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Olsson KW, Mani K, Burdess A, Patterson S, Scali ST, Kölbel T, Panuccio G, Eleshra A, Bertoglio L, Ardita V, Melissano G, Acharya A, Bicknell C, Riga C, Gibbs R, Jenkins M, Bakthavatsalam A, Sweet MP, Kasprzak PM, Pfister K, Oikonomou K, Heloise T, Sobocinski J, Butt T, Dias N, Tang C, Cheng SWK, Vandenhaute S, Van Herzeele I, Sorber RA, Black JH, Tenorio ER, Oderich GS, Vincent Z, Khashram M, Eagleton MJ, Pedersen SF, Budtz-Lilly J, Lomazzi C, Bissacco D, Trimarchi S, Huerta A, Riambau V, Wanhainen A. Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease. JAMA Surg 2023; 158:832-839. [PMID: 37314760 PMCID: PMC10267845 DOI: 10.1001/jamasurg.2023.2128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 06/15/2023]
Abstract
IMPORTANCE Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. OBJECTIVE To assess the midterm outcomes of endovascular aortic repair in patients with CTD. DESIGN, SETTING, AND PARTICIPANTS For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. EXPOSURE All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. MAIN OUTCOMES AND MEASURES Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. RESULTS In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. CONCLUSIONS AND RELEVANCE This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
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Affiliation(s)
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anne Burdess
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Suzannah Patterson
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Ahmed Eleshra
- Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany
| | - Luca Bertoglio
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Vincenzo Ardita
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Germano Melissano
- Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy
| | - Amish Acharya
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Celia Riga
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Richard Gibbs
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Jenkins
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arvind Bakthavatsalam
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Matthew P. Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Tessely Heloise
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jonathan Sobocinski
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Talha Butt
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Ching Tang
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Stephen W. K. Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China
| | - Sarah Vandenhaute
- 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
| | - Rebecca A. Sorber
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - James H. Black
- Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emanuel R. Tenorio
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Gustavo S. Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston
| | - Zoë Vincent
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand
| | - Matthew J. Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Steen Fjord Pedersen
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark
| | - Chiara Lomazzi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Abigail Huerta
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Oikonomou K, Pfister K, Kasprzak PM, Schierling W, Betz T, Sachsamanis G. Treatment of Secondary Aortoenteric Fistulas Following AORTIC Aneurysm Repair in a Tertiary Reference Center. J Clin Med 2022; 11:jcm11154427. [PMID: 35956044 PMCID: PMC9369578 DOI: 10.3390/jcm11154427] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: To present our experience with various therapeutic approaches for the treatment of secondary aortoenteric fistulas following open and endovascular aortic aneurysm repair. Methods and Materials: A retrospective data analysis of patients treated for secondary aortoenteric fistulas in a single vascular institution between January 2005 and December 2018 was performed. Analyzed parameters included patients’ demographics, clinical presentation, diagnostic work-up, perioperative data and repair durability during follow-up. Results: Twenty-three patients with aortoenteric fistulas were treated in the target period. The fistulous connection was located in 21 cases (91.3%) in the duodenum and in two cases (8.7%) in the small intestine. Average time between the initial procedure and detection of the aortoenteric fistula was 69.4 ± 72.5 months. The most common presenting symptom was gastrointestinal bleeding (n = 12, 52.2%), followed by symptoms suggestive of chronic infection (n = 11, 47.8%). Open surgical repair was performed in 19 patients (bridging in 3 patients), and endovascular repair was carried out in two cases and one patient underwent a hybrid operation. One patient underwent abscess drainage due to significant comorbidities. Mean follow-up was 35.1 ± 35.5 months. In-hospital mortality and overall mortality were 43.5% (10/23) and 65.2% (15/23), respectively. Patients presenting with bleeding had a significantly higher perioperative mortality rate in comparison to patients presenting with chronic infection (66.7% (8/12) and 18.2% (2/11), respectively, p = 0.019). Patients who underwent stent-graft implantation for control of acute life-threatening bleeding showed significantly better perioperative survival in comparison to patients that were acutely treated with an open procedure (66.6%, (4/6) and 0% (0/6), respectively, p = 0.014). Perioperative mortality was also higher for ASA IV patients (71.4%, 5/7), when compared to ASA III Patients (31.2%, 5/16), although this did not reach statistical significance (p = 0.074). Conclusion: Treatment of secondary aortoenteric fistulas is associated with a high perioperative mortality rate. Patients who survive the perioperative period following open surgical repair in the absence of hemorrhagic shock show acceptable midterm results during follow-up. Stent-graft implantation for bleeding control in patients presenting with life-threatening bleeding seems to be associated with lower perioperative mortality rates.
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Affiliation(s)
- Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-69-6301-4136
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Piotr M. Kasprzak
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
| | - Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany; (P.M.K.); (W.S.); (T.B.); (G.S.)
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Oikonomou K, Sachsamanis G, Kasprzak PM, Schierling W, Pfister K. Endovascular Exclusion of Juxtarenal Aortic Aneurysm in Concomitant Presence of an Aortocaval Fistula. EJVES Vasc Forum 2022. [DOI: 10.1016/j.ejvsvf.2021.12.021] [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: 11/28/2022] Open
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Kasprzak PM, Pfister K, Kuczmik W, Schierling W, Sachsamanis G, Oikonomou K. Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2021; 28:519-523. [PMID: 33899573 PMCID: PMC8276339 DOI: 10.1177/15266028211010469] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Open surgical repair of type Ia endoleak after endovascular aortic aneurysm repair/sealing (EVAR/EVAS) is associated with significant perioperative mortality and morbidity. Current endovascular redo techniques face limitations, especially when the infrarenal landing zone is inadequate and the previous endograft is rigid and features a short or no main body. We present a novel concept for the treatment of type Ia endoleak using a custom-made branched device. Technique The 5-branch-device (Cook Medical, Bloomington, IN, USA) consists of a nitinol skeleton with branches, covered with a low-profile polyester fabric loaded in an 18F sheath. The device features a minimum of 2 proximal sealing stents and includes branches for renovisceral vessels as well as an additional 8 mm branch for the contralateral iliac limb. Implantation and sealing in the renovisceral vessels is carried out in standard fashion, using transfemoral and transaxillary access. Distal sealing is achieved by tapering the branched component into the ipsilateral iliac limb and using a bridging balloon-expandable or self-expandable stent-graft through the additional branch to the preexisting contralateral iliac limb. Conclusion Treatment of type Ia endoleak with a new custom-made device enables sufficient proximal seal while minimizing suprarenal aortic coverage and facilitates adequate component overlap. The low profile branched design accommodates implantation through the preexisting endograft and catheterization of target vessels.
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Affiliation(s)
- Piotr M Kasprzak
- Department of Vascular Surgery, University Medical Centre Regensburg, Germany
| | - Karin Pfister
- Department of Vascular Surgery, University Medical Centre Regensburg, Germany
| | - Waclaw Kuczmik
- Department of General, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, Katowice, Poland
| | - Wilma Schierling
- Department of Vascular Surgery, University Medical Centre Regensburg, Germany
| | | | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Medical Centre Regensburg, Germany
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Sachsamanis G, Pfister K, Kasprzak PM, Schierling W, Denzinger S, Oikonomou K. Midterm Results after Open Surgical and Endovascular Management of Arterioureteral Fistula. Ann Vasc Surg 2020; 73:280-289. [PMID: 33359692 DOI: 10.1016/j.avsg.2020.11.014] [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: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. METHODS We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. RESULTS Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. DISCUSSION Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Karin Pfister
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas-Hospital Saint Josef Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Kopp R, Pfister K, Cucuruz B, Gallis K, Schierling W, Kasprzak PM. Risk of Mesenteric Ischemia Following Branched Endovascular Repair for Thoracoabdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.501] [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: 11/28/2022]
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Kopp R, Katada Y, Kondo S, Sonesson B, Hongo N, Tse L, Tsilimparis N, Crawford S, Panneton JM, Kölbel T, Xiong J, Guo W, Kasprzak PM. Multicenter Analysis of Endovascular Aortic Arch In Situ Stent-Graft Fenestrations for Aortic Arch Pathologies. Ann Vasc Surg 2019; 59:36-47. [PMID: 31009715 DOI: 10.1016/j.avsg.2019.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In situ fenestration of aortic stent grafts for treatment of aortic arch aneurysms is a new option for endovascular aortic arch repair. So far, only few reports have shown perioperative and short-term results of in situ fenestrations for aortic arch diseases. We present the multicenter experience with the aortic arch in situ fenestration technique documented in the AARCHIF registry for treatment of aortic arch aneurysms or localized type A aortic dissections and analyzed perioperative outcome and midterm follow-up. METHODS Patients with aortic arch pathologies treated by aortic arch in situ fenestration with proximal stent graft landing in aortic arch Ishimura zones 0 and 1 were included in the registry. Stent-graft in situ fenestrations were created using needles or radiofrequency or laser catheters and completed by implantation of covered connecting stent grafts. Single in situ fenestrations for the left subclavian artery (LSA) were excluded. RESULTS Between 06/2009 and 03/2017, twenty-five patients were treated by in situ stent-graft fenestrations for aortic arch pathologies at 9 institutions in 7 different countries, 3 of them as bailout procedures for stent-graft malplacement. In situ fenestrations were performed for the brachiocephalic trunk (n = 20), the left common carotid artery (n = 21) and the LSA (n = 9). Technical success for intended in situ fenestrations was 94.0% (47/50), with additional supraaortic bypass procedures performed in 14 patients. Perioperative mortality occurred in 1 (4.0%) patient, treated as a bailout procedure and 3 (12.0%) perioperative strokes were observed. One proximal aortic stent-graft nonalignment and 4 type III endoleaks, 2 early and 2 late, required reeintervention. During follow-up (1-118 months), the diameter of aortic arch aneurysms decreased from 61.5 ± 4.1 mm to 48.4 ± 3.2 mm (P = 0.02) and, so far, 6 patients died from diseases unrelated to their aortic arch pathologies with a mean survival time of 79.5 months and 3 endovascular reinterventions for distal aortic expansion were performed. Cerebrovascular event (n = 4) was the most relevant prognostic factor for mortality during midterm follow-up (P = 0.003). CONCLUSIONS The aortic arch in situ fenestration technique for endovascular aortic arch repair seems to be valuable treatment option for selected patients, although initial consideration of other treatment options is mandatory. Data about long-term durability are required.
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Affiliation(s)
- Reinhard Kopp
- Department of Vascular and Endovascular Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Yoshiaki Katada
- Department of Cardiovascular Surgery, Iwaki City Medical Center, Fukushima, Japan
| | - Shunichi Kondo
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Björn Sonesson
- Department of Vascular and Endovascular Surgery, Skane Vascular Center, Malmö University Hospital, Malmö, Sweden
| | - Norio Hongo
- Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Leonard Tse
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sean Crawford
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Tilo Kölbel
- Heart Center, University Hospital Hamburg, Hamburg, Germany
| | - Jiang Xiong
- Vascular and Endovascular Department, General Hospital, Beijing, China
| | - Wei Guo
- Vascular and Endovascular Department, General Hospital, Beijing, China
| | - Piotr M Kasprzak
- Department of Vascular and Endovascular Surgery, University Hospital Regensburg, Regensburg, Germany
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Gallis K, Kasprzak PM, Cucuruz B, Kopp R. Evaluation of visible spinal arteries on computed tomography angiography before and after branched stent graft repair for thoracoabdominal aortic aneurysm. J Vasc Surg 2017; 65:1577-1583. [DOI: 10.1016/j.jvs.2016.10.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 10/27/2016] [Indexed: 11/29/2022]
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Pfister K, Kasprzak PM, Jung EM, Müller-Wille R, Wohlgemuth W, Kopp R, Schierling W. Contrast-enhanced ultrasound to evaluate organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms. Clin Hemorheol Microcirc 2017; 64:689-698. [PMID: 27802212 DOI: 10.3233/ch-168003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the organ microvascularization after operative versus endovascular treatment of visceral artery aneurysms (VAAs) by contrast-enhanced ultrasound (CEUS) and colour-coded duplex sonography (CCDS). METHOD AND MATERIALS Between April 1995 to January 2016, 168 patients (78 males, 90 females; median age: 62 years) were diagnosed with VAAs at our hospital site. 60/168 patients (36%) fulfilled treatment criteria and had either open (29/60, 48%) or endovascular (31/60, 52%) aneurysm repair. Patients' characteristics and presentations were consecutively reviewed. Technical success and organ microvascularization were determined by CCDS/CEUS and correlated to computed tomography angiography (CTA) or magnetic resonance imaging (MRI). RESULTS 18/60 patients (30%) presented with acute bleeding. 16/18 emergency patients (89%) were treated by endovascular means. After emergency treatment, two patients showed segmental liver malperfusion by CEUS and CTA. One small bowel resection had to be performed.42/60 patients (70%) were electively treated. 27/42 patients (64%) had open and 15/42 (36%) endovascular aneurysm repair. There were no liver or bowel infarctions after elective treatment of hepatic or mesenteric artery aneurysms (n = 13) in CCDS/CEUS and in CTA. Treatment of patients with splenic or renal artery aneurysms led to partial or complete organ loss in 42% (8/19) after operative and in 50% (5/10) after endovascular treatment (p < 0.05). CONCLUSION The endovascular approach is the preferred therapeutic option in emergency to control bleeding. In contrast to hepatic or mesenteric procedures, patients for elective splenic or renal artery aneurysm repair have to be evaluated very carefully because of a high rate of partial or complete organ loss demonstrated by CEUS - either after open or endovascular aneurysm repair.
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Affiliation(s)
- Karin Pfister
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst M Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - René Müller-Wille
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Walter Wohlgemuth
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Reinhard Kopp
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Division of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Kasprzak PM, Kobuch R, Schmid C, Kopp R. Long-term durability of aortic arch in situ stent graft fenestration requiring lifelong surveillance. J Vasc Surg 2017; 65:538-541. [DOI: 10.1016/j.jvs.2016.05.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Pfister K, Schierling W, Jung EM, Apfelbeck H, Hennersperger C, Kasprzak PM. Standardized 2D ultrasound versus 3D/4D ultrasound and image fusion for measurement of aortic aneurysm diameter in follow-up after EVAR. Clin Hemorheol Microcirc 2016; 62:249-60. [PMID: 26484714 DOI: 10.3233/ch-152012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/01/2023]
Abstract
PURPOSE To compare standardised 2D ultrasound (US) to the novel ultrasonographic imaging techniques 3D/4D US and image fusion (combined real-time display of B mode and CT scan) for routine measurement of aortic diameter in follow-up after endovascular aortic aneurysm repair (EVAR). METHOD AND MATERIALS 300 measurements were performed on 20 patients after EVAR by one experienced sonographer (3rd degree of the German society of ultrasound (DEGUM)) with a high-end ultrasound machine and a convex probe (1-5 MHz). An internally standardized scanning protocol of the aortic aneurysm diameter in B mode used a so called leading-edge method. In summary, five different US methods (2D, 3D free-hand, magnetic field tracked 3D - Curefab™, 4D volume sweep, image fusion), each including contrast-enhanced ultrasound (CEUS), were used for measurement of the maximum aortic aneurysm diameter. Standardized 2D sonography was the defined reference standard for statistical analysis. CEUS was used for endoleak detection. RESULTS Technical success was 100%. In augmented transverse imaging the mean aortic anteroposterior (AP) diameter was 4.0±1.3 cm for 2D US, 4.0±1.2 cm for 3D Curefab™, and 3.9±1.3 cm for 4D US and 4.0±1.2 for image fusion. The mean differences were below 1 mm (0.2-0.9 mm). Concerning estimation of aneurysm growth, agreement was found between 2D, 3D and 4D US in 19 of the 20 patients (95%). Definitive decision could always be made by image fusion. CEUS was combined with all methods and detected two out of the 20 patients (10%) with an endoleak type II. In one case, endoleak feeding arteries remained unclear with 2D CEUS but could be clearly localized by 3D CEUS and image fusion. CONCLUSION Standardized 2D US allows adequate routine follow-up of maximum aortic aneurysm diameter after EVAR. Image Fusion enables a definitive statement about aneurysm growth without the need for new CT imaging by combining the postoperative CT scan with real-time B mode in a dual image display. 3D/4D CEUS and image fusion can improve endoleak characterization in selected cases but are not mandatory for routine practice.
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Affiliation(s)
- Karin Pfister
- Division of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Division of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Hanna Apfelbeck
- Division of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph Hennersperger
- Computer Aided Medical Procedures (CAMP), Technische Universitaet Munchen, Garching, Germany
| | - Piotr M Kasprzak
- Division of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Ertl M, Schierling W, Kasprzak PM, Kopp R, Brückl C, Schlachetzki F, Pfister K. Sonographic Changes in Optic Nerve Sheath Diameter Associated with Supra- versus Infrarenal Aortic Aneurysm Repair. J Neuroimaging 2016; 27:237-242. [PMID: 27545668 DOI: 10.1111/jon.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Quantification of changes in optic nerve sheath diameter (ONSD) using ocular sonography (OS) constitutes an elegant technique for estimating intracranial and intraspinal pressure. Aortic aneurysm repair (AAR) is associated with a reasonable risk of increased spinal fluid pressure, which is largely dependent on the extent of aneurysm repair (supra- vs. infrarenal). The aim of this study was to compare ONSD measurements in patients with suprarenal AAR (sAAR) or infrarenal AAR (iAAR). METHODS Thirty patients who underwent elective endovascular repair of infrarenal aortic aneurysms (Group iAAR) were included in the study; the characteristics in these cases were prospectively analyzed and compared with those in a previously investigated group of 28 patients treated for suprarenal aortic aneurysms (Group sAAR). Six measurements of ONSDs were performed in each patient at five consecutive time points. Statistical analysis was performed using the Wilcoxon test. A P value < .05 was considered statistically significant. RESULTS A highly significant difference between pre- and postinterventional values could be detected in both patient groups (P < .01). In Group sAAR, there was a mean .3-mm increase of the ONSD, whereas in Group iAAR, a mean .2-mm decrease could be detected. Both groups roughly reached baseline values by the end of their inpatient stay. CONCLUSIONS ONSD changes seem to be a reliable marker to estimate spinal perfusion. Since OS provides a suitable bedside tool for rapid reevaluation, it may guide physicians in the identification and treatment of patients at high risk for spinal cord ischemia.
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Affiliation(s)
- Michael Ertl
- Neurology Department, Klinikum Augsburg, Stenglinstr. 2, 86165, Augsburg, Germany
| | - Wilma Schierling
- Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Piotr M Kasprzak
- Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Reinhard Kopp
- Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Corinna Brückl
- Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Felix Schlachetzki
- Neurology Department, University of Regensburg, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Karin Pfister
- Department of Surgery, Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
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13
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Affiliation(s)
- Reinhard Kopp
- University Hospital, University of Regensburg, Germany
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14
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Pfister K, Kasprzak PM, Apfelbeck H, Kopp R, Janotta M. [The significance of contrast-enhanced ultrasound in vascular surgery]. Zentralbl Chir 2013; 139:518-24. [PMID: 24327488 DOI: 10.1055/s-0033-1351028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Vascular contrast-enhanced ultrasound (CEUS) is a special ultrasound application without the harmful side effects of nephrotoxicity and radiation exposure. CEUS can be used for advanced diagnosis of carotid stenosis and follow-up checks of endovascular repair of abdominal aortic aneurysms (EVAR). Low-flow phenomenon in peripheral vascular disease can easily be detected by enhanced colour-coded duplex sonography (CCDS). METHODS The technical requirements of CEUS are explained here for the aorta, carotid, and peripheral arteries. The benefits and risks compared to computed tomography (CT), magnetic resonance (MR) and angiography are evaluated. Based on a selective review of the literature and the authors' personal experiences, CEUS is recommended for routine surveillance after EVAR. RESULTS CEUS is a safe method using SonoVue® (Bracco) as the only approved agent for vascular examination. Special equipment and training is necessary. In prospective studies and meta-analyses the detection and characterisation of endoleaks is comparable to that of CT imaging. Neovascularisation as a sign of carotid plaques at risk can be seen without the need for invasive treatment. Imaging of crural vessels with enhanced CCDS is a promising but rarely needed option in diabetic and renally insufficient patients. CONCLUSION CEUS in vascular medicine should be performed prior to other methods to avoid nephrotoxic contrast agents for the patients, especially in follow-up checks after EVAR. The time and effort required are still limiting its practical breakthrough.
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Affiliation(s)
- K Pfister
- Gefäß- und Endovaskuläre Chirurgie, Universitätsklinikum Regensburg, Deutschland
| | - P M Kasprzak
- Gefäß- und Endovaskuläre Chirurgie, Universitätsklinikum Regensburg, Deutschland
| | - H Apfelbeck
- Gefäß- und Endovaskuläre Chirurgie, Universitätsklinikum Regensburg, Deutschland
| | - R Kopp
- Gefäß- und Endovaskuläre Chirurgie, Universitätsklinikum Regensburg, Deutschland
| | - M Janotta
- Gefäß- und Endovaskuläre Chirurgie, Universitätsklinikum Regensburg, Deutschland
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15
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Pfister K, Janotta M, Apfelbeck H, Kasprzak PM. How dangerous is a carotid plaque? VASA 2013; 42:155-7. [PMID: 23644365 DOI: 10.1024/0301-1526/a000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Schierling W, Troidl K, Apfelbeck H, Troidl C, Kasprzak PM, Schaper W, Schmitz-Rixen T. Cerebral arteriogenesis is enhanced by pharmacological as well as fluid-shear-stress activation of the Trpv4 calcium channel. Eur J Vasc Endovasc Surg 2011; 41:589-96. [PMID: 21316269 DOI: 10.1016/j.ejvs.2010.11.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 11/28/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to determine the importance of the shear-stress-sensitive calcium channels Trpc1, Trpm7, Trpp2, Trpv2 (transient receptor potential cation channel, subfamily V, member 2) and Trpv4 for cerebral arteriogenesis. The expression profiles were analysed, comparing the stimulation of collateral growth by target-specific drugs to that achieved by maximum increased fluid shear stress (FSS). DESIGN A prospective, controlled study wherein rats were subjected to bilateral carotid artery ligature (BCL), or BCL + arteriovenous fistula, or BCL + drug application. METHODS Messenger RNA (mRNA) abundance and protein expression were determined in FSS-stimulated cerebral collaterals by quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry. Drugs were applied via osmotic mini pumps and arteriogenesis was evaluated by post-mortem angiograms and Ki67 immunostaining. RESULTS Trpv4 was the only mechanosensitive Trp channel showing significantly increased mRNA abundance and protein expression after FSS stimulation. Activation of Trpv4 by 4α-phorbol-12,13-didecanoate caused significantly enhanced collateral growth (length: 4.43 ± 0.20 mm and diameter: 282.6 ± 8.1 μm) compared with control (length: 3.80 ± 0.06 mm and diameter: 237.3 ± 5.3 μm). Drug application stimulated arteriogenesis to almost the same extent as did maximum FSS stimulation (length: 4.61 ± 0.07 mm and diameter: 327.4 ± 12.6 μm). CONCLUSIONS Trpv4 showed significantly increased expression in FSS-stimulated cerebral collaterals. Pharmacological Trpv4 activation enhanced cerebral arteriogenesis, pinpointing Trpv4 as a possible candidate for the development of new therapeutic concepts.
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Affiliation(s)
- W Schierling
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
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17
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Pfister K, Rennert J, Uller W, Schnitzbauer AA, Stehr A, Jung W, Hofstetter P, Zorger N, Kasprzak PM, Jung EM. Contrast harmonic imaging ultrasound and perfusion imaging for surveillance after endovascular abdominal aneurysm repair regarding detection and characterization of suspected endoleaks. Clin Hemorheol Microcirc 2010; 43:119-28. [PMID: 19713606 DOI: 10.3233/ch-2009-1226] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Is Contrast Harmonic Imaging (CHI) comparable to computed tomography angiography (CTA) scan in detecting and characterizing suspected endoleaks after endovascular abdominal aneurysm repair in a non-selected group including reintervention procedure and branched endografts in daily practice? MATERIAL/METHODS In a prospective study computed tomography angiography (CTA) and contrast-enhanced ultrasound (CEUS) were performed in 30 consecutive patients (26 males, 4 females, mean age: 72 years, range: 38-87) with suspected endoleaks in follow-up (mean 13 months, range: 1-95) after endovascular abdominal aneurysm repair or procedure in dissection or penetrated ulcer of the aorta (25 infrarenal, 5 suprarenal stent grafts, mean aortic diameter 56 mm, range: 27-98). CTA was supposed to be gold standard for determining the presence of endoleaks (multislice CT, collimation 16 x 0.75 mm, 100 ml of iodized contrast agent bolus). Ultrasonography used a multi-frequency probe (1-4 MHz) with the modalities of colour coded Doppler sonography (CCDS), power Doppler (PD) combined with contrast enhancement and the technique of contrast harmonic imaging (CHI) and low mechanical index (MI < 0.2). 2.4 ml of SonoVue (Bracco, Altana Pharma GmbH, Italy) were administered to each patient intravenously as a bolus injection. RESULTS Out of 30 patients, 21 endoleaks were identified in CTA (6 type I or III, 15 type II), 22 in CHI. Thus, sensitivity for CHI was therefore 99%, its specificity 85% (Spearman correlation coefficient (CC) 0.92). In follow-up the localizations of endoleak type I or III exclusively detected by CHI were confirmed as true positive by angiography. Due to its dynamic characteristic CHI seemed to be more helpful in characterization of endoleaks than CTA. In case of a rupture after reintervention a type III endoleak leads to prompt intervention before receiving the result of the CT scan. Altogether, CHI failed to identify 1 combined type I and II endoleak (sensitivity 0.99). Both, CCDS and PD were positive only in 6/30 patients (CC 0.33 and 0.39). Interestingly the application of contrast agent doubles the detection rate of endoleaks (12/30) in CCDS and PD (CC 0.39). CONCLUSION Contrast harmonic imaging (CHI) compared to computed tomography angiography (CTA) accurately depicts endoleaks after endovascular abdominal aneurysm repair and stent-graft procedure in dissected and ulcerated aorta. It seems to be superior in characterization of the type of endoleaks and can be established in order to reduce iodized contrast agent and radiation exposure in follow-up. In contrast to CTA scan CHI can be offered to patients with chronic renal insufficiency and allows a dynamic examination and a perfusion analysis.
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Affiliation(s)
- K Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
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18
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Stehr A, Töpel I, Müller S, Unverdorben K, Geissler EK, Kasprzak PM, Schlitt HJ, Steinbauer M. VEGF: a surrogate marker for peripheral vascular disease. Eur J Vasc Endovasc Surg 2009; 39:330-2. [PMID: 19889554 DOI: 10.1016/j.ejvs.2009.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 09/28/2009] [Indexed: 11/26/2022]
Abstract
This study aims to evaluate the value of VEGF as a surrogate marker for peripheral vascular disease (PVD). Prior to treatment, serum VEGF levels were evaluated by enzyme-linked immunosorbent assay (ELISA) in 293 PVD patients. Risk factors and clinical parameters of PVD were documented. Twenty-six age-matched healthy volunteers served as controls. Serum VEGF values strongly correlated with Fontaine stages (p<0.006, stage IV vs. controls). High VEGF values prior to treatment were associated with poor outcome. Serum VEGF appears to indicate the severity of PVD and might serve as a surrogate indicator of disease severity.
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Affiliation(s)
- A Stehr
- Vascular and Endovascular Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany
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19
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Töpel I, Pfister K, Moser A, Stehr A, Steinbauer M, Prantl L, Nerlich M, Schlitt HJ, Kasprzak PM. Clinical Outcome and Quality of Life after Upper Extremity Arterial Trauma. Ann Vasc Surg 2009; 23:317-23. [DOI: 10.1016/j.avsg.2008.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 03/10/2008] [Accepted: 05/08/2008] [Indexed: 11/16/2022]
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20
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Steinbauer MG, Pfister K, Greindl M, Schlachetzki F, Borisch I, Schuirer G, Feuerbach S, Kasprzak PM. Alert for increased long-term follow-up after carotid artery stenting: Results of a prospective, randomized, single-center trial of carotid artery stenting vs carotid endarterectomy. J Vasc Surg 2008; 48:93-8. [DOI: 10.1016/j.jvs.2008.02.049] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 02/17/2008] [Accepted: 02/21/2008] [Indexed: 11/27/2022]
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21
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Stehr A, Steinbauer M, Pfister K, Töpel I, Herold T, Zorger N, Kasprzak PM. Diagnostik und endovaskuläre Behandlung einer proximalen Endograft-Instabilität nach thorakalem Endostent. Zentralbl Chir 2007; 132:211-5. [PMID: 17610191 DOI: 10.1055/s-2007-960754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Four cases of proximal endostent instability after endovascular tube graft treatment of thoracic aortic disease using the TAG Gore system are reported. This potentially hazardous complication is characterized by a lack of attachment of the device to the small curvature of the aortic arch. Towering up against the hemodynamic forces in this area, the endograft could collapse and occlude the aorta. To identify this complication we recommend to perform an early postinterventional CT-scan with parasagittal reconstruction and an observation of the proximal endograft by fluorography. Endovascular solutions for the treatment of this complication may be either a proximal extension by another endograft or fixation of the proximal endograft by a balloon expandable Palmaz stent.
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Affiliation(s)
- A Stehr
- Gefässchirurgie und Endovaskuläre Chirurgie, Klinik und Poliklinik für Chirurgie, Universität Regensburg, Regensburg
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22
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Abstract
Background: To evaluate the influence of anesthetic technique on perioperative neurological and cardiopulmonary complication rates in patients undergoing carotid endarterectomy. Patients and methods: 186 patients with symptomatic internal carotid artery (ICA) stenosis > 70% or asymptomatic ICA stenosis > 80% were prospectively randomized for either locoregional (LA) or general anesthesia (GA). Results: Neurological complication rates were similar in both groups (GA 2% vs. LA 2%). Cardiopulmonary complication rates were not significantly different (GA 4% vs LA 1%).There were no stroke-related deaths, but one patient from the GA group died from severe postoperative pneumonia. Thus, a significant difference in combined stroke / cardiopulmonary related death between the two groups (GA 1% vs LA 0%) could not be found. However, perioperative cardiopulmonary monitoring showed that significantly more patients operated under general anesthesia had hypertensive events, with systolic blood pressure values greater than 180 mmHg on postoperative day one. There were no differences in the number of postoperatively hypotensive episodes (systolic blood pressure values < 100 mmHg) between the two groups. Conclusions: Significant differences in the perioperative neurological and cardiopulmonary complication rates between general and locoregional anesthesia in patients undergoing carotid endarterectomy could not be observed.
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Affiliation(s)
- P M Kasprzak
- Department of Surgery/Vascular Surgery, Regensburg University Medical Center, Regensburg, Germany.
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23
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Steinbauer MGM, Stehr A, Pfister K, Herold T, Zorger N, Töpel I, Paetzel C, Kasprzak PM. Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease. J Vasc Surg 2006; 43:609-12. [PMID: 16520181 DOI: 10.1016/j.jvs.2005.11.045] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [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: 08/24/2005] [Accepted: 11/30/2005] [Indexed: 10/24/2022]
Abstract
We report two cases of proximal endograft collapse with an almost complete aortic occlusion after endovascular tube-graft treatment of thoracic aortic disease (thoracic aneurysm after a type B dissection, traumatic blunt aortic rupture) using the TAG Gore system. Oversizing of endografts is known to cause this complication. In our two cases, however, the oversizing was between 12% and 21.7%, which is less than the allowed oversizing of 25% that is recommended by the manufacturer. This endograft-related complication might be due to a poor alignment of the currently available endografts in highly angulated and tight aortic arches. In the first case, a combined endovascular and open emergent repair procedure achieved a reopening of the proximal endograft by proximal extension (TAG Gore). In the second case, proximal extension was not considered owing to a precise positioning of the endograft distal to the left carotid artery. A balloon-expanding Palmaz stent was therefore placed interventionally in the proximal part of the TAG graft to expand the endograft and to avoid another collapse of the device. This proximal endograft collapse has to be acknowledged as a potentially hazardous complication. We therefore recommend that the proximal part of thoracic endografts in the aortic arch should be closely monitored and we offer two possible endovascular solutions for resolving the problem of proximal endograft collapse.
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Affiliation(s)
- Markus G M Steinbauer
- Department of Surgery/Vascular Surgery, University of Regensburg, Regensburg, Germany.
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24
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Dietl B, Pfister K, Aufschläger C, Kasprzak PM. Die Strahlentherapie inguinaler Lymphfisteln nach gefäßchirurgischen Eingriffen. Strahlenther Onkol 2005; 181:396-400. [PMID: 15925983 DOI: 10.1007/s00066-005-1364-0] [Citation(s) in RCA: 19] [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: 09/09/2004] [Accepted: 01/14/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The formation of inguinal lymphorrhea following vascular surgery is a rare but potentially serious problem with an incidence of about 2%. There is no consensus on the most effective treatment for groin lymphorrhea. In a retrospective analysis the usefulness of irradiation in the treatment of inguinal lymph fistulas was investigated. PATIENTS AND METHODS From 08/1997 to 12/2000, 28 patients with inguinal lymph fistulas were irradiated postoperatively (4th-19th day) with a single dose of 3 Gy up to a total dose of 9 Gy on 3 consecutive days using 120- to 300-kV photons. Three further patients received 2 x 4 Gy and 3 x 5 Gy, respectively, due to an interposed weekend. RESULTS Secretion volume at the beginning of radiotherapy varied between 50 and 650 ml daily (mean 203 ml, median 175 ml), at the end of radiotherapy between 0 and 350 ml (mean 126 ml, median 120 ml). 3/28 lymph fistulas had resolved during radiotherapy. In 17/28 patients (60.7%) the drains could be removed within 10 days, in further 10/28 patients (35.7%) within 10-20 days after the end of radiotherapy. CONCLUSION Overall, irradiation of inguinal lymph fistulas proved to be an effective and well-tolerated treatment, facilitating removal of fistula drains within 10-20 days (mean 10.5, median 7 days) after the completion of radiotherapy, thus appearing a good alternative to other conservative treatment modalities.
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Affiliation(s)
- Barbara Dietl
- Klinik für Strahlentherapie, Universitätsklinik, Regensburg.
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25
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Pfister K, Töpel I, Steinbauer M, Stehr A, Kasprzak PM. Belastungs- oder lageabh�ngige Schwellung der Wadenmuskulatur mit Spannungsgef�hl und krampfartigen Schmerzen. Chirurg 2005; 76:404-10. [PMID: 15770492 DOI: 10.1007/s00104-004-0978-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Popliteal vein entrapment must be taken in consideration in patients with symptoms of venous insufficiency. Leg edema, swelling, calf pain, and muscle cramps are all unspecific signs. Most patients thus far have presented with deep vein thrombosis or chronic venous insufficiency. Popliteal entrapment syndrome must be taken into account in younger patients in whom predisposing factors are absent and chronic calf swelling is notable. Diagnosis is easily confirmed by noninvasive stress testing with duplex imaging and pencil Doppler probe placed over the posterior tibial artery. Additionally, digital subtraction angiography with the foot in neutral and dorsi plantarflexion is recommended for arterial entrapment. Surgery is advisable for treatment and can be done without significant morbidity. In asymptomatic patients, we suggest using the term "popliteal vein entrapment phenomenon." We describe different etiologies of popliteal vein entrapment in three cases and present a review of the literature.
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MESH Headings
- Adult
- Angiography, Digital Subtraction
- Athletic Injuries/complications
- Constriction, Pathologic/diagnostic imaging
- Constriction, Pathologic/etiology
- Constriction, Pathologic/surgery
- Diagnosis, Differential
- Edema/etiology
- Female
- Humans
- Joint Loose Bodies/diagnostic imaging
- Joint Loose Bodies/etiology
- Joint Loose Bodies/surgery
- Knee/blood supply
- Knee/diagnostic imaging
- Knee/surgery
- Knee Injuries/complications
- Male
- Middle Aged
- Muscle Cramp/diagnostic imaging
- Muscle Cramp/etiology
- Muscle Cramp/surgery
- Muscle, Skeletal/abnormalities
- Muscle, Skeletal/blood supply
- Muscle, Skeletal/diagnostic imaging
- Muscle, Skeletal/surgery
- Phlebography
- Popliteal Vein/diagnostic imaging
- Popliteal Vein/surgery
- Posture
- Risk Factors
- Tendons/abnormalities
- Tendons/diagnostic imaging
- Tendons/surgery
- Tomography, X-Ray Computed
- Venous Insufficiency/diagnostic imaging
- Venous Insufficiency/etiology
- Venous Insufficiency/surgery
- Weight-Bearing/physiology
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Affiliation(s)
- K Pfister
- Gefässchirurgie der Klinik und Poliklinik für Chirurgie der Universität Regensburg
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26
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Abstract
PURPOSE To report the endovascular management of a rare ruptured intercostal artery aneurysm. CASE REPORT A 45-year-old man presented with acute upper back and chest pain. Computed tomography of the chest revealed a ruptured intercostal artery aneurysm. The lesion was treated by endovascular coil embolization distal to the aneurysm and aortic stent-grafting of the intercostal artery origin. CONCLUSIONS Ruptured intercostal artery aneurysms can be treated by endovascular techniques. If coil embolization of the intercostal artery origin is not possible, additional aortic stent-grafting can be necessary.
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Affiliation(s)
- Ingolf Töpel
- Department of Surgery, University Hospital Regensburg, 93042 Regensburg, Germany.
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Wölfle KD, Bruijnen H, Loeprecht H, Rümenapf G, Schweiger H, Grabitz K, Sandmann W, Lauterjung L, Largiader J, Erasmi H, Kasprzak PM, Raithel D, Allenberg JR, Lauber A, Berlakovich GM, Kretschmer G, Hepp W, Becker HM, Schulz A. Graft patency and clinical outcome of femorodistal arterial reconstruction in diabetic and non-diabetic patients: results of a multicentre comparative analysis. Eur J Vasc Endovasc Surg 2003; 25:229-34. [PMID: 12623334 DOI: 10.1053/ejvs.2002.1849] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE in diabetic patients with critical limb ischaemia (CLI) an inferior success rate following infrainguinal bypass surgery is quite often suggested. The aim of this retrospective analysis was, therefore, to evaluate the graft patency and, particularly, the clinical outcome at 1 year in diabetic compared with non-diabetic patients. MATERIAL AND METHODS two hundred and eleven patients (diabetics 94; non-diabetics 117) with femorodistal reconstruction for CLI were studied. Groups were comparable with regard to the Fontaine classification, the distribution of vascular risk factors, graft material, distal anastomosis site, and the angiographic runoff grading. RESULTS diabetes did not adversely affect graft function. For diabetics and non-diabetics primary cumulative patency rate at 1 year was found to be 66 and 56%, respectively (p=0.10) and a virtually identical limb salvage rate of 85 and 83% was achieved (p=0.76). With regard to healing of ischaemic foot ulcers a trend against diabetics was noted with a healing rate of 81% compared to 96% in non-diabetics at 1 year (p=0.067); gangrenous foot lesions could be equally remedied in 94% and in 87% among patients with and without diabetes (p=0.44). The survival rate of diabetics, however, was significantly lower with 78% at 1 year compared with 95% in non-diabetic patients (p=0.0004). CONCLUSIONS our preliminary results support the view that infrainguinal bypass grafting can be safely done even in diabetics. Despite increased mortality in this group, liberal indication for reconstructive vascular surgery seems to be justified by favourable patency rates and clinical outcome in selected patients.
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Affiliation(s)
- K D Wölfle
- Klinik für Gefäss-und Thoraxchirurgie, Klinikum Augsburg, Chirurgische Universitätsklinik, Düsseldorf, Germany
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