR 1.42, 95% CI 0.84 - 2.41). Differences in peri-operative mortality between low and high volume surgeons were not statistically significant for either EVAR (OR 1.06, 95% CI 0.59 - 1.89) or open surgical repair (OR 1.18, 95% CI 0.87 - 1.63). CONCLUSION A high institutional volume may result in a reduction of peri-operative mortality following surgery for rAAA. This peri-operative survival advantage is more pronounced for open surgery than EVAR. Individual surgeon caseload was not found to have a significant impact on outcomes.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, Heraklion, Greece
| | - Evangelos Akoumianakis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete, Heraklion, Greece
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.
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Charalambous S, Klontzas ME, Kontopodis N, Ioannou CV, Perisinakis K, Maris TG, Damilakis J, Karantanas A, Tsetis D. Radiomics and machine learning to predict aggressive type 2 endoleaks after endovascular aneurysm repair: a proof of concept. Acta Radiol 2021; 63:1293-1299. [PMID: 34313492 DOI: 10.1177/02841851211032443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
BACKGROUND Persistent type 2 endoleaks (T2EL) require lifelong surveillance to avoid potentially life-threatening complications. PURPOSE To evaluate the performance of radiomic features (RF) derived from computed tomography angiography (CTA), for differentiating aggressive from benign T2ELs after endovascular aneurysm repair (EVAR). MATERIAL AND METHODS A prospective study was performed on patients who underwent EVAR from January 2018 to January 2020. Analysis was performed in patients who were diagnosed with T2EL based on the CTA of the first postoperative month and were followed at six months and one year. Patients were divided into two groups according to the change of aneurysm sac dimensions. Segmentation of T2ELs was performed and RF were extracted. Feature selection for subsequent machine-learning analysis was evaluated by means of artificial intelligence. Two support vector machines (SVM) classifiers were developed to predict the aneurysm sac dimension changes at one year, utilizing RF from T2EL at one- and six-month CTA scans, respectively. RESULTS Among the 944 initial RF of T2EL, 58 and 51 robust RF from the one- and six-month CTA scans, respectively, were used for the machine-learning model development. The SVM classifier trained on one-month signatures was able to predict sac expansion at one year with an area under curve (AUC) of 89.3%, presenting 78.6% specificity and 100% sensitivity. Similarly, the SVM classifier developed with six-month radiomics data showed an AUC of 95.5%, specificity of 90.9%, and sensitivity of 100%. CONCLUSION Machine-learning algorithms utilizing CTA-derived RF may predict aggressive T2ELs leading to aneurysm sac expansion after EVAR.
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Affiliation(s)
- Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Greece
| | - Michail E. Klontzas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, School of Medicine, University of Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, School of Medicine, University of Crete, Greece
| | - Kostas Perisinakis
- Department of Medical Physics, University Hospital of Heraklion, School of Medicine, University of Crete, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital of Heraklion, School of Medicine, University of Crete, Greece
| | - John Damilakis
- Department of Medical Physics, University Hospital of Heraklion, School of Medicine, University of Crete, Greece
| | - Apostolos Karantanas
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, Greece
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Galanakis N, Maris TG, Kalaitzakis G, Kontopodis N, Matthaiou N, Charalambous S, Tsetis K, Ioannou CV, Karantanas A, Tsetis D. Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI. Br J Radiol 2021; 94:20210215. [PMID: 34233490 DOI: 10.1259/bjr.20210215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. METHODS Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. RESULTS Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10-5 mm2/s to 331.51 ± 31 10-5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10-5 mm2/s vs 332.47 ± 22.95 10-5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64-0.93). CONCLUSIONS IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. ADVANCES IN KNOWLEDGE IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.
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Affiliation(s)
- Nikolaos Galanakis
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Georgios Kalaitzakis
- Department of Medical Physics, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Nikolas Matthaiou
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Stavros Charalambous
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Konstantinos Tsetis
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Apostolos Karantanas
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
| | - Dimitrios Tsetis
- Department of Medical Imaging, University Hospital Heraklion, University of Crete Medical School, Voutes, Heraklion, Greece
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Bontinis V, Antonopoulos CN, Bontinis A, Sfyroeras GS, Kontopodis N, Ioannou CV, Ktenidis K, Geroulakos G. A systematic review and meta-analysis of the streamliner multilayer flow modulator stent for treatment of complex aortic lesions. J Vasc Surg 2021; 74:646-656.e9. [PMID: 34019986 DOI: 10.1016/j.jvs.2021.03.031] [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: 09/20/2020] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated the safety and efficacy of multilayer flow modulator (MFM) stents (Cardiatis, Isnes, Belgium) for the treatment of complex aortic lesions. METHODS A systematic electronic research was conducted for studies reported from December 2008 to May 2020. Data extracted from 15 eligible case series (CS) were appropriately pooled and analyzed in a meta-analysis. The patient baseline characteristics were recorded, and 16 outcomes of interest were studied. The primary end points included 30-day all-cause and aneurysm-related mortality, aneurysm-related mortality at 1 year, vessel patency, and any endoleaks, ruptures, reinterventions, and aneurysm exclusion at the end of follow-up. RESULTS A total of 39 studies (15 CS and 24 case reports), involving 429 patients, met the inclusion criteria. Overall, 436 lesions were treated, and 1521 aortic branches were covered by the multilayer stent. The mean follow-up for the 15 CS with 404 patients was 14.6 months. Compliance with the instructions for use was reported by eight CS, with 75% of the procedures performed within the instructions for use. However, 41% of the patients reported by 12 CS had undergone a previous aortic intervention. The pooled 30-day all-cause and 30-day aneurysm-related mortality rates were 0.56% (95% confidence interval [CI], 0.00%-2.54%) and 0.00% (95% CI, 0.00%-0.80%), respectively. The pooled aneurysm-related mortality at 1 year of follow-up was 5.25% (95% CI, 0.07%-14.91%). The pooled vessel patency at the end of follow-up was 99.12% (95% CI, 97.73%-99.93%). The pooled reintervention and endoleak rates at the end of follow-up were 10.94% (95% CI, 3.64%-20.67%) and 10.70% (95% CI, 4.45%-18.66%), respectively. The crude spinal cord ischemia and renal failure rates were 0.69% and 1.8%, respectively. CONCLUSIONS The results from the present review and meta-analysis have indicated the safety and efficacy of MFM stents for treating challenging aortic pathologic lesions when used as first-line treatment and within the instructions for use. The almost zero pooled 30-day all-cause and aneurysm-related mortality rates combined with the low crude spinal cord ischemia and renal failure rates indicate the use of MFM stents is a good treatment option for complex aortic lesions in the short- and mid-term periods. The lack of long-term follow-up warrants further research concerning the efficacy of the device in the long term.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George Geroulakos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Kontopodis N, Galanakis N, Ioannou CV, Tsetis D, Becquemin JP, Antoniou GA. Time-to-event data meta-analysis of late outcomes of endovascular versus open repair for ruptured abdominal aortic aneurysms. J Vasc Surg 2021; 74:628-638.e4. [PMID: 33819523 DOI: 10.1016/j.jvs.2021.03.019] [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: 09/30/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We investigated whether the well-documented perioperative survival advantage of emergency endovascular aneurysm repair (EVAR) compared with open repair would be sustained during follow-up. METHODS A systematic review conforming to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement standards was conducted to identify studies that had reported the follow-up outcomes of endovascular vs open repair for ruptured abdominal aortic aneurysms. Electronic bibliographic sources (MEDLINE [medical literature analysis and retrieval system online], Embase [Excerpta Medica database], CINAHL [cumulative index to nursing and allied health literature], and CENTRAL [Cochrane central register of controlled trials]) were interrogated using the Healthcare Databases Advanced Search interface (National Institute for Health and Care Excellence, London, United Kingdom). A time-to-event data meta-analysis was performed using the inverse variance method, and the results were reported as summary hazard ratios (HRs) and associated 95% confidence intervals (CIs). Mixed effects regression was applied to investigate the outcome changes over time. The quality of the body of evidence was appraised using the GRADE (grades of recommendation, assessment, development, and evaluation) system. RESULTS Three randomized controlled trials and 22 observational studies reporting a total of 31,383 patients were included in the quantitative synthesis. The mean follow-up duration across the studies ranged from 232 days to 4.9 years. The overall all-cause mortality was significantly lower after EVAR than after open repair (HR, 0.79; 95% CI, 0.73-0.86). However, the postdischarge all-cause mortality was not significantly different (HR, 1.10; 95% CI, 0.85-1.43). The aneurysm-related mortality, which was reported by one randomized controlled trial, was not significantly different between EVAR and open repair (HR, 0.89; 95% CI, 0.69-1.15). Meta-regression showed the mortality difference in favor of EVAR was more pronounced in more recent studies (P = .069) and recently treated patients (P = .062). The certainty for the body of evidence for overall and postdischarge all-cause mortality was judged to be low and that for aneurysm-related mortality to be high. CONCLUSIONS EVAR showed a sustained mortality benefit during follow-up compared with open repair. A wider adoption of an endovascular-first strategy is justified.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University General Hospital of Heraklion, University of Crete, School of Medicine, Heraklion, Greece
| | - Jean-Pierre Becquemin
- Service de Chirurgie Vasculaire et Endocrinienne, Centre Hospitalier Universitaire Henri Mondor, Créteil, France; Vascular Institute of Paris East, Hôspital Paul D Egine, Champigny-sur-Marne, France
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom.
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Kontopodis N, Bree ED, Michelakis D, Ioannou CV. Oncovascular Resection and Reconstruction of Recurrent Retroperitoneal Liposarcoma Adherent to the Iliac Veins and Vena Cava. Vasc Specialist Int 2021; 37:58-59. [PMID: 33753575 PMCID: PMC8021491 DOI: 10.5758/vsi.210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion, Greece
| | - Eelco de Bree
- Department of Surgical Oncology, University of Crete Medical School, Heraklion, Greece
| | | | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion, Greece
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Kontopodis N, Ioannou CV. A Surprising Cause of Contained Aortic Rupture: Perforation from a Lumbar Osteophyte. Aorta (Stamford) 2021; 8:184-186. [PMID: 33761564 PMCID: PMC8043809 DOI: 10.1055/s-0040-1715468] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe a patient with contained aortic rupture due to perforation from a protruding lumbar osteophyte, who was treated by open surgery. This case underlines that less common aortic pathologies are possible, which require a high suspicion index to be diagnosed.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
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Charalambous S, Perisinakis K, Kontopodis N, Papadakis AE, Galanakis N, Kehagias E, Matthaiou N, Maris TG, Ioannou CV, Tsetis D. Discrimination of High-Risk Type-2 Endoleak after Endovascular Aneurysm Repair through CT Perfusion: A Feasibility Study. J Vasc Interv Radiol 2021; 32:807-812. [PMID: 33771713 DOI: 10.1016/j.jvir.2021.03.525] [Citation(s) in RCA: 3] [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] [Received: 01/11/2021] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022] Open
Abstract
A type-2 endoleak after an endovascular aneurysm repair is the most prevalent type of endoleak, but as the clinical consequence of its diagnosis is uncertain, at present, management decisions are solely based on aneurysm sac growth. The aim of this study was to investigate the potential of various computed tomography perfusion parameters for their ability to distinguish high-risk type-2 endoleaks from low-risk type-2 endoleaks after an endovascular aneurysm repair.
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Affiliation(s)
- Stavros Charalambous
- Interventional Radiology Unit and Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Kostas Perisinakis
- Department of Medical Physics, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit and Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Antonios E Papadakis
- Department of Medical Physics, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit and Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Elias Kehagias
- Interventional Radiology Unit and Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Nikolas Matthaiou
- Interventional Radiology Unit and Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Thomas G Maris
- Department of Medical Physics, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit and Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit and Department of Medical Imaging, University Hospital of Heraklion, University of Crete Medical School, Greece.
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Kontopodis N, Kehagias E, Tavlas E, Galanakis N, Tsetis D, Ioannou CV. The Use of a Suture Mediated Vascular Closure Device to Achieve Hemostasis following Arterial Access through Previously Implanted Synthetic Grafts. Ann Vasc Surg 2021; 73:496-499. [PMID: 33556517 DOI: 10.1016/j.avsg.2021.01.080] [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] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous endovascular aneurysm repair (EVAR) and peripheral interventions using the Perclose Proglide suture mediated system has not been adequately studied in patients with synthetic grafts at access sites. METHODS We report the use of the Perclose Proglide in 10 patients in whom previously inserted synthetic grafts in the groin were punctured for arterial access (5 for peripheral interventions and 5 undergoing EVAR). In patients undergoing peripheral interventions a single device was used, while in patients undergoing EVAR 2 devices were employed per access site. The preclosing technique was used in every case. RESULTS Hemostasis was achieved in all patients. No complications were observed except for a small laceration and a localized hemodynamically nonsignificant stenosis, without any clinical sequel. CONCLUSIONS This small case series indicates the feasibility of percutaneous access with the Perclose Proglide system to perform EVAR and peripheral endovascular interventions in the presence of synthetic grafts in the groin, with promising outcomes.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece.
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Emmanouel Tavlas
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece
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Kontopodis N, Igoumenakis D, Mastorakis G, Logothetis I, Daskalakis N, Ioannou CV. Local Metastatic Neck Cancer Involving the Distal Internal Carotid Artery Treated with En Bloc Resection and Arterial Reconstruction after Mandibular Osteotomy. Vasc Specialist Int 2020; 36:252-257. [PMID: 33177248 PMCID: PMC7790687 DOI: 10.5758/vsi.200046] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Head and neck cancers represent an aggressive form of neoplastic diseases that warrant surgical resection, in order to achieve optimal outcomes. Moreover, the involvement of the carotid artery is associated with a dismal prognosis and radical tumor resection becomes challenging. The current case report presents a patient with locally metastatic neck carcinoma attached to the right carotid bifurcation, involving both the external and internal carotid arteries up to the distal segment of the internal carotid artery (ICA) at the level of the C1 vertebra. The patient underwent en bloc tumor and vessel resection. The carotid artery was reconstructed using an interposition graft from the common carotid artery to the ICA by means of an autologous saphenous vein graft. A vertical mandibular osteotomy was performed, in order to expose the distal ICA. The postoperative recovery was uneventful. The patient was under follow-up for six months, without any signs of recurrence.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
| | - Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - George Mastorakis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - Ioannis Logothetis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - Nikolaos Daskalakis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
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Galanakis N, Kontopodis N, Charalambous S, Palioudakis S, Kakisis I, Geroulakos G, Tsetis D, Ioannou CV. Endovascular Aneurysm Repair with Bifurcated Stent Grafts in Patients with Narrow Versus Regular Aortic Bifurcation: Systematic Review and Meta-analysis of Comparative Studies. Ann Vasc Surg 2020; 73:385-396. [PMID: 33373765 DOI: 10.1016/j.avsg.2020.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Narrow aortic bifurcation (NAB) is considered as a risk factor for endograft limb thrombosis. The purpose of the study was to investigate the effect of narrow aortic bifurcation on outcomes of elective endovascular aneurysm repair (EVAR). METHODS A systematic review that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. We searched electronic bibliographic databases using a combination of controlled vocabulary (thesaurus) and free-text terms to identify relevant studies comparing outcomes of EVAR in patients with NAB versus those with regular aortic bifurcation. Pooled estimates of dichotomous outcomes were calculated using odds ratio (OR) and those of continuous outcomes using mean difference and 95% confidence interval (CI). To account for expected heterogeneity, the random-effects model was applied for statistical analysis. RESULTS Six observational studies were included, reporting a total of 2,673 patients (412 with NAR and 2,261 with friendly anatomy). Perioperative mortality was similar between the groups (OR 1.14, 95% CI 0.30-4.34, P = 0.85, I2 = 0%). Limb stenosis and kinking requiring additional intraoperative procedures was significantly more common among patients with NAB (OR 3.02, 95% CI 2.16-4.22, P < 0.00001, I2 = 0%). Nevertheless, 30-day reintervention rate was similar between the groups, as was the rate of limb occlusion during follow-up. CONCLUSIONS Available evidence suggests that at the expense of significantly more intraoperative additional procedures, EVAR with bifurcated devices can be safely performed in patients with NAB.
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Affiliation(s)
- Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete, Medical School, Heraklion, Crete, Greece.
| | - Stavros Charalambous
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Stefanos Palioudakis
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Ioannis Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete, Medical School, Heraklion, Crete, Greece
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Marketou M, Papadopoulos G, Kontopodis N, Patrianakos A, Nakou E, Maragkoudakis S, Chlouverakis G, Stratakis S, Tavlas E, Parthenakis F, Ioannou CV. Early Left Ventricular Global Longitudinal Strain Deterioration After Aortic Aneurysm Repair: Impact of Aortic Stiffness. J Endovasc Ther 2020; 28:352-359. [PMID: 33412985 DOI: 10.1177/1526602820976636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/31/2022]
Abstract
PURPOSE To associate the impact of aortic reconstruction using currently available grafts and endografts on pulse wave velocity in patients with abdominal aortic aneurysm (AAA) and to evaluate its effect on early cardiac systolic function indices. MATERIALS AND METHODS Seventy-three consecutive patients with AAA (mean age 70±8 years; all men) who underwent open (n=12) or endovascular repair (EVAR; n=61) were prospectively enrolled in an observational cohort study. Left ventricular global longitudinal strain (GLS; an important diagnostic and prognostic index of early systolic dysfunction) and carotid-femoral pulse wave velocity (cf-PWV) were estimated 1 week preoperatively, as well as at 1 and 6 months postoperatively. RESULTS A significant time effect was found for cf-PWV, which showed an increase at 1 month that remained through 6 months (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant change at 1 month that persisted 6 months later (p<0.001). No significant group effect was observed between EVAR and open repair (p=0.98), and there was no significant interaction (p=0.96). Notably, the difference in GLS between baseline and 6 months significantly correlated with the corresponding changes in cf-PWV (r=0.494, p<0.001). CONCLUSION AAA repair leads not only to an increase in aortic stiffness, as measured by the increase in pulse wave velocity, but also to reduced cardiac systolic function. Our findings highlight the need for a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.
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Affiliation(s)
- Maria Marketou
- Cardiology Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - George Papadopoulos
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
| | - Alexandros Patrianakos
- Cardiology Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Eleni Nakou
- Cardiology Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Spyros Maragkoudakis
- Cardiology Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Gregory Chlouverakis
- Division of Biostatistics, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
| | - Stavros Stratakis
- Nephrology Department, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
| | - Emmanouel Tavlas
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
| | - Fragiskos Parthenakis
- Cardiology Department, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece
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